challenges, strategy and health treatment approach to nutrition and

Transcription

INTERNATIONAL SEMINAR
CHALLENGES, STRATEGY AND HEALTH TREATMENT
APPROACH TO NUTRITION AND MOLECULAR
EPIDEMIOLOGY
Organized by :
HEALTH POLYTECHNIC OF HEALTH MINSITRY MEDAN
INSTITUTE OF HEALTH SCIENCE OF SUMUT MEDAN
INSTITUTE OF HEALTH SCIENCE OF NAULI HUSADA MEDAN
INSTITUTE OF HEALTH SCIENCE OF HAJI MEDAN
AND
UNIVERSITY OF PHILIPPINES, BURAPHA UNIVERSITY, NATIONAL
EPIDEMIOLOGY NETWORK (JEN) AND PADJAJARAN UNIVERSITY (UNPAD)
Date
Vanue
Website
Email
: Wednesday, 20 th May 2015
: Auditorium of Poltekkes Kemenkes Medan
Jl. Djamin Ginting Km. 13.5 Lau Cih Medan
: www.poltekkes-medan.ac.id
: [email protected]
2015
USU Press
Art Design, Publishing & Printing
Gedung F, Pusat Sistem Informasi (PSI) Kampus USU
Jl. Universitas No. 9
Medan 20155, Indonesia
Telp. 061-8213737; Fax 061-8213737
usupress.usu.ac.id
© USU Press 2015
Hak cipta dilindungi oleh undang-undang; dilarang memperbanyak menyalin, merekam sebagian atau
seluruh bagian buku ini dalam bahasa atau bentuk apapun tanpa izin tertulis dari penerbit.
ISBN 979 458 793 1
Perpustakaan Nasional Katalog Dalam Terbitan (KDT)
Proceeding: Challenges, Strategy and Health Treatment Approach to Nutrition and Molecular
Epidemiology / Editor: Bhisma Murti [et.al.] – Medan: USU Press, 2015.
xix, 371 p.: ilus.; 29 cm
ISBN: 979-458-793-1
1.Strategy – Health Treatment
I. Title
Dicetak di Medan, Indonesia
ii
2. Nutrition
3. Molecular Epidemiology
AKNOWLEDGEMENT
We convey our deepest thankful for great contribution from all distinguished resource person and
sponsors in this conference.
1.
The Chairman of Indonesian Agency For Development And Empowerment Human Resources
Of Health
2.
Health Department Head of the North Sumatra Province
3.
All the Directors of Indonesian Health Polytechnic of Health Ministry
4.
Joshua Ares Marcos, MD.DPAFP, MSc.,MPH,PhD (University of Philippines)
5.
Prof. Dr. Aporn Deenan (Associate Dean For Research and academic affairs Burapha University)
6.
Prof. dr. Bhisma Murti, MPH, MSc, Ph.D (Chairman of National Epidemiology Network (JEN)
and Chairman of Community Health Magister of Sebelas Maret University
7.
Prof. Dr.dr. Nurhalim Sahib from Padjajaran University (UNPAD)
8.
Prof. Dr.dr. Bidasari Lubis SPA
9.
The Chaiman of all Health Institute in North Sumatra Province
10. The Chairman of all Health Institution in North Sumatra Province
11. The Directors of Haji Adam Malik Center General Hospital dan dr.Pirngadi General Hospital
12. Sponsors : PT.Kimia Farma, PT.
iii
CONTENTS
Page
Acknowledgement ..............................................................................................................
iii
Content ..............................................................................................................................
iv
Steering Committee and Organizing Comittee ...................................................................
v
Welcome Speech of Director .............................................................................................
viii
Report Speech of Committee Chairman .............................................................................
x
Tentative Schedule Activities International Seminar .........................................................
xii
List Presenter Oral Presentation .........................................................................................
xiv
Poster List Presenter ...........................................................................................................
xvii
Oral Presentation ................................................................................................................
1
Poster ..................................................................................................................................
237
iv
STEERING COMMITTEE DAN ORGANIZING COMMITTEE
SEMINAR INTERNATIONAL
HEALTH POLYTECHNIC MEDAN, STIKESSU, STIKES NAULI
HUSADA DAN STIKES RS HAJI MEDAN
TAHUN 2015
A.
Person in the monitor
: drg. Usman Sumantri, M.Sc
(Kepala Badan PPSDM Kesehatan Kemenkes RI)
B.
Person In Charge
: 1.
dr. Kirana Pritasari, MQIH
(Kepala Pusat Pendidikan & Pelatihan
Tenaga Kes)
Dra. Ida Nurhayati, M.Kes
(Direktur Poltekkes Kemenkes Medan)
2.
C.
Steering Committe
1
2
3
4
5
6
7
8
9
D.
Organizing Committee
Chairman
Vice of the chairman
Secretary
Cashier
Vice of cashier
Secretariat
Dra. Trini Nurwati, M.Kes.
(Kepala Bidang Pengendalian Mutu Pusat
Pendidikan
dan Pelatihan Tenaga Kesehatan)
dr.Rr. Siti Hatati Surjantini, M.Kes
(Kepala Dinas Kesehatan Prov Sumut)
Soep, S.Kp, M.Kes (Pudir I)
Nelson Tanjung, SKM, M.Kes (Pudir II)
Dra. Ernawaty, M.Si, Apt (Pudir III)
Ir. Zuraidah Nasution, M.Kes (Komite
Etik)
Dr. Paul Sirait, SKM, MM. M.Kes (Ketua
STIKESSU)
Dra. Meiyati Simatupang, SST,M.Kes
(Ketua STIKES Nauli Husada)
Hj. Masdalifa, S.Kep, SKM, M.Kes
(Ketua STIKES RS Haji Medan)
: Fauzi Romeli, SKM, M.Kes
: Elizawarda, SKM, M.Kes
: Yusrawati Hasibuan, SKM, M.Kes
: Hara Habibi Hasibuan, SE
: Yusniar, SE
Salim Fahri Harahap, S.Sos, MM
: 1.
(Koordinator)
2
Dodoh Khodijah, SST, MPH
Manotar Sinaga, S.Kep (stikes Nauli
3
Husada)
4
Wan Masnah, SE, MM (Stikes RS Haji)
v
E.
Section Programs and
Events
: 1.
2
3
4
F.
Peer Review
: 1.
2
3
4
5
G.
Section Seminar
: 1.
2
3
4
H.
Section Accommodation
Transportation
: 1.
3
and Supplies
I.
Section Consumption
2
4
: 1.
2
3
4
J.
Section Publication and
: 1.
Dokumentation
2
3
4
K.
Seksi Fund &
Sponsorhip
: 1.
2
3
vi
Tengku Sri Wahyuni, SST, M.Keb
(Koordinator)
Ronald Sagala, S.Kep, Ns.M.Kep (Stikes
Nauli Husada)
Evawani Martalena Silitonga, SKM, Msi
(STIKESSU)
Hj. Yusridawati, S.Kep, M.Kep (Stikes RS
Haji)
Prof. Dr. Bhisma Murti, MPH, MSc,Ph.D
Prof. Dr. Apron Deenan
Prof. Dr. dr. Nurhalim Sahib
Jouhua Ares Marcos, MD.DPAFP, MSc,
MPH, PhD
Dr. Sri Wahyuni, SPd, M.Kes
Endang Susilawati, SKM, M.Kes
(Koordinator)
Yulina Dwi Hastuty, S.Kep, Ns, M.Biomed
Mazly Astuty, S.Kep, Ners,M.Kep
(STIKESSU)
Donal Nababan, SKM,M.Kes (STIKESSU)
Betty Mangkuji, SST, M.Keb
(Koordinator)
Drs. Zainuddin Harahap, M.Kes
Yuli Azni Hartaty Penarik, S.Kep.Ns (Stikes
Nauli Husada)
David Siagian, SKM, M.Kes (STIKESSU)
drg. Adriana Hamsar, M.Kes (Koordinator)
Suryani, SST, M.Kes
Marisa Evi Sinurat, S.Kep.Ns (Stikes Nauli
Husada)
Roslenni Sitepu, SKp, MARS
(STIKESSU)
Bernike Doloksaribu, SST, M.Kes
(Koordinator)
Meilda Fitri Sitepu, S.Kep, Ns (Stikes
Nauli Husada)
Sri Malem Indirawati, SKm,Msi
(STIKESSU)
Juidah, S.Kep, SKM, M.Kes (Stikes RS
Haji)
Nelma, SSi, M.Kes (Koordinator)
Idau Ginting, SST, M.Kes
Della Winda Gultom, SE (Stikes Nauli
Husada)
L.
M.
Security Section
Guest Section
4
Dian Fajariadi, Skep, Ners, M.Kep
(STIKESSU)
2
Erba Kalto Manik, SKM, M.Sc (Koordinator)
Mardan Ginting, SSi, M.Kes
: 1.
: 1.
2
Dra. Masniah, Apt, M.Kes (Koordinator)
Eveline M. Siagian, SKM, M.Kes (Stikes
Nauli Husada)
Direktur,
Dra. Ida Nurhayati, M.Kes
NIP 196711101993032002
vii
WELCOME SPEECH OF DIRECTOR
Wassalam / Good Morning
The honorable guest/ The Indonesian Agency For Development And Empowerment Human
Resources Of Health….drg.Usman Sumantri, M.Kes
Guest of honour/ Director of Medan Health Polytechnic of Health Ministry
Guest Of Honour/ Health Department Head of the North Sumatra Province
Guest of honour/ All the Directors of Indonesian Health Polytechnic of Health Ministry
Guest of honour/ The Chaiman of all Health Institute in North Sumatra Province
Guest of honour/ The Chairman of all Health Institution in North Sumatra Province
Guest of honour/ The Directors of Haji Adam Malik Center General Hospital dan dr.Pirngadi
General Hospital
Distinguished Speakers/ from University of Philippines : Joshua Ares Marcos, MD.DPAFP,
MSc.,MPH,PhD, from University of Burapha Thailand ; Prof. Dr. Aporn Deenan. (Associate Dean
For Research and academic affairs Burapha University, Chairman of National Epidemiology Network
(JEN) and Chairman of Community Health Magister of Sebelas Maret University : Prof. dr. Bhisma
Murti, MPH, MSc, Ph.D, Prof.Dr.dr. Nurhalim Sahib from Padjajaran University (UNPAD)
Excelency / The Lectures and all Health Students
Excelency/ all steering committee
Colleagues
Ladies and Gentleman
Good morning to everyone and thank you so much for joining us in International seminar.
I wish to extend a warm welcome to our eminent speakers and delegates from the various country
such Thailand and Philippines, and Speakers from JEN and UNPAD (Padjajaran University).
Welcome to Medan that is one the best province of Indonesia. We are delighted and honored to have
you all here with us to participate and share an important and valuable information to improve the
quality of our health and life.
Nowadays, the development of science, especially in the health field occur very rapidly. The
development of health in terms of epidemiology and biomolecular also experienced substantial
viii
increases associated with the emergence of more and more different kinds of diseases, especially
cancer.
If the growth is not cancerous quickly stopped and treated and untreated, the cancerous growth will be
very dangerous, and can spread to organs throughout the body called metastasis.The theme of this
seminar is “ Challenges, strategy and treatment of health problem with nutrition and molecular
epidemiology approach”.
The theme highlights the overall description challenges, strategies and treatment of health problem
through nutrition and molecular epidemiology and all this overview will help us to improve health and
prevent the disease.
At this special moment, I wish to take opportunity to say thank for all committee members and all
those who have contributed their best effort in making this seminar succeed.
I would like to thank the The Agency For Development And Empowerment Human Resources Of
Health, director of Health polytechnic of health ministry Medan, North sumatera institute of health
science (Stikes sumut) Nauli husada institute of health scienceand Haji institute of health science for
the best support in making the seminar possible.
I would like to thank all the distinguish speakers and reviewers for abstracts and posters that has
submitted to this seminar.
Last but not least, I would also like to thank to all participant for your participation and support for
this seminar. Thank you very much for coming and your kind attention.
Thank you……
ix
REPORT SPEECH OF COMMITTEE CHAIRMAN
Wassalam / Good Morning
The honorable guest/ The Indonesian Agency For Development And Empowerment
Human Resources Of Health….drg.Usman Sumantri, M.Kes
Guest of honour/ Director of Medan Health Polytechnic of Health Ministry
Guest Of Honour/ Health Department Head of the North Sumatra Province
Guest of honour/ All the Directors of Indonesian Health Polytechnic of Health Ministry
Guest of honour/ The Chaiman of all Health Institute in North Sumatra Province
Guest of honour/ The Chairman of all Health Institution in North Sumatra Province
Guest of honour/ The Directors of Haji Adam Malik Center General Hospital dan
dr.Pirngadi General Hospital
Distinguished Speakers/ from University of Philippines : Joshua Ares Marcos,
MD.DPAFP, MSc.,MPH,PhD, from University of Burapha Thailand ; Prof. Dr. Aporn
Deenan. (Associate Dean For Research and academic affairs Burapha University, Chairman
of National Epidemiology Network (JEN) and Chairman of Community Health Magister of
Sebelas Maret University : Prof. dr. Bhisma Murti, MPH, MSc, Ph.D, Prof.Dr.dr.
Nurhalim Sahib from Padjajaran University (UNPAD).
Excelency / The Lectures and all Health Students
Excelency/ all steering committee
Colleagues
Ladies and Gentleman
Good morning to everyone and thank you so much for joining us in International Seminar
Challenges, strategy and treatment of health problem with nutrition and molecular
epidemiology approach.
I wish to extend a warm welcome to our eminent speakers and delegates from the various
country such Thailand and Philippines, and Speakers from JEN and UNPAD (Padjajaran
University). Welcome to Medan that is one the best province of Indonesia. We are delighted
and honored to have you all here with us to participate and share an important and valuable
information to improve the quality of our health and life.
The theme of this seminar is “ Challenges, strategy and treatment of health problem with
nutrition and molecular epidemiology approach”.
x
The Purposes of this seminar are :
a.To increase understanding of current health problems (cancer) in the light of biomolecular
b.To give awareness for prevention of cancer
c.To give information and education about the prevention and treatment of cancer
The Speakers of this seminar are :
1. University of Philippines : Joshua Ares Marcos, MD.DPAFP, MSc.,MPH,PhD
2. University of Burapha Thailand ; Prof. Dr. Aporn Deenan. (Associate Dean For Research
and academic affairs Burapha University.
3. Chairman of National Epidemiology Network (JEN) and Chairman of Community Health
Magister of Sebelas Maret University : Prof. dr. Bhisma Murti, MPH, MSc, Ph.D
4. Prof.Dr.dr. Nurhalim Sahib from Padjajaran University (UNPAD)
5. Indonesian Cancer Foundation of North Sumatera area
6. Physics practitioner from Murni Teguh Memorial Hospital and chairman of Indonesian
medical physics in Sumatera: Ikhsan Bagatondi, ST, MSi.
The Activity of seminar are :
1.Oral Presentation with audio-visual methods by ........... article
2.Panel Discussion between participants and speakers.
3.Poster Presentation by ........... Article
Participants
a.Students of health academy in North Sumatra
b.Health workers (doctors, nurses, midwives, etc.)
c.General participants
And amount of all participants are one thousand and six hundreds (1600) persons.
At this special moment, I wish to take opportunity to say thank for all committee members
and all those who have contributed their best effort in making this seminar succeed.
I would like to thank the The Agency For Development And Empowerment Human
Resources Of Health, director of Health polytechnic of health ministry Medan, North
sumatera institute of health science (Stikes sumut) Nauli husada institute of health scienceand
Haji institute of health science for the best support in making the seminar possible.
I would like to thank all the distinguish speakers and reviewers for abstracts and posters that
has submitted to this seminar.
Last but not least, I would also like to thank to all participant and delegates for your
participation and support for this seminar. Thank you very much for coming and your kind
attention.
At last, I encourage all delegates and participants to participate actively in this seminar
including oral presentation and poster and I wish we will have a very productive, successful
and meaningful seminar.
Thank you
xi
TENTATIVE SCHEDULE ACTIVITIES INTERNATIONAL SEMINAR
WEDNESDAY, 20 MEI 2015
MC GENERAL ACTIVITIES:
1. Yetty Fauziah, M.Kep (STIKES Haji)
2. Hanna S Saragih, M.Kes (Department of Midwifery)
TIME
07.00-07.45
ACTIVITIES
REGISTRATION
SPEAKER
07.45-08.30
Opening Dance ---------------------------------- Students from the Department of
Midwifery
Opening ------------------------------------------- Protocol
National Ceremony ------------------------------ Melva Simatupang M.Kes
Pray ------------------------------------------------ Ganti Tua Siregar SKP MPH
Chairman Of The Committee Reports -----Fauzi Romeli SKM M.Kes
Message From The Director Of health
Polytechnic Medan ------------------Dra. Ida Nurhayati M.Kes
MODERATOR & NOTULEN
Committee
Committee
Guidance and Direction also opening the
Head of Human Resources
seminar -------------------------------------------- Development and Empowerment
of Health .... drg Usman Sumatri
M.Sc
08.30-09.00
Government policies in the handling and
prevention of cancer in Indonesia
drg Usman Sumatri M.Sc
Moderator :
Haripin Togap Sinaga BSc M.CN
(Department of Nutrition)
Notulen : Mazli Astuti
09.00-10.20
Epidemiology of cancer , carcinogenesis and
a screening
Universitas Sebelas MaretSurakarta
Prof. dr. Bhisma Murti, MPH,
MSc, Ph.D
Molecular oncology: gene expressions, cell
death signaling, and biomarker development
Universitas Padjajaran Bandung
Prof.Dr.dr. Nurhalim Sahib
Moderator :
Evawani Martalena Silitonga, SKM,
MSi
Notulen :
Evi Irianti, SKM, M.Kes
(Department of Midwifery)
10.20-10.50
10.50-11.00
Discuss
Souvenir
11.00-12.20
The role of health professionals in the
treatment of cancer
Universitas Phillipine : Joshua
Ares Marcos, MD.DPAFP,
MSc.,MPH,PhD
Moderator :
Haripin Togap Sinaga BSc M.CN
(Department of Nutrition)
Cancer management: collaboration among
health care professional
Universitas Burapha Thailand:
Prof. Dr. Aporn Deenan.
(Associate Dean For Research and
academic affairs Burapha
University.
Notulen :
Donald Nababan, SKM, M.Kes
(Stikes SU)
Committee
12.20-12.50
12.50-13.00
13.00-14.00
Discuss
Souvenir
Rest and Lunch
14.00-15.00
Early recognition of childhood cancer
Child Oncology Foundation
Medan
/Universitas Sumatera Utara
Prof. Dr.dr. Bidasari Lubis, SPA
The role of radiotherapy in cancer treatment
Teguh Murni Internasional
Hospital
Ikhsan Bagatondi, St, M.Si
15.00-15.30
15.30-15.40
15.40-16.30
xii
Discuss
Souvenir
Doorprice
Performing Arts / Evaluation
Poster
Committee
Committee
Committee
Moderator :
Rosanty Muchsin, S.Kep, M.Kes
(Stikes RS Haji)
Notulen :
Desi Ari
(Department of Environmental
Health)
Committee
Committee
Sponsor
Untuk oral presentasi :
Rabu/ 20 Mei 2015
Waktu
14.00-14.30
14.30-14.45
Ruang I Kep Gigi Lt 2
Ruang II R. Rapat kebidanan (
Ruang III lab kebidanan( Ruang IV Lab terpadu( 25-30
( 25-30 Orang )
25-30 Orang )
25-30 Orang )
Reviewer : Dr Joshua M
Reviewer : Prof Aporn D
Reviewer : Prof Bhisma M Reviewer : Prof Nurhalim
Moderator : Donald N
Moderator : Mazli
Moderator : Sri Malem
Moderator : Evi Irianti
Notulen : Maya
Notulen : Masrah
Notulen : Kirana P S
Notulen : Yulina Dwi H
Sessi I
Sessi I
Sessi I
Sessi I
Presentasi (3 presenter)
(Soep , dkk, Nurlaili R dkk,
(Farida dkk, Amira dkk, Renny (Nelson dkk, Hermansyah (Mustikawati dkk, Trisnawati,
Bina M)
dkk)
Reviewer
Orang )
dkk, Desi Sri dkk)
Hotma dkk)
Reviewer
Reviewer
Reviewer
15.00-15.30
Reviewer : Dr Joshua M
Reviewer : Prof Aporn D
Reviewer : Prof Bhisma M Reviewer : Prof Nurhalim
Moderator : Evawani
Moderator : Hotma
Moderator : Desi Ari H
Moderator : Haripin T
Notulen : Amira P
Notulen : Marlisa
Notulen : Asnita S
Notulen : Rosanti Muhsin
Sessi II
Sessi II
Sessi II
Sessi II
Presentasi (3 presenter) Presentasi (3 presenter)
(Sartini
15.30-15.45
16.00-16.30
dkk,
Delmaifanis (Nurlama dkk, Nurasnah dkk, (Nurul dkk, Herlinawati (Sri dewi dkk, Ikhsan B dkk,
dkk, Idau G dkk)
Risma D dkk}
dkk, Hermansyah)
Cindy dkk)
Reviewer
Reviewer
Reviewer
Reviewer
Sessi III
Sessi III
Sessi III
Sessi III
(Soep
dkk,
suryani
dkk, (Netty Panjaitan, dkk, Suriani (Betty M, dkk, Dodoh, (Melva dkk, Desprin dkk,
T.Sri wahyuni dkk)
G dkk, Siti Marlina, dkk)
dkk)
16.30-16.45
Mariaty dkk)
Reviewer
Reviewer
Reviewer
Reviewer
Ruang II
Ruang III
Ruang IV
09.00- 09.30 Sessi I
Sessi I
Sessi I
Sessi I
09.30- 09.45 Presentasi (3 presenter)
Reviwer
Reviwer
Reviewer
Sessi II
Sessi II
Sessi II
Reviwer
Reviwer
Reviewer
Sessi III
Sessi III
Sessi III
Reviwer
Reviwer
Kamis/ 21 Mei 2015
Waktu
Ruang I
Reviwer
10.00- 10.30 Sessi II
10.30- 10.45
Reviwer
11.00- 11.30 Sessi III
11.30- 11.45
Reviwer
Reviewer
xiii
LIST PRESENTER ORAL PRESENTATION
NO
1.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
xiv
TITLE
Effects Of Breastfeeding Counseling Self-Efficacy
(Bse) In Pregnant Women Towards Immediate
Breastfeeding And Giving The Colostrum In
Independent
Effect Workstress; Psychological Distress On
Immune
System
Kortisol
Levelsand
Immunoglobulins Gnurse
The Effectiveness Of Lavender Aromatherapy In
Reducing Pain Intensity Of Patients With Breast
Cancer In Rb2 Rsup Haji Adam Malik Medan 2014
Qualitative Study Of Premarital Sexual
Behavior In Girls Adolescent At Dharma Bakti
Senior Senior High School 2014
Effectiveness Reject Power Test Of Neem Leaf
Extract ( Azadirachta Indica Juss )
In Ethanol On The Bite Activities Of Aedes
Aegypti Mosquito
Description Of Anxiety Levels On School-Age
Children During Having Been Hospitalized
In Local General Hospital Of Dr. Djasamen
Saragih Pematang Siantar
The Influence Of Music Therapy On The Stress
Due To
Hospitalization In School Age Children At Dr.
Pirngadi General
Hospital Medan
Mapping The Risk Factor Of Leptospirosis In
Klaten District
The Effect Of Isotonic Water To The Active Phase
Of Primiparous Uterine Contractions
Relationship Of Mother’s Knowledge About Polio
Immunization In Village Mancang Community
Health Centers With Mother’s Behavior Post
Infant’s Polio Immunization Selesai- Langkat 2014
Effect Of Counseling Anxiety In Dealing With
Labor Primigravida
In The Community Health Centers Buket Hagu
Lhoksukon North Aceh
The Impacts Of Breastfeeding Counseling By
Kader Kesehatan
(Lay Health Workers) On The First Month
Exclusive Breastfeeding
(E1) Among Breastfeeding Women In Darul
Imarah Sub-District
Satisfaction Of People With Disabilities On
Rehabilitation Services In Aceh Province
Knowledge Description Of Pregnant Women On
Bonding Attachment At Third Trimester In
Sehat Maternity Clinic Of Pantai Cermin Sub
District 2014
Acceptability Purple Sweet Potato Butter Cake And
Carbohydrate Analysis For Diabetics Snack
The Influence Of Cooking On Crude Fiber Content
Of Boiled Spinach And Kale Steamed
PRESENTER
T. Sri Wahyuni dkk
REVIEWER
Dr Joshua M
Triniswati
Prof Nurhalim
Nurlama dkk
Prof Aporn Deenan
Soep dkk
Dr Joshua M
Mariaty dkk
Prof Nurhalim
Farida dkk
Prof Aporn Deenan
Triyonita
Prof Aporn Deenan
Nelson dkk
Prof Bhisma Murti
Delmaifanis dkk
Dr Joshua M
Betty M dkk
Prof Bhisma Murti
Idau G dkk
Dr Joshua M
Nurlaili R dkk
Dr Joshua M
Hermansyah dkk
Prof Bhisma Murti
Suryani dkk
Dr Joshua M
Cindy dkk
Prof Nurhalim
Mustikawati
Prof Nurhalim
17
Factors Affecting Knowledge Of Pregnant Women
About Nutrition During Pregnancy In Portibi Sub
District 2012
The Effectiveness Of Beethoven’s “Fur Elise’ As
Classical Music Therapy On Lowering Stroke
Clients’ Blood Pressure In The Inpatient Rooms Of
Dr. Pirngadi
Correlation Of Elderly Knowledge And Attitude To
The Utilization Of Elderly Integrated Service Post
In Community Health Center Of Tanah Tinggi
Binjai 2013
Disaster Risk Index In Simeulue District (Study
Case: Disaster Prone Areas Of Aceh Province)
Anemia In Connection With Pregnancy Trimester
Iii Postpartum Bleeding Events In Dandy Clinic
Kec. Mabar 2014
Ida Nurhayati
Dr Joshua M
Afniwati dkk
Prof aporn Deenan
Elizawarda
Prof Bhisma M
Desi Sri dkk
Prof Bhisma M
Sartini B
Dr Joshua M
22
Relationship Between Maternal Age With Severe
Preeclampsia In Marzoeki Mahdi Hospital Bogor
Dodoh K dkk
Prof Nurhalim
23
Personal Hygiene During Menstruation In Female
Teenegers At Junior High Schools 34 Padang City
West Of Sumatera Indonesia
Relationship Between Maternal Blood Glucose
Level And Newborn’s Birth Weight In Maternity
Clinic Of Medan Selayang District 2014
The Role Of Radiotherapy In The Treatment Of
Cancer
The Association Between Mother’s Education And
The Amount Of Dental Caries In First Molar Teeth
In 6-7 Years Old Of Sd Baptis Of Medan Denai In
2014
The Influence Of Antenatal Class Towards IIIrd
Trimester Primigravida Mothers’ Level Of Anxiety
In Facing Child Birth
The Relationship Of Anxiety Level To The Sleep
Og Inguinal Hernia Preoperative In Patient At Dr
Pirngadi Hospital Medan
Phenomenological Study On Pregnancy Care
Experience In Mothers At Jorong Berastagi Nagari
Ujung Gading, Lembah Melintang Subdistrict,
Pasaman Barat, West Sumatera
Parent Communication Relationship And Exposure
Fornografi Knowledge Of Youth On Sexual
Behavior In Adolescent
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Oral Presentation
1
2
RELATIONSHIP OF MOTHER’S KNOWLEDGE ABOUT POLIO
IMMUNIZATION WITH MOTHER’S BEHAVIOR POST INFANT’S POLIO
IMMUNIZATION IN VILLAGE MANCANG COMMUNITY HEALTH CENTERS
SELESAI- LANGKAT 2014
Betty Mangkuji¹ , Idau Ginting¹ , Dina Indarsita² , Hera Daniati ¹
Department of Obstetrics , Department of Nursing Polytechnic Health Ministry of Medan
Abstract
The breast-milk that comes out when the baby is aged 0-3 months contain antipoliomilities high levels
of substances that can neutralize the virus polio vaccine in the gut of children thus inhibiting the
formation of an antibody. The mothers do not know that breastfeeding soon after giving polio
immunization may affect the effectiveness of the polio immunization given by mouth. The aim of
research to determine the relationship of mother knowledge about polio immunization with the
mother's behavior post infant’s polio immunization in Mancang village Community Health Centers
Selesai Langkat. There ara 54 mothers as the samples who comes to immunizing infants aged 0-3
months, using purposive sampling. Data were analyzed using Fisher's Exact. Results of this study
found that the majority of mothers were both knowledgeable and well behaved post polio
immunization in infants 13 people (24.07%), and mothers who are less knowledgeable and less
behaved 38 people (70.38). There is a significant relationship between mothers knowledge and
behavior after the polio immunization, evidenced by the value of p = 0.000. Conclusions from this
research is a relationship between mothers knowledge and behavior after the polio immunization
because lower knowledge and behavior of the mothers are also getting less. Therefore, health workers
are expected to provide information about polio immunization so that the knowledge and behavior to
be better mothers .
Keywords : knowledge, behaviors, polio immunization
INTRODUCTION
Nowadays, fact of the world especially in
developing countries every 14.5 million
children under five years old were die because
of
preventable
diseases,
malnutrition,
dehydration due to vomiting and each year 3.5
million children under five die by diseases that
could be prevented by immunization,
According to Markum (2002 in Widayati,
2009 1)
Results of Indonesian Demographic and
Health Survey (IDHS) 2007 showed that
Infant Mortality Rate (IMR) 34 per 1,000 live
births and the Child under five Mortality Rate
(CMR) 44 per 1,000 live births. Target
achievement of the target in 2015 that Infant
Mortality Rate (IMR) 23 per 1,000 live births
and the Child under five Mortality Rate
(CMR) 32 per 1,000 live births. Based on data
from the Directorate General Sub-Directorate
Immunization PPM and PLP Health
Departement (2004) immunization coverage in
Indonesia is per antigen coverage namely to 4
doses of polio reach the target of 85%.
The first major outbreak in the United States
occurred in 1916, more than 27,000 people
affected by this disease and about 6,000
people die and most are children. There are
only 1,266 cases of polio around the world
until year 2004, mostly found in polio endemic
countries, namely Yemen, Nigeria, India,
Pakistan, Egypt, Afghanistan, that is in the
world, approximately 25% was in Indonesia
and was ranked third in this world.
The number of polio cases in Indonesia until
the date of 21 March 2006 was found in 305
children spread at 10 provinces in Indonesia,
namely West Java (59 cases), Banten (160
cases), Central Java (20 cases), Lampung (26
cases), Jakarta (4 jerseys), North Sumatra (10
cases), Riau (3 jerseys), East Java (10 cases),
Southern Sumatra (5 cases) and NAD (5
cases).
According to the North Sumatra Health Office
(2009),
achievement
of
immunization
programs in North Sumatra is quite high when
viewed from immunization term which the
3
306.221 babies are being targeted. It is known
that the third polio immunization for babies
286.359 (93.51%). Polio may cause mild or
very severe illness symptoms. This disease can
affect the digestive system and the nervous
system. Polio causes fever, vomits and muscle
stiffness and can affect the nerves resulting in
permanent paralysis. The disease can paralyze
breathing and swallowing muscles that support
the process, causing death. Between two and
five percent of people with polio will die from
this disease and approximately 50% of patients
who survive suffer permanent paralysis. Polio
can be spread when feces contaminate people
with food, water or hands (Proverawati and
Andhini 2010 p.56)
Poliomyelitis is an acute fever disease caused
by the polio virus. There are about 95% of all
polio infections. According to estimates of the
ratio of the disease without any symptoms of
the disease paralatik vary from 50:1 to 1000:1
(average of 200:1). Patients with an infection
without excreting the virus with feces can
transmit the virus to others. Approximately 4%
- 8% of polio infection without clinical
symptom.
Paralysis occurs as a result of damage to the
cells of motor neurons in the medulla spinalist
spinal cord) caused due to virus invasion. This
paralysis is asymmetrical so inclined to cause
deformity (body shape disorder) which tends
to stabilize or even become more severe. The
vast majority of paralysis will strike the leg
(78.6 percent), while 47.4 percent will strike
the arm. This paralysis will go gradually and
takes 2 days s / d 2 months).
According to Nelson (2006 in Widayati 2009,
5) it is important for parents to know why,
when, where, and how many times the child
should be immunized. The main obstacle to
the success of immunization of infants and
children in a health care system that is low
awareness and a lack need of immunization in
community.
The
entrances
to
the
immunization services are inaccurate, neglect
opportunities for vaccine delivery and accurate
source for public health and prevention
programs.
Immunization in infants and children not only
give prevention of disease in the child, but also
provide a wider impact because it can prevent
transmission of the disease to other children.
Therefore, the knowledge and attitudes of
parents, especially mothers, is very important
2
to understand about the benefits
immunization for children in Indonesia.
of
According to Ranuh (2006 in Widayati, 2009:
6) Mothers knowledge about immunizations
affect the implementation of immunization,
when the mothers knowledge about
immunization are less, feeling of unnecessary
or just going along with it, the course
immunization in children would not
appropriate with the schedule in both time and
distance. If mothers knowledge about
immunization are good, it’s expected of
immunization distribution are on schedule, so
that the immunization program can fulfill the
quantity and quality of the baby’s health,
finally have an impact on improving the health
status and community resources in the future.
Wahyuhono (2002, in Widayati 2009:8) claim
that post-immunization behaviors also affect
the success of immunization, where
breastfeeding (breast milk) after polio
immunization in infants aged 0-3 months can
weaken the polio vaccine which dripped into
the baby’s mouth, so that polio immunization
is not effective. Milk that came out at the time
of infants aged 0-3 months contain many
antipoliomelitik substances that can neutralize
the virus polio vaccine in the children’s gut
thus inhibiting the formation of antibody
substances.
From the description above, we want to know
about a Relationship Of Mother’s Knowledge
About Immunization Polio With Mother’s
Behavior Post Infants Polio Immunization in
the Mancang village Community Health
Centers Selesai, Langkat in 2014.
METHOD
This research is descriptive analytic with cross
sectional. The design which measurements or
observations were made at a certain moment
or at one time. All mothers who come to give
polio immunization for their baby in
Community Health Centers Selesai Langkat
during March to June 2014 as many as 115
people become population, and samples are
part of mothers who gave polio immunization
to their baby at the Community Health Centers
Selesai Langkat on March - June 2014.
Result
Table 1 .
Distribution Characteristics of Respondents Who Came For Infant’s Polio Immunisation
in the Mancang village Community Health Centers Selesai, Langkat 2014
Characteristics of Respondents
1. Age
<20 years
20 – 35
> 35 years
Total
2. Education
Elementary School
Junior High School
Senior High School
Coledge
Total
3. Work
Does not work
Work
Total
4. Resources
Mass media
Family
Health Workers
Total
Based on Table 1 it can be seen that the
demographic characteristics of the mothers
who come for their infant’s polio
immunization at the age of 0-3 months, the
majority of mothers aged 20-35 years old are
35 people (64.81%). Majority of mothers
education 23 people (42.60 %) are High
School. Majority of mothers job 29 people
(53.70%) are unemployed. The source of
information that majority given by health care
workers can be as many as 32 people
(59.25%).
Mother knowledge about polio immunization
in the Mancang village Community Health
Centers Selesai, Langkat can be seen in the
following table.
f
%
13
35
6
54
24,08
64,81
11,11
100
9
18
23
4
16,67
33,33
42,60
7,40
54
100
29
25
54
53,70
46,30
100
14
8
32
54
25,93
14,81
59,26
100
knowledge About Polio Immunization
in the Mancang village Community Health
Centers Selesai, Langkat 2014
No Maternal knowledge
F
%
1
2
38
16
70,38
29,62
54
100
Total
Less
Good
Based on the table 2 data obtained on the
mother's knowledge about polio immunization
is the majority have less knowledge as many
as 38 people (70.38%).
Mother's behavior post infant’s polio
immunization in the Mancang village
Community Health Centers Selesai, Langkat
2014, can be seen in the following table 3.
3
Table 3.
Frequency Distribution Of Mother's Behavior
Post Infant’s Polio Immunization
In The Mancang Village Community Health
Centers Selesai, Langkat 2014
Mother's behavior
No Post infant’s polio
immunization
F
%
1
Less
2
Good
Total
41
13
54
75,93
24,07
100
Based on Table 3 data obtained on Mother's
behavior post infant’s polio immunization is of
54 respondents the majority that behaves less
as many as 42 people (77.78 %).
Relationship mother’s knowledge about polio
immunization with mother's behavior post
infant’s polio immunization in the Mancang
village Community Health Centers Selesai,
Langkat 2014 are as follows:
Table 4.
Relationship Mother’s Knowledge About
Polio Immunization With Mother's Behavior
Post Infant’s Polio Immunization In The
Mancang Village Community Health Centers
Selesai, Langkat 2014
Mother
Mother's behavior
knowledge post infant’s polio
value value
about polio
immunization
Total count table
immunization Good
Less
F %
F %
f %
Less
0 0
38 70,38 38 70,38
Good
13 24,07 3 5,55 16 29,62 0,000 0,05
Total
13 24,07 41 75,93 54 100,0
Based on the research results, majority of
mother who come to the community health
centers for infant’s polio immunization has
less knowledge about polio immunization as
many as 38 people (70.38%), which behaves
less in the Mancang village Community
Health Centers as many as 41 people
(75.93%).
From the statistical test using Fisher's Exact
test with significance level of 5% (0.05) was
obtained p = 0.000. So that the results obtained
are p < 0.05 then ha received. This means that
there is a significant relationship between
4
mother's knowledge about polio immunization
with the mother's behavior post infant’s polio
immunization in the Mancang village
Community Health Centers Selesai, Langkat
2014.
Discuss
Results of the research that has been done it
can be seen that the majority of the 54
respondents are knowledgeable about as many
as 38 respondents (70.38%)
Sensing occurs through human senses,
namely: the senses of sight, hearing, smell,
taste and touch. Most of the human knowledge
acquired through the eyes and ears. The
researchers assumption of mother’s knowledge
who give polio immunization to their baby in
this study majority of them were less
knowledgeable due to their lack of a sense of
curiosity and concern for an information about
polio immunization. Then it is advisable to all
mothers to always be active in seeking
information about polio immunization.
From 54 respondents can be seen that 13
respondents aged < 20 years were majority
knowledgeable as many as 12 respondents
(22.22%), and of 34 respondents aged 20-35
years were majority less knowledgeable as
much as 22 respondents (40,74%), and from 6
respondents aged > 35 years the majority
knowledgeable about as many as 4
respondents (7.41%).
Notoatmodjo (2007) stated that age is closely
related to a person’s knowledge level because
the more human lifespan increased the more
the experience or the knowledge that they
gained.
So there is a gap with Notoatmodjo’s opinion
that age affects the person's knowledge.
Because in this study there are 6 mother aged
> 35 years the majority of them were less
(7.41%) and this is because at this age the
mothers seem do not care in searching for
information because they are more focused on
taking care of their family circumstances.
Based on the results data obtained from 54
respondents, It can be seen that the 9
respondents graduated from elementary school
that less knowledgeable as much as 9
respondents (16.67%), of 18 graduated from
Junior High School that majority less
(25.92%), of the 23 respondents graduated
from Senior High School that majority less
(25.92%), and of 4 respondents graduated
from
university
that
majority
well
(7.41%).
Education in general is all effort that planned
to influence others; either individuals, groups
and communities. So they will do what is
expected by the education actors in the search
for knowledge and aspects of life. The level of
education has a close relationship with the
social, cultural, political, economic, and so on.
Education is also one of the factors that
influence someone's perception to easily
accept new ideas / technologies.
There is no gap with Notoatmodjo that is with
education someone can grow and develop
through the learning process from the
education because in the process of learning a
person was given a lesson in order to become
from not knowing to knowing. So that a
person with low education, the lower of his
knowledge level that he get, because the less
educated tend to be more difficult to
understand something or receive information.
Vice versa, the higher one's education are
more likely easier to receive information and
to understand something. These affect their
insight. Education also will affect mother’s
mindset, attitude and actions.
Based on the results of research conducted
showed that of the 54 respondents, 25
respondents who worked that majority well
(24.07%), and of the 29 respondents who did
not work that majority less knowledgeable as
many as 26 respondents (48.14%).
Work is an activity that is performed daily, the
type of work performed can be categorized as
not working, wiraswata, civil servants and
private employees in all areas of work are
generally required a good social relationship.
Work owned an important role in determining
the quality of human. It limits the gap
between health information and practices that
motivate a person to obtain information and to
do something to avoid health problems.
From the research there is no gap with
Notoatmojo, where of the results obtained by
respondents influential enough because some
of the respondents worked. This is because the
mother has made interaction with others so
that the information about polio obtained and
received by the mother. It can be seen from the
results of the study. Mothers who work as
many as 25 respondents and the majority from
them who well knowledgeable as well as 13
respondents (24.07%) this is due to the mother
who work had made more interaction with
people around the workplace because they will
exchange information and knowledge they
have acquired. So that the mother's level of
knowledge even get higher. While Mothers
who do not work who less knowledgeable as
many as 26 respondents (48.14%) this is due
to the mothers who do not work did not gained
much information because they had not made
interaction with people outside their home
environment so that mother’s knowledge is not
much developed because the mothers do not
work had less knowledge rather than those
who work.
Based on results of the research data obtained
from 54 respondents pregnant women, it can
be seen that 18 respondents who obtained the
information from the mass media that majority
less knowledgeable as many as 11 respondents
(20.37%), of the 10 respondents who received
information from family that majority less
(11.11%), and of the 32 respondents who
received information from health official that
(38.89%).
According Notoatmojo (2007) Sources of
information are all things that become
intermediaries in conveying information,
stimulate someone’s mind and ability. Other
people around us is one among the social
component that influence our attitude.
According to the researchers assumption there
is gap with Notoatmojo (2007), which is the
information source obtained by the respondent
did not affect his knowledge. The theory says
the better sources of information will be the
better of someone's knowledge. Examples
5
information source from the health care
workers will be very good in providing
information on polio immunization because
health care workers are people who have been
trained and trusted by the community in the
health sector so that people will follow the
advices from health workers.
But the results obtained by researchers
respondents who received information from
health care worker that majority less
(38.89%). This may be due to mother
neglected the information that health care
worker submitted.
Based on the study data showed that the
majority of mother who give polio
immunization to their baby in Public Health
Centers Selesai 2014 that behaved less post
polio immunization to their baby as many as
41 people (75.93%). One of the factors that
influence the behavior is knowledge. Based on
the results of the study, the majority of
mothers who have less knowledge as many as
38 people (70.38%), 13 people (24.07%)
behaved well post polio immunization on
infants. So knowledge is an important domain
of the formation of a person's behavior
(Notoadmodjo, 2012 p.138).
According to the researchers assumption the
majority of respondents who behaved less due
to his less knowledgeable or mothers who
neglect the knowledge that she gets from
health workers. Examples of health workers
who provide information about polio
immunization with breastfeeding but the
mother does not care about the information she
gets, possibly because the mother was busy
taking care of the family and household.
Relationship Of Mother’s Knowledge And
Behavior Post Infant’s Polio Immunization In
The Mancang Village Community Health
Centers Selesai Langkat 2014
Based on the research that has been done
shows that the value of p < 0.05 then there is a
significant relationship between knowledge
and behavior where the majority of mothers
that well knowledgeable and well behave post
polio immunization to the baby as much as 13
people (24.07%), and the majority of mothers
6
that less knowledgeable and less behave as
many as 38 people (70.38 %).
This is consistent with research Widayati
(2009) in An- Nissa Maternity Hospital
Surakarta that there is a significant
relationship between mother’s knowledge
about polio immunization with mother's
behavior post polio immunization evidenced
by p value of 0.0001.
Conclusion
The majority of respondents that less
knowledgeable as many 38 respondents
(70.38%; less behaved as much as 41
respondents (75.93%), and there is a
significant relationship between mother’s
knowledge with mother's behavior post polio
immunization. This means that the lower the
person's knowledge, the behavior is also
increasingly less proven with p value of 0.000.
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(2008).
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and
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and
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(2010)
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Immunizations and Vaccinations .
Yogyakarta: Nuha Medika .
Widayati, Sri(2011). Relationship between
maternal knowledge with the
mother's behavior evidenced by postpolio immunization in the maternity
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Surakarta : Surakarta , 7 .
Widayati , Siti Nur . ( 2012) . Relationship
Between Immunizotion Mater-nal’s
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Surakarta , 33 .
Zulkifli, Andi. (2007 ). Polio Disease
Epidemiology.Scientific papers, 8.
7
THE EFFECTIVENESS OF NEEM LEAF EXTRACT
(Azadirachta Indica Juss) IN ETHANOL AS REPELLENT
FOR THE BITES OF AEDES AEGYPTY
Mariaty Silalahi¹, Lestari Rahma¹, Nelma2, Dina Indarsita3, Rizky Ayu Lestari4
1,2
Health Polytecnic, Ministry of Health, Medan, Analyst Department
Health Polytechnic, Ministry of Health, Medan, Nursing Department
3,4
Background : Aedes aegypti mosquito is the primary vector of dengue fever is common in tropical
countries, including Indonesia. Control measures with eradication of vector / adult mosquitoes using
plant neem (Azadirachta indica Juss) containing compound azadirachtin, salanin, nimbin and
nimbidin which can inhibit the appetite of adult mosquito Aedes aegypti. The purpose of this study to
determine the effect of neem leaf extract (Azadirachta indica Juss) on the growth and development of
the mosquito Aedes aegypti.
Methods : This research method using descriptive experimental (purely experimental test). Samples
of neem leaf extract and as an indicator is adult mosquito Aedes aegypti. The consentration of neem
leaf extract used 0% (g/ml) (control), 10% (g/ml), 20% (g/ml), 30% (g/ml), 40% (g/ml), 50% (g/ml),
60% (g/ml), and excuted the experiment twice.
Results : Frequency bite of Aedes aegypti was 210 at concentration of 10%, 195 at concentration of
0%, 164 at concentration of 30%, 138 at concentration of 40%, 129 at concentration of 50%, 88 at
concentration 60%.
Keywords: Aedes aegypti, Azadirachta indica Juss
In general, the Aedes aegypti
mosquito is a big enough problem that
concerns public health in countries with
tropical climates, including Indonesia. Aedes
aegypti is a vector of several serious diseases
that can infect humans, such as malaria,
encephalitis, "yelow fever", dengue fever,
dengue, filariasis , and arboviruses. One of the
major problems in Indonesia caused by the
mosquito Aedes aegypti is dengue fever and
dengue hemorrhagic fever.
One of the major problems posed in
Indonesia by the Aedes aegypti mosquito is
dengue fever and dengue hemorrhagic fever.
Dengue Hemorrhagic Fever (DHF) is one of
the diseases that has no cure or vaccine. The
treatment is supportive only in the form of bed
rest and fluids intravena. Eradicate action, by
wiping out mosquito lair and killing larva and
adult mosquitoes, is the best course of action
(Aradilla, 2009).
This disease go into Indonesia in
1968 through the port of Surabaya. In 1980
DHF has been reported spread in all provinces
in Indonesia. DHF clinical symptoms such as
high fever which lasts continuously for 2-7
days and bleeding manifestations are usually
preceded by seeing the typical signs such as
8
red spots (petechia) on patient’s body. The
patients can experience shock and death. Until
now the disease is still a public health
problem. The main vector of DHF is garden
mosquito called Aedes aegypti, while the
potential vector is Aedes albopictus
(Soegijanto, 2004).
Thrombocyte and endothelial cells
are estimated to have important role in the
pathogenesis of dengue fever and dengue
hemorrhagic fever, based on the fact that
dengue fever caused thrombocytopenia
accompanied
by
increased
capillary
permeability. The two components have long
been known to be an unity of function in
maintaining homeostasis, if one component
injuries, it will affect the activity of other
components. Thrombocytopenia (thrombocyte
count <100,000/mm3) is one of laboratoric
criteria in addition to increased hemotrokrit
>20% of the criteria for dengue diagnosis,
according to WHO (Soegijanto, 2006).
In Indonesia, dengue disease is a
health problem because there are many
endemic areas. DHF endemic area in general
is a source of spreading the disease to other
areas. Every extraordinary events (KLB)
dengue usually begin with an increasing
number of cases in that region. To limit the
spreading of dengue disease eradicating
mosquito lair movements, fogging, and
larvatiditation are needed continuously
(Widoyono, 2011). One of the plants that
contain botanical insecticide (naturally) is the
neem leaves (Azadirachta indica Juss). Plant
neem (Azadirachta indica Juss) belonging to
familia Meliaceae. Neem, especially the seeds
and leaves, contain several components from
secondary metabolic production allegedly very
useful in agriculture field (pesticides and
fertilizers) and in pharmaceutical field
(cosmetics and medicines). Among others are
Azadirachtin, salanin, meliantriol, Nimbin and
Nimbidin which are the best essence in
agricultural (pesticides and fertilizers) and
pharmaceutical (cosmetics and medicines).
Based on research conducted by RD Ndione,
O Faye, M Ndiaye, A DIEYE, and JM
Afoutou in 2007, using seeds of neem leaves
against Aedes aegypti Linnaeus 1762, which
also
contains
azadirachtin,
salalinin,
meliantriol, Nimbin and Nimbidin, capable to
kill Aedes aegypti larva. The effect of neem
leaf extract insecticides against Aedes aegypti
larva (Aradilla, 2009).
It is known that Azadirachtin is food
appetite derivation and ecdyson blocker (insect
growth hormone blockers). Salanin is one of
food appetite derivation. Meliantriol act as a
deterrent (repellent) so that insects are
reluctant to approach these plants. Nimbin and
Nimbidin
have
antimicrobial
activity,
antifungal and antiviral in humans and animals
(Aradilla, 2009). Because of it, the research
wants to know the effectiveness of neem
leaves (Azadirachta indica Juss) known as
natural reject test against Aedes aegypti
mosquito.
Objective
1. To determine the effectiveness of neem
leaf extract (Azadirachta indica Juss) as a
reject test of Aedes aegypti to break the
chain of dengue fever spreading.
2. To know the effectiveness reject power
test of neem leaf extract (Azadirachta
indica Juss) in ethanol on the bite
activities of Aedes aegypti.
3. To determine the concentration of neem
leaf extract (Azadirachta indica Juss) as a
reject power test against Aedes aegypti.
Research Methods
This study is a descriptive
experimental study (experimental test pure)
because researchers conducted experiments
the effectiveness reject power test of neem leaf
extract (Azadirachta indica Juss) in ethanol on
the bite activity of Aedes aegypti mosquito
and then described the results in article.
Indicators in this study is Aedes
aegypti mosquito adults because it has a better
defense system o than larval instar III and IV,
so that it can be assumed that the dose is able
to avoid the adult mosquito.
Equipment and Materials
a. The container in the form of gauze
confinement to put mosquito,
b. glass funnel,
c. measuring 5 ml pipette,
d. measuring 10 ml pipette,
e. pipette,
f. glass,
g. filter paper,
h. paper cab,
i. Aspirator,
j. plastic cups,
k. gauze,
l. plastic bottles.
Materials :
a. Raw foods used for mosquito breeding
such are rabbits or guinea pigs,
b. Food ingredients used for breeding
larva are floured chicken liver or fish
pellets,
c. Alcohol 70 %,
d. Distilled water,
e. Neem leaf powder.
Procedures
Aedes aegypti Rearing Procedures
Breeding mosquitoes from egg bank
of Aedes aegypti mosquito or catching it in the
wild by using an aspirator; Aedes aegypti
mosquitoes were caught incorporated into
gauze cages measuring 50x50x50 cm;
Mosquitoes in the confinement fed (guinea pig
blood) for 45 minutes and 10% sugar water
and then enter the water compartment, inside
the container circled filter paper with 1/3
position filter paper into the water where
mosquitoes lay their eggs.
9
Every day the container is examined
for the presence of eggs. If found, the next is
the hatching eggs process is by way of filter
paper containing the eggs, transferred to
plastic trays measuring 20 x 30 cm or 30 x 40
cm and add water until 2/3 trays; Eggs that
hatch into larvae (larvae) are given in the form
of flour eat chicken livers and water nam; ve
changed every 3 days to avoid deposition of
food / in plastic cups filled with water ¼
section, then a plastic cup is inserted into the
cage (cage) mosquito grown up.
Neem Leaf Extract Production Procedures
a. The neem leaves cleaned first with clean
water and then drained at room
temperature for a week.
b. The results of dried neem leaves are
blended to be ready in the experiment.
Do immersion by putting the blended
neem leaves earlier into the jar and add
the alcohol 70%.
c. Leave it for 7 days and at the same time
shake it if sediment occured.
d. After 7 days separate the wasted with
the filtrate.
e. Return the container / jar open.
f. Make a dilution with the addition of
distilled water.
g. The dilution result is ready for
experiments.
Experimental Procedures
a. Prepare the eggs of Aedes aegypti
rearing results from the egg banks; let it
stand for a week to happen ekslskion
eggs into adult mosquitoes,
b. Apply the extract on hand with neem
leaf extract dilution, respectively - each
5% - 12.5%; on Testing repelan power
required to close the glove fingers so as
not to be subjected test mosquito bites;
stopwatch to calculate the duration of
contact between mosquitoes to test arm;
No
1
2
3
4
5
6
7
10
c.
d.
e.
f.
In one test cages supplied 25 female
mosquitoes in a state of hunger;
The arms are used as bait to be equated
first condition that is by washing with
running water, then dried until it is
completely dry;
Each arm will be used as bait smeared
repelan solution 0.1 ml to 30 cm2
surface area; For each treatment tested
concentrations used one arm in one cage
containing 25 mosquitoes in a state of
hunger;
Observations were made every 5
minutes in every hour up to six hours;
Calculated number of mosquitoes that
land and or biting the arm;
power calculated by the formula: DR =
(K - P) / K x 100%. Where DR is a
repellent power, while K is the number
of mosquitoes landed on the control
arm, and P is the number of mosquitoes
landed on the arm smeared repelan.
Neem leaves can be deemed to have
power when the value repelan repellent
Power (DR) can reach 95%.
Hypothesis :
There is a difference in the reject power
test of neem leaf extracts against Aedes
aegypti mosquito bites with a
concentration of 10%, 20%, 30%, 40%,
50%, and 60%.
Data Analysis
Used the analysis of one direction
variance to determine whether there
are differences between treatments 1,
2, and so on with more than one
repetition (Sudjana, 1994). In this
study, it will tested whether there are
average differences in reject power of
neem leaf extracts against Aedes
aegypti bites at concentrations of 10%,
20%, 30%, 40%, 50%, and 60%.
Tabel1. The procedures for making neem leaf extract
Filtrate
Aquadest
Concentration
(%)
0 mL (control)
100 mL
0
10 Ml
90 mL
10
20 mL
80 mL
20
30 mL
70 mL
30
40 mL
60 mL
40
50 mL
50 mL
50
60 mL
40 mL
60
Results and Discussion
The results of the research that has been done on the effect of repellen Neem leaf extract on Aedes
aegypti as follows :
Table 2. Effect of Neem Leaf Extracts Against Aedes Aegypti Within 2 Hours
The concentration of neem leaf extract
0%
10%
20%
30%
40%
50%
60%
Experiment 1
375
82
74
62
57
53
31
Experiment 2
375
128
121
102
81
76
57
Total
750
210
195
164
138
129
88
After two experiments, there is a difference
between the experiment 1 and the experiment
2. At concentration of 10%, there is a
difference between experiment 1 (82
mosquitoes bite the arm) and experiment 2
(128 mosquitoes bite the arm). At
concentration of 20%, there is a difference
between experiment 1 (74 mosquitoes bite the
arm) and experiment 2 (121 mosquitoes bite
the arm). At concentration of 30%, there is a
mosquitoes bite the arm) and experiment 2
(102 mosquitoes bite the arm). At
concentration of 40%, there is a difference
between experiment 1 (57 mosquitoes bite the
arm) and experiment 2 (81 mosquitoes bite the
arm). At concentration of 50%, there is a
mosquitoes bite the arm) and experiment 2 (76
mosquitoes bite the arm). At concentration of
60%, there is a difference between experiment
1 (31 mosquitoes bite the arm) and experiment
2 (57 mosquitoes bite the arm).
Table 3. Effect of neem leaf extract in 15 minutes ( in 2 attempts )
The frequency
of mosquito
bites
10%
20%
30%
40%
50%
60%
(in minute)
1
9
22
6
2
3
3
2
12
26
7
6
9
3
3
17
21
14
7
9
3
4
17
16
13
11
10
4
5
21
16
13
11
10
4
6
18
10
18
13
9
7
7
15
7
16
11
8
3
8
18
11
14
16
7
8
9
13
12
14
19
14
3
10
11
11
6
14
14
9
11
15
6
7
6
7
9
12
11
8
8
4
9
9
13
11
6
8
4
7
9
14
13
10
7
8
9
8
15
9
13
7
7
4
6
Total
210
195
164
138
129
88
11
Concentration of 10 % from first
minute 9 bites, in the second minutes 12 bites,
the third minutes 17 bites, in the fourth
minutes 17 bites, in the fifth minutes 21 bites,
in the sixth minutes 18 bites, in the seventh
minutes 15 bites, in the eighth minutes 18
bites, in the ninth minutes 13 bites, in the tenth
minutes 11 bites, in the eleventh minutes 15
bites, in the twelfth minutes 11 bites, in the
thirteenth minutes 11 bites, in the fourteenth
minutes 13 bites, and in the fifteenth minutes 9
bites, the number of mosquitoes that bite the
arm at a concentration of 10 % are 210 bites.
At a concentration of 20 % from the
first minute 22 bites, in the second minutes 26
bites, in the third minutes 21 bites, in the
fourth minutes 16 bites, in the fifth minutes 16
bites, in the sixth minutes 10 bites, in the
seventh minutes 7 bites, in the eighth minutes
11 bites, in the ninth minutes 12 bites, in the
tenth minutes 11 bites, in the eleventh minutes
6 bites, in the twelfth minutes 8 bites, in the
minutes 10 bites, and in the fifteenth minutes
13 bites, the number mosquitoes that bite the
arm at a concentration of 20% are 195 bites.
At a concentration of 30% in the first
minute 6 bite, in the second minutes 7 bites, in
the third minutes 14 bites, in the fourth
minutes 7 bites, and in the last fifteenth
minutes 7 bites. The number of mosquitoes
that bite the arm are 164 bites.
At a concentration of 40 % in the first
in the third minutes 7 bites, in the fourth
12
bites. The number of mosquitoes that bite the
arm that are 138 bites.
minutes 10 bites, in the fifth minutes 9 bites, in
the sixth minutes 9 bites, in the seventh
minutes 8 bites, in the eighth minutes 7 bites,
in the ninth minutes 14 bites, in the tenth
minutes 9 bites, in the fifteenth minutes 4
arm are 129 bites.
minutes 3 bites, in the second minutes 3 bites,
minutes 4 bites, in the fifth minutes 4 bites, in
the sixth minutes 7 bites, in the seventh
minutes 3 bites, in the eighth minutes 8 bites,
in the ninth minutes 3 bites, in the tenth
arm are 88 bites.
Based on the result obtained that there
are 70% of mosquito that bite the arm at
concentration of 10%; there are 72,14% of
mosquito that bite the arm at concentration of
20%; there are 76,57% of mosquito that bite
the arm at concentration of 30%; there are
80,28% of mosquito that bite the arm at
concentration of 40%; there are 81,57% of
mosquito that bite the arm at concentration of
50%; and there are 87,42% of mosquito that
bite the arm at concentration of 60%.
Table 4. Descriptive Data in Each Reject Power Test Concentration of Neem Leaf Extracts
Against Aedes Aegypti
Anova: Single Factor
SUMMARY
Groups
Count
Sum
Average
Variance
0
3
1500
500
46875
0.1
3
420
140
4204
0.2
3
390
130
3721
0.3
3
328
109.3333 2641.333
0.4
3
276
92
1731
0.5
3
258
86
1519
0.6
3
176
58.66667 814.3333
Table 5. Results of Data Analysis of Variance Test of The Reject Power Test Concentration of
Neem Leaf Extracts Against Aedes Aegypti
ANOVA
Source of
Variation
SS
Df
MS
F
P-value
F crit
Between Groups 419499.81
6
69916.63 7.957258 0.000713 2.847726
Within Groups
123011.333 14
8786.524
Total
542511.143
20
Based on the results if the data
presented in Table 4.4 shows that the value of
Fcount = 7.957258 and Fcriteria = 2.847726, and
the P - value = 0.000713. Therefore Fhitung >
Fcriteria or P - value < 0.005, this means that H0
is rejected. Conclusions based on the results of
data processing are there are significant
differences reject power test of neem leaf
extract with a concentration of 10%, 20%,
30%, 40%, 50%, 60% against the bite
activities of Aedes aegypti. In other words, the
leaf extract of neem (Azadirachta indica Juss)
is effective in reducing (rejected) the bite
activities of Aedes aegypti.
Conclusions
1. At a concentration of 10% the bite on the
arm are 210 bites within 15 minutes.
arm are 195 bites within 15 minutes.
3. At a concentration of 30 % the bite on the
arm is slightly reduced to 164 bites within
15 minutes.
4. At a concentration of 40 % the bite on the
arm is reduced to 138 bites within 15
minutes.
arm reduced to 129 bites within 15
minutes.
arm reduced again to 88 bites in 15
minutes.
7. The higher concentration of the extract, the
fewer number of bites on the arm at the
same time. The entire test results indicate
neem leaf extract as repelan which have
protective power of less than 90% for 2
hours against Aedes aegypti contact. Neem
leaf extract can serve as repelan, because it
has the contents of ecdyson blockers and
salanin.
Recommendations
1. Informed public to use natural
insecticides, one of it is an extract of
neem leaves to replace the anti-mosquito
lotion made from chemicals.
2. It is need to repeated the research by
using other mosquito species with
different methods in order to know
whether the neem leaf extract affected
broadly to all types of mosquitoes.
13
Reference
1. Aradilla , U.S. 2009. Effectiveness Test
larvicides Ethanol Extract Neem leaves (
Azadirachta indica ) against larvae of
Aedes aegypti . Diponegoro University ,
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2. Faculty of Medicine , 2004. Dengue
Script Complete Training for Trainers
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4. Kardinan , A. 2007. Plant Repellent and
Mosquito Repellent . Jakarta : Agromedia
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5. Shinta.2012 . Media Health Research
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Patchouli ( Pogostemon cablin B. ) ,
leaves Badotan ( Ageratum conyzoides L
) , Flower Boxwood ( Cananga odorata
hook F & Thoms ) and leaves of
rosemary ( Rosmarinus officinalis L ) For
Against Aedes aegypti repelan , [ online ]
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at
<
http://www.medialitbang.com/html > [
Accessed 13 march 2014 ] .
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Airlangga University Press .
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2011. Health Entomology . Jakarta :
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of DHF . Bekasi : Key Partners .
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CURRENT RADIOTHERAPY FACILITIES IN INDONESIA
Ikhsan Bagatondi Nasution: Dodoh Khodijah
Departement of Radiotherapy, Murni Teguh Memorial Hospital, Medan
Jurusan Kebidanan Poltekes Kemenkes Medan
ABSTRACT
Background: WHO in 2014 declared globally cancer is a major cause of morbidity and mortality.
Selection of cancer treatment includes surgery, radiotherapy or chemotherapy. Approximately 5060% of cancer patients require radiotherapy. Treatment of cancer in LMICs and challenge to make
radiotherapy as a key component of cancer treatment that can be accessed patient is a foremost
concern of all stakeholders both at national and international levels.
Objective: Acquire an overview of the Indonesian radiotherapy facility in 2015.
Methods: Using the results of studies conducted based on literature studies and field studies.
Results: The development of Indonesian radiotherapy centers in 2015, when compared to 2008
increased by 22.72%. Overall there was 41 external radiotherapy equipment. There is 23 Unit using a
Linear Accelerator and 18 Unit using Co-60 equipment. The Estimation of patients who will receive
radiotherapy services in 2015 approximately 29,300 patients. When compared with patients who need
radiotherapy approximately 199,940 patients, only 14.65% which can be served.
Conclusion: Need an arrangement from the Indonesian Government to assist the treatment of
radiotherapy for Social Security Organizing Bodies participants. Monetary cost is built on radiation
techniques, not just in a class that is based on the number of hospital rooms.
Key words: Radiotherapy, cancer and social security organizing bodies
Introduction
According to the WHO Cancer is a term for a
large group of diseases that can affect any part
of the body, also known as malignant tumors
and neoplasms. Another trait of cancer is the
creation of abnormal cells that grow quickly
out of the habit which can then invade
adjoining parts of the body and spread to other
organs, the latter process is called metastasis,
which is the leading cause of cancer deaths
[1].
According to the World Cancer Report 2014,
published by the International Agency for
Research on Cancer (IARC) of the World
Health Organization (WHO), Globally cancer
remains a major cause of morbidity and
mortality with 14 million new cancer cases
and 8 million cancer-related deaths reported in
2012 [2]. Approximately 60% of cancer cases
occur in countries of Africa, Asia, Central and
South America with 70% of cancer deaths are
from these areas.
According to the World Health Organization
(WHO), the incidence of cancer between 2008
and 2030 is projected to rise 82% in the group
of low-income countries (lower income
countries), up 70% in the group of lowermiddle income countries (Lower middle
Income Countries) and up 58 % in uppermiddle income countries (upper middle
income countries). There is a rise in cancer
incidence by 40% in high-income countries
(HICs). The case in LMICs is equal to twothirds of all cases [3]. According to the World
Bank, Indonesia groupped into Lower Middle
Income country [4]. Indonesia is the world's
fourth most Populous nation, with 249.9
million people [5]. The Ministry of Health of
the Republic of Indonesia held a Basic Health
Research (Riskesdas) in 2013, the results
showed the prevalence of tumor / cancer in
Indonesia is 1.4 per 1000 population.
Indonesia's highest cancer in women is breast
cancer and cervical cancer. Whereas in men
are lung cancer and colorectal cancer. The
highest prevalence occurs in Yogyakarta at 4.1
per 1000 population. The prevalence in North
Sumatra is 1 per 1000 population [6].
The Government of Indonesia in 2015 through
the Ministry of Health of the Republic of
Indonesia has started commitments cancer
prevention in Indonesia, together with national
cancer prevention committee (KPKN) and
Indonesia
Cancer
Foundation.
Commitment Cancer Prevention activities in
15
Indonesia, for special attention to: 1)
Improvement of promotive and preventive
efforts to raise public awareness about cancer;
2) Development of early detection in order to
reduce the number of cancer deaths; 3) Treat
cancer according to the standard, the necessary
monitoring and evaluation of the effectiveness
of alternative treatments that are offered
through the mass media and electronic; 4)
Improved quality of life for cancer patients
through effective palliative effort; 5) Support
all elements of society in a comprehensive
cancer control and continuous [7]. The main
purpose of diagnosis and treatment of cancer is
to cure or prolong the life of patients and
ensure the best quality of life that can be done
for people with cancer. Selection of treatment
modality should be done with caution between
surgery, radiotherapy or chemotherapy.
Selection is based on the best evidence-based
treatment given available resources [8].
Radiotherapy uses radiation such as X-rays,
gamma rays, electron beams or protons to
damage cancer cells and stop the growth.
Radiotherapy is the treatment of localized,
directed only to the part of the body that
requires [9]. High-energy radiation used will
permanently damage the DNA of cancer cells.
Other healthy body tissues will be affected
temporarily, but these cells were able to repair
this DNA damage and still grow normally
[10]. Radiotherapy if used before surgery to
shrink tumors so more easily removed when
surgery is known as neoadjuvant treatment. If
done after surgery to destroy remaining tumor
known as adjuvant treatment [10]. Curative
use of radiation called a radical treatment,
aimed at providing long-term beneficial effects
for patients. Radiation can also be given
before or after chemotherapy to improve
overall treatment outcomes. Palliative
treatment aims to shrink tumors and reduce
pain. Palliative treatment can also extend the
life of [11] .Radiotherapy play an important
role in the fight against cancer. Approximately
50-60% of all cancer patients in need of
radiotherapy in the treatment of the disease
[12,13]. The current situation of the treatment
of cancer and cancer in LMICs challenge to
make radiotherapy, as a key component of
cancer treatment, which can be accessed in
these countries has become a major concern
that is recognized by all stakeholders both at
the country level and internationally [14, 15].
16
Methode
This paper represented the results of a study
conducted by literature studies [16,17] and
field studies to obtain a picture of radiotherapy
facility in Indonesia by 2015 [18].
Result
Development of radiotherapy centers in
Indonesia when compared with data from the
literature [16,17] has increased by 22.72%.
Overall there were 41 aircraft external
radiotherapy, which uses Linear Accelerator
Unit 23 18 Unit again while using Co-60, as
seen
in
Table
1.
One unit that uses a Co-60 is used for
stereotactic radiation surgery (SRS) is Leksell
Gamma Knife in Siloam Hospital Lippo
Village.
The calculations were carried out to see
estimates of cancer patients that can be served
with teletherapy equipment are 60 new
patients / month. So if in the calculations for 1
year, then the number reached 720 patients
that can be served for 1 teletherapy machine
unit. This calculation is still within tolerance
limits specified by the International Atomic
Agency (IAEA) which mentions for the state
Low Middle Income Countries such as
Indonesia, One unit can serve 500-1000
Aircraft teletherapy patient per year [15].
Estimates of the number of patients who will
receive radiotherapy services in 2015
approximately
29,300
patients.
When
compared with patients who need radiotherapy
approximately 199 940 patients, only 14.65%
which can be served. This figure is a rough
idea of the conditions in Indonesia and will
change if the use of Indonesia's population in
the latest census. Estimates of the number of
patients will decrease if accounted for more
details about the down time and the number of
fractionated
radiotherapy
equipment
specifically for each type of cancer. Advanced
radiotherapy techniques such as Intensity
Modulated Radiation Therapy (IMRT) is
already on the island of Sumatra, namely in
the Murni Teguh Memorial Hospital, using
IMRT QA equipment and software
Gafchromic Film PTW Verisoft. In 2008, the
radiation technique such as Intensity
Modulated Radiation Therapy, Stereotactic
Radiation Surgery (SRS), Stereotactic Body
Radiation Therapy (SBRT) only in the General
Hospital of the National Center Cipto
Mangunkusumo, but now there Muchtar Riadi
Comprehensive Cancer Center Hospital
(MRCCC), and in the Siloam Hospital TB
Simatupang. Both of the above hospitals have
been using Rapid-Arc, which the advantages
of this technique compared to IMRT is a faster
treatment time. While Dharmais Cancer
Hospital and Gading Pluit Hospital just the
IMRT
technique.
Soetomo Hospital in Surabaya also has the
ability to run this IMRT techniques.
Data in 2008 stated that there are 8 active
radiotherapy centers do Brachytherapy
Technique. These performed in 2 Dimensions
Brachytherapy technique, using the C-Arm. In
the 2015's, 3D Brachytherapy techniques
already exist in three hospitals in Indonesia,
namely in Dharmais Cancer Hospital in
Jakarta, Saiful Anwar General Hospital in
Malang and Murni Teguh Memorial Hospital
in Medan.
Discussion
In 2008, the entire hospital which have
radiotherapy facilities owned by the
Government of the Republic of Indonesia.
Currently
Private
Hospital
has
had
radiotherapy facilities. There are 2 Private
parties who have radiotherapy facilities in
Medan - North Sumatra ie Murni Teguh
Memorial Hospital and Vina Estetica Hospital.
There are six private hospitals have
radiotherapy facilities in the island of Java,
Pertamina Central Hospital, MRCCC Hospital,
Siloam TB Simatupang Hospital, Gading Pluit
Hospital in North Jakarta, Siloam Hospital
Lippo Village in Lippo Karawaci, Banten and
Ken Saras Hospital in Ungaran Central Java.
Ownership Hospital by private parties would
be a bit much into account the investment
made in providing radiotherapy services.
Today almost all hospitals work together in
serving participants the social insurance
agency participants should get radiotherapy
services, the Hospital who have radiotherapy
facilities should provide radiotherapy services
with a predetermined amount of tariff value.
The amount of rates depending on the class
Hospital. If you look carefully you can bet that
as the Government Hospital Referral Regions
with the number of rooms in which more
certainly has a higher grade than the Private
Hospital. Noting that the Government has not
been able to meet the adequate provision of
radiotherapy facilities in Indonesia, the
hospital had radiotherapy facilities need to be
given incentives or take into account the rate is
based technique Radiotherapy given to the
patient. Currently there is a problem in view of
the Government through INA-CBGs rates only
know one Coding (excluded on Top Up) in an
outpatient procedure that is Radiotherapy.
There is no difference in rates between
hospitals having LINAC Facility sophisticated
techniques such as IMRT Hospital who have
radiotherapy facilities Co-60 with 2D
techniques. Thus the patient care 0f the social
insurance agency can be maximized and
encourage advances in techniques of treatment
given.
Conclusion
Limitations on various things in this paper
does not diminish the important message that
Indonesia is still very short of radiotherapy
centers. Shortcomings in terms of equipment
availability and distribution, access to
radiotherapy centers which are unevenly
distributed and affordability of treatment. The
Government of Indonesia through the program
social insurance agency has made affordability
of treatment is no longer a burden, but if the
government has not been able to provide the
rate calculation based radiotherapy technique,
it needs to make cost sharing between the
patient
and
the
government
[15].
So in the end the government's commitment in
the Cancer Prevention activities in Indonesia
with one of the points for special attention on
Improving the quality of life of cancer patients
through effective palliative efforts may be
improving the quality of life of patients
through effective curative measures.
17
Tabel 1.Availability of Treatment
PROVINCE
No
POPULATION AT 2010
CENSUS*
RT C
INCIDENCE
C
Need RT TREAT/YEAR
NATIONAL
o-60
(60%)
***
LINAC **
3
3
1 SUMATERA UTARA
RS MURNI TEGUH
MEMORIAL
a.
HOSPITAL
b. RSUP H ADAM MALIK
c. RS VINA ESTETICA
12.982.204
2 SUMATERA BARAT
RSUP M DJAMIL PADANG
3 RIAU
RSUD ARIFIN ACHMAD a. PEKANBARU
5.133.989
1
LINAC 2DIMENSION
5.538.367
1
4 SUMATERA SELATAN
RSUP DR MOHAMMAD
a. HUSIN
7.450.394
1
5 BANTEN
RS SILOAM
HOSPITAL - LIPPO
a.
VILLAGE
10.632.166
1
LINAC 3DC + IMRT
LINAC 3DC
LINAC 3DC
10.905
2160
0
1 7.188
4.313
720
1
I
0 7.754
4.652
720
1 10.431
6.258
720
8.931
500
8.071
10080
36.165
1440
27.201
3600
2.904
1440
31.480
4320
3.268
720
0 4.236
2.542
720
1 5.077
3.046
720
I
I
I
LINAC 2DIMENSI0N
I
0
I
1 14.885
LEKSELL GAMMA KNIFE PERFEXION****
6 DKI JAKARTA
RSUPN DR CIPTO
a. MANGUNKUSUMO
b. RS KANKER DHARMAIS
RSPAD GATOT
c. SOEBROTO
d. RS MRCCC - SEMANGGI
RS SILOAM - TB
e. SIMATUPANG
f. RS PERSAHABATAN
h. RS PUSAT PERTAMINA
g. RS GADING PLUIT
9.607.787
7 JAWA BARAT
RSUP HASAN SADIKIN
a. BANDUNG
43.053.732
8 JAWA TENGAH
RSUD DR MOEWARDI a. SOLO
RS DR MARGONO b. PORWOKERTO
RSUP DR KARIADI c. SEMARANG
RS KEN SARAS d. UNGARAN
DAERAH ISTIMEWA
9 YOGYAKARTA
32.382.657
7
I
11
3 13.451
LINAC 3DC + IMRT+ IGRT+SRS/SRT
LINAC 3DC + IMRT
III
II
I
LINAC 3DC
LINAC RAPID ARC (VMAT)
I
I
I
LINAC
LINAC
LINAC
LINAC
I
I
I
I
RAPID ARC (VMAT)
3DC
3DC
3DC + IMRT
1
4
I
1
1 60.275
I
I
1
4 45.336
I
I
LINAC 3DC
II
LINAC 3DC
3.457.491
I
1
1
1 4.840
I
I
3
3 52.467
LINAC 3DC + IMRT
II
I
LINAC 3DC
I
a. RSUP DR SARDJITO
10 JAWA TIMUR
RSUD DR SOETOMOa. SURABAYA
RSAL DR. RAMELAN b. SURABAYA
RSUD SYAIFUL ANWAR c. MALANG
11 BALI
RSUP SANGLAH a. DENPASAR
37.476.757
12 KALIMANTAN TIMUR
RS ABDUL WAHAB
a. SJAHRANI
3.026.060
Co-60 2D
3.890.757
3
1
0
II
1 5.447
I
1
Co-60 2D
13 KALIMANTAN SELATAN 3.626.616
18
0 18.175
1
I
0
0
RSUD ULIN a. BANJARMASIN
Co-60 2D
I
14 SULAWESI SELATAN
RS UNIVERSITAS
a. HASANUDDIN
RSUP DR WAHIDIN
b. SUDIROHUSODO
15 ACEH
8.034.776
1 11.249
6.749
1440
Co-60 2D
4.494.410
0
0
I
0 6.292
3.775
0
16 BANGKA BELITUNG
1.223.296
17 BENGKULU
1.715.518
0
0
0 1.713
1.028
0
0
0
0 2.402
1.441
0
18 KALIMANTAN TENGAH 2.212.089
0
0
0 3.097
1.858
0
19 SULAWESI TENGAH
NUSA TENGGARA
20 TIMUR
2.635.009
0
0
0 3.689
2.213
0
4.683.827
0
0
0 6.557
3.934
0
21 GORONTALO
1.040.164
0
0
0 1.456
874
0
22 JAMBI
3.092.265
0
0
0 4.329
2.598
0
23 LAMPUNG
7.608.405
0
0
0 10.652
6.391
0
24 MALUKU
1.533.506
0
0
0 2.147
1.288
0
25 KALIMANTAN UTARA
622.350
0
0
0 871
523
0
26 MALUKU UTARA
1.038.087
0
0
0 1.453
872
0
27 SULAWESI UTARA
2.270.596
0
0
0 3.179
1.907
0
28 PAPUA
2.833.381
0
0
0 3.967
2.380
0
29 KEPULAUAN RIAU
1.679.163
0
0
0 2.351
1.410
0
30 SULAWESI TENGGARA
2.232.586
0
0
0 3.126
1.875
0
31 KALIMANTAN BARAT
NUSA TENGGARA
32 BARAT
4.395.983
0
0
0 6.154
3.693
0
4.500.212
0
0
0 6.300
3.780
0
33 PAPUA BARAT
760.422
0
0
0 1.065
639
0
34 SULAWESI BARAT
1.158.651
0
0
0 1.622
973
0
238.023.673
27
23
18 333.233
199.940 29300
TOTAL
2
1
LINAC 3 DC
I
* = Sensus Penduduk Tahun 2010
** = DATA RISKESDAS 2013 HAL 86 ( 1,4 permil)
*** = Assume 1 Equipment will treat 720 patient/year (60 patient/month)
**** = Calculation based on 2 px/day x 5 day/week X 50 week, Ref : [20].
RT C = Radiation Therapy Center
References
World Health Organization. (2015). Cancer.
Geneva.
Forman D, Ferlay J. (2010). The Global And
Regional Burden Of Cancer. WHO.
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World Health Organization. (2010) Global
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Laporan Hasil Riset Kesehatan Dasar (2013).
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Indonesia. Kementerian Kesehatan
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World Health Organization. (2015). Treatment
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Cancer Council Victoria. (2014) Radiotherapy.
Cancer Council Victoria. Melbourne.
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Radiation. It's Commonly Used To
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IAEA. (2008). Division of Human Health,
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Clinical, Medical Physics, Radiation
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Barton MB, Frommer M, Shafiq J. (2006).
Role Of Radiotherapy In Cancer
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(7):584-95
Samiei
M.
(2014)
Health
Systems
Strengthening For Cancer Control. In:
Stewart Bw, Wild Cp. WHO. Geneva.
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Samiei M. (2013). Challenges Of Making
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Developing Countries In Cancer
Control. Network for Cancer Treatment
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Grover S., Xu MJ., Yeager A., Rosman L.,
Groen RS., Chackungal S., Rodin D.,
Mangaali M., Nurkic S., Fernandes A.,
Lin LL., Al, T (2015). A Sys- Tematic
Review Of Radiotherapy Capacity In
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Low-And Middle-Income Countries.
Oncol.
Gondhowiardjo., Prajogi, G.B., & Sekarutami,
S.M. (2008). History And Growth Of
Radiation Oncology In Indonesia.
Biomed Imaging Interv J. Jul-Sep; 4(3):
e42..
THE CORRELATION OF ELDERLY KNOWLEDGE AND ATTITUDE
TO THE UTILIZATION OF ELDERLY INTEGRATED SERVICE POST
IN COMMUNITY HEALTH CENTER OF TANAH TINGGI
BINJAI 2013
1
Elizawarda 1
Department of Midwifery, Poltekkes Kemenkes Medan
Author's Corresponding (+6281263860665)
ABSTRACT
Introduction Indonesia is a country that has a population in the world's fourth most populous. With a
population more than 200 million people in 2000 to 7.5% or 15 million inhabitants are elderly
residents. According to the World Health Organization (WHO) report that elderly population in
Indonesia in 2020 has reached 11.34% or 28.8 million people registered, 6.9% live babies that causes
the elderly population in the world and based on Central Bureau of Statistics (BPS) in the years 20052010 the number of elderly people will be equal to the number of children is 8.5% of the population
or about 19 million people. Given the level of health and well-being is improving the survival rate of
Indonesia's population is also increasing (Hatta, 2006).
Methods This research is an analytical study with cross sectional method aims to identify the
knowledge, attitudes, and the correlation between knowledge and attitudes of elderly with utilization
of elderly integrated service post in Community Health Center of Tanah Tinggi Binjai. The
population of elderly who utilize was 120 peoples. The sampling technique used purposive sampling
by 55 respondents.
Result and Discussion Based on the research find that correlation between knowledge to the
utilization of elderly integrated service post, the result P = 0.000 <0.05, the correlation between
attitude to the utilization of elderly integrated service post with result P = 0.000 <0.05, meaning it can
be concluded that there is a correlation between knowledge and attitude of elderly with utilization
elderly integrated service post in community health center of Tanah Tinggi Binjai in 2013.
The suggestion is that health professionals must be able to improve understanding of information on
the utilization of elderly integrated service post .
Keywords : Knowledge, Attitude, The Utilization of Elderly Integrated Service Post
INTRODUCTION
One indicator of the success of development is
the increasing life expectancy of the
population. With the increased life expectancy
of the population, caused the number of
elderly people from year to year (Resmana,
2011)
Indonesia is a country that has a population in
the world's fourth most populous. With a
population of more than 200 million people in
2000 to 7.5% or 15 million inhabitants are
elderly residents. Based on the projections of
the Central Bureau of Statistics (BPS) in the
years 2005-2010 the number of elderly people
will be equal to the number of children is 8.5%
of the population or about 19 million people.
According to the WHO, elderly population in
Indonesia in 2020 has reached 11.34% or 28.8
million people registered, 6.9% live babies
that causes the elderly population in the world.
Given the level of health and well-being is
improving the survival rate of Indonesia's
population is also increasing (Hatta, 2006).
According to the National Commission on
Elderly in its book entitled "Population Profile
Erderly 2009" said that the proportion of the
elderly population in Indonesia, there has been
a significant increase over the last 30 years
with a population of 5.3 million (4.48 percent
of the total population of Indonesia ) in 1971
to 19.3 million (8.37 percent of the total
population of Indonesia) in 2009. Then, based
on population projections Elderly Indonesia in
2020, is expected to reach 28.99 million. The
increase in the elderly population is due to an
increase in life expectancy as a result of health
care quality improvement (Elderly Population
Profile, 2009)
21
According to the Health Profile of North
Sumatera Province in 2011 that total
population in North Sumatra amounted to
13,103,596 people, and the number of elderly
in North Sumatra in 2011 recorded 797 813
people or 6.08%. As well as the number of
elderly in the city of Binjai as many as 14 523
people. Elderly integrated service post should
be a leading pioneer in tackling the problem of
the increasing levels of the elderly in
Indonesia. Namely by means of disseminating
knowledge and attitudes about the need for
quality of life of individuals and the
importance of planning and inventory needs in
the old days later.
Results of research conducted to Dwi Handy
(2011), in the community health center of
Weru obtained information that runs through
cadres of integrated service post. Of the 100
respondents who obediently follow integrated
service post many as 29 people (29%), and as
many as 71 people (71%) did not follow
integrated. From these studies have proved
that there is still a lack of awareness of the
elderly to take advantage of the elderly
integrated service post.
From the 2011 data profile of North Sumatra
showed that from 14.523 the number of
elderly people, only 3,850 people or 26.51%
got health services in Binjai. From the
beginning of the survey that has been done in
January 2013, in Health Community Center of
Tanah Tinggi Binjai there were 120 elderly
people, spread over two Integrated service
post namely Habibi Habibah as many as 60
people and Timbang Langkat as many as 60
people. Preliminary data that got from
interviews with elderly integrated service post
officer in Community health center of Tanah
Tinggi Binjai, generating that only 54 elderly
people who implement and utilize the
importance of integrated service post. Thus,
while the conclusion of the authors stated that
there is still a lack of knowledge and attitudes
towards the use of erderly integrated service
post.
From the foregoing, we need a further study
on the importance of the correlation between
knowledge and attitude toward the existence
and the utilization of elderly integrated service
post.
22
RESEARCH METHODS
This research was conducted with cross
sectional study design on January to July 2013
were conducted at community health center of
Tanah Tinggi Binjai. The population in this
study were all erderly who utilize elderly
integrated service post in Community health
center of Tanah Tinggi Binjai in 2013,
amounting to 120 people with a total sample
of 55 elderly people using the formula by
purposive sampling technique.
The type of data used are primary and
secondary data. With the measuring tool in the
form of a questionnaire prepared by the author
based on theoretical. The data has been
obtained and then analyzed with the univariate
and bivariate analysis.
RESULTS AND DISCUSSION
RESULTS
The results of this study according on primary
data conducted in community health center of
Tanah Tinggi Binjai in 2013 obtained the
following results:
1. Univariate Analysis
a. Distribution of respondents based on the
utilization of erderly integrated service post,
knowledge and attitudes.
Distribution of respondents based on the
utilization of erderly integrated service post,
knowledge and attitudes in community health
center of Tanah Tinggi Binjai 2013 can be
seen in the pie chart below:
Chart 1.
Frequency Distribution Of Respondents
Based On The Utilization Of Erderly
Integrated Service Post In Community
Health Center Of Tanah Tinggi Binai 2013
Elderly Integrated
Service Post
25
30
person
person (45,5 %)
(54.5 %)
Unutilize
Utilize
Based on the chart 1 shown that total 45.5%
(25 people) elderly have utilized intergrated
service post.
Chart 2.
Frequency Distributionof Erderly
Knowledge With Utilization Of Erderly
Integrated Service Post In The Region Of
Community Health Center Of
Tanah Tinggi Binjai 2013
Elderly Knowledge
11
Person
(20 %)
18
person
(32,& %)
Good
Chart 3.
Frequency Distribution of Erderly Attitude
With Utilization Of Erderly Integrated
Service Post In The Region Of Community
Health Center Of
Tanah Tinggi Binjai 2013
Elderly Attitude
37
Person
(67,3 %)
No
The Utilization
Yes
No
F
%
F
%
18 100 0
0
7 26,9 19 73,1
5 45,5 6 54,5
30 54,5 25 45,5
Knowledg
e
Total
P
Value
F %
18 100 0,000
26 100
11 100
55
Less
Based on chart 2 shown that total of 20.0% (11
people) less knowledgeable about utilization
of elderly integrated service post.
18
Person
(32,7 %)
Table 1
Frequency Distribution of Correlation
Between Elderly Knowledge to the
Utilization of Erderly Integrated Service
Post in Community Health Center of Tanah
Tinggi Binjai 2013
1 Good
2 Enough
3 Less
Total
Enough
26
Person
(47,3)
a. The distribution of respondents according to
the relationship of knowledge with the
utilization of erderly integrated service post
can be seen in the table below:
Negative
Positive
Based on the chart 3, as much as 32.7% (18
persons) Elderly being negative about the
utilization of elderly integrated service post.
2. Bivariate Analysis
From the table above was obtained that there 5
out of 11 (45.5%) of respondents who do not
utilize the erderly integrated service post had
less knowledge. While among the elderly who
take advantage of integrated service post exist
as much as 18 out of 18 respondents (100%)
who have a good knowledge. Test results
obtained by statistical values p value = 0.000
then it can be concluded there is a difference
between utilization of integrated service post
incidence proportion of Elderly who have a
good knowledge of the elderly who have less
knowledge (there is a significant relationship
between the knowledge of elderly with
utilization of integrated service post elderly).
b. Distribution of respondents based on
relationships with elderly attitude to utilization
of of erderly integrated service post can be
seen in the table below:
Table 2
Frequency Distribution of Correlation
Between Elderly Attitude to the Utilization
of Erderly Integrated Service Post in
Community Health Center of Tanah Tinggi
Binjai 2013
The Utilization
Yes
No
F
%
F
%
29 78
8
21
F
37
%
100 0,000
Negative
1
5
17
94
18
100
Total
30
54,5
25
45,5
55
No
Sikap
1
Positive
2
Total
P
Value
From the results of the analysis of the
correlation between the attitudes of the elderly
with the utilization of erderly integrated
23
service post obtained that there are 29 of 37
(78,4%) of respondents utilizing erderly
integrated service post have a positive attitude.
While the elderly who do not utilize the
erderly integrated service post seen that there
was 1 of the 18 respondents (5.6 percent) who
had a negative attitude. Test results obtained
by statistical values p value = 0.000 then
concludes there is a difference between
utilization of erderly integrated service post to
incidence proportion of elderly who have a
positive attitude to the elderly who have a
negative attitude (there is a significant
relationship between the attitudes of the
elderly with the utilization of erderly
integrated service post).
DISCUSSION
a. Distribution of respondents based on the
utilization of erderly integrated service
post, knowledge and attitudes in
community health center of Tanah
Tinggi Binjai 2013.
The research that has been conducted in
Community Health Center of Tanah Tinggi
Binjai in 2013, from the chart.1 shows the
frequency distribution of integrated service
post’s utilization is known that elderly who
utilized integrated service post is as much as
30 elderly people (54.5%).
According Notoatmodjo (2003), when the
acceptance of new behavior or adoption of
behavior through a process based on the
knowledge, awareness and attitudes then the
behavior will be lasting (long lasting).
Conversely, if the behavior is not based on
knowledge and awareness then it will not last
long. The participation of the elderly to
integrated service post supported by
knowledge of integrated service post by
elderly can be lasting.
Utilization of health services by the family
also affect the elderly integrated service post
depends on family predisposition include
family characteristics tend to use health
services include demochartic variables,
variables of social structure, as well as beliefs
and attitudes toward medical care (Muzaham
F, 1995).
According to the assumptions of researchers,
from the study due to lack of utilization of
erderly integrated service post caused by lack
24
of knowledge and attitudes and support of the
elderly families.
From the research that has been done in the
community health center of Tanah Tinggi
Binjai in 2013, based on the chart 2 shows
total of 20.0% (11 people) less knowledgeable
about utilization of elderly integrated service
post.
Based on the amount of information obtained
by the elderly about the use of erderly
integrated service post then, according to
Notoatmodjo (2007) mention that the more
information got then more in knowledge also
because the information is one of the factors
that can affect a person's level of knowledge. It
just proves that the utilization of elderly
integrated service post affected by lack of
knowledge about the utilization of erderly
integrated service post so it caused unknown
the benefit of it.
John Locke an empiricism of Britain said that
human beings are born minds is a kind of
blank note book. In the scientific record books
recorded sensory experiences. And further
John Locke said, the rest of the knowledge we
gain with ideas derived from the sensing and
the first reflection and simple. Long story
short, knowledge gained by empiricism is
more because of the experiences that ever
passed, how the complexity of knowledge can
be traced to experiences (Prince, 2011).
According to the researchers assumption, lack
of knowledge about elderly integrated service
post due to lack of information and experience
about the utilization of erderly integrated
service post.
Based on the chart 3, as much as 32.7% (18
persons) elderly being negative about the
utilization of elderly integrated service post. In
this case, Thurstone stated that attitude is a
form of evaluation or emotional response to
something. Thus, the attitude pointing in the
direction of positive and negative that has to
do with one's psychological life. So, in terms
of the attitude of the elderly to Utilization of
elderly integrated service post in community
health center of Tanah Tinggi Binjai show
negative positive attitude because attitude is
the basis on readiness or willingness to follow
the activities of elderly integrated service
post. With such a good attitude, the elderly
tend always present or follow the activities
held at elderly integrated service post. This is
understandable because they are a mirror of
one's attitude of readiness to react to an object.
Readiness is a potential tendency to react in
certain ways when people are faced with a
stimulus that calls for a response.
According to Gordon Allport, the attitude of a
person's psychological readiness to react to
stimuli originating from within or outside
himself. Attitude shows on something that is
still a potential which at times can actual when
exposed to certain stimuli.
According to the researchers assumption that
negative attitude obtained from the elderly
because it illustrates the attitude like or dislike
a person against an object. Attitudes are often
derived from their own experience or from
others who are closest. Therefore, the
introduction of integrated service post elderly
need to be improved by health workers.
b. Knowledge and attitudes correlation to
the Utilization of Erderly Integrated
Service Post in Community Health
Center of Tanah Tinggi Binjai 2013
From the results of the relationship between
knowledge of the utilization of elderly
integrated service post analysis in Table 1
shows that there are as many as 5 of 11
(45.5%) of respondents who do not utilize
elderly integrated service post have less
knowledge. Whereas among the elderly who
utilize integrated service post there were 18
of 18 (100%) of respondents who have a good
knowledge.
After the Chi Square test showed p value =
0.000. This figure gives the sense that the
correlation between the level of elderly
knowledge with utilization of
integrated
service post statistically significant, the less
level of knowledge of the elderly, will be
increasingly less the utilization rates of
elderly integrated service post .
The study results were presented appropriate
to Notoatmodjo (2007), that someone who
does not want to follow the integrated service
post elderly can caused because the person is
not or not yet know the benefits of integrated
service post. Supported also by the theory of
Lawrence Green mentioning that the behavior
of a person in good health can be affected by
three factors, one factor predisposing factors
among embodied in knowledge.
Results of the study according to the study
conducted by Fitri Hayani (2012) argued that
the respondents who have a good knowledge,
many of them which utilize elderly integrated
service post, while respondents who have less
knowledge, they less utilize elderly integrated
service post.
Results of this study are also consistent with
research conducted to Yunita Sriasih (2006)
argued that there is a significant correlation
between the level of knowledge on the
utilization of elderly integrated service post.
And researchers hope that the elderly improve
their knowledge about elderly integrated
service post.
It can be concluded in this study that there is a
correlation between knowledge of the
utilization of elderly integrated service post
which means the better knowledge of the
elderly to the utilization of elderly integrated
service post will be more willing to utilize it.
So the results of this study did not find any
gap between research results with the theory
mentioned above.
Based on table 2 of the research that has been
conducted in community health center of
Tanah Tinggi Binjai in 2013, shows the crosstabulation between attitudes and utilization of
elderly integrated service post in Community
health center of Tanah Tinggi Binjai in 2013.
It is known that as much as 37 respondents
who have a positive attitude about elderly
integrated service post, and 29 respondents, or
78.4% of the elderly utilized integrated service
post. Then the 18 respondents who had a
negative attitude and one elderly respondents
or 5.6% of the elderly do not utilize elderly
integrated service post.
After the Chi Square test, the results obtained
p value = 0.000 <0.05. The rate gives the sense
that the relationship between the attitude of the
elderly to utilization of elderly integrated
service post statistically significant. The
meaning is that if the elderly have a positive
attitude it will be more active to utilize the
elderly integrated service post and if the
25
elderly have a negative attitude it will be
increasingly less utilization of
elderly
integrated service post. The results showed the
majority of elderly with a negative attitude has
a inactive utilization of elderly integrated
service post. This is consistent with the
statement of Notoatmodjo (2003) that attitude
will make a person toward or away from other
people or other objects. In this regard a
positive attitude makes the elderly did not
utilize elderly integrated service post.
Results of the study according to the study
conducted by Fitri Hayani (2012) argued that
the respondents who have a good attitude,
many of them will utilize elderly integrated
service post, while respondents who have less
attitude, many of whom lack utilize the elderly
integrated service post. Therefore, the better
attitude about the use of elderly integrated
service post, the better participation of the
elderly integrated service post.
research conducted to Yunita Sriasih (2006)
argued that there is a significant correlation
between attitudes toward the elderly
integrated service post program. Researchers
hope that the elderly have a high attitude
towards the elderly integrated service post .
It can be concluded in this study that there is a
correlation between the attitude of the elderly
with the elderly
integrated service post
utilization which means the bad attitude of the
elderly of
elderly integrated service post
utilization will be even less willing to take
advantage of elderly integrated service post.
So the results of this study did not find any
gap between research results with the theory
mentioned above.
CONCLUSIONS AND SUGGESTIONS
CONCLUSION
Based on the results of research on the
correlation of knowledge and attitude to the
utilization of elderly integrated service post in
community health center of Tanah Tinggi
Binjai in 2013 can be concluded as follows:
1. The results showed that as many as 20% of
the elderly have less knowledge about the
utilization of elderly integrated service
post in community health center of Tanah
Tinggi Binjai in 2013.
26
2. The results showed that as many as 32.7%
of elderly had a negative attitude about the
utilization of elderly integrated service
3. The results showed that as many as 45.5%
of elderly who do not utilize elderly
integrated service post in community health
center of Tanah Tinggi Binjai in 2013.
4. There is a correlation between knowledge
and utilization of elderly integrated service
5. There is a correlation between attitudes to
the utilization of elderly integrated service
SUGGESTIONS
1. Expected to head of community health
center to be able to make a schedule
extension, regulations and counseling on a
regular basis of elderly integrated service
post and sustainable (sustainable) in order
to be used by elderly integrated service post
in community health center of Tanah
2. To be more open in disseminating
information to the elderly integrated service
post and for further research of this study
are expected to be developed.
3. Expected to health professionals to improve
complete education and counseling
activities in order to get the correct
information about elderly and elderly
integrated service post so that the
knowledge and attitudes of the elderly to be
good and positive.
REFERENCES
Arikunto, S, 2003, Prosedur Penelitian Suatu
Pendekatan Praktek. Edisi Baru,
Rineka Cipta: Jakarta
Bandiyah, S, 2009, Lanjut Usia dan
Keperawatan
Gerontik,
Nuha
Medika:, Yogyakarta
Depkes. RI,
1999,repository.USU.ac.id/bitsstream/
…/4/Chapter%20//pdf
Dinkes Provsu, 2012, Profil Sumatera Utara
Tahun 2011, Dinkes Provsu, Medan.
Fallen, R dan Budi, R, 2010, Keperawatan
Komunitas, Nuha Medika: Yogyakarta
Hatta, 2011.
http://www.scribd.com/doc/9207741
3/03-BAB-I- Integrated service post
-Lansia (accessed at 2 Februari
2013)
Hesti, W, 2007, Asuhan Keperawatan Pada
Lanjut Usia di Tatanan Klinik,,
Fitrimaya: Yogyakarta
__________, W, 2010, Asuhan Keperawatan
Pada Lanjut Usia di Tatanan Klinik,,
Fitrimaya: Yogyakarta
Hidayat, A, 2011, Metode Penelitian
Keperawatan dan Teknik Analisis
data, Salemba Medika: Jakarta
Hutahuruk. Agustina 2005. Faktor-Faktor
Yang
Mempengaruhi
Pelayanan
Integrated service post Lanjut Usia.
Medan : Tesis Program Administrasi
dan Kebijakan Kesehatan Sekolah
Pasca Sarjana Sumatera Utara
Machfoedz, I, 2008, Metodologi Penelitian
(Kualitatif
dan
Kuantitatif),
Fitrimaya:, Yogyakarta
Maryam, R, dkk, 2008, Mengenal usia Lanjut
dan Perawatannya, Salemba Medika: Jakarta
Muzaham, F.2005. Sosiologi Kesehatan.
Universitas Indonesia : Jakarta
Ma’rifatul Lilik,2011, Keperawatan lanjut
Usia, Graha Ilmu,: Jakarta
Murwani, A, 2010, Gerontik, Konsep Dasar
dan Asuhan Keperawatan Home Care
dan
Komunitas,
Fitrimaya:
Yogyakarta
Notoatmodjo, S, 2005, Metodologi Penelitian
Kesehatan, Rineka Cipta: Jakarta
__________, S, 2007,Promosi Kesehatan
Teori dan Aplikasi , Rineka Cipta: Jakarta
__________, 2010. Metodologi Penelitian
Kesehatan, Rineka Cipta: Jakarta
Nugroho, W, 2000. Keperawatan Gerontik
Edisi 2, EGC: Jakarta
__________, 2008. Keperawatan Gerontik
Edisi 2, EGC: Jakarta
Nursalam, 2003. Konsep dan Penerapan
Metodologi
Penelitian
Ilmu
Keperawatan., Salemba Medika:
Jakarta
Pangeran, A, 2011. Teori Pengetahuan,
<http://www
adhamaskipangeran.blogspot.com>
(accessed at 5 Maret 2013).
Profil Penduduk Lanjut Usia, 2010, Komisi
Nasional Lanjut Usia: Jakarta.
Politeknik Kesehatan Kemenkes Medan.
2012. Panduan Penyusunan Karya
Tulis Ilmiah. Medan
W.Resmana,2011.
eprints.undip.ac.id/32716/4/4_PENDA
HULUAN.pdf (accessed at 10 Januari
2013
27
RELATIONSHIP BETWEEN ANXIETY LEVEL TO SLEEP FULL
FILLMENT OF INGUINAL HERNIA PREOPERATIVE PATIENTS
AT DR.PIRNGADI HOSPITAL MEDAN
Suriani br Ginting1, Agustina Boru Gultom1, Wiwik Dwi Arianti2
1, 2
Nursing Department of Poltekkes Kemenkes Medan
Abstrak
Anxiety is a condition that can be experienced by everyone in daily life. Usually we experience a state
of anxiety when we deal with things out of the ordinary everyday activities ( Sylvia , 2008) . This
effect is caused by anxiety disorders and sleep patterns of rest. According to Potter (2005 ), that the
patients often experience preoperative anxiety. Pre operation is when the decision for surgical
intervention will be done and it will cause complaints for patients who live with anxiety and cause
sleep disorders. The purpose of this study was to determine the relationship between the level of
anxiety on the fulfillment of the patient's sleep in pre inguinal hernia operation with the type of
descriptive correlational cross-sectional study design with a total sample of 37 respondents were
acquired in July 2014 by accidental sampling technique. Statistical analysis using chi square test .
The results showed that the p value 0.00 ( p < 0.05 ) which shows the relationship between the level
of anxiety on the sleep fulfillment of inguinal hernia preoperative in patients. It is recommended that
improving preoperative nursing care to deal with cases of anxiety before undergoing surgery.
Keywords : Anxiety, Sleep Fulfillment, Pre Operative
BACKGROUND
A hernia is a protrusion outside the organ or
other tissue due to an increase in intraabdominal pressure that cause abnormal body
openings ( Garcini , 2010). Inguinal hernia is a
condition of the release of an organ or
structure from its normal organ through a
defect in the inguinal area that can not be
returned to its original place manually and
would have implications invasive surgery by
restoring the structure of the organ is
surgically ( Muttaqin & Sari , 2009),
Inguinal hernia is one of the cases digestive
surgery in the world. It is still a challenge in
improving the health status of the community
because of the costs required in the handling
and loss of labor due to the slow pace of
recovery and recurrence rate. The overall
number of operations in France hernia surgery
as much as 17.2 % and 24.1 % in the United
States (Albiner , 2003) .
In Indonesia hernia ranks eighth with a
number of 291.145 cases. Inguinal hernia was
found 25 times more in men than women
(Albiner , 2004) .
The surgical procedure will provide an
emotional reaction to the patient. For example,
28
preoperative anxiety is an anticipation of a
patient's experience that can be considered as a
threat to its role in the life, integrity in the
body, or even life itself . It is known that the
troubled mind will directly affect the
functioning of the body (Muttaqin & Sari ,
2009) .
The impact is often caused by a state of
anxiety that can be manifested by all systems
of the human body both physiologically,
psychologically and spiritually. One impact is
disturbance of rest and sleep patterns
commonly from someone entering a hospital
or health facility.
Sleep is part of the healing of an illness .
Achieving good quality sleep is important for
health . Similarly to recover from illness ,
clients who are ill often need more sleep and
rest than healthy clients. However , the disease
usually prevent some clients to get adequate
sleep and rest ( Potter , 2010) .
According to research of Triningsih ( 2012)
about the relationship between the level of
anxiety to meet needs of the patient's sleep
patterns preoperative in Jasmine ward of
Panembahan Senopati Hospital Bantul,
Yogyakarta, indicates that respondents who
are at the level of anxiety being there as much
as 62.86 % , and as much as 54.28 % of
respondents pattern need less sleep . And
based on the results of the study showed a
significant relationship between the level of
anxiety with the fulfillment sleep patterns of
0,313 or 31.3 % with a significance of 0.020 (
sig.p < 0.05 ) .
Based on preliminary studies conducted in
hospitals Dr.Pirngadi Medan, found that the
number of surgery patients in 2013 were 3169
patients. Inguinal hernia surgery patient data in
2013 were 372 people, in December 2013
there were 39 people .Based on interviews at 3
preoperative patients in hospitals of
dr.Pirngadi Medan , where two patients
undergoing surgery for the first time said
patients feel anxious and disturbed sleep
fulfillment , whereas the third patient to
undergo a second surgery to say a little bit
anxious but the fulfillment of sleep is not
disturbed .
Problems
The formulation of the problem in this
research is how relationship between anxiety
level to sleep fullfillment of inguinal hernia
preoperative patients at dr.Pirngadi hospital
Medan.
Research Objectives
To describe the relationship between anxiety
level to sleep fullfillment of inguinal hernia
Medan.
Hypothesis
There is a relationship between anxiety level
to
sleep fullfillment of inguinal hernia
Medan 2014.
RESEARCH METHODS
The type of research is descriptive correlative
with cross sectional design with the aim to
determine the relationship of the level of
anxiety on the sleep fulfillment of inguinal
hernia preoperative patient at Dr.Pirngadi
Hospital Medan. Data were collected in June
2014. The population of this study were all
patients who undergo inguinal hernia surgery,
amounting to 372 people in 2013. Samples
numbered 37 people, taken as many as 10% of
the population with accidental sampling
technique with the inclusion criteria: 1)
Patients Inguinal hernia surgery is planned
after the hospitalization 1-3 days in hospital,
2) Willing to be a respondent, 3) undergo the
first surgery, 4) Adult patients with age ≥ 17
years. Data collection technique was done by
interview using a questionnaire. Data were
analyzed using univariate analysis with
frequency distribution, bivariate analysis with
chi-square formula.
RESULTS
Table 1
Respondents Frequency Distribution
According To Anxiety Level To Face Hernia
Inguinalis Pre Operative At Dr.Pirngadi
Hospital
No
Category
F
%
1
Moderate
12
32,4
2
Mid
21
52,8
3
Severe
4
10,8
Total
37
100
Table 1 shows the level of anxiety of patients
facing surgery inguinal hernia is a mild
anxiety are 12 person( 32.4 % , Mid anxiety
was 21 person ( 52.8 % ) and severe anxiety
there are 4 people ( 10.8 % ) .
Table 2
Respondents Frequency Distribution
According To Sleep Fullfillment To Face
Hernia Inguinalis Pre Operative At
Dr.Pirngadi Hospital
No
Category
F
%
1
Unfullfilled
25
67,6
2
Fullfilled
12
32,4
Total
37 100
Table 2 shows the fulfillment of the sleeping
patient in the face of an inguinal hernia
operation are not fullfill as many as 25 people
( 67.6 % ) and fullfilled as many as 12 people
(32.4 %) .
29
Table 3
Cross Table Sleep Fullfillment to Anxiety
Level of Inguinalis Pre Operative Patients At
Dr.Pirngadi Hospital
No Anxiety
Level
1
2
3
Sleep Fullfillment Total
Fullfilled
F %
Mild
9 24,3
Moderate 3 8,1
Severe
0 0
Total
12 32,4
P
Unfullfill
F % F
%
3 8,1 12 32,4
18 48,6 21 56,8 0,00
4 10,8 4 10,8
25 67,6 37 100
Table 3 shows the fulfillment of sleeping
patients undergoing inguinal hernia repair in
the category are not fulfilled experiencing
mild anxiety levels as much as 3 people ( 8.1
% ) , experienced mid anxiety level was as
much as 18 people ( 48.6 % ) and experienced
severe anxiety level of 4 people ( 10.8 % ).
While the fulfillment of unmet sleep in the
category experiencing mild anxiety levels
were 9 people ( 24.3 % ) and anxiety level was
as much as 3 people ( 8.1 % ) .
DISCUSSION
Anxiety is a disorder of mood ( affective )
which is characterized by feelings of fear or
worries that deep and sustained, not impaired
in reality , the personality remains intact, the
behavior can be disturbed but within normal
limits( Hawari , 2006).. Based on the results of
the research showed that the level of anxiety in
the face of surgery patients are at a level of
anxiety was the number of 21 people ( 52.8 %
). This is likely due to patients undergoing
surgery for the first time making the patient
fear. Fears of patients may be afraid of
anesthesia , fear of death, fear of the changes
in body image, and may even fear the
administrative costs of the hospital .
Of all patients with average anxiety symptoms
were anxious to statements regarding
autonomic symptoms that include dry mouth,
flushing, easy sweating, headache, head feels
heavy as many as 8 people (21.6%).
According to Hawari (2006) stated that in
addition to feeling worried, bad feeling and
irritability, physical complaints may occur in
patients who experience anxiety as head ache
and weight as well as easy to sweat.
The patient's need for sleep can be disrupted
due to the operation plan to be implemented.
30
Operation plan to make patient continue to
think about the situation that disrupts sleep of
surgery patients. Adequate rest is very
necessary for patients who will undergo
surgery due to adequate sleep can help cure
patients (Muttaqin, 2009). Based on the results
of the study showed there were as many as 25
people (67.6%) patients sleep needs are not
met. Based on the answers of respondents who
most needs are not met are sleeping on the
question of whether there are no feelings /
thoughts that disturb you before sleep
experienced by 25 people (67.6%). This
suggests that preoperative patients of hernia
inguinalis sleep needs are not met. To avoid
this effort that can be performed is counseling
about the importance of adequate rest for the
quality of healing and prevention of disease,
support bedtime rituals by listening to music,
watching television, worship and a warm bath
before bed, creating a quiet environment,
comfortable room temperature, suitable
ventilation and lighting, improves comfort and
relaxation such as wearing loose sleep,
encourage the patient to urinate before going
to bed and provide a comfortable position for
sleeping. (Kozier, 1991)
Anxiety experienced by individuals can have a
detrimental effect both on the need for sleep .
Anxiety can increase norepinephrine levels in
the blood by stimulating the sympathetic
nervous system . This chemical change can
cause a lack of sleep stages of NREM sleep
and REM sleep , and more changes in the
stage of sleep and more frequent awakening
during sleep ( Kozier , 1991) .
Based on the analysis results obtained with the
chi square test p value : 0.00 < 0.05 with a
95% confidence level indicates that there is a
significant relationship between anxiety level
to
sleep fullfillment of inguinal hernia
Medan. The results are consistent with the
statement of Potter and Perry (2010 ) which
states that worried about personal problems or
situations are often disturb sleep .
Research results are also consistent with
research Triningsih ( 2012) states that there is
a significant relationship between the level of
anxiety with the fulfillment sleep patterns of
0,313 or 31.3 % to p ; 0.02 < 0.05. So it is
need an action to reduce anxiety by improving
perioperative nursing care by giving impetus
to the disclosure of the patient's feelings, to
listen, to understand the patient, providing
information to patients about surgical
procedures to get rid of such concerns and
support the patient's spiritual beliefs .
CONCLUSIONS AND
RECOMMENDATIONS
Based on the research results can be concluded
that the anxiety level of inguinal hernia
patients majority were in anxiety levels were
as many as 21 people (52.8 %), the sleep
fulfillment of hernia inguinalis preoperative
patient majority were not met as many as 25
people ( 67.6 % ) and there is a significant
relationship between the level of anxiety on
the fulfillment of the patient's sleep in the face
of pre inguinal hernia repair with p value =
0.00 ( p < 0.05 ) . Based on the results of the
study suggested that nurses improve
preoperative nursing care by delivering an
attempt to reduce anxiety by giving impetus to
the disclosure of feelings and provide
information to patients about surgical
procedures .
REFERENCES
Albiner,S, 2003. Perbandingan Nyeri Pasca
Hernioplasty Shouldice Pure Tissue Dengan
Lichtenstein Tension Free, Medan : USU
Arikunto, 2010. Prosedur Penelitian Suatu
Pendekatan Praktik. Jakarta : Rineka
Cipta.
Elvira, DS.,2008. Gangguan Panik. Jakarta :
FKUI
Faradila,N.,2009. Hernia, Riau : Faculty of
Medicine –Universitas Riau
Garcini,
2010.
Mengenal
Hernia.
http://medicastore.com/artikel/291/Menge
nal_Hernia.html, diakses 24 Februari
2014
Hawari,D., 2006. Manajemen Stress Cemas
Dan Depresi, Jakarta : FKUI
Kozier et al, 1991. Fundamental Of Nursing.
Concepts,
Process
and
Practice,
California : Addison Wesley
Lanywati,E., 2001. Insomnia Gangguan Sulit
Tidur, Yogyakarta : Kanisius IKAPI
Lukaningsih,LZ., dkk, 2011. Psikologi
Kesehatan, Yogkarta : Nuha Medika
Long, 1996. Perawatan Medikal Bedah.
Terjemahan, Bandung : Yayasan IAPK
Padjadjaran.
Mansjoer,A., dkk, 2001. Kapita Selekta
Kedokteran, Jakarta : Media Aesculapius
FK UI
Muttaqin,A.,dkk,2009. Asuhan Keperawatan
Perioperatif, Jakarta : Salemba Medika.
Muslimah, 2013. Mengatasi Susah Tidur,
http://muslimahor.id/kesehatan
muslimah/mengatasi-susah-tidur.html,
diakses 11 Juni 2014
Nursalam, 2008. Konsep Dan Penerapan
Metodologi
Penelitian
Ilmu
Keperawatan, Surabaya : Salemba
Medika
Potter,PA.,
dkk,
2010.
Fundamental
Keperawatan, Edisi VII, Terjemahan,
Jakarta : Salemba MEdika
Prasadja, 2006.
Efek Kurang Tidur,
http://repository.usu.ac.id/bitstream/1234
56789/20113/4/Chapter%2011.pdf,
diakses 11 Juni 2014
Riyanto,A. 2010. Modul Pengolahan dan
Analisa Data Kesehatan, Yogyakarta :
Nuha Medika
Smeltzer dan Bare, 2002. Buku Ajar
Keperawatan
Medikal
Bedah.
Terjemahan, Jakarta : EGC
Stuart, GW., 2007. Buku Saku Keperawatan
Jiwa, Edisi 5, Terjemahan, Jakarta : EGC
Sugiarto,E.,2008. The Secret of Sleep, Jakarta
: Prestasi Pustaka
Triningsih,W., 2012. Hubungan Antara
Tingkat Kecemasan Dengan Pola
Pemenuhan Tidur Pasien Preoperasi
di Bangsal Melati RSD Panembahan
Senopati Bantul Yogyakarta
31
DISASTER RISK INDEX IN SIMEULUE DISTRICT
(Study Case: Disaster Prone Areas of Aceh Province)
1
Desi Sri Pasca Sari Sembiring 1, Ritha F. Dalimunthe 1,2, Delvian SP, MP 1, 3,
R.Hamdani 1, 4
Study Program of Natural Resource and Environmental Management, Graduate School, University of Sumatera
Utara, Jln. T.Maas, Medan, Indonesia
2
Department of Economic, Faculty of Economic, University of Sumatera Utara. Jln. Prof.T.M.Hanafiah
Medan,Indonesia
3
Department of Forestry, Faculty of Agriculture, University of Sumatera Utara, Jln. Tri Dharma Ujung No. 1,
Medan, Indonesia
4
Department of Social Anthropology, Faculty of Social Science and Politic, Jln.Dr Sofyan No3 University of
Sumatera Utara, Medan, Indonesia
Email Adress
1
[email protected], [email protected], [email protected], [email protected]
ABSTRACT
This study aims to: know the threats ,vulnerabilities and capacity in the research study and how is the
disaster risk index of this area. The method of analysis used to define the results of the exploration
problem is a descriptive study. To complement the descriptive explanation of some of the test that is :
analyze the hazard,vulneribility and capacity do with make a table, map,disaster history and count
Disaster Risk Index. From 8 regions in Simeulue are evenly distributed dissemination potential
capacity. With an average score for the ability to anticipate threats of 1063, organizing ability and the
ability of a solution of 889 monitoring and evaluation of 470. The region and the highest level of
anticipation is East Simeulue and Alafan. From 8 regions in Simeulue are worrying spread of
potential vulnerability. With an average score of between disaster index, variable economic conditions
of 3843, the physical condition of the building has a score of 7848 and the condition of vulnerable
2880. Region and the highest level of vulnerability is Alafan and Salang. From 8 regions in Simeulue
are evenly distributed dissemination potential capacity. With an average score for the ability to
anticipate threats of 1063, organizing ability and the ability of a solution of 889 monitoring and
evaluation of 470. The region and the highest level of anticipation is East Simeulue and Alafan. From
the above calculations it can be concluded that the level of disaster risk is highest in Alafan and
Salang.
Keywords: Disaster Risk , Proneness, Simeulue
Introduction
Indonesia is a country with a highly potential
for disaster . There are several potential
disasters include natural disasters such as
earthquakes, volcanic eruptions, floods,
landslides, and others. Potential disasters in
Indonesia can be classified into two main
groups , namely the potential main hazard and
the collateral hazard. The main potential
hazards can be seen among others, on the
map of potential earthquake in Indonesia,
which indicates that Indonesia is a region with
earthquake zones prone, landslide potential
maps, maps of potential catastrophic volcanic
eruptions, catastrophic potential map tsunami,
flood potential maps and others. From the
above indicators can be concluded that
Indonesia has the potential major hazards
(main hazard Potency) high. Certainly it is
32
very unfortunate for the country of Indonesia.
Besides the high potential major hazards,
Indonesia also has the potential
collateral
hazard potency (IDEP, 2007).
A disaster defined as a serious disruption and
functioning of society, causing widespread
human, material or environmental losses,
which exceed the ability of an affected society
to cope using only its own resources (EEA,
2006). Disaster is defined also as a serious
disruption of the functioning of a society,
causing widespread loss of human life in terms
of material, economic or environmental and
are beyond the ability of the society to cope
using their own resources ( UNISDR, 2004).
By UN definition (Cardona, 2005), the risk of
losses is a function of three components:
hazard, element at risk and vulnerability. In
the case of risk of human losses, the element at
risk is the exposed population. The hazard
occurrence refers to the frequency of returning
period at a given magnitude, whereas the
vulnerability is “the degree of loss to each
element should a hazard of a given severity
occur"(Blaikie et al., 1994).
Disaster Risk Reduction is a series of activities
before, during and after a disaster is done to
prevent , reduce , avoid , and recover from
disasters. According to UNESCO/ISDR (2006
), is a preparedness measures that enable
governments, organizations, communities, and
individuals to be able to respond a disaster
situation quickly and appropriately. Included
in the preparedness action is the preparation of
disaster management plans, maintenance
resources and personnel training. Preparedness
activities focused on the development of plans
to respond to disasters quickly and effectively.
Preparedness, efforts are being made to
anticipate disasters, through the appropriate
steps to organizing and efficient, (Latif ,
2008). Risk is the exposure to chance of loss It
is a combination of the probability of an even
occuring and the significance of the
consequence, known as impact, of the event
occuring. The term "risk "come from the early
italian "risicare" meaning to dare (Bernstein,
1996).
Simeulue island categorized proneness since
they often experience an earthquake and
tsunami , the Regional Disaster Management
Agency ( BPBD ) Simeulue District has strong
earthquake and tsunami occurred in 1907.
Furthermore, on November 2, 2002 an
earthquake reaching 9.3 on the Richter Scale (
SR ), December 26, 2004 reached 9.1
magnitude and tsunami reached 30 meters ,
March 3, 2005 earthquake reaching 9.1
magnitude, February 20, 2008 ,5 April 2009,
August 18, 2009 and December 19, 2009. On
January 16, 2011 an earthquake of 5.9
magnitude , January 18, 2011 the power of the
SR 5.7 ,5 April 2010 with the strength of 7.2
Richter . On October 17, 2011 in Simeulue
earthquake occurred again with a magnitude of
5.2 SR and January 11, 2012 with a strength of
7.1 SR and April 2012 with a strength of 8.5
Richter. On October 5, 2010 a cyclone hit
West Teupah Subdistrict 5 and damaging
homes and on March 30, 2011 back hurricanes
in Central Simeulue and damaging three
houses. So it can be concluded that these
districts are areas that has prone to disasters.
From the description of the history of this
disaster Simeulue included in disaster-prone
areas (TDMRC : Tsunami and Disaster
Mitigation Research Center Syah Kuala
University, 2011) and have been socialized in
Aceh Province.
On last 5 years of disaster : the tsunami and
earthquake in Aceh /Nias 2004, and earthquake
2005, earthquake in West Sumatra 2006, tsunami
Pangandaran West Java 2006 and other disaster.
Maintsreaming Disaster Risk
Management
One of the areas in Indonesia that are
routinely experienced the earthquake called
Pulau Simeulue in Aceh
Implementation of Disaster Risk Management :
-Emergency
Figure
1. Reseach
Background
-Rehabilitation
and Emergency
-Development (Mitigation and Preparedness)
What are the hazards,vulnerabilities
and Simeulue capacity as disasterprone area
Graph 1.The background of this study
Based on research Silbert, M, 2011, noted the
importance of economic development to
reduce vulnerability to disasters. Vulnerability
analysis should take into account vulnerable
groups such as women, the poor, and small
island in developing countries. Based on the
background, that is Simeulue proneness, the
history of disaster and implemented policies
and respect to disaster risk management, so the
main problem of this reseach : What are the
threats hazards, vulnerability and capacity in
the study area and how is the disaster risk
index of this area.
Research Methodology
The Reseach was done on June 2012-June
2013. The research location is determined by
purposive sampling (Sudjana, 1988) the
disaster proneness areas in the province of
Aceh, Simeulue. Collecting data do in three
ways, literate study, questionnaire and field
observation. The method of analysis used to
define the results of the exploration problem is
a descriptive study. To complement the
descriptive explanation of some of the test that
is : analyze the hazard,vulneribility and
capacity do with make a table, disaster history
and Disaster Risk Index with the formula :
33
Sample amount was determined using Taro
Yamane’s formula
(in Israel, 1992), as follows:
n= N
1+N (e)2
n = sample amount;
N = population amount;
e = confidence level – 10 %
RESULT AND DISCUSSION
Based
on Disaster
Management Act to calculate the
level
of risk of
Disaster
Risk, it
can
be
seen from three variables,
namely, the
threat (Hazard), Vulnerability and Capability.
The
vulnerability of
a
community is
Determined by the
level
of disaster risk. Disaster risk is a function of
the threat to
the
state
of vulnerable, which can be changed by the
existence
of
ability.
By
using this
formula then when there are no vulnerabilities
and threats, risks resulting value is 0, but on
the contrary if a region has a value of more
than 100 disaster risk, this means that the
region has a high risk of disaster. With the
model as follows:
No
Variabel
1
2
3
4
5
Tsunami
Gempa Bumi
Kebakaran
Longsor
Angin Topan
In this study, researchers lowered these
variables into a few factors and sub-factors in
order to obtain the weighted value of each
variable
threats,
vulnerabilities
and
capabilities. The following diagram decrease
variables into a few factors based on a review
of studies and the results of focus group
discussions in Simeulue community.
3.1 Value Threat
Threats are rare or extreme events of the
environment due to human activity or natural
because that adversely affect human life,
property or activity to the level that caused the
disaster (UNDP, 2009). Simeulue island
consists of more than 40 islands located in the
Indian Ocean and in the outer islands of
Sumatera. From the observation and data
analysis of the obtained multiple threat picture
in this disaster-prone areas. Value is calculated
through observation researchers threat while in
the study by determining the location of
impact and the weight of values were then
calculated by multiplying the frequency of
occurrence. Value threats in Simeulue district
can be seen in Table 3.1.
Frekuensi dan Penilaian Skor Dampak
Bobot Teupah SelatanSimeulue Timur Teupah Barat Simeulue TengahTeluk Dalam Salang Simeulue Barat
Antisipasi dampak
f Skor
f Skor f Skor f Skor f Skor f Skor f Skor
1
8
9 1
72
0
0
1 72
0
0
1 72 0 0 1
72
5
9
9 12 972 15 1215 13 1053 12 972 12 972 12 972 13 1053
4
5
5 5
125
8 200 4 100 4
100 4 100 4 100 5 125
5
3
3 1
9
1
9
1
9
2
18
2 18 1 9 1
9
5
4
3 1
12
1
12 2 24
0
0
0 0 1 12 1
12
Tolak Ukur
Alafan
f Skor
1 72
14 1134
5 125
4 36
2 24
Tabel 3.1. Frequency and Threat Assessment Scores
From the above results, we can conclude that
from 8 regions in Simeulue are evenly spread
of potential threats. With above average scores
index disasters, earthquakes pose a threat
variables with the highest frequency, as many
as 103. Then fires, landslides, hurricanes and
tsunamis, respectively 39, 13, 8 and 1. Scores
34
for each indicator that the tsunami disaster
threat of 360, Earthquake of 8343, amounting
to 975 fires, landslides and hurricanes by 117
by 96.
And the region which is the highest threat
level are Alafan and Simeulue East. This is
because the region as the capital of Simeulue
East sub-district is a densely populated area.
At the time of the earthquake is easy there is a
risk of fire because the stove fell, candles and
fall short of current flow occurs. Triggers
Another fire building construction material of
wood. Mitigation of earthquake made
hereditary society is making a house with
basic materials so that the board is not too
risky when the earthquake happened but on
the other hand is more combustible material
than brick building material.
Position Simeulue is near the line of the
meeting between the Indian plate. Australian
and Eurasian plates. Sumatera island arc and
the western section is part of the Eurasian
plate. While the other plate is under the Indian
Ocean. Limit the collision of two plates can be
observed in the form of lines deep ocean
trenches to the west of Sumatera to the
Andaman Islands. In the collision region, the
Indian Plate under Sumatera menunjam 50 "
60 cm / rock mass above referred to as the
contact area of a subduction zone /
penunjaman. The highly risk index is Alafan
than the other, this was due to the earthquake
epicentrum point located at coordinates 3.316
° North latitude and 95.854 ° East line, with a
depth of 30 kilometers and approximately 250
kilometers south of Banda Aceh and + 50 km
from Alafan region so that the vibrations are
stronger than other regions.
3.2 . Value Vulnerability
According to the Ministry of Research and
Technology of the Republic of Indonesia, the
vulnerability is a condition of a community or
society that leads or has an inability in the face
of threats. Society is said to have
vulnerabilities if they are not able to anticipate
and survive a threat. The vulnerability arises
because the pressure acts of individual or
community.
The forms of vulnerabilities that exist in
society seen from indicators of economic
conditions, the physical condition of the
building and the condition of the vulnerable
population. Susceptibility values calculated
through observation while on-site research
study by determining the impact and value
weights are then calculated by multiplying the
frequency of occurrence. The value threats in
Simeulue district can be seen in Table 4.
This would be a situation faced by people with potentially disaster areas in Simeulue district can be
seen in Table 4
No
1
2
3
Variabel
Antisipasi dampak
f Skor f Skor f Skor f Skor f Skor f Skor f Skor
Kondisi Ekonomi
3
7 9 15 945 10 630 6 378 5 315 4 252 6 378 7 441
Kondisi Fisik Bangunan 4
8 9 30 2160 15 1080 9 648 7 504 12 864 11 792 13 936
Kondisi Penduduk Rentan 3
8 8 7 448 5 320 8 512 4 256 5 320 7 448 4 256
Tolak Ukur
Alafan
f Skor
8 504
12 864
5 320
Tabel 3.2. Frequency and Vulnerability Assessment Scores
from 8 regions in Simeulue are worrying
spread of potential vulnerability. With an
average score of between disaster index,
variable economic conditions of 3843, the
physical condition of the building has a score
of 7848 and the condition of vulnerable
pensusuk 2880. Region and the highest level
of vulnerability is Alafan and Salang.
Subdistrict Alafan is the most vulnerable
region from other regions . Physically this area
directly facing the Indian Ocean with no
obstacles. Alafan region includes areas that
have economic resources low and limited
access to transportation either by land or sea.
Land access many disconnected because a lot
of damaged roads and bridges , the network
exit is also very limited because there is no
port, so that when disaster strikes the area is
extremely vulnerable to food aid, medicines
and other. Access to communication and
electric lighting is also inadequate in this area
because there is no telecommunication
networks and information that goes into this
region.
35
The second highest vulnerable region is the
District Salang because this area is not hilly
like many other areas. So they have to run far
enough to reach the hill. But when the 2004
tsunami happened community can still save
themselves for the hills , because the distance
to the area is still quite safe. Results interview
mentioned that knowledge has been acquired
to save themselves from generation to
generation, to save himself and family
members, do not remember the others but
continue to run to reach the hill.
3.3. Rated Capacity
Ability is a combination of strength and
existing resources within a community, social
or organization that DAPT reduces the level of
risk or the impact of disasters (ISDR, 2002).
Existing capabilities in an environment can not
be separated from the power of the parties
therein (Ministry of Research and Technology
of the Republic of Indonesia). From the
observation and data analysis of the obtained
several images in capacity of disaster-prone
areas. Rated capacity is calculated through
observation while on-site research study by
determining the impact and value weights are
then calculated by multiplying the frequency
of occurrence. Rated capacity in Simeulue
district can be seen in Table 5.
Antisipasi hasil
f Skor f Skor f Skor f Skor f Skor f Skor f Skor
1 Kemampuan Antisipasi Ancaman
7
9
7 17 1071 19 1197 18 1134 17 1071 15 945 15 945 16 1008
2 Kemampuan Mengorganisir Solusi
5
8
7 16 896 18 1008 14 784 15 840 15 840 15 840 16 896
3 Kemampuan Pengawasan & Evaluasi 7
8
5 12 480 12 480 11 440 12 480 11 440 12 480 13 520
No
Variabel
Tolak Ukur
Alafan
f Skor
18 1134
18 1008
11 440
Table 3.3. Frequency and Capacity Assessment Scores
from 8 regions in Simeulue are evenly
distributed dissemination potential capacity.
With an average score for the ability to
anticipate threats of 1063, organizing ability
and the ability of a solution of 889 monitoring
and evaluation of 470. Region and the highest
level of anticipation is East Simeulue and
Alafan.
Alafan have a high threat to the community in
managing the risk of tsunami and earthquakes
should be to greater capacity, such as in
anticipation,
community
organizing,
monitoring and evaluation. Although this
indicator is to adopt disaster risk management
system from the outside, but this indicator has
been applied to the public, for example, people
have been able to anticipate early on in the
event of an earthquake and tsunami. When an
earthquake is high then the village elders
(customary
village
head
and
dean)
immediately ascertain whether a tsunami
through the receding sea water and dry well. If
such symptoms occur they immediately
announced to go up into the hills. For
monitoring indicators and the solution is
usually done by the village elders to ensure
that all citizens have gone up a hilltop and
36
traditional elders have been able to make
further plans after they were evacuated, for
example, a search team go to the forest and
fine food sources for people who evacuated in
the Mount and Security team to ensure that the
condition of the village safe.
East Simeulue community is high capacity
region because after the 2004 tsunami many
NGOs are in, so local knowledge is getting
applied and coupled simulation, in addition to
the preparedness is further enhanced by the
presence of an early warning system of the
community in the form of wind chimes that
have been applied.
At the time of the 2004 tsunami eastern
Simeulue relatively safer, harmful effects in an
earthquake collapsed many houses but
communities in Simeulue Timur has the
capacity to anticipate the event of an
earthquake with the development board.
3.4. Disaster Risk Index
By using this formula then when there are no
vulnerabilities and threats, risks resulting
value is 0., But on the contrary if a region has
a value of more than 100 disaster risk, this
means that the region has a high risk of
disaster. Results obtained from observation
through interviews and focus group
discussions, grouped by the disaster areas in
Simeulue District can be seen in table 6.
No District
1
2
3
4
5
6
7
8
Reseach Variable
Disaster
risk
Threats Vulnarabilities Capacity
index
Teupah
1190
Selatan
Simeulue
1436
Timur
Teupah
1258
Barat
Simeulue
1090
Tengah
Teluk
1162
Dalam
Salang 1093
Simeulue
1271
Barat
Alafan 1391
1688
2447
1618
2685
1538
2358
1075
2391
1436
2225
2030
2265
1633
2424
3553
2582
82
87
The figure was obtained from the
conversion of the value set by the Disaster
Management Act is equal to 100. From the
above calculations it can be concluded that the
level of disaster risk is highest in Alafan and
Salang. The same thing was concluded by
Bappeda Simeulue, 2012 in mapping disaster
risk index Simeulue island with a GIS
(Geographic Information System), that the
District Alafan and Salang are the most risk
areas on the island.
82
49
75
98
86
191
Table 3.4. Main Analysis Disaster Risk Index
1.Alafan
2.Salang
Graph 2. Main Analysis Disaster Risk Indeks 2013
Alafan and Salang is the highly risk index area
than the other , this was due to the earthquake
epicentrum point located at coordinates 3.316
° North latitude and 95.854 ° BujurTimur ,
with a depth of 30 kilometers and
approximately 250 kilometers south of Banda
Aceh and + 50 km from Alafan region so that
the vibrations are stronger than other regions.
Alafan Physically is an area directly facing the
Indian Ocean with no obstacles. Alafan region
includes areas that have economic resources
low and limited access to transportation either
by land or sea. Land access many
disconnected because a lot of damaged roads
and bridges , the network exit is also very
limited because there is no port, so that when
disaster strikes the area is extremely
37
vulnerable to food aid, medicines and other.
Access to communication and electric lighting
is also ineffective in this area because there is
no
telecommunication
networks
and
information that goes into this region, it make
difficult to communicate out of the island of
Simeulue. Salang is the second highly risk
cause there is no close hill around for
evacuated place. The people must be run for
30 minute to reach the hill.
3.5.Conclusion
From 8 regions in Simeulue are evenly
distributed dissemination potential capacity.
With an average score for the ability to
anticipate threats of 1063, organizing ability
and the ability of a solution of 889 monitoring
and evaluation of 470. Region and the highest
Alafan. From 8 regions in Simeulue are
worrying spread of potential vulnerability.
With an average score of between disaster
index, variable economic conditions of 3843,
the physical condition of the building has a
score of 7848, and the condition of vulnerable
2880. Region and the highest level of
vulnerability is Alafan and Salang. From 8
regions in Simeulue are evenly distributed
dissemination potential capacity. With an
average score for the ability to anticipate
threats of 1063, organizing ability and the
ability of a solution of 889 monitoring and
evaluation of 470. Region and the highest
Alafan. From the above calculations it can be
concluded that the level of disaster risk is
highest in Alafan and Salang. It can be seen
from the disaster risk index Alafan shown 191
score and Salang area 98 score.
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39
RELATIONSHIPS OF PRECIPITATING FACTORS
AND PREDISPOSING FACTOR TO HYPERTENSION INCIDENT
IN INTERNIST POLYCLINIC OF DR.PIRNGADI GENERAL
HOSPITAL MEDAN 2014
Risma Dumiri Manurung, Tiurlan Mariasima Doloksaribu
Department of Nursing Poltekkes Medan
Abstract
Hypertension is a condition where the systolic and diastolic pressure exceeds the normal threshold of
140/90 mmHg and is often called the silent killer because most people do not realize suffer from
hypertension due to lack of understanding, education and the adverse effects of hypertension (Ridwan,
2010). Predisposing factors: age, heredity, gender and precipitating factors: body weight, smoking,
and alcohol. This study aims to determine the relationship between predisposing and precipitating
factors for hypertension in patients who were treated at the polyclinic dr Pirngadi in Medan 2014.
Type analytical research with cross sectional design. Research conducted in dr Pirngadi Medan, the
sample size of 80 people with sampling technique accidental sampling. Data processing and analysis
using Chi-Square test, the hypothesis Ha accepted if there is a significant relationship predisposing
and precipitating factors on the incidence of hypertension with a 95% confidence level (p ≤ 0.05).
Research results showed no significant relationship. Suggested to the respondents to maintain a diet
that prevents obesity, reducing salt intake, high fiber foods, improve lifestyle, avoiding stress and
positive thinking.
Keywords: Predisposing factors, factors Originator, Hypertension
Hypertension is a condition where the systolic
and diastolic blood pressure exceeds the
normal threshold of 140/90 mmHg. The
disease is also often referred to as the silent
killer because most people do not realize had
been suffering from hypertension, due to lack
of understanding, education and the adverse
effects of hypertension (Ridwan, 2010).
World Health Organization (2011) mentions
hypertension caused 8 million deaths per year
worldwide and 1.5 million deaths per year in
the region of Southeast Asia (Kartikasari,
2012)
The prevalence of hypertension in Indonesia
Results Household Health Survey (Survey) in
2001 showed that 8.3% of the population
suffer from hypertension and increased to
27.5% in 2004 (Rahajeng, 2009). Patients with
hypertension disease is quite high in the city of
Medan (Medan city health office) in 2012, 46
736 people suffer from hypertension are
compiled from the number of visits from 39
health centers and hospitals. Of this total, male
patients as many as 23 497 people, or more
than 23 239 women who only person
(Andalas, 2012).
40
Individuals with a family history of
hypertension had a two times greater risk of
suffering from hypertension. The incidence of
hypertension increases with age, and men have
a higher risk of developing hypertension early
(Anggraini et al, 2009).
Obesity
increases
the
incidence
of
hypertension due to fat causing a blockage in
the blood vessels thus increasing blood
pressure. High salt intake causes excessive
expenditure of natriouretik hormone which
indirectly increases blood pressure. Smoking
habits influence in increasing the risk of
hypertension (Anggraini et al, 2009). Rahajeng
(2009) states predisposing and precipitating
factors of hypertension are age, male gender,
low education level, smoking habits,
consumption of caffeinated beverages> 1 time
per day, alcohol consumption, lack of physical
activity and obesity.
Results of a preliminary study in Hospital Dr
Pirngadi Medan, ambulatory patients with
hypertension in 2012 as many as 848 people,
and increased in 2013 by 12.
RESEARCH METHODS
Type of analytical research with cross
sectional study design. Research conducted at
the Internist Polyclinic of Dr. Pirngadi Medan
Hospital , conducted from January to June
2014. The population was all patients with
hypertension who came to the Internist
Polyclinic of Dr. Pirngadi Medan Hospital.
Sampling using accidental sampling with a
sample size using formula Notoadmodjo
(2005) .
Univariate analysis of data by means of the
frequency distribution table, then made a
conclusion by using a formula percentage and
Bivariate analysis using the chi-square test
with 95% degree of confidence, α = 0.05 with
HA hypothesis is accepted if p ≤ 0.05.
4:14 According to the table above shows that
there is a statistically significant relationship
between predisposing and precipitating factors
to the onset of hypertension by 95%
confidence level α = 0.05. The results include
the results of the factor of age with p value =
0.014 (p ≤ 0.05), heredity with the result p
value = 0.026 (p ≤ 0.05), and the gender factor
with p value = 0.019 (p ≤ 0.05), the weight
factor is obtained p value = 0.024 (p ≤ 0.05),
non factor with the result p value = 0.006 (p ≤
0.05), and of the factors of alcohol with the
result p value = 0.004 (p ≤ 0.05).
RESULTS
a. Age Factor
Table 1.
Distribution Frequency of Respondent
According to Age Factor at Internist
Polyclinic of DR. Pirngadi General Hospital
Medan Tahun 2014
Age
N0
Frequency
%
Factor
1
<46
28
35
2
46-55
25
31,2
3
56-65
24
30
4
>65
3
3,8
Total
80
100
Tabel 1. Majority respondent aged >41 year as
many as 58 person (72,5%).
Tabel 2.
Distribution of Age Factor Cross
Tabulation To Hypertension at Internist
Medan 2014
Respondent Condition
Age
Non
No
Hyperten
Factor
% Hyperten %
si
si
1
<46
11 39,3 17 60,7
2 46-55
17
68
8
32
3 56-65
17 70,8
7
29,2
4
>65
0 0
3
100
Total
45 56,25 35 43,75
Total
%
28
25
24
3
80
100
100
100
100
100
Table 2. Respondent proportion hypertension
higher 56-65 year as many as 17 person
(70,8%) and in 46-55 years as many as 68%.
b. Herediter
Table 3.
According to Herediter Factor at
Internist Polyclinic of DR. Pirngadi
General Hospital Medan Tahun 2014
Herediter
Frequenc
N0
%
Factor
y
1
Yes
41
51,2
2
No
Total
39
80
48,8
100
Table 3. Majority respondent suffered from
hypertension because of herediter factor as
many as 41 persons (51,2%).
Tabel 4.
Distribution of Herediter Factor Cross
Medan 2014
Herediter
Non
No
Total
Hyperten
factor
% Hypertensio %
sion
n
Yes
28
68,3
13
31,7
41
No
17
43,6
22
56,4
39
Total
45
56,25
35
43,75 80
%
100
100
100
Table 4. Majority respondent herediter factor
as many as 28 person (68,3%) and
hypertension sufferer without any herediter
factor as many as 17 person (43,6%).
41
c. Gender
Table 5.
According to Gender Factor at
N0
Gender
Frequency
%
1
Man
46
57,5
2
Woman
Total
34
80
42,5
100
Tabel 5. majority respondent were as many as
46 person (57,5%).
Tabel 6.
Tabel 4.
Distribution of Gender Factor Cross
Medan 2014
Respondent condition
No GentHyperten
Total
Non
%
%
sion
Hypertension
1 Man 31 67,4
15
32,6
46
2 Woman 14 41,8
20
58,2
34
Total
45 56,25
35
43,75 80
%
100
100
100
Table 6. Majority respondent who suffered
hypertension were man as many as 31 person
(67,4%) while woman as many as 14
person(41,8%).
d. Weight Factor
Table 7.
Frequency Distribution of Respondent
According to body weight Factor at
Body
N0
Frequency
%
weight
1
Normal
44
55
2
3
Thin
4
5
Fat
32
40
Total
80
100
Table 7. majority respondent have normal
weight as many as 44 orang (55%).
42
Table 8.
Cross Tabulation Distribution of Gender
Factor To Hypertension at Internist
Medan 2014
Non
No Body Hyperten
% Hyperten %
weight sion
sion
1 Normal 23
52,3 21
47,7
2 Thin
0
0
4
100
3
Fat
22 68,75 10
31,25
Total
45 56,25 35
43,75
Total
%
44
4
32
80
100
100
100
100
Table 8. majority respondent who have
overweight suffred hypertension as many as
22 person (68,75%),
e. Smoking factor
Table 9.
According to smoking Factor at
Frequen
N0
Smoke actor
%
cy
1
Smoker
48
60
2
Not smoker
Total
32
80
40
100
Table 9. majority respondent were smoker as
many as 48 person (60%).
Table 10.
Cross Tabulation Distribution of smoking
factor Factor To Hypertension at Internist
Medan 2014
Smoke
r
Non
Hipertensi %
factor
Hipertensi
1 Smoker 33 68,75
15
2 Not
12
37,5
20
smoker
Total
45 56,25
35
No
%
Total
%
31,25
62,5
48 100
32 100
43,75
80 100
Table 10. majority hypertension respondent
have smoking habit as many as 33 person
(68,75%) while non smoker as many as 12
person (37,5%)
Table 12. majority hypertension respondents
have alcoholic habit as many as 26 person
(74,5%).
f. Alcohol Factor
Table 11.
According to Alcoholic Factor at
Alcohol
N0
Frequency
%
factor
Alcoholic
1
35
43,8
2
Not
alcoholic
Total
45
56,2
80
100
Tabel 13
According to Respondent Condition at
Internist Polyclinic of DR. Pirngadi General
Hospital Medan Tahun 2014
Respondent
N0
Frequency
%
condition
Hypertension
1
45
56,2
2
Table 11. majority respondent were non
alcoholic as many as 45 person (56,2%).
35
43,8
Total
80
100
Table
13. majority respondent withi
hypertension, condition as many as 45 person
(56,2%)
Tabel 12.
Cross Tabulation Distribution of Alcohol
factor Factor To Hypertension at Internist
Medan 2014
Kondisi Responden
Alcohol
Non
No
Total
Hiperten
factor
%
Hiperten %
si
si
Alcoholi
1
26 74,5
9
25,7 35
c
2
19 42,2
26 57,8 45
Not
alcoholic
Total
45
56,25 35 43,75 80
Non
Hypertension
%
100
100
100
2. Bivariate Analysis
Table 14.
Related Predisposing Factor with Causing Factor to Hypertension Incident at Internist
Polyclinic of DR. Pirngadi General Hospital Medan 2014
Factor
p
Non
Total
%
Hypertensi
value
%
Hypertensi
%
on
on
Usia
<46
11
39,3
17
60,7
28
100
46-55
17
68
8
32
25
100
0,014
56-65
17
70,8
7
29,2
24
100
>65
0
0
3
100
3
100
Total
45
56,25
35
43,75
80
100
Herediter
Genetic
Non Genetic
Total
28
17
45
68,3
43,6
56,25
13
22
35
31,7
56,4
43,75
41
39
80
100
100
100
0,026
Gender
43
Man
Woman
Total
31
14
45
67,4
41,8
56,25
15
20
35
32,6
58,2
43,75
46
34
80
100
100
100
Normal
Thin
Fat
Total
23
0
22
45
52,3
0
68,75
56,25
21
4
10
35
47,7
100
31,25
43,75
44
4
32
80
100
100
100
100
Smoker
Smoker
Not smoker
Total
33
12
45
68,75
37,5
56,25
15
20
35
31,25
62,5
43,75
48
32
80
100
100
100
26
74,3
9
25,7
35
100
19
42,2
26
57,8
45
100
45
56,25
35
43,75
80
100
0,019
Body weight
Alcohol
Alcoholic
Not
Alcoholic
Total
0,024
0,006
0,004
According to the table above shows that there is a statistically significant relationship between
predisposing and precipitating factors to the onset of hypertension by 95% confidence level α = 0.05.
The results include the results of the factor of age with p value = 0.014 (p ≤ 0.05), heredity with the
result p value = 0.026 (p ≤ 0.05), and the gender factor with p value = 0.019 (p ≤ 0.05), the weight
factor is obtained p value = 0.024 (p ≤ 0.05), non factor with the result p value = 0.006 (p ≤ 0.05), and
of the factors of alcohol with the result p value = 0.004 (p ≤ 0.05).
DISCUSSION
1.Relationship between age factor with
occurrence of hypertension
The loss of tissue elasticity and large arteries
become stiff causing blood at each beat of the
heart is forced to pass through narrow blood
vessels of the usually causing the rise in blood
pressure which is a factor of old age patients
with hypertension. (Susanto, 2010)
Based on the results of the study conducted by
researchers obtained the relationship of age
with hypertension, the results showed that the
proportion of respondents with higher
hypertension condition at the age of 56-65
years, amounting to 17 people (70.8%).
Results of bivariate analysis using the chisquare test p values obtained value = 0.014 (p
≤ 0.05) with a 95% confidence level. The p
value indicates that there is a statistically
significant relationship between the factors of
age with hypertension, results are consistent
with the results of research Kartikasari (2012)
who says that age is a risk factor for
44
hypertension, where the risk of hypertension at
age 60 years up is 11.340 times greater when
compared with less than 60 years of age. This
research is also consistent with the results of
research conducted by Aris Sugiharto, where
for ages 56-65 years had a 4.76 times greater
risk of developing hypertension compared
with 25-35 years of age. As well as research
results Sigarlaki (2006) obtained the age group
56-77 years had the highest distribution that is
(55.88%) for the occurrence of hypertension.
Heredity Factors
2.Relationship between the occurrence of
Hypertension
Genetic factors in the family would cause the
family has a risk of suffering from
hypertension. It is associated with elevated
levels of intracellular sodium and low ratio of
potassium to sodium. Research conducted by
Androgue and Madias regarding the
pathogenesis of potassium and sodium in
hypertension, said heredity influence on
primary hypertension through several genes
involved in the regulation of vascular and
renal reabsorption of sodium by (Kartikasari,
2012).
2012, found male patients as many as 23 497
people, or more than 23 239 women who only
person (Andalas, 2012).
Results of this study respondents who have a
history of hereditary factors as much as 28
people (68.3%). Results of the analysis
obtained by chi square test p value = 0.026 (p
≤ 0.05) indicates that there is a significant
relationship
between
heredity
with
hypertension.
4.Relationship between Weight Factor with
Excess weight and hypertension often go hand
in hand, because of the extra few kilograms
makes the heart work harder. Pumping power
of the heart and circulation of blood volume
obese patients with hypertension was higher
than hypertensive patients with normal weight
(Sutanto, 2010).
The results are consistent with research
Anggraini, et al (2009), Hypertension is
lowered or is genetic, individuals with a
family history of hypertension had a two times
greater risk of developing hypertension than
those who do not have a family history of
hypertension. Powered research Kartikasari
(2012) said the subject with a family history of
suffering from hypertension have an increased
risk of hypertension 14.378 times greater when
compared with subjects without a family
history of suffering from hypertension.
3.Relationship between Factors Sex with
Men often experience signs of hypertension at
the age of late thirties, while women often had
hypertension after menopause. Woman's blood
pressure, especially systolic, increased more
sharply with age. After age 55, women do
have a higher risk of developing hypertension.
One of the causes of these patterns is the
difference between the two sexes. Decreased
estrogen production at menopause, women
lose the beneficial effect that increases blood
pressure. (Casey.A, 2012).
So also based on the results of research
conducted by researchers note that the gender
factor associated with the occurrence of
hypertension, with the result that the
proportion of respondents found the condition
of hypertension is higher in the male gender,
amounting to 31 people (67.4%). Results
obtained chi square test p value = 0.019
statistically show that there is a significant
correlation between gender factor with
hypertension. In line with the research
Rahajeng (2009), the sex, the proportion of
men in hypertension group was higher than the
control and males were significantly at risk of
hypertension 1.25 times that of the female.
Data Health Office (DHO) Medan city in
Results of research conducted by researchers
note that the weight factor associated with the
occurrence of hypertension, with hasi that the
proportion of respondents with hypertension
was higher in respondents who weigh as much
fat as 22 people (68.75%). Based on the results
obtained by the chi square test p value = 0.024
indicates that there is a significant relationship
between the variables of weight with
hypertension.
Results of research supported by the National
Institutes for Health USA (NIH, 1998)
dalamAnggraini, et al (2009), the prevalence
of high blood pressure in people with a Body
Mass Index (BMI)> 30 (obese) is 38% for men
and 32% for women, compared with a
prevalence of 18% for men and 17% for
women for those who have a BMI <25
(normal nutritional status according to
international standards).
5.Relationship between
Cigarettes with
Smoking causes an increase in blood pressure.
Smokers can dihubungkandengan an increased
incidence of malignant hypertension and the
risk of experiencing ateriosklerosis renalyang
artery stenosis (Anggraini, et al, 2009).
researchers note that cigarette factors
associated
with
the
occurrence
of
hypertension, with the proportion of
respondents that hypertension is higher among
respondents who have a smoking habit of 33
people (68.75%). Results obtained chi square
test p value = 0.006 indicates that there is a
significant association between cigarette
factors with hypertension.
45
In line with the results Oroh (2013) that
respondents who have a habit of smoking had
a six times greater chance of suffering from
hypertension compared to those who did not
have the habit of smoking. As well as research
results Rahajeng (2009), based on smoking
behavior, the proportion of respondents who
had never smoked every day in hypertension
group was higher (4.9%) than the control
group (2.6%), and risk behaviors never
smoked this significantly found by 1.11 times
compared to never-smokers.
Alcohol Factor
6.Related with Hypertension Occurrence
Risk factor for hypertension consume alcohol.
It has been demonstrated that consuming
alcohol every day can raise blood pressure by
1.21 mmHg systolic and diastolic blood
pressure by 0.55 mmHg for an average of one
drink per day (Russell et al, 1991). Excessive
alcohol use will also trigger a person's blood
pressure. Besides being good for blood
pressure, alcohol addiction will also make it
difficult to remove (Susilo, 2011).
researchers have known that the alcohol factor
associated
with
the
occurrence
of
hypertension, with the results that the
proportion of respondents with hypertension
condition was higher in respondents who have
the habit of drinking alcohol as many as 26
people (74.5%). Results obtained chi square
test p value = 0.004 indicates that there is a
significant correlation between alcohol factor
with hypertension.
In line with the results of Casey (2012),
excessive drinking, which is three times or
more a day was a factor contributing 7% of
cases of hypertension. Powered research Oroh
(2013) of respondents who consume alcohol
have a greater chance of 4.378 times suffer
from hypertension compared to those who did
not consume alcohol. Rahajeng (2009), based
on the behavior of alcohol consumption, the
proportion of alcohol one last month found
higher in hypertensive group (4.0%) than in
controls (1.8%). The risk of hypertension for
those who consume alcohol one last month
found meaningful, that is equal to 1.12 times.
46
CONCLUSION
1.There relationship of age on the incidence of
hypertension with p value = 0.014.
2. Based on heredity: that there is a hereditary
factor for hypertension with p value = 0.026 (p
≤ 0.05).
3.Berdasarkan sexes: that there is a male sex
relationship with hypertension with p value =
0.019 (p ≤ 0.05).
4.Berdasarkan weight factor: there is a
relationship of weight to hypertension with p
value = 0, 024 (p ≤ 0.05).
5.Berdasarkan cigarette factors: that there is a
relationship to the incidence of hypertension
with chi square test was obtained p value =
0.006 (p ≤ 0.05).
6.Berdasarkan factors habit of drinking
alcohol there is a significant relationship to
hypertension, with p value = 0.004 (p ≤ 0.05).
SUGGESTION
1.Tohealth workers of dr Pirngadi Hospital
Medan especially poly diseases in order to
further improve the education and health
education about the relationship between
predisposing and precipitating factors of
hypertension.
2.To patients with hypertension are advised to
avoid obesity, reducing salt intake, high fiber
foods eat- improve lifestyles, and avoid stress
and positive thinking.
REFERENCES
Adib, M. 2011. Pengetahuan Praktis Ragam
Penyakit Mematikan yang Paling Sering
Menyerang Kita. Jakarta : Buku Biru
Arikunto, S. 2006. Prosedur Penelitian.
Jakarta: Rineka Cipta
Anggraini, AD. DKK. 2009. Faktor-Faktor
yang Berhubungan dengan Hipertensi.
Skripsi : FK UNR.
Casey, A. dan Herbert B. 2012. Menurunkan
Tekanan Darah. Jakarta : Bhuana Ilmu
Populer
Ellizabet, L. 2010. Stop Merokok Gerailmu.
Yogyakarta
Kurnia, R. 2007. Karakteristik Hipertensi.
Skripsi : FKM USU
Kartikasari, AN. 2012. Faktor Resiko
Hipertensi. Jurnal : FK UNDIP
Notoatmodjo, S. 2010. Metodologi Penelitian
Kesehetan. Jakarta : Rineka Cipta
Oroh, DN. 2013. Hubungan Antara Kebiasaan
Merokok Dan Konsumsi Alkohol Dengan
Kejadian Hipertensi. Jurnal : Ilmu
Kesehatan
Masyarakat,Fakultas
Kedokteran Sam Ratulangi
Politeknik Kesehatan Kemenkes. 2012.
Panduan Karya Tulis Ilmiah. Medan
Rahajeng, E. dan Sulistyowati T. 2009.
Prevalensi Hipertensi dan Determinannya
di Indonesia. Jakarta : Pusat Penelitian
dan Farmasi Badan Penelitian Kesehatan
DEPKES RI
Ridwan, M, 2010. Tekanan Darah dan
Pencegahannya. Jakarta : Dian Rakyat
Sigarlaki. Herke . J.O. 2006. Karakteristik dan
Faktor Berhubungan dengan Hipertensi.
Jurnal
:
Ilmu
Kesehatan
Masyarakat,Fakultas Kedokteran UKI
Susilo, Y. dan Ari W. 2011. Cara Jitu
Mengatasi Hipertensi. Yogyakarta : Andi
Sutanto. 2010. Cegah dan Tangkal Penyakit
Modern. Yogyakarta : Andi
Udjianti,
WJ.
2010.
Keperawatan
Kardiovaskular. Jakarta : Salemba
Medika
http://www.medan-andalas.2012 (Diakses 7
Januari 2014)
47
PERSONAL HYGIENE DURING MENSTRUATION IN FEMALE TEENEGERS
AT JUNIOR HIGH SCHOOLS 34 PADANG WEST OF SUMATERA INDONESIA
Sri Dewi 1), Tintin Sumarni 2), Aini Yusra3)
Solok Nursing Study Program of Poltekkes Kemenkes Padang
ABSTRACT
Menstruation is the natural monthly occurrence in healthy adolescent girls with the onset occurring
anytime between the ages of 8 to 16 years old until pre-menopausal adult women, resulting in about
3000 days of a menstruation in an average woman’s lifetime. The neglect of menstruation and its
implications for the dignity, health and safety of women is increasingly well documented. The current
understanding is that menstruation causes girls to be absent from school, and that continued absence
leads to dropout and attrition. The main objective of this study was therefore to focus on describe the
reproductive personal hygiene upon menstrual period in female teenagers. The research design is
descriptive with population female teenagers who has menstrual periods from class VII and VIII of
Junior High School 34 Padang. The sample size was aimed at 175 respondents. Questionnaire was
given all respondents and then analyze with distribution frequencies. The results shown that 93%
respondents using sanitary pads. 69,1% respondents buy pad and 78,9% respondents dispose of pads.
77,1 % respondents using pads more than six hours. 57,1% respondents not have good vulva hygiene
during menstruation. As a result of this study, we propose additional recommendations, including
increasing facility for female students to get information about menstrual hygiene management.
Menstruation should be taught and discussed with girls at an earlier age, prior to reaching menarche.
Keyword: Menstrual Hygiene, Menstruation, Reproductive Health
BACKGROUND
Globally, approximately 52 % of the female
population ( 26% of the total population) is of
reproductive age (UN, 2010). In Indonesia, the
number of teenagers increasing rapidly each
years from 1970 until 2000 from 18% become
21% of the total population (Eny Kusmiran,
2009:3).
Menstruation is the natural monthly
occurrence in healthy adolescent girls with the
onset occurring anytime between the ages of 8
to 16 years old until pre-menopausal adult
women, resulting in about 3000 days of a
menstruation in an average woman’s lifetime.
The neglect of menstruation and its
implications for the dignity, health and safety
of women is increasingly well documented.
Research exist on the challenges girls face
while menstruating, their knowledge source
and cultural traditions regarding menstruation.
The current understanding is that menstruation
causes girls to be absent from school, and that
continued absence leads to dropout and
attrition (Unicef, 2012).
from the bellowing data shows an overview of
the phenomenon of knowledge and action of
adolescents on reproductive health it’s
48
Adolescent Reproductive Health Indonesias
survey (IYARHS, 2002/2003) Showing that
teens who know sign legally baligh, boys 55%
-65%, women 36% - 69%. The person who
spoke by teenagers about Reproductive
Health, friends 68%, 14.4% parents, 14% of
teachers, relative 30% (Marwanti, 2004).
Adolescence begins with the very rapid
growth and are usually referred to puberty. As
proposed by Santrock (1993) puberty is a rapid
change to the physical maturation invorving
hormonal and bodily changes that occur
primarily during early adolescence. With the
rapid changes that pass the physical changes
that can be observed such as height and weight
in adolescents or so-called growth and sexual
maturation as a result of hormonal changes.
Adolescence is a period of transition marked
by physical, emotional and psychological
changes. Adolescence, between the age of 1019 years, is a period of maturation of the
human reproductive organs, and usually called
puberty. Adolescence is a transition period
from childhood to adulthood. (Yani
Widyastuti, 2009: 11).
From several research since the last 100 years
shows that there is a tendency accelerated
adolescents experience menarche. In 1860 the
average age of adolescents experience
menarche is 16 years 8 months and 12 years 3
months in 1975. There is decrease of
menarche age is caused by the improvement of
nutrition, improvement of health services, and
community environments. If person sooner
experienced menarche of course she will be
sooner enter the reproductive period too.
(Notoatmojo, 2011)
Now Days in Indonesia the adolescent
problems is very complex and worrying, this
occurs because the teenager's knowledge about
reproductive health is still lacking, only 17.1%
of young women know properly about the
treatment of their reproductive organs.
To anticipate that problems, teens should have
been equipped with a wide range of
knowledge from their parents about how to
reproductive health care (Marwanti, 2004).
According to a research , 75% of deaths in
adolescence occurs due to behavioral factors.
Diseases due to behavioral problems such as
injuries or accidents, sexually transmitted
diseases, food disorders, reproductive health
problems, smoking, drugs abuse, emotional
problems and so on, which will affect your
personal life, family, nation and country in the
future (Tumbuh Kembang Anak dan Remaja,
2002).
The impact of otherwise maintain reproductive
organs during menstruation, reproductive
organs can be affected by fungus or mites that
can cause itching or discomfort, abnormal
vaginal discharge and other sexually
transmitted diseases (Eny Kusmiran, 2011:
24).
According to Becker (1979), quoted from
Notoadmojo (2003: 124) health behavior
(Healt Behavior), things that include with
one's actions or activities to maintain and
improve their health. Including measures to
prevent disease, maintain personal hygiene
and reproductive health.
One of way to take care of reproductive organs
is by doing treatment during menstruation.
Treatment during menstruation is also needed
because the vessels in the uterus during
menstruation is very susceptible to infection.
Cleanliness should be very guarded because
germs can easily enter and cause disease of the
reproductive tract.
Treatment during menstruation can be done by
the pads should not be used for more than six
hours, the pads should be replaced as often as
possible when it is full by menstrual blood,
note pads nature, sterile or non-sterile, do not
use pants that are too tight, do vulva hygiane
(Eny Kusmiran, 2011: 24).
Researchers also conducted a preliminary
study in SMPN 34 Padang, by doing
interviews in SMP 34 Padang on January 4,
2014 were carried out on 10 female students,
there are four female students, changing pads,
two times a day during menstruation, 2
students say frequent use tight pants at the
time of menstruation in order to feel
comfortable, 2 students say changing pads, 3
times a day at first and second day during
menstruation, and 2 students say often
experience vaginal discharge before and after
menstruation without knowing the cause and
smelling.
This research aims to describe the behavior of
young women of reproductive organ
preservation during menstruation in SMP
Negeri 34 Padang.
Methodology
This is a descriptive study aimed to describe
the behavior of young women of reproductive
organ preservation during menstruation in
junior high School 34 Padang 2014. The
variables in this study are: the length of time
the use of pads, pants usage, perform vulva
hygiene (how to cleans vulva).
The population in this study are all students of
class VII consists of 7 classes with the number
108 person, and the class VIII which consists
of 7 classes with the number of 115 person,
bringing the total population of 223 people.
The samples in this study using total sampling
technique where the sample in this study all of
population in SMPN 34 Padang who ever
menstruate, the number of girls who ever
menstruate
are 175 person out of 223
students, while 48 other students had never
experienced menstruation.
49
Results & Discussion
1. Long time use of pads
Most (77.1%) female students have less
healthy habits in the use of sanitary napkins
during menstruation in SMPN 34 Padang
2014. This study is same with research
Suryanti B (2012), which examines the
Adolescent Health Behavior When
Menstruation is known that changing pads
during menstruation slightly by 64%.
Treatment during menstruation is also
needed because the vessels in the uterus
during menstruation is very susceptible to
infection.
Cleanliness should be very guarded
because germs can easily enter and cause
disease in the reproductive tract. One of
the ways the treatment of reproductive
organs is pads should not be used for more
than six hours. (Kusmiran, 2011).
In this study, the majority (77.1%)
students who have unhealthy habits when
use of pads during menstruation, this is
due to lack of students know about the
long time use of sanitary napkins during
menstruation, in accordance with the
opinion of Suryati (2012) that factors
related to behavior of adolescent hygiene
during menstruation is parental education,
knowledge, attitude, availability of
facilities cleaning tools and peer support.
2. Use of type / material pants
The majority (57.1%) students have
healthy habits in the use of materials /
types of pants at the time of menstruation
in SMPN 34 Padang 2014. One of the
reproductive
organs
care
during
menstruation, it’s use materials / types of
pants that can absorb sweat and wear pants
that are not too tight , sometimes people
prefer to wear pants that are too tight
during menstruation their reason is more
comfortable when wearing tight pants,
because the pads are worn when
menstruation is not loose when wearing
tight pants.
Use of pants that are too tight can lead to
sexually transmitted diseases such as
fungal infection, or experience other
symptoms such as menstrual cramps,
rashes and indigestion.Use of pants that
can absorb perspiration can use underwear
made from cotton, especially when active
outdoor activities. Cotton easily absorb
50
sweat and moisture, as well as good for air
circulation.
In this study in the UKS of SMPN 34
Padang has been no organized activities
for
reproductive
health
problems,
especially for the use of materials / types
of pants that are healthy for the
reproductive organs during menstruation,
but the attendant health center has been
giving counseling to the students of SMPN
34 Padang on reproductive health issues,
so most great students already understand
how to care for their reproductive organs,
including the use of pants at the time of
menstruation.
This is accordance with the opinion of
Wulandari, Nirvana, and Nurfarhanah
(2012) who studied the picture of
Understanding
Students
Regarding
Adolescent Reproductive Health Through
Information
Services,
understanding
student at SMAN 1 Padang on adolescent
reproductive health as much as 51% of
students already have an understanding of
adolescent reproductive health, and there
are adolescent still don’t understand about
the adolescent reproductive health (49%).
3. Measures vulva hygiene (how to clean
vulva)
The majority (55.4%) students have
healthy habits in the act of vulva hygiene
(how to clean vulva) when menstruation
in SMPN 34 Padang 2014. This is done by
majority of syudents have know about
how to care for their reproductive organs,
most students get information from
parents and officials Lubuk Buaya health
centers that have provided counseling on
reproductive health in SMPN 34 Padang.
When compared to the results of research
Mulyanti (2001) in Purwakarta found that
the maintenance of good hygiene practices
by 25% and 75% of poor hygiene
maintenance practices means is still low.
According to Becker (1979), quoted from
Notoadmojo
(2003:
124)
healthy
behaviors (Healt Behavior), ie, things that
connected with one's actions or activities
to maintain and improve their health.
Including measures to prevent disease,
maintain
personal
hygiene
and
reproductive health.
Vulva hygiene action is action to clean the
female organ, one of them with clean
water. The correct way is to wipe clean the
vulva from front to back. The purpose of
do vulva hygiene during menstruation is to
prevent infection of the female organs,
maintaining the cleanliness of the vulva.
Treatment of reproductive organs is
extremely important. If not treated
properly, it can cause various adverse
effects, such as infection. How to care and
maintenance can be carried out according
to the demands of the religious, cultural
and medical (Yani, 2009: 3).
Conclusion
Description the behavior of young women on
the maintenance of the reproductive organs
during menstruation in SMPN 34 Padang 2014
as follows:
1.
It can be seen more than most
(77.1%) female students have
less healthy habits in the use of
sanitary
napkins
during
menstruation in SMPN 34
Padang 2014.
2.
(57.1%) students have healthy
habits in the use of materials /
types of pants at the time of
menstruation in SMPN 34
Padang 2014.
3.
(55.4%) students have healthy
habits in the act of vulvar
hygiene (how cebok) at the
time of menstruation in SMPN
34 Padang 2014.
Suggestion
Based on the research results and conclusions
presented above, there are some things you
want authors suggest that further improve
student behavior on the maintenance of the
reproductive organs during menstruation in
SMPN 34 Padang 2014, among others, are as
follows:
1. For SMPN 34 Padang
Expected to SMPN 34 Padang in order
to increase the interest to find
resources related to reproductive
health care during menstruation. With
the
information
students
can
understand and appreciate that
reproductive health care is very
important for their future lives and
future.
2. For institutions
Expected in educational institutions
mainly aimed at school teachers to
provide clear information about
reproductive health care during
menstruation, and increase reading
materials in the library, especially
books related to reproductive health
maintenance. The teacher education
and school facilities that support
reading, so that the students
themselves will have a wider
knowledge and a better understanding
of and understand the function and
benefits of reproductive health care for
the students, especially during
menstruation.
3. For Puskesmas Padang Lubuk Buaya
Support health care workers is very
influential on attitudes and behaviors
to
maintain
hygiene
during
menstruation so it needs to be
improved health education in schools
so as to increase knowledge about the
importance of clean and healthy
behavior through counseling.
4. For Methodology is expected to
further research to be able to do
further research on other variables, the
design and the different ways of
measuring research relating to the
behavior of young women on the
maintenance of the reproductive
organs during menstruation.
51
QUALITATIVE STUDY OF PREMARITAL SEXUAL BEHAVIOR IN
GIRLS ADOLESCENT AT DHARMA BAKTI SENIOR HIGH SCHOOL
2014
Soep 1, Hanna Sriyanti Saragih 2, Wardati Humaira 3
1
Nursing Department of Medan Health Polytechnic of Health Ministry;
Midwifery Department of Medan Health Polytechnic of Health Ministry
Author Correspondency : [email protected]
2,3
ABSTRACT
Adolescence is a transition period that is physically and psychologically, especially sexual hormones
in the body marked by sexual maturity. Research carried out in 33 provinces in 2008, as many as 97%
of middle and Senior High School teens never watched porn. Those who once embraced, kissing ,
masturbation , and oral sex reached 93.7 %. This study aims to determine the cause of premarital
sexual behavior in adolescent girls at Senior High School of Dharma Bakti 2014.
This research is a descriptive study using a qualitative approach , source of data obtained through
observation and interviews with 6 informants at Dharma Bakti Senior High School and one teacher of
Dharma Bakti Senior High School as a key informant. Data analysis techniques starting from data
collection, data reduction, data presentation and conclusion.
The results of research showed that sexual behavior that occurs is beyond the limit. According to the
informant handrails, a hug and a kiss was common and reasonable. The cause of such behavior due to
factors that lower knowledge, positive attitude that sees such behavior, media information and
circumstances that support such behavior. Expected to health workers or the parties involved to
provide education and health promotion particularly about early sex education or reproductive health
in adolescents.
Keyword
: Behaviour, Sexual, Adolescent
Adolescence is a transition period in which the
physical and psychological changes from
childhood to adulthood . This period is often
referred to as puberty. Experts theorized that
puberty term used to denote both the shape
and the biological changes that occur with
rapid physiological childhood from childhood
to adulthood , especially changes in
reproductive organs. Changes in sexual
hormones in the body marked by sexual
maturity so that sexual urge arises increasingly
overflow (Ministry of Health, 2010).
According
to
World
Health
Organization (WHO), adolescence is when the
child has reached the age of 10-19 years.
According to Law of Indonesia which No. 4 of
1979 concerning the welfare of children,
adolescents are individuals who have not
attained the age of 21 years old and unmarried.
According to the Labour Law, the child was
considered adolescents when it has reached the
age of 16-18 years or are married and have
own place. According to the Marriage Act of
Indonesia no.1 of 1974 , when a teenage child
is considered mature enough for marriage is 16
years for girls and 19 years for boys. Ministry
52
of Education and Culture considers
adolescents aged 18 years when it is
appropriate to graduate from Senior High
School .
Based on data from the Ministry of
Health of the Republic of Indonesia in 2006,
Indonesian teenagers (aged 10-19 years)
amounted to about 43 million people or
19.61 % of the total population. In 2008 , the
number of teenagers in Indonesia has
estimated has reached 62 millions. In West
Java by the Central Bureau of statistics (BPS)
in 2008 there are number of adolescents
(aged 10-19 years ) as many as 8.145.616
people, made up of 51.8 % men and 48.2 %
women .
Adolescent
problems
today's
increasingly complex and worrying. Especially
regarding the matter of sexual and
reproductive health. It was triggered by the
lack of information they take in. Just imagine,
adolescents aged 13-18 years had premarital
sex. Similarly, about 60% of them do it in her
own home. Data gathered by the Indonesian
Family Planning Association mentioned that in
2006 there were many teens having sex
without using any contraception tool to protect
them. While the National Commission for
Child Protection Survey conducted in 33
provinces in 2008, as many as 97% of middle
and Senior High School teens ever watched
porn. Those who once kissing, masturbation,
and oral sex reached 93.7%. And adolescents
junior who is not virgin as much as 62.7%, and
that adolescents do abortions ever at 21.2%.
According to the 2007 Demographic and
Health Survey, young women and men aged
15-24 years who know about the fertile period,
reached 65%. He also said young women and
men who know the risks of pregnancy, sexual
intercourse, each only 63%. Research on
sexual transmitted diseases (STDs) conducted
in Jakarta by University of Indonesia in 2005,
showed teenagers knowledge about STDs is
still very low, except for HIV / AIDS, namely
95%, and syphilis approximately 37%
(Adhitya, 2012).
In Indonesia, there are an estimated 1 million
teenagers become pregnant outside of
marriage , while worldwide an estimated 15
million teens become pregnant each year , 60
% of them became pregnant ( Hidayat in
Tinceuli , 2010). From some studies say one of
the causes of pregnancy outside of marriage is
the inability to control biological urge of
teenagers (Tinceuli , 2010) .
Ministry of Health of the Republic of
Indonesia revealed that from 1189 unmarried
adolescents ( aged 13-19 years) in West Java
and 922 teenagers in Bali , found 7% of
adolescent girls in West Java and in Bali 5 %
admitted never experienced in pregnancy.
Chairman of the Network for Women and
Children ( JPPA ) in Central Java , Widanti
(2011 ) says that the number of girls who
become pregnant will continue to increase,
reflected in her research on junior and senior
Senior High School level in 2010, which
shows in each school have an average of four
to seven students found are pregnant , even
during the year increase of 10% to 15 % (
Ministry of health, 2011).
The results of the few cities in Indonesia about
the sexual behavior of adolescents who are at
risk also in that case get 17.60 % in East
Jakarta, Bogor 42.6 %, 48.1 % Pandeglang,
Palembang 20.4 %, 14.1 % Prabumulih, and
Depok 11.2 % (Shinta , 2009) .
According to data from the Regional
Health Research ( RISKESDA ) in 2010 found
the number of adolescents ( male and female )
with the status of unmarried 63 048 86.7 % ,
had sexual intercourse with the number of
males 3.0 % and females 1.1 %. Married Age :
10-14 years of 4.8 % and 41.9 % with 15-19
years.This means that sexual behavior before
marriage has begun to occur at a very young
age . In addition to the above data other health
problems that can occur in adolescents are
suffering from HIV / AIDS . Young people (
teenagers ) are the highest HIV / AIDS pain
sufferers. According to the Minister of Health
stated that North Sumatra needs attention of
Provincial Health Office because of
increasing HIV- AIDS case data. Based on
data from the North Sumatra Health Office,
the number of HIV cases in 2009 were 1096
and cases increased in 2012 of 2189 cases.
While cases of AIDS in 2009, of 1553 cases
and in 2012 there were 4241 cases. Moreover ,
the number of deaths due to AIDS in 2009
amounted to 338 increased in 2012 to 751.
Regarding STDs , in 2009 amounted to 1845
cases and rise in 2012 to 4212 cases.
Youth Companion research on sexual
behavior in four cities showed 3.6% of
adolescents in the city of Medan, 8.5% of
adolescents in the city of Yogyakarta, 3.2% of
adolescents in the city of Surabaya, and 31.1%
in Kupang have free sexual intercourse. While
the research conducted by Synovate Research
on adolescent sexual behavior in four cities:
Jakarta, Bandung, Surabaya and Medan with
the number of respondents 450 people with
ages between 15-24 years. This study resulted
in that approximately 50% of respondents got
the sex information from friends, watched
porn film as much as 35% and only 10% for
school. Ironically, only 5% of respondents get
sex information from their parents, and as
much as 81% of teens admitted more
comfortable talking sex with his friends than
to his parents. Adolescent sexual behavior is,
however, very great risk of being infected by
HIV / AIDS, as well as abortion. The third
problem is the data that reinforce sexual
behavior research which has been carried out
in several cities in Indonesia (Julianti, 2012).
A case of premarital sex occurs to a students
of Darma Bakti Senior High School. She came
to Suryani Maternal Clinic in Medan Johor to
do planotest ( pregnancy test ) . The student
came accompanied by her boyfriend.
According to her, they had sexual
intercourse at her boyfriend’s boarding house.
Examination results were obtained that the
53
student was not pregnant. They
protective form of a condom to
pregnancy, but to ensure that she
pregnant, and therefore they came
midwife to do planotest.
use a
avoid
is not
to the
Objective
The general objective of this research is
knowing the cause of premarital sexual
behavior in adolescent girls in Dharma Bakti
Senior High School of Medan in 2014.
Advantage of Research
Simple research activity is expected to provide
benefits for both adolescents concerned as
well as for society at large.
Methods
Research Design
Design of this research is to use descriptive
qualitative
approach
through
in-depth
interviews. This research was conducted in
Dharma Bakti Senior High School of Medan.
The study began in March to April 2014.
Chronology of informant
Search informants adolescents in accordance
with the purpose of this research was
conducted
with
snowball
technique.
Informants in this study were 6 teenagers and
a teacher as key informant who know and can
give answers to the questions researchers in
both oral and written. On the implementation
of in-depth interview, the interviewer use an
interview guide and took data recorder by
Multi Player 4 (mp4) with it is not known by
the informant..
Data Collection Technique
To do a fairly study required a complete data
were obtained from data collection techniques.
In this research,
in-depth interviews,
observation and documentation used as data
collection.
Data Analysis Methods
Data obtained from indepth interview
processed using qualitative data analysis rests
on three related processes, namely : describing
phenomena, classify, and see how the concepts
that emerged was one with the other.
54
Results
1. Knowledge
All informants in this study have same opinion
regarding the definition of adolescent,
according to them adolescent is somebody
who is already in Senior High School, big
body, has been courting, has menstruation.
Slightly different from the statement of key
informant who said that in senior high school
there were a few others have started familiar
courtship and even pregnant while attending
Junior High School (SMP).
After the informant was asked about what the
impact of social and dating style, those
informants that revealed that teenage
promiscuity that goes beyond these limits tend
to lead to free sex, influence the development
of more modern era and also the lack of
parental role. In line with the statement of
teenagers who become key informants in this
study, key informant revealed the same thing
that teenage promiscuity is now unnatural, and
outside influences Westernized, and the
influence of the mass media that can provide a
big influence on adolescent promiscuity.
For more information by in-depth interview
about the knowledge of teens about premarital
sex, back again in further question of what
kind of sexual activities. Most informants said
that the example of the sexual behavior for
example handrails, a hug, a kiss that can rise to
desire to make a love. Informants can not reply
that its were question about the impact of
premarital sexual behavior itself, virtually all
informants say the same to the impact of
aberrant sexual behavior, for example
pregnancy, suicide ,destroyed future. In
relation to the above key informants revealed
that the cause of youth in deviant sexual
behavior is influenced by several factors,
friend , age , and environment.
Analysis of research that all informants are not
yet fully know properly about the definition of
adolescents. All the informants who were
asked have different opinions about the
definition of adolescents. Most of informants
said that they began to date since Senior High
School and different with key informants
statement that stated that most of them have
begun dated at junior high school. Promiscuity
of teenagers today is already very free. From
the statement of some informants and also key
informants stated that free promiscuity caused
the sex behavior due to the influence of the
times
and
unsupportive
environment.
However, their opinions about premarital sex
is good enough although still not so precise.
The deeper excavated informants knowledge
about sexual behavior informant statements
regarding an example of premarital sexual
behavior.
According to informants that the
impact of free sex was like pregnancy,
depression, and loss of confidence. It is caused
by several factors such as the influence of
friends, the times, and the environment.
2.Attitude
Adolescent attitude or response when
asked about the sex education given in schools
all said they agree and it is very important in
order to know which ones are good too and
that is not good, so do informant statement,
once asked the attitudes or opinions of key
informants about whether important sex
education in schools agreed with the statement
that it is very necessary to give sex education
and hope there are certain parties that
specifically conveying such information.
Having asked internally or core of the
extent to which the attitude of informants in
dating some informants say honestly or openly
revealed and there is also an informant that
little secretive about the extent of his attitude
in dating. In this case the opinion of the
informants said that the attitude of the
informant it was perfectly natural and still
within normal limits. Informants said that the
handrails, hugs, and kisses are common and
reasonable, because it symbolizes affection of
love.
But when asked why the informant said
ordinary and reasonable about the forces of
dating, the most informants say for fear of
losing, endearment.
Then informant asked about why not to engage
in premarital sex, most informants have the
attitude and the reasons are almost the same,
which is associated with self-esteem, fear of
pregnancy, religion was banned, the future is
still important.
After in-depth questioning informants opinion
about the causes of deviant sexual behavior is
influenced several factors less attention to
family, from friends, watch videos, invited a
girlfriend, too dear, so someone desperate for a
teenager to deviant sexual behavior. This is
consistent with the opinion of key informants,
about the causes of deviant sexual behavior in
a person's teens can be due to many things, for
example by reading adult books are not worth
reading by teenagers, that can cause fatal
curiosity later.
All informants stated that there was a
ban on the environment, culture , and norms
against premarital sexual behavior . In line
with the statement of key informants , that in
terms of culture, especially the culture of
Indonesia is still very strong , only Indonesia
has detracted from western culture and
consider deviant sexual behavior was a
regular. Moreover, Indonesia is too likes to
imitate new things. In this case the key
informants said that it depends on the
personality of each one how to achieve such
changes. Researchers analyzed that it is
important to give sex education in school to
create good attitude of adolescent.
The importance of sex education in order to
know which ones are good and which is bad.
Results obtained interviews about sexual
behavior that has been done, informants found
handrails, hugs and kisses are common. The
reason they chose this attitude as an expression
of affection, and equally willing . Though such
behavior has violated the culture, religion, or
customs that are around. And when asked the
reason why they have not reached the stage of
sexual intercourse, all informants found still
thinking about self-esteem, and fear of getting
pregnant . In this case the researchers could
not agree with the positive attitude of the
informant. And it turns out the reason
someone who desperate to deviant sexual
behavior because of the lack of attention to the
family, media information, and call his
girlfriend. This is consistent with the fact that
the case today .
Not much different from the statement of key
informant who said the cause of deviant sexual
behavior, for example by reading adult books
that are not appropriate.
In this study, most informants got information
about premarital sexual behavior by media
such as the internet, facebook, social media.
Almost all informants say never watch or see
porn things. Once asked in depth, that the
influence of mass media on adolescent sexual
activity and how the media response to some
teenagers still fear, the need for self-esteem,
not intentions, fear of pregnancy, and religious
prohibitions. After being asked increasingly in
a world where the influence of informants on
the activities premarital sexual behavior in
55
adolescents, most teens say that it is the
biggest influence of the mass media because it
is free to access. In line with the statement of
the key informants said that the mass media is
one of the biggest causes adolescents to
behave particularly concerned about deviant
sexual behavior.
Even though elementary school children
already know the Internet sites that could
endanger themselves . Analysis investigators
that most of the informants said information
media such as the Internet is giving a huge
impact on the behavior of premarital sex. And
all the informants claimed to have never
watched a porn video and picture scenes
inappropriate for show . This corresponds to
the facts that occurred in the present , because
the mass media are very easily accessible . In
line with the opinion of the key informants
said that children under the age was already
easily access sites that are inappropriate for or
on display in the show .
4. Situation and Conditions
The results obtained after being asked how
informants are interested in premarital sexual
behavior is initially still shy , just want
spoiled. The informant said that they often
used park as dating place, because it is where
the people going out, there are also those who
say go to a movie, and eat together outside .
More in-depth questioning of the relationship
circumstances where an informant against
premarital sexual behavior , informants said
that they do such behavior because it is carried
away and embarrassed in crowded places .
There is also an informant who said that the
sexual behaviors such as handrails , hugs and
kisses already is commonplace and is not
ashamed of that place was not so crowded in
mind. Key informants mentioned that teens do
things that are anomalous , particularly
regarding premarital sexual behavior is
influenced several occasions , for example
when the house empty , so they take advantage
of
existing
opportunities.
Researchers
analyzed that the romantic places and deserted
situation commonly visited informants to do
such sexual behavior.
This statement is consistent with the fact that
the case today . It is undeniable that the teens
now have crossed the limits of reasonableness.
In fact, each of us visited recreational places
ensured that there are couples who are making
love . Based on the results of interviews
56
conducted that sexual behavior such as
handrails , a hug , a kiss , is commonplace .
Even nowadays that teenage promiscuity had
crossed the line and has reached the final stage
which is the stage of sexual intercourse.
Discussion
1. Knowledge
According to the informants that the teen was
who already in Senior High School, great
body, is already courting and has
menstruation. The statement illustrates that
their lack of understanding about herself.
According Pinem (2009) adolescence (10-19
years) is a special and important time, because
it is a maturation period of human
reproductive organs. Adolescence is also
called puberty, is a unique transition period
marked by a variety of physical changes,
emotional and psychological. While the style
of the current date according to them is not
shameless, free, damaged, over the limit, is not
thinking about the future, is not thinking about
self-esteem. In accordance with the incident
that occurred at this time.
Impacts of dating style itself according to
them has exceeded the limits and tends to lead
to free sex, influenced by modern era and also
the lack of parental role. Key informants in
this study provide a statement in line with the
informant that the association is now
unnatural, and outside influences of
westernized, and the influence of the mass
media that can provide a big influence on
adolescent
promiscuity,
making
teens
interested in try what they saw .
The results showed that most of the informant
know what they think about premarital sex that
premarital sex is the activity of sleep together
and sexual intercourse ( like husband and
wife). In this case most of the informants
already knew what it was premarital sex. From
6 informants interviewed four of them
understand about premarital sex and the two of
them do not understand what it is premarital
sex. According to them the premarital sexual
behavior such as handrails , a hug, a kiss that
can give rise to desire . Disagrees with the
informant who do not understand what
premarital sex and what kind of example of
premarital sexual behavior . According Boyke
( 2013 ) sexual behavior is behavior that arise
because of the sexual drive .
Forms of sexual behavior varies, ranging from
dating , holding hands , hugging , making out ,
to have sex . In this study once asked about the
impact of sexual behavior that deviates some
informants say so many negative impacts such
as casual sex, pregnancy, stress, dropouts,
suicides, broken because it thinks the future is
destroyed . In this case the informant already
knew quite well the impact of deviant sexual
behavior. According Pinem (2009 ) as a result
of premarital sexual behavior for adolescents,
especially sexual intercourse like reproductive
health disorders, STDs, unwanted pregnancy ,
psychological trauma ,the future of which was
destroyed , gave birth to an unhealthy baby ,
cause shame in the family .
As a result, many of these teens who are not
virgins , and even pregnant ( Noviardi , 2013 ).
The results are consistent with research
Darmasih (2009 ) about the factors affecting
premarital sexual behavior in adolescents of
Senior High School in Surakarta, knowledge
with premarital sexual behavior has a
significant connection, it is stated that the
better knowledge of teens about premarital sex
, then the adolescent will have a better
premarital sexual behavior.
2. Attitude
According to Taufik Dariyo in the ( 2010)
attitude predisposes ( determinants ) that gave
rise to appropriate behavior with attitude .
Attitude starts from the knowledge perceived
as a good (positive) or not either (negative) ,
then internalized into him . If the perceived
positively then one tends to be positive. The
reason is because someone that agrees with
what she knows . But otherwise if someone
has a negative perception then it would tend to
shy or do not do .
The study provides an overview of all the
informants overwhelmingly approved that the
importance given sex education in schools so
that they know where the good and the bad .
This opinion is in line with key informants
were also strongly suggest the existence of sex
education was given in schools by certain
parties to reduce the level of sexual behavior
in adolescents today. With the early sex
education is done in schools , the young
people will increasingly know and understand
the changes that occurred around her .
According Esti (2008 ) administration of sex
education in schools is good , that is for
children to get the correct information about
sexuality. Teaching sex explicitly into many
classes and children we are inundated with
information that has been prepared for them to
understand .
Results of this study most of the informants
believe sexual behavior such as handrails ,
hugs , kisses , and others is an attitude that is
still within reasonable limits. The behavior
they do with reason because both want and
like , which is a symbol of love for couples
and justification for this attitude is considered
not to harm one another . On the other hand
informant reason not to have sexual
intercourse for fear of being pregnant , the
future shattered , depression. The researchers
thought justified , which means teens are still
know the limits of the impropriety or very
fatal behavior.
Sexual behavior is all behavior driven by
sexual desire, both with the opposite sex or
same sex. The forms of this behavior can be
diverse, ranging from feeling attracted to
behavior dating, petting, and intercourse.
Sexual object can be a person (either similar or
opposite sex), people in fantasy, or yourself.
Most of this behavior does not have an impact,
especially when it does not cause physical
consequences for the person concerned or
social environment. But some sexual behavior
(which is done prematurely) actually can have
the very serious psychological effects, such as
guilt, depression, anger, and aggression
(Sumiati et al, 2009). Results of this study
most of the informants said that deviant sexual
behavior is influenced by several factors less
attention to family, from friends, watch videos,
invited a girlfriend, too dear, so someone
desperate for a teenager to deviant sexual
behavior.
In line with the opinion of key informants
regarding the factors that cause young people
in deviant sexual behavior with adults who
have not read the book worth reading
teenagers, that can cause fatal curiosity later.
According Sumiati et al (2009 ) factors that
cause premarital sexual behavior were
hormonal changes that increase sexual desire
teenager , prevailing norms , media
information , supervision of parents, there is a
tendency that the more freely between men
and women . Results of the study ( Planned
Parenthood Federation of America Inc. , 2004)
in 1038 adolescents aged 13-17 years about
sexual relations showed 16 % of teens agreed
with sexual intercourse , 43 % did not agree
with sexual intercourse , and 41 % stated that
57
one should not sexual intercourse ( Ririn ,
2009).
In this study , informants were asked about
how their views on the environment , culture ,
norms that there is no prohibition against
sexual behavior. All key informants and
informant also said that there is a ban on the
environment, culture and norms . The results
are consistent with research Fitriana (2010 )
which showed that there was a significant
correlation between attitudes about premarital
sex sexual behavior.
3. Media Information
Media information is a channel to convey a
message that is used to facilitate the reception.
Acceptance message for teens. Based on its
function as a messenger ( Notoadmodjo ,
2011) . The influence of the media information
that increasingly have the ease of access by
anyone, directly or indirectly, will be able to
give effect also to the knowledge, attitudes and
behavior. All informants in this study claimed
have been exposed to pornographic media
either intentionally or unintentionally .
Media exposure like pornography is also
considered as a tool to spur and stimulate
sexuality itself. Most informants claimed that
the information media such as the internet
(social media) is the biggest influencers to
give changes in premarital sexual behavior.
According to Esti (2008) information media
such as television, newspapers, magazines and
other influences can create an obsession
towards sex among adolescents. Junior high
and Senior High School does not need and is
not interested in sex drive imitation or fake.
But the new power in his body made her
sexual instincts wake and responsive. TV,
magazines, etc. are the main source of sexual
stimulation. The results are consistent with
research of Taufik (2010) all informants and
key informant also give the same explanation
that the influence of the mass media is very
possible for the occurrence of pre-marital sex
through mobile phones, Internet and
pornographic films among teens
The results are consistent with research of Evi
, et al ( 2013 ) who has interviewed informant
about sexual behavior and found that
informants influenced by the media
information such as TV , HP , and internet.
The mass media is most often used to obtain
information about sexual behavior such as a
58
phone / mobile phone , computer / internet and
VCD / DVD / CD.
Factors chance (the circumstances) of
premarital sex is very important to consider ,
because if there is no chance of both space and
time, premarital sex will not happen. Opening
up opportunities for teens to have sex can be
influenced by several factors such as: the
business of parents, administration of excess
facilities , shifting moral values in society (
Health Ministry , 2010). The results in this
study there are many factors that support for
the pre -marital sexual behavior among
adolescents . One of them is the situation and
favorable conditions for the occurrence of
premarital sex behavior . Various places such
as parks, because it is where the people going
out, there are also those who say go to a
movie, and eat together outside .
This opinion is in line with the opinion of key
informants who say the current situation is
usually empty house, so they take advantage
of existing opportunities. Most informants also
said that deserted places not forever be a place
where people in dating. Sometimes in a
crowded place was a teenager now not shy in
expressing affection towards their partners.
Because they assume that the handrails, hugs,
kisses, still a natural thing. They just think that
sexual behavior was only when he had sexual
intercourse with her partner. Results of
research conducted to Taufik research (2010)
on sexual behavior in adolescents analyst in
the town of Pontianak obtained that most
informants tend to argue that the
circumstances that allow for the occurrence of
pre-marital sexual relations that began when
the couple spend time together, dating in a
dimly lit and dark without the supervision of
others.
Conclusion
1. Knowledge
Knowledge informants in this study indicate
that the informant of 6 girls and 1 key
informant obtained all informants define the
different juvenile sense. There are four
informants who can answer very well what it
is premarital sex and the two informants did
not understand at all like what was said
premarital sex. Then there are three informants
answer with good examples of sexual behavior
and two informants said that in addition to
having sex then it does not include the
behavior sex then one informant did not
answer . In conclusion teens knowledge about
premarital sex is still lacking .
2. Attitude
Attitudes toward premarital sexual behavior
informant date suggests that had passed the
limits of reasonableness . From 6 informants
studied revealed that sexual behavior been
done already at stage 5 of the 12 stages of
courtship behavior . Sexual behavior such as
handrails , a hug , a kiss , a hug while kissing a
sexual behavior that is still within reasonable
limits. In conclusion, teenagers have positive
attitude sex behavior.
3. Media Information
Media information is a media that has a broad
enough coverage. Information media such as
the Internet is a medium that is a very big
influencer for adolescents because it is very
easy and fast to access. Results of the study
found that from 6 adolescents informants
including key informant argued that the mass
media such as the internet is a very big
influencers for teenage promiscuity.
The situation and conditions used by most of
the informants in this study chose the
circumstances that is quiet and romantic place.
The results also show linkage with the lack of
communication, lack of attention given by
parents, thus allowing pre-marital sexual
behavior. Of 6 young girl informants said
there were five informants prefer a quiet place
and only one person who said the place was
not crowded rule.
Recommendations
1. Expected teenagers to be able to improve
the knowledge, attitudes and behaviors are
positive about what the sexual behavior and
the dangers of such behavior. So that teens
can apply in life and interaction, through
the activities of spiritual, teens mosques,
and extracurricular.
3. It is expected that the Senior High School of
Dharma Bakti Medan in order to provide
sex education to students. It is intended to
broaden students about the dangers and
impact of such deviant sexual behavior. Sex
education may be provided in the form of
counseling,
posters,
appeals,
announcements and others.
4. It is expected that the educational
institutions can increase the number and
variety of literature in the library of the
institution, especially on reproductive
health in adolescents.
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Reproduksi. Yogyakarta: Fitramaya
THE SATISFACTION OF PEOPLE WITH DISABILITIES
ON REHABILITATION SERVICES IN ACEH PROVINCE
1
Hermansyah1, Fahmi Ichwansyah2, Enny S3
Lecturer Ministry of Health, Health Polytechnic, Aceh Province
Head Officer Ministry of Health, Health Research and Development Center,
Aceh Province
3
Head Officer Handicap International, Aceh Province
Email: [email protected]
2
Introduction Since military conflict and post-tsunami disaster affected Aceh Province, it caused
people with disabilities. Disability is an interaction of three main things, including weakness or
damage to body functions, activities of daily living and environmental conditions. The aim of this
study is to explore the satisfaction of people with disabilities on rehabilitation services and its impacts
on communities.
Methods This quantitative survey was conducted in 3 months by using questionnaires to 200 people
with disabilities in eight districts in Aceh Province. The data were analyzed descriptive by using a
computer system.
Result and Discussion This study showed that all respondents activities such as mobility, activities of
daily living, household activities both in adults and children, participation and self reliance have
changed significantly after undergoing the rehabilitation process by health officers. The majority of
participants’ perception is in positive category (74.0%). About 35.5% of participants suggested that
the equipment used for rehabilitation services should be improved to be in better quality. Thus,
improving better health care services for people with disabilities is highly required.
Keywords: Satisfaction, Rehabilitation Services, People with Disability
Introduction
Disability is a malfunction or reduced a
function can be measured objectively/seen,
because of the loss/abnormality of body
parts/organs of a person, such as the absence
of the hand, paralysis of certain parts of the
body. These defects can always be for
someone, which can produce different
behaviors in different individuals, such as
brain damage may make the individual is
mentally retarded, hyperactive, blind, etc.1
According Article 1 in Indonesia Law
No. 4/1997 on People with Disabilities (PwDs)
states that disabled people are all people who
have physical and or mental abnormalities,
which may interfere with or an obstacle for
him to conduct a proper activity, consisting of:
physical disability, mental disability, as well
as physical and mental disabilities (both).2
According to the most recent US cencus
analysis, there are 40 million adults with a
severe limitation in physical function who are
considered “work disabled”.3 People with
disabilities in the USA are protected by the
Americans with Disabilities Act (ADA),
which outlines the necessary environmental
requirements for businesses and public areas
such as curb cuts and ramps, and prevents
discrimination from employment based on
disability. In the USA, people with disabilities
also have access to state-run programs such as
vocational rehabilitation that are designed to
assit in achievement of higher education and
job placement/maintenance.4
Since military conflict and tsunami
disaster affected Aceh Province, it caused
people with disabilities.5 Because of that, we
have to to support health and social initiatives
related to disability issue, whatever the
context, offering them assistance and
supporting them in their efforts to become
self-reliant. It could be important how to
implements activities that will allow people
with disabilities in Indonesia to have greater
opportunities to exercise their rights to
enhance their dignity.6
The formulated a strategy which stated
that the specific objectives of the activities are
to increase the capacity of institutions and
services working in disability field, confirming
to general public and decision makers are
aware that disability is a human rights,
development issue and empowering people
61
with disabilities and their organization to
become active actors in their communities.1
This survey was expected to generate an
output that is important to the performance and
results of all activities taking place during this
so it will benefit some interest groups, such as:
1)People with Disabilities; its open
participation space for the disabled person and
to evaluate the implementation of the
rehabilitation services program that has
received so far. 2)Government/program
manager; obtaining the update information on
the implementation of rehabilitation services
in Aceh province; should be strengthening the
public service skills and referral systems for
people with disabilities; and should be
integrating the program of physical
rehabilitation services on people with
disabilities into the Aceh's Health Insurance
system.
The Aims of study
The aim of this study was to explore the
satisfaction of people with disability on
rehabilitation services, and its impact on
community. The study specifically focused on
assessing client satisfaction in terms of the
quality of services (accessible, efficient and
impactful) and the appropriateness of services
considering the needs of people with
disabilities in Aceh Province.
Research design
This study used a survey design with
quantitative approach, namely a method that
aims to describe the actual situation or
phenomenon in which all variables were
observed and measured at a point time
simultaneously without an intervention or
treatment.
Site and study sample
The survey was carried out in 6
regencies (Aceh Besar, Aceh Tengah, Bener
Meriah, Bireuen, Pidie Jaya, Aceh Utara) and
2 municipalities (Banda Aceh, Kota
Lhokseumawe) in Aceh Province. Samples for
the survey has determined purposively by
Handicap International as its working area. It
was implemented its current rehabilitation
project as many as 200 people with
disabilities.
The target groups of the survey are the
persons with disabilities receiving physical
rehabilitation services (Physical therapy,
62
Prosthetic Orthotic, Assistive devices) from
Handicap International rehabilitation project in
the period December 2010 to January 2011 at
Public Health Center, Hospital regencies
municipality level, and were willing to be a
respondent in this survey without pressure or
volunteer.
Procedure
The time period of data collection in
this survey was took 3 months. Data collection
was done by interviewing respondents face-toface with using questionnaires that were
containing a series of questions ranging from
general information, client status, the cause of
malfunction, the service received, satisfaction
levels and recommendations for improving the
quality of rehabilitation services. Data
collection was conducted by enumerators were
selected by survey team and before surveys
conducted all enumerators will be trained in
the use of questionnaires, surveys ethics, and
disability etiquette.
Data processing is done in several
stages, namely: editing, coding and data entry.
Editing was an activity to examine each
statement or question that has been filled such
as charging completeness, consistency
between the lists of questions with answers,
answers and filling error correction. In the
coding stage, make code was carried out by
researchers of any information that has
accumulated on the right column of the
questionnaires. Furthermore the categorical
value (score) for each indicators was made in
the form of figures 5 (five) for indicators with
a very good condition or agreed until the
number 1 (one) for the category was less or
not satisfied.
Data Analysis
The researchers conducted data analysis
techniques used to the questionnaires
instrument was conducted on each variable to
determine the frequency and proportion of
each variable with using the formula:
Percentage = (f / n) x 100% where: f =
Frequency, and n = Number of Respondents.8
The data processed were analyzed
descriptively by using a computer and
displayed in frequency distributions to have
obtained a description in form of a table, graph
or diagram. Interpretation of percentage, the
survey team used calculated using the criteria:
Less (1 to 20%); Less than half (21 to 40%);
Almost half to more than half (41 to 60%);
More than half (61 to 80%); and Almost
entirely to whole (81 to 100%).
Result and Discussion
Based on data collecting results, its
known that the total number of respondent in
this survey was 200 people with disability
which clustered in six Regencies namely
Bener Meriah (22.5%), Bireuen (20.5%), Aceh
Utara (20.0%), Aceh Tengah (15.0%), Aceh
Besar (9.5%), and Pidie Jaya (2.0%) and two
Municipalities namely Lhokseumawe (8.0%)
and Banda Aceh (3.0%). It was found the most
number of respondents was in Bener Meriah
Regency (22.5%), whereas the least one was in
Pidie Jaya Regency (2.0%).
Table 1.
Number of Respondents by
Demographic Characteristics (N
= 200)
Characteristics of Respondents
Gender
Male
Female
Age Group (years)
0-4
5-9
10 - 14
15 - 19
20 - 60
Over 60
Educational background
Not school yet
No school
Primary school / equivalent
Junior high school / equivalent
Senior high school / equivalent
Bachelor degree
Master degree
Others
Occupation
Not working / housewife
Civil servant / Army / Police
Farmer / laborer
Non government staff
Businessman
Others
Monthly Family Income
category
Below Rp. 1.300.000, Above Rp. 1.300.000, -
f
%
91
109
45.5
54.5
31
16
5
4
97
47
15.5
8.0
2.5
2.0
48.5
23.5
43
34
45
20
24
29
1
4
21.5
17.0
22.5
10.0
12.0
14.5
0.5
2.0
44
23
34
6
17
76
22.0
11.5
17.0
3.0
8.5
38.0
131
69
65.5
34.5
Characteristics of People with Disability
For this research result found 54.5% of
them were female. Age group of majority was
20 to 60 years (48.5%). The most educational
background was elementary school graduate or
equivalent (22.5%). More type of occupation
was no working (housewives) of 22.0%. More
respondents (73.5%) were using the facilities
financing sourced from Aceh's Health
Insurance Program (Jamkesmas/JKA).
Disability experienced by all age
categories with different types of occupation
that was being acted by the respondent. Types
of disabilities experienced by respondent vary
greatly which have been obtained from birth
(congenital) or during their lives. To minimize
it was needed to do exercises every day to
consider the severity of the disability is
experienced and is unable to do it themselves,
and may also be caused by a lack of
knowledge about exercises and activities that
the respondent owned.
More than 40 million people in the
United States have a physical or mental
impairment that significantly affects life
activities and work performance. The total
annual costs of disability are currently
estimated at US300 billion.12
The factor of family income per month
that was still under the monthly minimum
wage provinces (Rp 1.300.000,-) have
indicated the average on standard of living
financially respondents were in categories with
low economic status. Utilization of financing
facilities sourced from Jamkesmas/JKA
ongoing at this time of great help disabled
people in the process of undergoing
rehabilitation.
Disability increases with age, and a
variety of resources are available to older
persons with disabilities. Older persons should
discuss difficulties managing independent
living with their physician and contact their
local senior center to learn more about
available programs, such as physical activity
programs and home modification.12
Researchers analyzed data from
Mexican-Americans older than 65 who were
followed for 18 years. They concluded that, on
average, this group of people spends more
than half of their remaining years with serious
physical disabilities that limit their ability to
do everyday tasks.13 These findings indicate
that poverty and lifelong disadvantages
seriously undermine the health of many older
Mexican-American. The family tends to step
in to provide care to even seriously impaired
older parents. It must develop policies and
programs that complement the family in their
ability to provide care to older infirm parents
in order to improve quality of life both the
older parents and their caregivers.13
63
Source of information
Source of information should be
obtained by during the rehabilitation process
more available from health workers (85.0%).
Type of disability experienced varies widely
from birth or acquired during their lives. Type
of therapy given during rehabilitation was
more using infrared (79.0%). Type of
rehabilitation exercises and activities at home
undertaken by 46.5% of respondents has been
done everyday.
Source of information obtained during
the rehabilitation process was obtained from
health officers with different educational
backgrounds, both working in the public
health center, hospital, or midwife in the
village suggests that the role of health workers
in socialized medical rehabilitation services
are already well underway. Meanwhile, the
World Health Organization provides the
definition of disability into 3 categories:
impairment,
disability,
and
handicap.
Impairment mentioned as a condition of
abnormal or loss of structure or function of
psychological or anatomical. Disability is the
inability or limitations as a result of
impairment to perform activities in a manner
that is considered normal for humans.
Handicap is a disadvantage for a person due to
impairment, disability which prevents it from
fulfilling the role of the normal (in the context
of age, gender, and cultural factors) for the
person concerned.1
Impairment is evaluated as a measured
change in an individual’s health status.
Disability is an individual’s inability to
perform a task successfully. Disability is not
necessarily related to any health impairment or
medical condition; although a medical
condition or impairment may cause or
contribute to an ongoing disability.11
These are some of the disability
definitions proposed by some experts, such as:
a) someone who looks and act differently from
ordinary people or other; b) a person who is
the part of their body was not working for a
long time and does not go away; c) someone
who has a barrier to do usual daily activities
(washing, eating, etc.); and d) someone who
cannot learn, and cannot make their own
decisions as anyone else.
Of some of the definitions set forth
above, we can conclude a larger sense that
disability is an interaction between the three
main things, namely: the weakness or damage
to body functions, activities of daily living and
environmental conditions.
64
Access to rehabilitation services
Access to rehabilitation services site
was easily accessible by the respondents in a
close distance (≤2 km), travel time was short
(≤10 minutes), and availability of the
transportation. In addition, 96.5% was easy in
administration, 77.5% in undergoing the
rehabilitation process was accompanied by
relatives or family member, and 72.5% have
been ease of collecting cost to undergo the
rehabilitation process.
The Americans with Disabilities Act of
1990 requires that all medical practitioners be
prepared to provide all patients “full and equal
access to their health care services and
facilities”.
Many
practices
cannot
accommodate
patients
with
mobility
impairment; therefore, adults who require a
wheelchair for mobility may be denied the
care that they need. Improved awareness is
needed about the Americans with Disabilities
Act requirements and the standards of care for
patients with mobility impairment.14
Rehabilitation services
Most
participants
identified
the
rehabilitation services along process such as:
referral history was known 100.0%
undergoing rehabilitation process at Public
Health Centers, 16.0% to Hospital District, to
the Provincial Hospital only 4.5%, while
obtaining a referral to both the Hospital
District and the Province Hospital was 2.5%.
All respondent activities or abilities were
mobility; activities of daily living; household
activities both in adults and children alike;
participation; and independence undergone
significant changed after a rehabilitation
process. Support given by the family after
rehabilitation was able to overcome those
aspects that complicate the lives of
respondents. All of health officers have been
providing good rehabilitation services to the
respondent by health officers, namely: in
Public Health Center (72.0%), the Hospital
District (59.5%), and the Provincial Hospital
(57.1%).
Perception during rehabilitation process
The following table represents the number of
respondents based on the perception given by
the respondents during their rehabilitation
process in terms of various categories were as
follows.
Table 2. Number of Respondents by Their Perception During Rehabilitation Process
(N = 200)
Respondent Perception During Rehabilitation Process
f
%
You feel that you can do more things by yourself after using
Rehabilitation services
Absolutely not good
3
1.5
Not good
34
17.0
Good
150
75.0
Very good
13
6.5
Satisfy with your life before getting the rehabilitation intervention
Absolutely not satisfy
7
3.5
Not satisfy
128
64.0
Satisfy
65
32.5
Satisfy with your life after getting the rehabilitation intervention
Absolutely not satisfy
3
1.5
Not satisfy
42
21.0
Satisfy
146
73.0
Very satisfy
9
4.5
More independent in life
Yes
137
68.5
No
63
31.5
Able to do all my Activities of Daily Living
Yes
135
67.5
No
65
32.5
More self confidence
Yes
157
78.5
No
43
21.5
More able to participate in family events
Yes
138
69.0
No
62
31.0
No improvements, same as before
Yes
34
17.0
No
166
83.0
My health has improved
Yes
168
84.0
Not
32
16.0
More able to participate in social activities in the community
Yes
130
65.0
No
70
35.0
The above table gives a detailed picture
of respondents' perceptions during their
rehabilitation process was as follows:
Respondent felt able to do more things alone
after undergoing rehabilitation services was
good in the category (75.0%), feeling
dissatisfied with your life before it underwent
rehabilitation intervention (64.0%), feeling
satisfied with your life after a rehabilitation
intervention
(73.0%),
living
more
independently (68.5%), able to perform
activities of daily living (67.5%), had more
self-confidence (78.5%), better able to
participate in family events (69.0%), felt there
was progress, the same as before (83.0%), his
health has improved (84.0%), and better able
to participate in social activities in the
community (65.0%). It can be concluded that
respondents’
perception
during
their
rehabilitation process was more in the positive
category (74.0%).
Rehabilitation services also require a
referral system that starts at the level of basic
services in health centers, and for people with
disabilities who have more serious severity
and if the clinic does not have the power
physiotherapist and facilities that were not
complete/available, then the respondent the
opportunity to undergo a rehabilitation process
at a higher level, namely District Hospital and
65
Provincial Hospital. It has become very
important because this study showed that all
the respondents activities or abilities such as
mobility; activities of daily living; household
activities both in adults and children alike;
participation; and independence change
significantly
after
undergoing
the
rehabilitation process by health officers.
Suggestions for improvement Rehabilitation
services
The following table represents the number of
respondents based on their suggestions for
improvements of rehabilitation services in the
future.
Table 3. Respondents’ Suggestions for Improvements of Rehabilitation Services (N=200)
Respondents’ Suggestions for Improvements of The Rehabilitation
f
%
Services
Provide better quality materials/equipments
71
35.5
Home visits
29
14.5
Improve training
27
13.5
Provides regular visits to people with disabilities
18
9.0
More time for rehabilitation sessions
15
7.5
Give more information
14
7.0
Improve the attitude of the staff
8
4.0
Rehabilitation service center should be closer to the community
7
3.5
Other
7
3.5
Involving caregivers in the rehabilitation process
4
2.0
According to the table, the suggestions
put forward by respondents to improve
rehabilitation services in the future based on
the first ranking was 35.5% of respondents
suggested that the service provider and where
service to provide materials or better quality
equipment in order to speed up the recovery
process in people with disability.
In the United States, the American
Medical Association’s Guides to the
Evaluation of Permanent Impairment is the
most commonly used source assessing and
rating an invidual’s permanent impairments.
Ultimately, in deciding on an appropiate level
of work restrictions, the physician must
evaluate the situation of each patient by
considering 3 concepts: Capacity (work
training, strength, endurance); Tolerance
(ability to perfom sustained work at a given
level), and Risk (probability bof substantial
harm upon return to previous work duties). If
an individual is not capable of returning to his
or her previous employment, consideration
may be given to increasing physical fitness
and stamina, recognizing other abilities and
talents, and perhaps vocational retraining.11
In this research study, we can learn
about improve the quality of care and access to
rehabilitation for people with disabilities
through strengthening the identification and
referral system; strengthening the skills of
public services (midwives in charge of
66
identification and referral and rehabilitation
staff at the subdistrict, district and province
levels) through training and technical support
to health authorities; integration of physical
rehabilitation in the social insurance system of
the Aceh Province (JKA); and establishment
of mechanisms for incurred costs management
at community level.
Conclusion
This quantitative survey identified the
people with disabilities’ satisfaction related to
rehabilitation services. First, type of
rehabilitation exercises and activities at home
should be carried out by the respondent
everyday taking into account the severity of
the disability and with the help of caregivers.
Second, support given by the family after
rehabilitation was able to overcome those
aspects that complicate the lives of
respondents. Third, to helped the people with
disabilities to perform the activities to meet
their basic needs through an exercise that
continuously trained in order to reduce
dependence on others. Finally, to improve
rehabilitation services in the future to the
service provider and a service to provide the
material or equipment was better quality,
home visits by health officer and increased
training during rehabilitation so as to speed up
the recovery process and improving the health
care to people with disabilities.
Acknowledgments
This survey was held in collaboration
with Health Research and Development Center
Ministry of Health, Aceh Province and
Handicap International Branch Aceh Province,
so we would like to sincerely thank to both of
them.
References
1. Aide Médicale Internationale. 2007.
Disability/Kecacatan. Health Messenger,
Majalah
Kesehatan
Untuk
Pekerja
Kesehatan Indonesia, Edisi 6/September
2007, Banda Aceh: PT. Aceh Media
Grafika.
2. Undang-Undang
Republik
Indonesia
Nomor 4 Tahun 1997 Tentang Orang
Cacat. Jakarta.
3. Brault M. 2008. Americans with
Disability: 2005, Current Population
Reports. Washington, DC: US Cencus
Bereau: p.70-117.
4. Wilbanks, Susan R and Ivankova, Nataliya
V. 2014. Exploring Factors Facilitating
Adults with Spinal Cord Injury
Rejoining the Workforce: A Pilot Study.
Disability and Rehabilitation, Early Online,
p.1-11.
5. Forum Keperawatan Bencana Aceh, 2009.
Keperawatan
Bencana.
Proyek
Pendidikan
Keperawatan
Bencana
Japanesse Red Cross Society di Banda
Aceh dan Aceh Besar berkenaan dengan
Program Rehabilitasi dan Rekonstruksi
Tsunami di Indonesia.
6. Melati, A. 2011. Gambaran Kebahagiaan
Pada Penyandang Tuna Daksa Dewasa
Awal.
Skripsi,
Fakultas
Psikologi
Universitas Sumatera Utara. Access at:
789/28956/4/Chapter%2011.pdf.
7. Notoatmodjo, S. 2003. Metodologi
Penelitian Kesehatan, PT. Rineka Cipta,
Jakarta.
8. Arikunto, S. 1998. Prosedur Penelitian:
Suatu Pendekatan Praktek. Edisi Revisi
IV, Cetakan Kesebelas, Jakarta: PT. Rineka
Cipta.
9. Supranto, J. 2001. Pengukuran Tingkat
Kepuasan Pelanggan untuk Menaikkan
Pangsa Pasar. Jakarta: Rineka Cipta.
10. Suryawati, dkk. 2006. Penyusunan
Indikator Kepuasan Pasien Rawat Inap
Rumah Sakit di Provinsi Jawa Tengah.
Jurnal Manajemen Pelayanan Kesehatan,
Vol. 09, No. 4.
11. Parasuraman, A Zeithaml, Valerie A. dan L
Berry. 1991. Delivering Quality Service.
New York: The Free Press A Divission of
Mc Millan Inc.
12. Zeller, John L., Burje, Alison E., Glass,
Richard M., 2007. Assessing Disability.
JAMA, November 7, 2007, Vol. 298.
No.17, p.2096.
13. Preidt, Robert. 2015. Older MexicanAmericans Often Disabled, Study Say.
Journal of Gerontology, Series B:
Psychological and Social Sciences, News
Release, March 26, 2015.
14. Lagu, T., Hannon, N.S., Rothberg, M.B.,
Wells, A.S., Green, K.L., Windom, M.O.,
Dempsey, K.R., Pekow, P.S., Avrunin, J.S.,
Chen, A., Lindenauer, P.K., 2013. Access
to Subspecialty for Patients with
Mobility Impairment. A Survey. Annals
of Internal Medicine. 19 March 2013. Vol.
158, p.441-446.
67
EFFECT WORKSTRES : PSYCHOLOGICAL DISTRESS
ON KORTISOL AND IMMUNOGLOBULIN’S LEVELS OF NURSE
IN IMMUNE SYSTEM IN HAJI HOSPITAL MEDAN
Tri Niswati Utami
College of Health Sciences Nurliana Medan
[email protected]
ABSTRACT
Work stress comes from the environment system. Environmental aspects such as social conditions,
stressors and resources received by individual differences in life (such as family and work). Sources
of stress in the work environment can cause a negative response. Psychological distress associated
with the emotional state of the individual and social distress related to an individual's ability to relate
to others. Individuals who do not have the ability to accept stressor can be affects physical and mental
health and quality of life. Stress response in the form of biologycal response and perception of
response. If the body's response is stronger and able to banish stress, the body under normal
circumstances and the body is able to maintain the balance of the phase of stress so it does not harm
the body. If prolonged stress, the body will perform activation response time, thus causing damage to
the body, resulting in the risk of illness and injury. The purpose of this study was to determine the
effect of work stress: psychological distress on the immune system and the cortisol levels of
immunoglobulinG (IgG). The study design was observational with cross sectional study. Its about 23
samples were taken at random nurses in the ICU, ER and hospital of nursery Haji in Medan .The
results showed that there was no significant relationship between the characteristics of the respondents
with work stress. Based on r value=0.532 and p = 0.009. There is significant influence from
psychological distress on the level of cortisol. Furthermore, on the result of r value =-0.719 and the
value of p=0.000, is significant influence from psychological distress on the level of IgG.
Keywords: distress, imune system, kortisol, Imunoglobulin G
Introduction
The hospital is a work environment that
filled with sources of stress. Some data
indicate that the stress levels of nurses is very
high. Nurse work stress are found in the
Intensive Care Unit, Emergency Unit and
Nursery. Stress nurses working in Yogyakarta
Private Hospital associated with the dual role
conflict and social support. In fact, most
nurses in Indonesia are women. Dual role
performed by women is very risk with familywork conflict (Almasitoh, 2012). Stress nurses
working in Dr. Pirngadi hospitals of Medan in
2010 amounted to 42.24% especially in night
shift nurses (Putri, 2010).
Distress is a negative psychological response
to a stressor, as indicated by the presence of
negative psychological state (Simmon&
Nelson, 2001; Quick, 2002). Research work
stress and psychological distress finding
symptom sof anxiety and depress if appears as
aprominent characteristic in distress, this
situation may occur in different degrees.
Behavioural stress symptoms such as: 1)
Physiological symptoms such as : abdominal
pain, increased heart rate and shortness of
68
breath, increased blood pressure, headaches
and heart attack. 2) Psychological symptoms
such
as
anxiety,
tension,
boredom,
dissatisfaction in work, headache/migraine,
muscle tension, insomnia or sleep. 3)
Behavioral symptom ssuch as: delaying work,
declining achievement and productivity,
sabotage behaviours, increasing frequency of
absence from work, eating disorder behaviour,
losing appetite, drinking alcohol,
being
aggressive, stealing, declining quality of
interpersonal relationships (family and friends)
and a suicidal tendency(Robin, 2005).
Methods
The Subjects were nurses in Haji Hospital
Intensive Care Unit (ICU), Emergency Unit
and Nursery room at Medan. Samples were
taken randomly as many as 23 nurses.
Observational study was conducted using
cross sectional study design. Work Stress
measurement used questionnaires GHQ-12
(General Health Quesionaire-12) and imunitas
measurement used conducted laboratory tests
of blood cortisol levels and immunity
examination IgG levels.
Frame work study
Respondents
GHQ-12
Psychological distress
Social distress
Low immunity:
Kortisol
IgG
Picture 1. Frame work study; Subowo (2013), Pinel (2009)
Hypotesis
1. There is no influence from
characteristics of respondents on
distress
2. There is influence from
psychological distress on the level
of cortisol
3. There isinfluence from
psychological distress on the
levelof IgG
4. There is influence from social
distress on the level of cortisol.
5. There is influence from social
distress on the level ofIgG
Data Analysis
The data obtained would be analyzed using
statistic non parametric, including analysis of
data normality, univariat, bivariat and then
applying spearman correlation.
Results
Survey 23 respondents consisted of 15
respondents distress and 8 respondents is not
distress. Characteristic of the respondents in
this study are described based on age group,
education and years of service shows in the
table 1.
Table 1. Data Characteristics of Respondents by Age group, Education and Years of Service in Haji
Hospital Medan
Number
Category
Frequency
Percent (%)
1
Age
21 – 25
3
13
26 – 30
9
39
31 – 35
6
26
36 – 40
3
13
41 – 50
2
9
Total
23
100
2
Education
Diploma
18
78.3
Bachelor’s degree
5
21.7
Total
23
100
3
Years of Services
5 – 10
11
47.8
69
11 – 15
16 – 20
>20
Total
8
2
2
23
34.8
8.7
8.7
100
Table 1 indicates the age majority is 26-30 years old as many as 39%. The most groups of
education is Diploma as many as 78.3% and the most group years of service is 5-10 years as many as
47.8%. The Respondent are distres and not distres (normal) indicated at table 2.
Table 2 Distribution of Respondents Distress
Number
Category
1
Distress
2
Normal
Total
Frequency
15
8
23
Percent (%)
65.2
34.8
100
Table 2 indicates the respondent are distress as many as 65.2% and normal as many as 34.8%.The
influence of psychological distress with cortisol levels shows in table 3.
Table 3 The influence from psychological distress on the level of cortisol and IgG
Number
Psychological
Spearman rho (r)
p Value
distress
1
Kortisol
0.532
0.009
2
IgG
-0.719
0.000
N
23
23
Table 3 indicates that the results, levels of cortisol value r=0.532 and p =0.009 showed a strong
relationship and patterned positive, meaning that the higher levels of psychological distress will
increase cortisol levels. Statistical test results obtained there is significant relationship between
psychological distress with cortisol levels (p =0.009). IgG levels r=-0719 and the value of p=0.000
showed a strong relationship patterned level is negative, meaning that the higher levels of
psychological distress will reduce levels of IgG. Statistical test results obtained there is significant
relationship between psychological distress with IgG levels (p =0.000).
Table 4. The Influence from social distress onthe immunity: the level of cortisol and IgG
Number
Social Distress
Spearman rho (r)
p Value
N
1
Kortisol
0.135
0.540
23
2
IgG
-0.340
0.113
23
The results levels of cortisol value r = 0135
shows no relationship/relationship is weak and
the value of p = 0.540 showed no significant
results. Statistical test results IgG r = -0.340
indicates the level and pattern of relationship
is negative, it means increasing social distress
will decrease slightly the level ofIgG.
Statistical test result p = 0.113 showed no
significant relationship between distress onthe
levels of IgG.
Discussion
Respondent characteristics such as age,
education and years of service variabels are
with no influence on work stress; nurse
distress. The results are consistent with the
concept of distress a holistic models of
70
stress.The physical or psychological stimuli
which the individual responds are commonly
referred as either stressors or demands.
Stressors at work take the form of role
demands, interpersonal demands, physical
demands, workplace policies and job
conditions (Quick et al., 1984). The
relationship between the worker and the work
environment are not harmonized may lead to
distress. Some research out lines that the
labour relations and working environment are
the right model for a negative response
(Nelson et al., 2001).
Influence stress on immune system
According to data analysis with
Spearman correlation (r) showed significant
relationship between psychological distress
with increased cortisol levels as well as levels
of IgG. This Research conducted immune
system in elderly people, feelings of
depression and anger can weaken the immune
system. They are prone to stress and
depresion. Stress causes physiological changes
inthe body that weakens the immune system,
and ultimately affect the health of so
susceptible to disease, and the incidence of
abnormalities ofthe immune system with the
appearance of psoriasis and eczema.The
glucocorticoid hormones and cortisol trigger
the anti-inflammatory reactions in the immune
system (Fatmah, 2006).The immune system as
close relationship with the emotions, the
relationship has been demonstrated since
1919, Japanese researchers found an
association of physical and emotional set
backs tuberculosis patients during their
immune system in an emotional rage episode.
In 1926 American researchers found the
number of lymphocytes decreased in
individuals who experience shock (Subowo,
2013).
Conditions of distress is a negative
response due to a stressor, stressor also
activates the sympathetic nerve, there by
increasing the amount of epinephrine and
norepinephrine is released from the adrenal
medulla. Segerstrom & Miller (2004) found
that the effects of stress affects the immune
function. Excessive distress can cause
changesto health, such as disorders:
psychological cardiovascular and muscle.
Health problems occur because the body
accept a state of stress and responds to
stressful conditions through the brain.
Instead the condition of tranquillity will
enhance the immune system. Tranquility,
positive thinking is a positive emotional
response to increase optimistic attitude, so
avoid the stress. Optimistic attitude cause a
state of balance (Homeostasis). Homeostasis
occurs because of the feedback mechanisms
that limit excessive reactions and maintain
normal conditions. Endurance immunologic
response pattern of the prayer tahajud can
decrease the cortisol hormone(Soleh, 2006).
There are changes in the concentration of IgG
and IgA levels before and after memorizing
the holy AlQur’an in Qori (Laukha, 2010).
The level of IgG significantly higher in the
group of respondents who experience digestive
disorders and disorders atopic dermatitis (Said
dkk., 2012).
Conclusion
Work stress; psychological distress
saffects the immune system, evidenced by an
increase in cortisol levels and decrease in IgG.
Unbalance demotions cause the body's
immunity levels decrease. Inverse correlation
between in creased levels of cortisol and
decrease IgG. The immune system works to
protect the body from infection, bacteria,
viruses and cancer cells and other foreign
substances in the body. Psychological distress
in the long time run affect the immune system,
decreased immune system and weak, the body
susceptible to disease and increases the risk of
cancer.
References
Almasitoh, U. H. (2011). Work stress Judging
from Dual Role Conflict and Social
Support on Nurse. PSIKOISLAMIKA,
Islamic Psychological Journal (JPI),
Vol. 8 No 1, 63-82.
Fatmah. (2006). Low immunity response in
the eldery. Health Magazine , Vol 10,
No 1, 47-53, Jakarta.
Laukha, M. (2010). Changes Immunoglobulin
G (IgG) and immunoglobulin A (IgA)
in AlQur'an memorizer in Depok
Indonesia The foundation of Baitul
Quran.
Skripsi,
UIN
Syaruf
Hidayatullah,
40-57,
Jakarta
Indonesia.
Nelsons, D., Quick, J., & Simmons, B. (2001).
Handbook of health psychology.
Marwah: NJ: Elbaum.
Pinel,
J.
P.
(2009).
Biopsychology.
Yogyakarta: library studying
Putri, R. (2010). Illustration of work stress on
a night shift nurse in the emergency
department of Dr. Pirngadi Hospital,
Medan. University of Sumatera Utara.
Quick, J. C., & Tetrick, L. E. (2002).
Handbook
Occupational
Health
Psychology. 97-116, America: The
American Psychological Association
(APA).
Quick, J., & Quick, J. (1984). Organizational
stress and preventive management.
New York: Mc Graw-Hill.
Robbins, S. P., & Judge, T. A. (2005).
Organizational Behavior. New York:
Prentice Hall.
71
Said, I. P., Tabri, F., Ilyas, F., & Sjahril, R.
(2012). The relationship between Ig G
and IgM anti Helicobacter Pylori with
events of Adult Atopic Dermatitis.
University of Hasanuddin, 1 - 14,
Makassar.
Segerstrom, S., & Miller, G. (2004).
Psychological stress and the human
immunie system: A meta-analytic
study of 30 years of inquiry.
Psychological Bulletin, 601-630.
72
Simmons, B., & Nelson, D. (2001). Eustress at
work: The relationship between hope
and health in hospital nurses. Health
care management riview, 7-18.
Soleh. (2006). Therapy of Prayer Tahajud to
cure various diseases. Jakarta:
Hikmah.
Subowo. (2013). Clinical Immunology. 451 472, Jakarta: CV Sagung Seto.
THE ASSOCIATION MOTHER’S EDUCATION AND THE AMOUNT
OF FIRST MOLAR CARIES TEETH
IN 6-7 YEARS OLD OF SD BAPTIS
MEDAN DENAI 2014
Herlinawati, Intan Aritonang, Hasny
Department of Dental Nursing, Polytechnic of Kemenkes Medan
ABSTRACT
Education is one of the factor that infuences of healthy status for someone. The participation of
parents mostly a mother is very important in guidence, give understanding, improving and to
preparing facility for their children that can to keep their oral hygiene. The first molar replace the first
position that easy affected by caries because there is niches and fissure with the of teeth eruption at
the child in 6-7 years old, so that the prevention to caries expecially the teeth are many niches and
fissure on the surface is very important. The kind of research is using analitic survey with cross
sectional desain. The population of this research are the all of children in 6-7 years old SD
(elementary school) Baptis with numerals 40 children where as the sample is the total of population
are 40 children. This research aims to knows that the relation of mother’s education with the total of
the first caries molar of children in 6-7 years old. the result of this research it shows for 40
respondences, 32 children have caries (80%) on the first molar, while are not caries only 8 children (
20%). The level of mother’s education is elementary school, all of the children have caries on the
first molar. Based on chi square experimen have done, got the result there was any relation between
mother’s education and amount of the total of first molar caries (p<0,05), the children in 6-7 years old
SD Baptis have to keep their oral hygiene. Be excepted of the participation of parents in how to guide
their children to maintain oral hygiene and defend growth and development of the children’s first
molar so that it can oppose earlier caries.
Keywords
: Mother’s education, first molar caries teeth
INTRODUCTION
Healthy is the most important for
every human to can do any activities as
physically, physicology, and social prosperity
completely and it is not only just do not have
disease
or weakness
( WHO). On of health efforts is to support the
self sufficiency of society for health live (
Depkes RI 2010).
According to Health Act no. 36 (2009)
article 93 paragraph 1 and 2 that dental and
oral health care aims to maintain and increase
the society health level by prevention of
dental caries, and to care the dental health by
local government and also by individual dental
health care, school and society. Based on
result of research of basic health (2013), the
national prevalence of dental and moral health
is 25.9%, in which 14 provinces have a higher
prevalence of dental and oral health over than
national level.
The national prevalence of teeth
brushing in each day is 94.2% in which 15
provinces has the lower prevalence than
national level.
The education of dental health is
designed and directed efforts to build a
situation in which individual or society group
change the old behavior with disadvantages
for the dental health. The society has a
motivation to improve the dental health care
through dental health education. The dental
health education has not yet realized
effectively. This is indicates by the result of
dental health survey of Depkes RI in 1990 in
which the rate of dental tissue and niche is
higher (Budiharto, 2008).
Koentjoroningat (1997) said that
education is a majoring in absorbed the
educational knowledge of anyone related to
the behavior to the absorbed knowledge. The
higher educational level, the easier to absorbed
the knowledge. Education is a personal
characteristic element that always related to
the individual/society health level. The higher
individual educational level, the easier to
absorbed the information of health issue. The
easiness of anyone to get more information
will influence the forming of health new
behavior, such as the information about the
73
oral and dental care. In this sense, the formal
education in Indonesia
is consist of
elementary school (SD), junior high school
(SLTP), Senior High School (SLTA) and
higher educational academic level (PT). the
educational level determines the logical
reasoning of anyone that enable him to
absorbed any information and has a rational
thinking into respond the information of the
problems (Cumming, et.al., Azwar, 2007).
Dental caries is found in the entire
world, to any age, nation or economic
condition. According to researcher in Europe
nations and Asia as well as Indonesia, that 80
– 95%of child who age less than 18 years old
have dental caries. The percentage of dental
caries is increase for the development of
human culture and only 5% of population who
have immune to the dental caries (Tarigan, R.
2012). Generally, the people assume that child
dental must not be cared because their teeth
will changed by the old ones. (Suwelo, I.S.
1991). There are any parents who did not
aware that adult’s teeth had growth on the age
of 6 years. The growth of adult dental is
assumed as milk teeth because the milk teeth
has not yet be replaced. Therefore, more of the
first molar has caries as one of dental and jaw
development of the child that must be cared.
(Susanto, GW 2011). The first molar is in the
first position with caries because there is niche
and fissure in addition to the dental eruption
on the age of 6 – 7 years old. The prevention
of dental caries with niche and fissure on its
surface is very important (Sariningsih, E,
2014).
Based on the preliminary survey of
researcher, it indicates that of twenty child (in
age of 6 – 7 years old) only three child without
dental caries. Based on the aforementioned
background, the writer interest to do a research
on a correlation of mother’s education and the
number of first molar caries of the child whose
age 6 – 7 years old at SD Babtis of Medan
Denai.
Purpose of Research
In order to study a association
between mother’s education and the amount of
dental caries in first molar teeth in 6 – 7 years
old of SD Baptis of Medan Denai.
Benefit of Research
1. As input to the parents especially for
mothers who have child on age 6 – 7
74
years old at SD Baptis about the first
molar caries.
2. As input to the child on age 6 – 7
years old at SD Baptis about the first
molar caries.
3. As consideration for the next
researchers about the first molar
caries of the child whose age 6 – 7
years old.
Hypothesis
There is a correlation of mother’s
education to the number of first molar caries
of the child on age 6 – 7 years old at SD
Baptis sub-district of Medan Denai.
Method
This research is analytic study with
observation method and cross sectional design
to study a correlation of mother’s education
and the number of first molar caries of the
child whose age 6 – 7 years old at SD Baptis
of Medan Denai.
Population and Sample of research
Population is all of research object or
studied object (Notoatmodjo, S 2010). The
population in this research is all of the child
whose age 6 – 7 years old at SD Baptis subdistrict of Medan Denai for 40 students.
Sample is object will be studied and
assumed represent all of population or a part
of the studied objects./ (Notoatmodjo, S,
2010). In this research, the sample is child
whose age 6 – 7 years old at SD Baptis subdistrict of Medan Denai. In the sampling, the
researcher takes a part of population. If the
number of population is greater (> 100) the
sample is 10 – 15% or 20 – 25% or more. But
if the number of population is less than 100,
the population to be sample. In this research,
the sample is all of child in age of 6 – 7 years
old at SD Baptis sub-district of Medan Denai
for 40 students (Total population).
The primary data for educational level
of mother is collected from the interview to
the student and teacher. And the first molar
were assessed and recorded on the assessment
form.
On this research, the number of dental
caries is categorized to be four, i.e. : good = 0,
medium = 1, poor 2 and 3, severe poor = 4.
While the educational level was categorized in
three : lower = elementary school, medium =
SMP and SMA and higher = higher education.
The collected data were processed by
any steps, i.e. editing, coding, data entry,
cleaning data and the data was analyzed by
statistical test using computer software. The
univariance data was analyzed to study a
depiction and characteristic of each variable.
The bivariance data was analyzed to study a
correlation between the mother’s education
and the number of first molar caries was
analyzed by statistical test using chi – square
test with confidential level 95%,
Results of research
Table 1.1. Frequency distribution of
respondent based on educational level of
mothers of the child on age 6 – 7 years old
at SD Baptis sub-districf of Medan Denai of
2014.
No Mother’s
Number Percentage
education
(n)
(%)
1
Elementary
6
15
school (SD)
2
Junior high
7
17.5
school (SMP)
3
Senior High
14
35
school (SMA)
4
Higher
13
32.5
education
Total
40
100
Based on Table 1.1 it indicates that
percentage of education level of mother of the
child on age 6 – 7 years old at SD Baptis is
elementary school (SD) for 6 person (15%),
junior high school for 7 person (17.5%), senior
high school for 14 person (35%) and higher
education level for 13 person (32.5%). More
of respondent is graduate of senior high school
(SMA) (35%) and the few of respondent is
graduate of elementary school (SD) (15%).
Table 2.2. Frequency distribution of
respondent based on the number of first
molar caries of the child on age 6 – 7 years
old at SD Baptis of sub-district of Medan
Denai in 2014
First molar
Number
Percentage
caries
(n)
(%)
With caries
32
80
Without caries
8
20
Total
40
100
Based on table 1.2, it indicates that the
number of percentage of first molar of the
child on age 6 =- 7 years old at SD Baptis with
caries is 32 child (80%) while percentage
without caries is 8 child (20%).
Table 1.3. A correlation of the education of
mother and the number of first molar caries
of the child on age 6 – 7 years old at SD
Baptis sub-district of Medan Denai of 2014
Category
of caries
Good
Medium
Poor
Very
poor
Total
Educational level of
mother
SD
SMP Unive
and
rsity
SMA
0
4
3
0
3
8
1
5
1
5
9
1
6
21
13
Num
ber
7
11
7
15
P
(95%)
0.007
40
Based on Table 1.3 it indicates that the
mother who graduate from junior and senior
high school (SMA and SMA) has a higher
rate of caries (4 of first molar) of the child for
9 child (22.5%).
Based on results of chi-square test
indicates that there is a significant correlation
between the educational level of mother and
the number of first molar caries (p < 0.05).
Discussion
Dental caries is dental tissue disease
that indicated by the damage of dental tissue
from the teeth furface (niche, fissure and
interproximal area) to the pulp. Dental caries
can found to each people and found on one of
teeth surface or more and expand to the depth
part of the teeth for example from email up to
dentine and pulp. This caries is caused by
carbohydrate, microorganism and salivary and
the dental form and surface (Tarigan R, 2012).
One of causal factor of dental caries is
the less of awareness in care the dental and
oral health such as to brush the teeth rightly
and effectively in addition to the diet factor.
Diet also influences the dental and oral health,
because diet produces energy. For example
carbohydrate protein, fat and minerals in
addition to the influence of pre-eruption, post
eruption of teeth. Diet also clean the teeth and
will damage the dental caries. The food that
clean the teeth is apple, guava, yam, etc. in
contrary to the soft diet and patch to the teeth
such as candy, biscuit, etc. (Tarigan R, 2013).
75
Based on Table 1.2, it indicates that of
40 respondents, 32 of them has caries (80%)
on the first molar, while without caries found
to 8 respondent (20%). All of the child of the
mother who graduate of elementary school has
first molar caries. And the child from the
mother who graduate of junior and senior high
school of 21 child, 4 of the child have not
caries.
According to dictionary of Education
(1984), education is a process where anyone
develop any capabilities, attitudes and
behavior in the society environment. Based on
definition, it means that education is a tool to
change the human behavior. Education is a
process or activity for the personality
development and individual or social
capability. It means that education is a forming
of mentality, i.e. attitude with capability in the
form of intelligence, knowledge and skill.
Education is all of efforts to build personality
and human capability physically and
spiritually in a long of live, either in or out of
school for the development of unity of
Indonesia and society (Hasibuan, 2005).
Based on chi-square test there is a
significant correlation between education level
of mother and the number of first molar caries
(p < 0.05). Education is one of factors
influence individual health status. The role of
parents especially mother is required to guide,
and provide the child with understanding,
facilities of dental and oral care. First molar
tooth has a first position that attacked by caries
because there is niche or fissure and the
eruption time of the teeth for the child on age
6 – 7 years old. The prevention of caries for
the teeth with niche and fissure on the surface
is very necessary.
Conclusion and Suggestion
A. Conclusion
Based on the result of research, the writer
interest to withdraw a conclusion that the
educational level of mother in junior and
senior high school (SMP and SMA) has a
higher rate of dental caries (4 first molar) for 9
child (22.5%) while the educational level of
mother who graduate in elementary school all
of the child have first molar caries.
Based on chi-square test it indicates that there
is a significant association between the
educational level of mother and the number of
first molar caries (p<0.05). It means that more
76
higher a mother education the amount of first
molar caries teeth be lower.
B. Suggestion
1. The school must build a mutual
cooperation with society health center
(Puskesmas) in dental health care
activities in school (UKGS) in order to
provide the child on age 6 – 7 years
old with oral and dental health care
especially to the first molar.
2. The child on age 6 – 7 years old at SD
Baptis must maintain the dental and
oral health by brush the teeth
effectively and rightly.
3. The parents must play an important
role in guide the child and maintain
the oral and dental health of the child
and maintain the growth and
development of first molar of the child
to prevent the dental caries early.
DAFTAR PUSTAKA
Budiharto. 2008. Pengantar Ilmu Perilaku
Kesehatan dan Pendidikan Kesehatan
Gigi. Buku Kedokteran. EGC: Jakarta
Dictionary of Education (1984)
Harshanur, W. I. 1995. Anatomi Gigi. Buku
Kedokteran Gigi. EGC: Jakarta
Herijulianti, E. 2002. Pendidikan Kesehatan
Gigi. Buku Kedokteran Gigi. EGC:
Jakarta
Notoatmodjo, S. 2003. Pendidikan dan
Perilaku Kesehatan. PT Rineka Cipta.
EGC: Jakarta
Notoatmodjo, S. 2010. Metodologi Penelitian
Kesehatan. PT Rineka Cipta. EGC:
Jakarta
Sariningsih, E. 2014. Gigi Busuk dan Pocket
Periodontal Sebagai Fokus Infeksi. PT
Gramedia. Jakarta
Susanto, G. W. 2011. Terapi Untuk Kesehatan
dan Kecantikan Gusi. Erlangga
Suwelo, S. I. 1991. Petunjuk Praktis Sistem
Merawat Gigi Anak di Klinik. Buku
Kedokteran. EGC: Jakarta
Tarigan, R. 2012. Karies Gigi. Buku
Kedokteran. Buku Kedokteran. EGC:
Jakarta
RELATIONSHIP BETWEEN MATERNAL BLOOD GLUCOSE LEVEL
AND NEWBORN’S BIRTH WEIGHT IN MATERNITY CLINIC
OF MEDAN SELAYANG DISTRICT 2014
Melva Simatupang, Yusrawati Hasibuan, Tri Marini SN
Department of Midwifery, Poltekkes Kemenkes Medan
Abstract
According to IDF in 2012, there were over 300 million people worldwide are suffering from diabetes
and approximately 60 million from that population are women who eventually are at reproductive age
(15-49 years of age). In Indonesia, incidence of gestational diabetes mellitus is around 1.9-3.6% and
the prevalence is around 1.9-3.65%. In addition to that, prenatal deaths from mothers who previously
had gestational diabetes mellitus accounts for 3.5%. Thus, this study aims to investigate the
relationship between maternal blood glucose level and newborn’s birth weight. This study is a
quantitative study using cross sectional design. The population taken in this study was all pregnant
women who attended Maternity Clinic of Medan Selayang District. From that population we assessed
the total number of 51 people as our sample in which all were third trimester pregnant women who
attended Maternity Clinic of Medan Selayang District from July to October 2014. Based on our study,
we found that there is relationship between maternal blood glucose level and newborn’s birth weight
(r = 0.569) and relationship between maternal weight gain and newborn’s birth weight ( r = 0.365).
Meanwhile there isn’t any relationship appeared in gravidity status. The result obtained from using
backward method showed r square 0.392, P value <0.05 and the most influential variable is maternal
weight gain. Therefore, we suggest all health care providers to provide appropriate antenatal care in
order to screen, control as well as manage the condition of gestational diabetes melitus.
Keywords: blood glucose level, birth weight.
Introduction
Diabetes Mellitus (DM) is one of non
communicable diseases, marked by the
increase of blood glucose level due to
insufficient insulin secretion or insulin
resistency. Based on the recent report of IDF
(International Diabetes Federation) in 2012,
there were over 300 million people worldwide
are suffering from diabetes and approximately
60 million from that population are women
who eventually are at reproductive age (15-49
years of age). Insulin resistency usually
begins in the middle of the pregnancy (20-24
weeks of gestation). Through facilitated
diffusion on placental membrane in fetus
circulation, there happens to be an abnormal
energy source content that may contribute to
later complications.
In Indonesia, based on SulliavanMahan diagnosis criteria, it was reported that
the prevalence of gestational diabetes mellitus
is 1.9-3.65%. In case of individuals (pregnant
women) who have familial history of diabetes
mellitus, the prevalence is even increasing to
5.1 % and approximately 40 % of women that
previously had gestational DM gave birth to
overweight babies regardless the age of
gestation and around 20-50% babies who were
born from gestational DM mothers suffer from
hypoglycemia (blood glucose < 30 mg/dl).
Proportion of diabetes melitus in women who
are actually at reproductive age is 3.6%,
therefore firm strategies are needed in order to
decrease the prevalence and prevent the case.
Gestational diabetes mellitus will
further lead to complications due to its efect
on both metabolic and hormonal condition.
The proportion of this type of disease accounts
for 0.3-0.7%. Undetected or uncontrolled
diabetes mellitus will not only danger the
pregnancy but also the labor, therefore
gestational DM is a life threatening condition
for both mother and newborn. Babies who
were born from mothers who previously had
gestational diabetes mellitus will be more
likely to suffer from type 2 diabetes mellitus.
Aleida (2011) stated that gestational DM is a
continous condition which means that it may
happen to be persistent and women at
reproductive age are more likely to develope
that condition. Approximately 40-60% of
women who had gestational diabetes mellitus
develope diabetes or glucose intolerance
afterwards.
77
Gestational diabetes mellitus doesn’t
only contribute to prenatal deaths but also
prenatal morbidities. In addition to that,
gestational DM also plays a role in increased
ceasarean-section and higher risk of chronic
hypertension for the mothers. Women who
suffered from gestational DM are more likely
to give birth to overweight babies, thus
explaining why these women undergo
ceasarean-section. Further more 20-50% of
babies who were born from gestational
diabetes mellitus mother suffer from
hypoglycemia in the first 24 hours after birth.
In the other hand, women who had diabetes
mellitus prior to pregnancy are more likely to
get more complicated pregnancy and labor,
overweight babies, blood vessels narrowing
and fetal death, babies with congenital defect
at around 4.1%. In case of bad glycemic
control through pregnancy, some other
complications may appear, such as vascular
complication which causes low birth weight,
neurology defect (20%), hypoglycemia (2525%), hypomagnesemia, hyperbilirubinemia
(20-25 %), neonatal asphyxia(25%) and
neonatal acute respiratory distress syndrome
(ARDS).
A preliminary study that took place in
Mahdarina Maternity Clinic in Medan
Selayang District, assessing 7 pregnant
women, showed a relationship between blood
glucose level of third timester pregnancy
women and newborn’s birth weight, r = 0.44.
Based on that result, we are intrested in
investigating the relationship between blood
glucose level of pregnant women and
newborn’s birth weight.
The objective of this study is to
investigate the relationship between maternal
blood glucose level and newborn’s birth
weight in Maternity Clinic of Medan Selayang
District in 2014 by measuring several
parameters, as well as to identify most
influential factor that contributes to newborn’s
birth weight. Therefore, we hypothesized that
there is a relationship between blood glucose
level of pregnant women and newborn’s birth
weight. We expect that this study will provide
additional information in order to increase
health care by implementing early detection of
the disease.
Method
This study was conducted by using
cross sectional method in order to investigate
78
the relationship between maternal blood
glucose level and newborn’s birth weight. This
study took place in Maternity Clinic of Medan
Selayang District from July to October 2014.
The population of this study was all
third trimester pregnant women that visited the
Maternity Clinic of Medan Selayang District
for medical check up through July till October
2014. Subjects are elligible when all the
inclusion criteria can be fullfiled. Hence we
determined several inclusion criteria as
follows:
1. Third trimester pregnant women that
has stated aggreement to this study
2. Pregnant
women
without
any
previously recorded complications,
such as hypertension, heart diseases,
pulmonary diseases and infection.
We also determined the sample size by
using this formula,
n=
2
+3
(r = 0.44 and β = 0.1), thus the sample size
became 51.
In conducting this study we didn’t
only use the secondary data but also the
primary data. Primary data was obtained from
direct interview with respondents using
questionnaire instrument and venous blood
was taken to measure the glucose level by
using glucose meter. Blood sampling was only
conducted after the respondents had been
informed. Birth weight was measured directly
at the first few minutes after birth.
Instruments used during this study are
as follows:
1. Questionnarie
which
assesses
characteristics of respondents; age,
age of current pregnancy, parity status,
education level
2. Blood glucose measurement using
glucose meter, alcohol swab, strip test,
needle (lancet), and lancing device.
3. Baby scale
We also applied several consecutive
procedures as follows:
A. Blood Sampling
1. Determining sample based on inclusion
criteria.
2. Asking the agreement statement from the
subjects through inform consent.
3. Assessing the questionnarie.
4. Instructing the participants to fast from 10
pm to 7 am next morning when blood
5.
6.
7.
8.
9.
10.
11.
12.
sample will be taken. In this research,
blood sampling procedure was conducted
by standardized lab analysts and
midwives.
Preparing the patient.
Applying tourniquet in the upper arm.
Palpating the vein in which the blood will
be taken.
Applying the alcohol swab on the surface
of the site.
Using 3 ml syringe to take the blood,
blood taken was 2 ml.
Putting off the tourniquet.
Transporting all blood sample to Health
Laboratory of North Sumatra for blood
glucose measurement.
Colecting the result of the measurement.
B. Weight gain was assessed from
patient’s medical record. Patient is
considered having weight gain when
there is an increase of weight prior to
delivery from weight recorded before
pregnancy. Amount of gained weight
was obtained by substracting weight
prior to delivery from weight before
pregnancy.
C. Newborn’s birth weight was obtained
from clinic’s documentation.
All data were then analyzed using
univariate, bivariate and multivariate analysis.
Statistical analysis being used in this study
was multiple linear regression.
Results
Table 1
Characteristics of patients at Maternity Clinic
of Medan Selayang District 2014
Var.
n Min Max Mea
SD
n
Age
51 18
43
28.5 5.79
7
Blood
51 65
306 114. 44.
Glucose
53
018
Parity
51 1
5
2
1
Weight
Gain
Birth
Weight
51
7
21
51
2500 420
0
10.0
2
3123
.53
2.55
434.
20
Based on the above result, majority of
pregnant women are around the healthy
reproductive age. The avarage blood glucose
level is mostly above normal (114.53 mg/dL).
a. Bivariate Analysis
After assessing both variables (blood
glucose level and birth weight), we found that
there is a significant positive relationship
which means that the more the blood glucose
level of a pregnant woman, the more likely she
will give birth to overweight babies (r =
0.569). The result using correlation and
regression mode showed that newborn’s birth
weight is proportional to maternal blood
glucose level (2480.471 + 5.615 (blood
glucose)). Furthermore we also assessed the
relationship of weight gain and newborn’s
birth weight in which we found significant (r =
0.365 and r square = 0,33 with p < 0,05).
We also found that newborn’s birth
weight is not related to maternal parity status
(r = 0.251, r square = 0.06, p = 0.76).
b. Multivariate Analysis
The regression equation that we
obtained is “ Bith weight = 2085.106+5.133*
blood glucose + 45.194* gained weight”
which indicates that newborn’s birth weight is
influenced by both maternal blood glucose
level and gained weight during pregnancy.
Discussion
1. Relationship between blood glucose
level and newborn’s birth weight
As seen in our study, there is a
significant relationship between blood glucose
level and newborn’s weight. This is in
accordance with another study from Robert
that stated that overweight babies are more
likely to be born from mothers who previously
had higher blood glucose level. This is also
supported by Research group that found that
there is a strong relationship between maternal
blood glucose level and newborn’s weight.
Another study by Vaishali et. al also supported
this result in which higher maternal glucose
level contributes to higher newborn’s birth
weight.
This study is in line with recent theory
stating that there’s always been metabolic
changes (hormones, glucose) which plays a
role in supplying adequate nutrition for the
fetus. Fetus gain glucose from maternal supply
79
through the placental membrane, thus fetal
blood glucose level will represent maternal
blood glucose level as well. The regulatory
mechanism for glucose level is primarily done
by insulin. When mother is not able to secrete
adequate insulin to lower her high blood
glucose level, the fetus will then compensate
this by secreting more insulin which will also
stimulate the growth of the fetus and later may
lead to insulin insensitivity in the baby.
2. Relationship between maternal
parity status and newborn’s birth
weight
Our study found that there is no
relationship between maternal parity status and
newborn’s birth weight. Through literature we
found that the only difference between first
and later pregnancy usually is felt as
subjective feeling by mothers. Due to loosen
endometrium, most women who are having the
second pregnancy feel that their belly gets
bigger much more quickly so that they feel
that the babies are overweight or bigger than
that in the first pregnancy (Murkoff et. al,
2006).
3. Relationship of maternal weight
gain and newborn’s birth weight
According to our study, there is a
positive relationship between maternal weight
gain and newborn’s birth weight. This result is
in accordance with Shin Kim and team that
found that only 5.6% normoweight women
without DM that gave birth to overweight
babies compared to 12.6% overweight/ obese
women without DM that gave birth to
overweight babies. Meanwhile in overweight/
obese women with DM the proportion is even
increasing to 17.3%.
Another study in Bunda Setia
Maternity Clinic also found similar result that
women who gained excessive weight during
pregnancy are more likely to give birth to
overweight babies (OR = 0.126).
Normally maternal weight gain during
pregnancy is approximately 9 to 13.5 kg
(Mandriwati,2008). In second and third
trimester, weight gain as many as 0.4 kg each
week is considered normal in healthy women.
In the other hand, women who are
underweight or overweight are encouraged to
gain 6 to 8 kg during second and third
trimester or 9 to 11 kg respectively.
80
Another study showed that weight
gain is positively correlated to newborn’s birth
weight, p < 0.01, correlation strength:
medium. Maternal weight is the result of
addition of both maternal weight before
pregnancy and weight during pregnancy. This
serves as representation of maternal nutritional
status prior to pregnancy. Maternal weight
shows strong relationship to newborn’s birth
weight in which underweight mothers are tend
to give birth to underweight babies, while in
the other hand, overweight mothers are more
likely to give birth to overweight babies.
Phaneendra et. al also mentioned that both
excessive and insufficient weight gain during
pregnancy can lead to serious problem for both
mother and baby.
Conclusion and Future Direction
1. There is a strong relationship between
maternal blood glucose level and
newborn’s birth weight (r = 0.569) in
Maternity Clinic of Medan Selayang
District 2014.
2. There is no relationship between
parity and newborn’s birth weight in
Maternity Clinic of Medan Selayang
District 2014.
3. There is a relationship between
maternal weight gain and newborn’s
birth weight (r = 0.365) in Maternity
Clinic of Medan Selayang District
2014.
4. Blood glucose level during pregnancy
showed r square = 0.392 indicating
that this variable is able to explain
39.2% variation in the dependet
variable (newborn’s birth weight).
5. The most influential independent
variable to newborn’s birth weight is
maternal weight gain.
Therefore, we suggest all health care
providers to provide appropriate antenatal care
in order to screen, control as well as manage
the condition of gestational diabetes melitus.
References
Cunningham, F.Gary. 2007. Wliiam Obstetrics
ed 22nd. Mc-GrawHill.
Departemen Kesehatan R.I Laporan Hasil
Riset Kesehatan Dasar (RISKEDAS)
Indonesia Tahun 2007. 2008. Jakarta:
Badan Penelitian dan Pengembangan
Kesehatan.
Murkoff H, Einsberg A, Hathaway S,2006
Kehamilan, Medical Consultant.edisi 3,
Jakarta : Arcan.
IDF.Women and Diabetes, Internasional
Diabetes.2012. [accsessed from http://
riskesdas.idf.org/women
–
anddiabetes. on 14th December 2012
Jurnal
Kesehatan
Reproduksi
Vol.3.
No.1.2012. Jakarta .Badan Penelitian
dan
Pengembangan
Kesehatan
Kementerian
Kesehatan
Republik
Indonesia.
Mansjoer, arif. 2000. Kapita selecta jilid 1.
Jakarta : Media Aesculapius.
Mochtar R, Sinopsis Obstetri Penyakit
endokrin dalam Kehamilan Edisi
2.1998. Penerbit kedokteran.
Prawirohardjo S, Buku acuan Nasional
Pelayanan Kesehatan Maternal dan
Neonatal. Yayasan Bina Pustaka 2000.
Jakarta. JNPKR.
Neil , Wendy R ,Perawatan Kehamilan, 2008 ,
penerbit Dian rakyat, Jakarta edisi ke 7.
Sastroasmoro S,2011, Dasar – dasar
Metodologi Penelitian Klinis, Sangung
Seto Edisi ke 4.
Accsessed
from:
http://www.blogdokter.net/2007/06/25/d
iabetes-melitus-ii-pada-kehamilan/.
Accsessed from: consumer.healthday.com on
26th October, Overweight Moms May
Have
Dangerously
Big
Babies,
Excessive weight gain leads to serious
problems for mothers and infants, study
suggests
IDF.Women and Diabetes, Internasional
Diabetes.2012. [accsessed from http://
riskesdas.idf.org/women
–
anddiabetes. Diakses on 14th Desember
2012
Robert G , Denis , Pregnancy outcomes in
women without gestational diabetes
mellitus related to the maternal glucose
level, Is there a continuum of risk?
Diabetes carrier.
Maternal Postprandial Blood Glucose Levels
and It’s Relation with The Pregnancy
Outcomes.
Pregnancy Outcomes in Women Without
Gestational Diabetes Mellitus Related to
the Maternal Glucose Level
Hyperglycaemia and Adverse Pregnancy
Outcomes.
81
PHENOMENOLOGICAL STUDY ON PREGNANCY CARE
EXPERIENCE IN MOTHERS AT JORONG BERASTAGI NAGARI
UJUNG GADING, LEMBAH MELINTANG SUBDISTRICT, PASAMAN
BARAT, WEST SUMATERA
Nurul Azmi, Nur Afi Darti
Abstract
Pregnancy care is done during pregnancy which is more emphasized on the health of the mother. The
objective of the study was to find out the experience in pregnancy care in mothers of Jorong
Berastagi. The study was phenomenological qualitative with Colaizzi analysis. The samples were five
mothers who had met the criteria, taken by using purposive sampling technique. The data were
gathered by conducting in-depth interviews and field research. The result of the study showed that
there were ten themes which described the characteristics of nursing care experiences in mothers
pregnancy. The thematics categories included complaint during pregnancy, stimulus whitch causes the
complaint, mothers response to the source for getting information about the fact that they had to
accept about pregnancy, attempts to cope with complaint/pregnancy problem, the source of
information to examine the pregnancy, any action for supporting health during the pregnancy which
included medical and alternatives, the kinds of favored food during pregnancy, and activity during the
third trimester of pregnancy, support which was obtained during pregnancy, and any culture which
was believed during pregnancy. Since there was the deviation in pregnancy care in the study area,
competent nurses were needed. In the implementation of holistic nursing care, nurses should give
their respect to the local peoples cultural values so that the local people will easily accept modern
medical science at Puskesmas in order to improve their health.
Keywords : Experience, Pregnancy care, Phenomenology
1. Background
Pregnancy is the most exciting and
eagerly awaited every couple.
Manuaba (2010),
stating that the pregnancy is
intrauterine
fetal
growth
and
development ranging from conception
and ends until the delivery. Pregnancy
lasts for about 10 months, or 9
calendar months, or 40 weeks, or 280
days (Bobak et al, 2005).
Adaptation to the hormones of
pregnancy is a result of pregnancy and
mechanical stresses due to the
growing uterus and other tissues. This
adaptation of protecting a woman's
normal physiological function, meet
metabolic demands of pregnancy a
woman's body, and provide for the
needs for the development and growth
of the fetus. (Medforth et al, 2011).
The impact of the adaptation of
pregnancy cause a sense of discomfort
82
during kehamlan like fatigue, frequent
urination, nausea, vomiting, breast
sensitive, prone to vaginal infections,
decreased appetite, decreased muscle
tone, lordosis, headache (Bobak et al,
2005).
Prenatal care is very influential on the
health and safety of the baby to be
born. Women who regularly go to
health care facilities for prenatal care
will have good health and a healthy
baby. While women who have poor
health will be more susceptible cause
of infant mortality. Quality antenatal
care still needs to be improved
continuously,
because
of
the
availability of referral facilities for
high-risk cases can reduce maternal
mortality (Sri, in 2013).
Expectant mothers and maternity
mortality is influenced by several
factors: education, science, social,
cultural,
social,
economic,
geographical and environmental,
mother Accessibility to health
facilities as well as macro policies in
the quality of health services. One of
the factors that affect maternal
mortality is the attitude and behavior
of the mother during pregnancy itself
and supported by the knowledge of the
mother against her pregnancy.
(Agustini, 2013).
Indonesian society there is a
traditional antenatal (Devy et al,
(2011). Culture for the community an
important thing, even among trusted
and been a lifeline. Community
jorongBrastagih,
revealing
some
phenomena. In this ethnic culture
phenomena in the experience of
prenatal care , where pregnant women
do pregnancy checks to artisan
machination, even pregnant women
already perform checks to midwives,
but due to hereditary culture in this
area, pregnant women still undergo
the masseuse and also listen to
messages from a masseuse in matters
abstinence during a period of
pregnancy. Ordering is also done so
that the position of the fetus remains
in place again, because the activity is
believed to affect changes in maternal
fetal
position.
But more about this culture is not yet
known, so it is necessary to dig about
the behavior of the public to know and
dig Experience Pregnancy Care On
Mothers in JorongBrastagihNagari
Ujung
Gadingsubdistrict
Valley
Crossing.
2. Research Methodology
The research is a qualitative research
with phenomenological approach,
about Pregnancy Care Experience At
Mothers in JorongBrastagih Ujung
GadingsubdistrictNagari
Valley
Crossing. The inclusion criteria: 1)
mothers Minang tribe, 2) Having a
maximum of 5 years experience, 3)
Willing to be a respondent to obtain
richer information (rich information)
as well as voluntary or not under
pressure. The sample selection of this
study through purposive sampling
technique as much as 5 people having
reached the saturation of data (Polit
and Beck, 2008).
Collecting data in this study conducted
by the method of observation (passive
participant observation) and in-depth
interviews (depth interview).Data
analysis method with approach
Colaizzi (1978) in Polit en Beck,
(2012).
Member checking conducted by
researchers to participants to validate
the results of interviews and thematic
results done during data analysis.
3. Results
Ujung GadingNagari tribes divided
into two parts, but the vast majority
were ethnic MinangNagari as well as
all
residents
of
the
Ivory
UjuangMinang and indigenous people
say that they use the custom also
Minang.
The end of the economic situation
Nagari population was down to the
middle of ivory, most of the
population have jobs as farmers, farm
employees and wirausaha.Tingkat
education / graduate education in
Nagari Ujung Gading most most
elementary level as many as 11 264
inhabitants, as many as 13 051
inhabitants junior, Bachelor ( S1-S2)
as many as 11 893, as many as 1,575
high school, kindergarten as many as
1,474 lives and Academy (D1-D3)
1,025 souls.
The study involved five participants
who have experience maximum
prenatal care experience five years
ago, the average age of the last child 5
years old, high school education
background. All the participants are
married
and
not
working.
83
Table 1. Categories and themes were obtained from all participants.
No Themes
1. Complaints experienced during pregnancy
Categories
Do not want to eat and appetite
Edema in legs
Numbness in the feet
Colds
Dizziness dizzy view
No appetite
Nausea
Body feels weak
Pain in the nipple
Myoma.
2. Stimulus that cause odor complaints
The smell of cookingrice, chilifries,
the smellmeatballsandmilk
eat rice
3. Response to the acceptance of pregnancy the mother during Grumpyhusband
pregnancy
Lappingstomachwhile pregnant
Wantto terminate the pregnancy
Hate with pregnancy
4. Efforts to deal with complaints / problems of pregnancy
Go to the midwife
PHC
Hospital
Artisan buzz
Alternative treatment
Eating bark and areca
5. Sources of informationthat was obtainedforprenatal care
Brother
Family
6. Acquiredform of actionto
knowingDJJ
supporthealthcareduringpregnancyincludesmedicaland
Knowing thedate of delivery
alternative.
Knowing thematernalandfetalhealth, ultrasound
immunization
obtainingvitamins
Fixingthe position ofthe fetus
relax the body
Fetalhealth check
Determining whentogive birth.
7. The preferred type of nutrition during pregnancy Milk
milk
bread
Spicyfish curry
Sourspicygoulash
fried chicken
CarrotsvegetablesandvegetableJipang
steamedcakesusechili
8. Activities conducted in the third trimester of pregnancy
Walk in the morning
9. Supportobtained duringprenatal careexperience
Husband always concern
availability husband
Family and dear brother
Husband helps her needs.
Glad to neighbors
Good socialization,
Relationship with her husband, a good family
Husband still mingingatkan to eat
10 Culturebelievedduring pregnancy
During pregnancyshould not besitting behindthe
Do not sitin front of thedoor
84
4. Conclusions and Recommendations
Research results obtained from the fifth
respondents about pregnancy care community
in Jorong Brastagi found that this community
has a cultural concept about prenatal care, and
there are some cultural practices conducted for
pregnancy care. The concept is in the form of
complaints during pregnancy, the stimulus that
causes the complaint, the response to
pregnancy, tackling complaints of pregnancy,
resources obtained for prenatal care, acquired
form of action to support health care during
pregnancy, type of preferred food during
pregnancy, the activities conducted the third
trimester of pregnancy, the support obtained
during prenatal care and culture believed
during
pregnancy.
do an alternative massage. Prenatal care is
commonly
done
by
mothers
in
JorongBrastagih
is
setting
activities,
alternative massage to improve the position of
the fetus, the choice of food, and gained
support during pregnancy.
Women's health problems are increasingly
complex and require a comprehensive
settlement requires competent management
nurses in the field. So in an effort to
implementation of holistic nursing care nurses
should respect the cultural values of society.
Thus the public will be more receptive to
modern science and by itself would make the
decision to utilize health services at the health
center which is expected to improve the health
of local communities
The cultural practice carried out during
pregnancy that consume traditional foods, and
85
MAPPING THE RISK FACTOR OF LEPTOSPIROSIS
IN KLATEN DISTRICT
Nelson Tanjung1, Desy Ari Apsari2, Erba Kalto Manik3
1,2,3
Health Polytechnic, Ministry of Health, Medan, Evironmental Health Department
email : [email protected]
Background: Leptospirosis is a zoonotic, that occurs in many part of the world, most countries in
Southeast Asia declared as endemic areas of leptospirosis. Indonesia is a country with high case
fatality rate of leptospirosis reaching 7.1%, with a range between 2.5 - 16, 45%, in patients aged over
50 years the mortality rate can reach 56%. Klaten district includes one of the distribution of
leptospirosis. Data in 2008 showed that 21 were positively infected by leptospires of 66 people under
investigation. In 2010 there were 5 deaths from 15 cases were found. Cases continue to rise in 2011
and expanded in several villages and districts, especially areas that are near the area of rice fields and
streams. Knowing distribution maps the risk factor of leptospirosis in Klaten.
Methods: An observational study design with a combination of ecological and case-control
study. Implemented in Klaten in 2011. Subjects were residents who are leptospirosis diagnosed or
infected with Leptospira. Diagnosis is confirmed by a doctor based on clinical criteria of WHO-1982
and/or diagnostic test equipment (leptotec and/or MAT). Samples were taken of 210 people
consisting of 105 cases and 105 controls. Analysis of data used is average nearest neighbor,
Mc. Nemar and conditional logistic regression (CI: 95%).
Results: The mapping distribution of leptospirosis in Klaten is clustered at coordinates 454 230,
9.15211 zone 49S, a radius of 423.86 meters. Mapping of risk factors in areas with poor sanitation.
Risk factors showed that house sanitation (OR = 7.89, 95% CI: 2.68 to 23.21, p = 0.000), employment
(OR = 3.77, 95% CI: 1.49 to 9 , 54, p = 0.005) and the presence of mice (OR = 3.58, 95% CI: 1.35 to
9.49, p = 0.010).
Conclusion: Characteristics of cluster formation region is close to the rice field area, a densely
populated residential houses at a distance close enough/meetings (less than 20 meters). The most
dominant risk factor is a house sanitation.
Key words: Mapping, risk factors, leptospirosis
Leptospirosis including zoonoses that
occur throughout the world, especially in the
tropics and subtropis1. Most countries in
Southeast Asia expressed as leptospirosis2
endemic areas. Leptospirosis incidence
worldwide is difficult to know exactly,
because the disease is often under diagnosed.
Mild cases are often not diagnosed as
leptospirosis. World Health Organization
(WHO) noted that the incidence in temperate
regions ranged between 0.1-1/ 100,000
population per year, whereas in the humid
tropics tend to be higher at 10-100 / 100,000
population per year. During an outbreak in a
high risk group the incidence can reach
>100/100,000 penduduk3,4.
Reports Leptospirosis Society (ILS),
states that in 1999-2000 the outbreak of
leptospirosis occur several countries, namely
in India, Thailand, France, USA, Brazil,
Uruguay, Indonesia and several other
countries. In fact, the 2000 data mentioned
86
case fatality rate (CFR) in Indonesia (16.7%)
ranks third in the world after Uruguay (100%)
and India (21%)5. On average CFR
leptospirosis in Indonesia is quite high at
7.1%, with a range between 2.5 to 16.45%. In
fact, in patients aged over 50 years the
mortality rate can reach 56%.
Leptospirosis in Indonesia in the last 6
years (2004-2010) tends to increase, as a result
of the increase in cases in several areas that are
often flooded, especially in Jakarta and Central
Java. It was reported that in 2007 the number
of cases reached 666 with 57 deaths in 2008
fell to 263 cases with 16 deaths. Regional
distribution of leptospirosis in Indonesia, West
Java, Central Java, Yogyakarta, Lampung,
South Sumatra, Bengkulu, Riau, West
Sumatra, North Sumatra, Bali, West Nusa
Tenggara, South Sulawesi, North Sulawesi,
East Kalimantan and West Kalimantan.
Recorded outbreaks in Indonesia occurred in
Riau (1986), Jakarta (2002) (138 specimens
obtained with 44.2% positive), Bekasi (2002),
and Semarang (2003)6.7.
Leptospirosis disease was first
discovered in the district of Klaten in 2005
were 3 cases. Based on the incident Klaten
District Health Office carry out screening.
Screening results indicate that 21 people tested
positive for leptospira infection of 66 people
were examined. Leptospirosis re-emerged in
2008 in the Northern District of Klaten. In
2010 there were 5 deaths of 15 cases were
found. Until 2011 leptospirosis in Klaten
district continues to increase8.
The problems is disease already
widespread in several villages and districts,
especially areas that are close to the rice fields
and streams. The rainy season, housing and
environmental sanitation conditions where rats
around the residence is thought to be the cause
of the increase in cases. Mapping the
incidence of leptospirosis is one attempt to
obtain location information accurately
mapping the spread of leptospirosis following
risk factors.
Reseach Methods
This observational study design was
used with a combination of ecological studies
case control study, to study the distribution
pattern and risk factors for leptospirosis in
Klaten District. The variables studied were
individual characteristics (income, occupation
and education), and environmental (density
residential, home sanitation, where rats and
location of the cage). Subjects were people
who were diagnosed with leptospirosis either
found in hospitals and in the community
survey results, confirmed by a doctor's
diagnosis based on clinical criteria set by the
WHO (1982) and or diagnostic test equipment
(leptotek and or MAT). Sampling was done by
purposive sampling. Spatial analysis is used to
view the distribution pattern of leptospirosis.
1. Mapping analysis of leptospirosis
Results of the analysis showed that the
average nearest neighbor nearest neighbor
index (nearest neighbor ratio) from the point
of the case was 0.7 (<1), the value of
Z score : - 5.84 and p-value of 0.01, thus it can
be said distribution pattern of leptospirosis in
the district of Klaten is clustered distribution
(clustered), as shown in Figure 1.
Figure 1. Analysis of
Leptospirosis Risk
Factors in the district of Klaten
April 2009 - August 2011
Regional grouping use
cases seen Purely Spatial analysis Bernoulli
model. Results of the analysis as shown in
Figure 2 shows a grouping in the form most
likely cluster centered at coordinates 454 230,
9.15211 UTM zone 49S, a radius of 423.86
meters and a p-value of 0.017, in the village of
the District Senden Ngawen. Two secondary
cluster, centered on the coordinates 470 031,
9.15427 UTM zone 49S, a radius of 102.59
meters and a p-value of 0.017, in the village of
the District Kenaiban Juwiring. District of
Karangdowo Karangjoho village centered on
the coordinates 474 406, 9.1474 UTM zone
49S, a radius of 107.17 meters and p-value of
0.017.
87
Figure 2. Clustered of Leptospirosis
Grouping of leptospirosis cases that
occurred in the Klaten district shows that the
potential transmission of leptospirosis to the
people who live in areas where clusters (most
likely cluster and cluster secodary) are likely
to be greater when compared to people living
in other areas outside the clusters.
Characteristics of cluster formation
region (most likely cluster and cluster
secodary) in general is an area with a high
population density, the majority of the
population worked as farmers or agricultural
laborers and the distance between the houses
are
very
close.
Results indicate that the buffer in the case of
point clusters of cases at the primary and
secondary clusters tend to cluster in a radius of
15 m - 30 m (Fig 3). Leptospirosis cases are
more common in residential areas with fairly
high density of buildings, thus environmental
conditions are very favorable for mice. Homes
are fairly close distance rat facilitate moving
from one house to another either for nesting
and foraging.
Results of research on leptospirosis
transmission occurring in urban areas in
Salvador, Brazil showed that leptospirosis
transmission tends to occur in poor residential
areas
with
fairly
dense
residential
neighborhood poor sanitary conditions9.
Similarly, the results of research
conducted in São Paulo Southeastern Brazil,
88
stated that the increase in cases of leptospirosis
occurs largely in the poor, who live in dense
residential area and dirty10. WHO states that
the environment is very dense slum is one of
the risk factors of leptospirosis11.
Figure 3. Buffer in Rice Fields Most Likely
and Secondary Clustered
Buffer in rice fields showed that
62.96% of cases of leptospirosis in the primary
and secondary clusters tend to cluster in a
radius of 15 m - 50 m from the edge of the
fields, as shown in Figure 4. Based on
observations in the field looks a lot holes
around the rice field which is a nesting and
breeding place for rats. Habits make holes
around the rice fields aims to nurture their
children, besides mice will also make a hole in
the dike irrigation to reside. Availability of
rice can be used as indicators of an increase in
the rat population, because this environment is
a suitable habitat for the development of rat12.
Sehgal research on leptospirosis
epidemiological
patterns,
noted
that
leptospirosis is often seen in rural agricultural
areas in some South and Southeast Asian
countries including India's rural peninsula,
Northeast Thailand, southern China and the
Philippines. In which case the peak usually
occurs in the growing season and the harvest
season13.
Results of multiple ring buffer against
local roads or districts showed 44% of cases of
leptospirosis stay at a radius of 15-50 m from
local road / districts, but almost all of the cases
live quite close to the road environment..
However results observations showed that
50.5% of cases stayed in a radius of <50 m of
sewerage, most of these facilities are open
sewerage. Sunaryo research on factors that
affect the mapping and leptospirosis, stating
that the spread of leptospirosis cases that form
cluster in Semarang due to the environmental
risk factors that slum with waste water
disposal system which poor 14.
Reis in an environmental impact study
to Leptospira infection in slum dwellings
mention that the house is located close to the
sewerage open (<20 m) greater risk of
Leptospira infection (PR = 1.42, 95% CI: 1, 14
to 1.75) 15. Bovet in the study also stated that
the occurrence of leptospirosis in humans
because of their interaction with the
environment one of which is the physical
environment associated with the state of the
waste water ways16.
Buffer river showed that 28.57% of
the cases live in a radius of ≤ 50 m from the
river. Nardone stated that the residence
location adjacent to the river (ORMH = 3.0,
95% CI: 1, 6 to 5.6) is a risk factor associated
with the incidence of leptospirosis. but in this
study the proportion of cases who live very
close to the river <30%, so it can be concluded
that the risk factors for transmission of
leptospirosis is not dominated by residential
location close to river17. These results are
similar to studies Sugunan which states that
one of the risk factors for leptospirosis
outbreak was soaking in water (OR = 3.23,
95% CI: 1.47 to 7.21), whereas one of the risk
factors that could potentially cause acute
leptospirosis is to make the river as a source of
drinking water (OR = 4.4, 95% CI: 1.1 to
18.0)2.
Visualization using satellite images on
the Google Earth shows that the geography of
the spread of leptospirosis tend to be similar
among closely to the area of rice fields,
settlements densely populated with houses
close enough distance/conference (less than 20
meters). Primary cluster distribution region
that is located in the village of the District
Senden Ngawen and secondary clusters
located in the village of the District
Karangjoho
Karangdowo
and
Village
Kenaiban District of Juwiring, as shown in
Figure 5.
Figure 4. Buffer Rice Field in Most Likely
Cluster
89
Figure 5. Maps The Spread of Leptospirosis
2. Analysis of risk factors for leptospirosis
Bivariable analysis aims to determine
the relationship of each variable that is
suspected as a risk factor to the incidence of
leptospirosis. Mc.Nemar test results at 95%
confidence level can be seen in Table 1.
Table 1. Analysis Bivariable for Risk Factor
of Leptospirosis
Case
Control
OR
Exp
Unexp
Income
Low
33
43
Standart 13
16
Employment
Exposure 21
43
Unexposure9
32
Educations
Low
44
31
High
13
17
Density
Exposure 2
9
Unexposure2
92
House sanitation
Poor
43
54
Good
4
4
Present of rodents
Exposure 7
42
Unexposure6
50
Cattle pen position
< 50 mtr 29
44
≥ 50 mtr 18
14
90
95%CI
p
3,30 1,74-6,70 0,00*
4,78 2,29-11,14 0,00*
2,38 1,21-4,97 0,00*
4,5
0,93-42,79 0,03*
13,5 4,98-51,33 0,00
7
2,96-20,15 0,00*
2,44 1,38-4,49 0,00*
The analysis showed that the income
(OR = 3.30, 95% CI: 1.74 to 6.70, p; 0,00) is a
risk factor for leptospirosis cases in the district
of Klaten. This means that people who are
included in the category of low-income or
below the minimum wage (<Rp. 766 022) tend
to be more likely to be exposed to
leptospirosis. Data showed 58.10% and
72.38% of cases the respondents have incomes
below the minimum wage (UMR).
Okatini research that reveals that the
individual
characteristics
such
as
socioeconomic level is a risk factor for the
incidence of leptospirosis in Jakarta (OR =
1.93, 95% CI: 1.073 to 3.462, p: 0.039)18.
Other studies have shown a positive
correlation between individual characteristics,
namely economic levels with the incidence of
leptospirosis. Stated that the increase in cases
mostly occur in poor people who live in the
slums, inadequate sanitation conditions
mentioned as a source of transmission of
leptospirosis. Economic level low enough to
trigger allegedly poor sanitation in the area 10.
Employment (OR = 4.78, 95% CI:
2.29 to 11.14, p: 0.00), this means that people
in occupations potentially comes in contact
with the source of contaminants, (eg: farmers /
farm workers, ranchers, ornamental fish
sellers, abattoir workers, scavengers or other
jobs that are associated with water and or
sources of contaminants) are most likely to be
exposed to leptospirosis. In accordance with
Murtiningsih research that says that work as a
farmer (OR = 4.09, 95% CI: 1.18 to 14.12, p:
0.025) were risk factors for leptospirosis in
Yogyakarta19. Sarkar also said that exposure to
sources of contaminants in the workplace
increases the risk of leptospirosis 20.
Level of education (OR = 2.38, 95%
CI: 1.21 to 4.97, p: 0.00) indicates that
pertained education leptospirosis risk factors
in Klaten District. Factors person's educational
background is often associated with the type of
work that ultimately have an impact on
earnings. Someone who has a higher level of
education are more likely to get a good job, a
good income with standard anyway. Thus it
would affect the quality of life. Research
Okatini mentioned that the level of education
(OR = 3.74, 95% CI: 1.72 to 8.21) were risk
factors
leptospirosis18.
Residential density is a risk factor for
leptospirosis (OR = 4.5, 95% CI: 0.93 to
42.79, p: 0,03). Residential density often
associated with the arrangement of the house.
If the house irregular arrangement will create
places that can be used as a rat's nest, as well
as the waste generated, it can be used as a
source
of
food
for
rodents.
Sanitary house seen in this study is based on
several components of basic sanitation among
waste management, waste water disposal,
building construction, type of floor and rat
proofing conditions. The results showed that
92.38% of cases of leptospirosis in the district
of Klaten live in houses with poor sanitation.
Hand and Ristiyanto in the research stated that
hygiene / sanitation home (PR = 3.75, 95% CI:
1.28 to 10.16, p = 0.010) were risk factors for
leptospirosis in Demak. The low quality of
such services can be caused due to the
handling of poor waste management21.
The existence of rats (OR = 7, 95%
CI: 2.96 to 20.15, p = 0.00) and the location of
the enclosure (OR = 2.44, 95% CI: 1.38 to
4.49, p = 0.00), so it can be said that the
exposure of these two factors can increase the
risk of leptospirosis. The results showed that
97.14% of the cases seen rats around her house
and 46.66% of them stated often see rats in the
house (> 3 times/week). Similarly, the location
of the enclosure which showed that 45.71% of
cases put the cage together with a dwelling (0
meters from the house), while 28.81% making
cattle pen in a radius <50 meters from the
house.
Results of multivariable analysis using
logistic regression conditional test showed that
the risk factors that have a relationship with
the incidence of leptospirosis in Klaten district
in order are sanitary housing (OR = 7.89, 95%
CI: 2.68 to 23.21, p = 0.000), work (OR =
3.77, 95% CI: 1.49 to 9.54, p = 0.005) and the
presence of rats (OR = 3.58, 95% CI: 1.35 to
9.49, p = 0.01) , The analysis also showed that
47.28% incidence of leptospirosis in Klaten
district affected by their exposure to the three
risk factors at the same time, as tampat in
Table 2.
Table 2. Multivariable Analysis of Risk
Factors incidence of leptospirosis
Variabel OR
95%CI p
Pseudo Log
R2
Li.hood
House
7,89 2,680,000
sanitations
23,21
Employme 3,77 1,49-9,54 0,005 0,47
nt
Present of 3,58 1,35-9,49 0,010
rodents
-37,038
These results are consistent with
research Sarkar in Salvador Brazil, which
mentions the incidence of leptospirosis due to
sanitary conditions poor housing as the
collection of garbage, close to open sewers
and the presence tikus20. Reis also mentions
that Lepospira infections caused by
environmental exposure associated with
housing, work environment and a sign of the
presence of rats 15.
3. Model spatial relationships
Model of spatial relationships is the
visualization of the distribution of risk factors
that have an association with leptospirosis, the
results of multivariable analysis consisted of
sanitation home, work and the presence of rats.
visualization of the distribution of three risk
factors shows that the distribution of
leptospirosis in the district of Klaten more are
in areas with higher levels of residential
density. 56.19% of cases spread in the area of
an average residential density > 3.475 per
home (Figure 6).
91
Figure 6. Spread Mapping of Risk Factor
Results overlay exposure to risk factors in
cases of leptospirosis showed that 60% of
cases of leptospirosis exposed by one or more
of these three risk factors, while 40% of them
are exposed to other risk factors outside the
model. The frequency distribution of the
combination of exposure to risk factors for
leptospirosis in Klaten district can be seen in
Table 3.
Table 3. Exposure Risk Factors incidence of
leptospirosis
Exposure Risk Factors
House sanitations
Employment
Present of rodents
House sanitation and employment
House sanitation and present of
rodents
House sanitation, employment and
present of rodents
Risk factors outside the model
Cases
N
23
11
5
16
5
%
21,90
10,48
4,76
15,24
4,76
3
2,86
42
40
Data in the table showed the dominant
exposure of risk factors of the case are as
much as 21.90% of sanitary home and work as
much as 10.48%. Exposure to a combination
of two risk factors showed 15.24% of cases of
exposure to risk factors for home sanitation
and jobs, 4.76% of cases of exposure to risk
factors for the presence of rats and sanitary
home. As for exposure to the combination of
92
three risk factors shows the proportion of
2.86%. Furthermore, 40% of whom
leptospirosis cases are caused by exposure to
other risk factors, among which are equally
harmful activity contact with sources of
contaminants and environmental factors.
The results showed 82.9% of cases
have a habit of activities related to the sources
of contaminants in this water, including
fishing, swimming or bathing cattle in the
river, as well as looking eel, grazing and
herding cattle in the fields. The data also
showed that 69.5% of the cases are still found
which build cattle sheds with a distance <50
meters from the main house and even some of
them put the cage of the roof to the main
house. On the other hand still found 82.9% of
cases have a habit of activities related to the
sources of contaminants in this water. Among
the activities of fishing, swimming or bathing
cattle in the river, as well as looking eel,
grazing and herding cattle in the fields.
This fact further strengthens the principle that
the onset of disease epidemiology is needed
more than one cause (multiple causation) 22.
Conclusion
1. Distribution of leptospirosis cases in the
district of Klaten is clustered.
2. The incidence of leptospirosis in the district
of Klaten scattered in a radius of 15-30
meters in the surrounding rice paddies, 30-
50 meters around the local / district and
less than 50 meters around the river.
3. Employment associated with the incidence
of leptospirosis in Klaten District. Work as
farmers / farm workers as well as work that
allows a person exposed to contaminated
water rat urine will increase the risk of
transmission of leptospirosis.
4. The environmental conditions of housing
and sanitary housing that is associated with
the presence of rat leptospirosis cases in the
district of Klaten. House poor sanitation
and the number of mice around the house
increases the risk of transmission of
leptospirosis.
5. The mapping of leptospirosis in Klaten
district associated with environmental
factors. Home sanitary risk factors, the
presence of rats and residential density is a
risk factor dominant in the cluster area
leptospirosis.
Recommendations
A. Klaten District Health Office through
health centers seek to increase community
participation in the control of risk factors
for leptospirosis in both cluster and noncluster areas are:
a. preferably in the cluster area activities:
1. motivate people to perform regular
mutual
cooperation
to
improve
environmental sanitation housing
2. dissemination of the importance of using
personal protective equipment when
working, especially on jobs at risk
Leptospira
3. encourage people to re-harness trap
(mousetrap) in an effort to reduce
pupolasi rats around the residence.
b. preferably non-cluster region on activities:
1. The socialization of a clean and healthy
lifestyle that focused on personal hygiene
in an effort to prevent the occurrence of
Leptospira infection, especially in those
who frequently perform outside activities
2. Dissemination of the importance of using
personal protective equipment when
working, especially on jobs at risk Spira
B. Klaten District Health Office should
improve coordination with health centers in
the implementation of leptospirosis
surveillance and monitoring system of
mice, primarily in regions or clusters and
dense residential area and close to the area
of agriculture (rice) and rivers.
C. It needs further research to determine the
level of endemicity or level of vulnerability
to the spread of leptospirosis in the region
of Klaten District.
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DESCRIPTION OF KNOWLEDGE OF HIV/AIDS BY THE ELEVENTH
YEAR STUDENT OF SMAN 1 KUTALIMBARU DELI SERDANG
DISTRICT 2014
Netty Panjaitan, Surita Br Ginting
Department of Nursing, Poltekkes Medan
ABSTRACT
This study is descriptive research by cross sectional design it is aimed to know the description
of students knowledge of the eleventh grade of SMA (Senior High School) of HIV/AIDS.
Independent variables are ages, gender and source of information which dependent variables are of
students knowledge of the eleventh grade of SMA (Senior High School). The sample of this research
is about 38 students. The result shows that good knowledge is about 16 students (42,1%), fair
knowledge is about 13 students (34,2%) and lack of knowledge is 9 students (23,7%). Due to this
research the respondents’ knowledge of HIV/AIDS commonly is good but it is hoped that students
especially the eleventh grade of SMA (Senior High School) sustain and increase their understanding
of HIV/AIDS in order they are out of HIV/AIDS infection earlier..
Keywords : knowledge, immune deficiency, HIV/AIDS
References : 13 sources
1. The background
Human
immunodeficiency
virus
infection and acquired immune and deficiency
(HIV/AIDS) are spectrum of conditions
caused by infection with the Human
immunodeficiency virus (HIV). Following
initial infection, a person may experience a
brief period of influenza- like illness. This is
typically followed by a prolonged period
without symptom. As the infection progresses,
it interferes more and more with immune
system, making person much more susceptible
to common infections like tuberculosis, as well
as opportunistic infection and tumors that do
not usually affect people who have working
immune system.
Human Immunodefisiency Virus is
transmitted primarily via unprotected sexual
intercourse (including anal and oral sex),
contaminated blood transfusions , hypodermic
needles, and from mother to child during
pregnancy, delivery, or breastfeeding. There
is no cure or vaccine. A disease outbreak
which is a present over a large in the world
and is actively spreading.. There are many
misconception about HIV/AIDS, need health
education
Since its discovery, AIDS has caused an
estimated 36 million deaths worldwide as of
2012.And in 2013 it resulted in about 1.34
million deaths. As of 2012 approximately 35.3
million people are living with HIV globally.
The recording which has been held by
World Health Organization (WHO) in the last
few years show that the teenagers group which
are very susceptible to HIV/AIDS. Uncommon
situation of HIV/AIDS also occurred in
North Sumatra, In the year of 2012, the
amount of HIV case in North Sumatra were
3.573 cases. The highest case was dominated
by the productive age of 20-29 years (47,8%),
followed by the ages of 30-39 years (30,9%),
and the group of ages 40-49 years (9,1%). Of
this amount, 4.250 cases or 18,7% were dead..
Knowing that incubation period of HIV/AIDS
which is taken a long time, it is about 5-10
years, it can be realized that the group ages of ,
15-19 years has been infected by HIV/AIDS ,
they are about teenagers (Indonesia Health
Profile, 2012
2. The significance of the study
The significances of this study are generally as
additional input and information to know the
teenagers knowledge of HIV/AIDS so that it
can be proposed to have service to the
teenagers to realize the danger of HIV/AIDS
earlier.
95
3. Research Method
This study is descriptive which object
is to know the description of the eleventh year
student of SMA N 1 Kutalimbaru Deli
Serdang District knowledge of HIV/AIDS.
The design applied is cross sectional at the
same time.
4. The method of collecting data
Data collection which has been done
in this study is by delivering the questioners ,
first the researcher introduced herself and
explain the objective of the study, provide a
letter of agreement as a respondent and give
the questioner which should be filled by
respondents and returned back to the
researchers.
From this research which entitled
“Description Of Knowledge Of HIV/AIDS
By The Eleventh Year Student Of SMAN 1
Kutalimbaru Deli Serdang District found
which has been analyzed and presented in the
following table:
Table 4.1
Distribution Of Respondent’s Frequency
Based On Age In SMAN 1 Kutalimbaru
Age
Frequence
Percent (%)
< 17
17
44,7
≥17
21
55,3
TOTAL 38
100
Table 4.3
Distribution of Respondents Based On
Source Of Information (SOI) In SMAN 1
Kutalimbaru Deli Serdang District 2014
SOI
Electr.Media
Print Media
Medical staffs
TOTAL
male
13
34,2
female
25
65,8
TOTAL
38
100
From table 4.2 can be seen that total
respondent who are male are 13 students
(34,2%), female are 25 students (65,8%).
96
Percent %)
15,8
26,3
57,9
100
From table 4.3 it can be seen that total
respondent who get information from
electronic media are 6 students (15,8%) , print
media are 10 students (26,3%) and medical
staffs are 22 (57,9%).
Table 4.4
Distribution Respondent Frequency Based
On Knowledge In SMAN 1 Kutalimbaru
Knowledge
Frequency
Percent(%)
Good
16
42,1
Fair
13
34,2
Poor
9
23,7
TOTAL
38
100
From table 4.4 can be seen that
respondent total who have good knowledge
are 16 students (42,1%), fair knowledge are
13 students (34,2%) and poor of knowledge
are 9 students (23,7%).
From table 4.1 it can be seen that the total
respondents which ages <17 years are 17
students (44,7%) and ≥17 years are 21
students (55,3%).
Table 4.2
Distribution Of Respondents’ Frequency
Due To Gender In SMAN 1 Kutalimbaru
Gender
Frequency
Percent (%)
Frequency
6
10
22
38
Table 4.5
Distribution of Frequency of Respondent
knowledge about HIV/AIDS based on age
in SMAN 1 Kutalimbaru, Deli Serdang
District 2014
Ag
e Knowledge
Good
F
(%)
<17 7
7,9
≥17 9
23,7
To tal 16 42,1
Fair
F
6
7
13
(%)
15,8
18,4
34,2
Poor
F
4
5
9
(%)
10,5
13,2
23,7
To t a(%)
l
17
21
38
44,7
55,3
100
From table 4.5 it can be seen that
respondent the age of <17 years found good
knowledge are 7 students (18,5%), fair
knowledge are 6 students (15,8%) and poor
knowledge 4 students (10,5%).
While at the age of ≥17 years found
good knowledge are 9 students (23,7%), fair
knowledge are 7 students (18,4) and poor
knowledge 5 students(13,2%).
Table 4.6
Distribution Of Frequency Of Respondents
Knowledge About HIV/AIDS Based On
Gender In SMAN 1 Kutalimbaru, Deli
Serdang District 2014
Gen
der
Knowledge
Good
Fair
Tot %
Tot
2
5,3
5
Ma
le
Fe ma 14
le
To tal 16
%
13,2
To
tal (%)
Poor
Tot %
6
15,8 13 34,2
36,8
8
21,1
3
7,9
25
65,8
42,1
13
34,2
9
23,7 38
100
From table 4.6 it can be seen that
respondent total can be seen respondent total
of male found who have good knowledge are 2
students (5,3%), fair knowledge are 5 students
(13,2%) and poor knowledge are 6 students
(15,8%). While female found 14 students
(36,8%) good knowledge, 8 students (21,1%)
fair knowledge and 3 students (7,9%) poor
knowledge.
Table 4.7 Distribution Of Frequency Of
Respondent Knowledge About HIV/AIDS
Based On Information Sources In SMAN 1
Kutalimbaru, Deli Serdang District 2014
In
For ma
Tion
Sour ces
Electronic
Me dia
Print
Me dia
Medical
Staffs
TO TAL
Knowledge
Good
Fair
Jlh
%
J lh
2
5,3
1
3
7,9
11
16
(%)
%
Poor
Jl h %
To tal
6
2,6
15,8
3
1
7,9
2,6
6
10
15,8
26,3
28,9
6
15,8
5
13,2
22
57,9
42,1
13
34,2
9
23,7
38
100
From table 4.7 it can be seen that total
respondent
who have information of
HIV/AIDS
electronic media found good
knowledge are 2 students (5,3%), fair
knowledge is
1 student (2,6%) and poor
knowledge are 3 students (7,9%). While those
who have information of HIV/AIDS from
print media found good knowledge are 3
students (7,9%), fair knowledge are 6 students
(15,8%) and poor knowledge is 1 student
(2,6%). Then those who have information of
HIV/AIDS from medical staffs found good
knowledge are 11 students (28,9%), have
berpfair knowledge are 6 students (15,8%)
and poor knowledge are 5 students (13,2%).
5. Discussion
5.1.Respondents of the age <17 years found
have good knowledge about 7 students
(18,4%), fair knowledge 6 students
(15,8%) and lack of knowledge 4 students
(10,5%). While the ages of ≥17 years
found good knowledge 9 students (23,7%),
fair knowledge is 7 students (18,4) and
lack of knowledge 5 students (15,2%).
Age causes the character, at the age of
above 17 years known as adult age which
the ability and the way of thinking in
learning, understanding and receiving the
change
easily, so it influences the
knowledge. This findings are relevant
Notoatmodjo’s idea.
5.2. Respondents as male found 2 students
(5,3%) they have good knowledge, having
fair knowledge about 5 students (13,2%)
and lack of knowledge is about 6 students
(15,8%). While female found 14 students
(36,8%) have good knowledge, 8 students
(21,1%) fair knowledge 3 students
(7,9%).Of the result of interview the
researchers found the female knowledge is
better than the male because female feel
willing to know highly. There is the gab
between theory which proposed by
Cameron (2005), the research has been
done on the knowledge of gender.
Female is better in counting, and more
aggressive. While female have verbal
language better than male or they usually
do their emotion in facing the problems.
The result show that have lack of
knowledge they are 6 students (15,8%). It
is caused by they are lack of active and
they have lack willingness to know
something.
5.3. Information sources of HIV/AIDS found
from electronic media, print sources and
health staffs. Of the third sources of
information, media or other information
source can influence the respondent
knowledge
to
get
information of HIV/AIDS, that is by close
friends with the respondents such as
parents, teacher, friends and non
government organization, Because the act
of close friends can influence and imitate
by other people.
From the result of the research it
shows that the majority of respondents
who have good knowledge who get the
information of
HIV/AIDS are from
medical staffs about 11 students (28,9%).
97
Respondents who have lack of knowledge,
they may be influenced by lack of
knowledge to have information of
HIV/AIDS which found by respondents.
Information is needed to advance the
knowledge of HIV/AIDS, in order the
respondents realize the danger of
HIV/AIDS earlier.
Good information can give influence
of the change or the increasing of
knowledge which is relevant with
Notoatmodjo’s idea, that is source of
information influence knowledge if
information of other people or other media
This study is done by three
assessments knowledge of respondents
HIV/AIDS, the researchers devided into
three categories they are, good, fair and
poor. Based on the research it is found
that the respondents who have good
knowledge are dominant good knowledge
they are 16 students (42,1%). Respondents
who have good knowledge have less
affected by HIV/AIDS, because the have
known the HIV/AIDS and its preventive,
while the respondents who have lack of
knowledge have more influenced to have
HIV/AIDS because of their less
understanding of HIV/AIDS.
6. Conclusion
Of the result of the study which entitled “
description of the eleventh year student of
SMAN 1 Kutalimbaru Deli Serdang District
knowledge of HIV/AIDS in 2014” can be
found the conclusion as follows :
1. Respondents
who
have
good
knowledge are the dominant they are
at the age of ≥17 years, they are
23,7%.
2. Respondents
who
have
good
knowledge at female are 36,8%.
3. Respondents the good knowledge of
HIV/AIDS are found from medical
staffs they are 28,9%.
4. The description of respondents
knowledge of HIV/AIDS, generally
are good. Respondents who have good
knowledge are 42,1%, fair knowledge
are 34,2% and lack of knowledge are
23,7%.
98
7. Suggestions
7.1. It is hoped that the government (health and
educational department) medical staffs/
and relevant institutions to advance the
teenagers’ knowledge by having service
and good books of HIV/AIDS.
7.2. It is hoped that the parents to possess the
knowledge of HIV/AIDS in order they
can guide and teach their children at home.
7.3. It is hoped that non government
organization (NGO) is active to advance
the teenagers knowledge by having the
service for the teenagers in their
environments in order they are not
infected by virus HIV/AIDS.
8. References
Alimul, Azis. 2006. Riset Keperawatan dan
Teknik Penulisan Ilmiah. Jakarta:
Salemba Medika.
Arikunto,
Suharsimi.
2006.
Prosedur
Penelitian. Jakarta: Rineka Cipta.
Darmawan, H. 2009. HIV/AIDS di Dunia.
http://[email protected]. Diunduh
tanggal 03 Januari 2014.
Hutapea, Ronald, 2011.AIDS an PMS dan
Pemerkosaan. Jakarta: Rineka Cipta.
Joko,Profil D.Serdang www.google.com.
Diakses 10/1/2014.
Nasronudin, Margarita. 2007. Konseling,
Dukungan, Perawatan dan Pengobatan
ODHA. Surabaya: Airlangga University
Pres.
Niken, dkk, 2011. HIV/AIDS Kita Perlu Tahu.
Yogyakarta : Penerbit Fitramay.
Notoatmodjo, Soekidjo. 2007. Metodologi
Penelitian Kesehatan. Jakarta: Rineka
Cipta.
Nursalam, 2009. Askep pada Pasien
Terinfeksi. Salemba medika.
Rudi, M. 2012. Indonesian Health Profile.
www.google.com. Diakses 20 Desember
2013.
Sarlito, Sarwono, 2011. Psikologis Remaja.
Rajawali. Jakarta: Pers.
Setyoadi,
2012.
Strategi
Pelayanan
Keperawatan Bagi Penderita AIDS.
Yogyakarta: Graha Ilmu.
Yusfi, 2010. Mengungkap Tuntas HIV/AIDS.
Jakarta: Rineka Cipta.
FACTORS ASSOCIATED WITH ELDERLY VISITS TO ELDERLY
INTEGRATED SERVICE POST IN DURIAN KENAGARIAN GADANG
PUSKESMAS GAMBOK SIJUNJUNG 2014
Okky Perdana Putra, Efriza
Stikes Fort De Kock Bukit Tinggi
ABSTRACT
Elderly IHC is the development of Government policy through health care for the elderly which
operate through the PHC program, involving the participation of the elderly, families, community
leaders and social organizations in its implementation. The average visit to Posyandu Elderly Elderly
from January to March in Kenagarian Durian Tower Puskesmas Gambok Sijunjung is 48% of the
population. This study aims to determine the relationship of knowledge, the role of Posyandu and
support the family with a visit to the IHC Elderly Elderly. This research used descriptive analytic with
cross sectional approach conducted in Kenagarian Durian Tower in 2014 with a sample of 159
respondents by using Chi-Square.Hasil research found there is a relationship between knowledge
(pvalue = 0.001 and OR = 3.222), the role of cadres (pvalue = 0.010 and OR = 2.501) and family
support (pvalue = 0.000 and OR = 11.410) with a visit to Posyandu elderly lansia.Diharapkan to
family and health cadres to be able to increase the motivation of the elderly so that they are willing to
attend to the elderly Posyandu each month.
Keywords: Knowledge, Cadres, Family, Elderly
Background
Improving Social Welfare Elderly is a series of
activities carried out in a coordinated manner
between the Government and the community
to empower the elderly so that the elderly can
still perform their social function and play an
active role in social life naturally, nation and
state (PP No. 43 Th 2004) , While the efforts
of health care for the elderly should be
directed to maintain in order to stay healthy
and productive life socially and economically
in accordance with the dignity of humanity.
Efforts to health care for the elderly is done by
Government, Local Government and / society.
(UU No. 36 Th. 2009).
Integrated Service Post (Posyandu) Seniors
according to the Guidelines for IHC Seniors,
Elderly National Commission in 2010 is a
further container service to the elderly in the
community that the process of formation and
implementation is done by the people together
with non-governmental organizations, inter
governmental and non-governmental sectors,
private, social organizations and others with
health care focused on promotive and
preventive efforts. The Posyandu elderly can
also be provided social services, religion,
education, skills, sport and arts and culture as
well as other services needed by the elderly in
order to improve the quality of life through
health and welfare to support them. In addition
they can work and develop their own potential.
There are several factors that lead to low
behavior of the elderly visited Posyandu.
Predisposing factors consist of education,
knowledge, attitudes, and perceptions.
Supporting factors consist of families, and the
availability of time. And reinforcing factor is
the attitude (Notoatmodjo, 2010).
Sijunjung Health Department has 11 health
centers, community health centers Gambok
which has an area of 467.87 km2 work and
31% hilly terrain, there are 3 Nagari in
Puskesmas Gambok, namely Muaro, Silokek,
and Durian Tower. The average visit to
Posyandu Elderly Elderly from January to
March in Muaro Nagari is 685 elderly (58% of
the population), in Nagari Silokek is 51
Elderly (51% of the population), and in Nagari
Durian Tower is 126 elderly (48% of the
population). Based on the data obtained the
number of visits was lowest for the Nagari
Durian Tower. And from preliminary studies
done by interviewing elderly 8 in Nagari
Durian Tower, 2 people say do not know about
the benefits of Posyandu elderly, one person
said the family did not want to drop off and
accompany the implementation of the current
99
elderly Posyandu elderly, two people said their
families while in the invented deliver
Posyandu , one person said cadres never told
schedule elderly Posyandu activities, one
person said cadres often visit to the house, and
one more person says he regularly to the IHC
to determine their health status.
The purpose of this study was to determine the
factors associated with kunjunganLansia to
IHC Elderly in Kenagarian Durian Tower
Sijunjung 2014
Research Methodology
This research uses descriptive analytical
method with cross sectional approach. The
research population is elderly aged 60 years
and above in Kenagarian Durian Tower
Sijunjung 2014, amounting to 263 people and
is used as a sample of 159 elderly people.
Analysis using univariate and bivariate
analysis with chi-square test.
Table 1. Knowledge Relationships, cadres
Role and Family Support with Visits
to Elderly Integrated service post in
Kenagarian Durian Gadang Sijunjung
2014
Variabel
Respondents
knowledge
High
Low
Cadres role
Plays
not
Participate
Family
Support
Support
Not support
Elderly visit to
integrated service post
Good
Not good N
%
n %
n
P
OR
73 71.6 29
25 43.9 32
28.4
56.1
102
57
0.001 3.222
68 70.1 29
30 48.4 32
29.9
51.6
97
62
0.010 2.501
62 88.6 8
36 40.4 53
11.4
59.6
70
89
0.000 11.410
The elderly who have low knowledge visit to
Posyandu elderly are not so good. This is
because the elderly are not so aware of the
understanding, benefits and types of activities
carried out at the IHC Elderly. Elderly Some
also said that they were reluctant to come to
IHC because they feel bored with the activities
at Posyandu elderly and they were afraid to
check his health, for fear of the possibility of
bad will happen to his health, so that the
100
elderly do not really care about any activities
undertaken in IHC Elderly.
If the Elderly get good service from the cadre,
of course, the Elderly will be glad to visit
Lansia.Sedangkan Posyandu cadres who do
not play a role also in touch with not good
visit to Posyandu elderly. This is illustrated by
the statement of respondents who said that
they did not come to Posyandu, cadres do not
visit the house and invites elderly to come to
Posyandu elderly, this is because the distance
between home Elderly at home too much and
cadres cadres also did not have a vehicle to
visit the elderly to his home and kaderpun not
always do counseling posyandu activities, this
is because the material is very little known
cadres and cooperation to the health such as
health centers are still not optimal.
According to researchers based on research
that has been conducted for more than half of
the respondents who have no family support
turns Elderly visit to Posyandu well. This is
illustrated, the statement of respondents stated
that although the family did not have time to
escort and assist the elderly to Posyandu
elderly, and families are also less seek a
healthy and nutritious meals for the elderly,
but the elderly still have a high willingness to
pay a visit to Posyandu elderly because elderly
itself already know the information, benefits,
and the type of activities carried out at the IHC
Elderly. Elderly also consider counseling is
done in Posyandu is important, because of the
extension Elderly know information about
health, so that they can maintain their health.
Due to the high self-motivation elderly who
have no family support still had a good visit to
Posyandu.
While there are some elderly people who
receive family support but still not been to
elderly Posyandu. This is illustrated by the
statement of respondents who said that their
family had to provide information about the
benefits of Posyandu elderly, advising the
elderly to maintain their health and provide
good support to the elderly on the
implementation of the Elderly IHC, but
Elderly itself that does not want to pay a visit
to IHC because they feel lazy and bored with
the existing activities in the IHC Elderly and
prioritize them to work and earn money while
IHC Elderly implemented.
One that can be done is a health center in order
to add to the schedule of the Elderly IHC 2
times or 3 times in sebulandan can create new
activities that the elderly do not feel bored to
come to Posyandu elderly, such as the holding
of competitions in sports and cooking among
the Elderly .Diharapkan to family and health
cadres to be able to increase the motivation of
the elderly so that they are willing to attend to
the elderly Posyandu each month.
Conclusion
1. There is a significant relationship between
knowledge of the Elderly with a visit to the
IHC Elderly Elderly in Kenagarian Durian
Tower Sijunjung 2014 with pvalue value =
0.001, and the value Odds Ratio (OR) = 3.222.
the role of the health cadres with a visit to the
IHC Elderly Elderly in Kenagarian Durian
Tower Sijunjung 2014 with pvalue value =
0.010, OR = 2.501 and the value.
family support with a visit to the IHC Elderly
Elderly in Kenagarian Durian Tower Sijunjung
2014 with pvalue value = 0.000, OR = 11.410
and value.
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the
Commission
NasionalLanjutUsia, 2010
Government regulations Rino. 43 In 2004,
TentangPelaksanaan UpayaPeningkatan
welfare SosialLanjutUsia
UndangRINo.36 Act of 2009 on Health
UndangRINo.11 Act of 2009 on Social
Welfare
101
THE INFLUENCE OF ANTENATAL CLASS TOWARDS IIIRD
TRIMESTER PRIMIGRAVIDA MOTHERS’ LEVEL OF ANXIETY
IN FACING CHILD BIRTH
Bina Melvia Girsang
Jln. Sukabangun II Kom.griya Palembang
Sriwijaya University
Email: [email protected]
ABSTRACT
Background: Anxiety is most experienced by primigravida mothers in IIIrd trimester. This anxiety
could possibly be the cause of obstetrics
complication which happens when the stress
hormone(adrenalin dan noradrenalin) were release due to anxiety. The complication can be in such
form as pre-eclampsia, eclampsia, hypertension risk during pregnancy, premature birth, and
miscarriage. It can also be the reason of time taking-child birth in phase II. This complication needs
such an antenatal treatment as antenatal class can facilitate the needs of service during pregnancy.
This research’s purpose is to figure out IIIrd trimester primigravida mothers’ level of anxiety
differences in facing child birth before and after taking the antenatal class.
Method: This research is a quantitative research with pre-experiment design and only group pretest –
posttest plan. It takes 15 people as a sample and uses quetionaire and observation sheet to collect data.
The sample was taken by using simpel random sampling. Data collection was taken in Local
Goverment Clinic on Merdeka Street–Palembang during November 20th to December 3rd 2013.
Result: The result shows the following characteristic of respondents: the greatest number of ages in
range <20 and >30 years are 9 respondents (60%), unemployed mothers are 11 respondents (73,3%),
mothers with adequate income are 8 respondents (53,3%), and moderate-educated mothers are 10
respondents (66,7%). Statistic proves that there is a significant influence between IIIrd trimester
primigravida mothers who participate in antenatal class and who do not in terms of anxiety level
when facing child birth in Merdeka Local Government Clinic in Palembang (p value=0,000;≤0,05).
Conclussion: Based on the research, the Antenatal class is expected to be implemented as an
anteanatal services during pregnancy. Furthermore, the research is also expected to be able to conduct
analysis towards other factors that can influence mothers’ anxiety level during pregnancy.
Keywords : Primigravida Mothers, IIIrd Trimester, Antenatal Class, Anxiety
INTRODUCTION
Maternal and perinatal death remains a major
problem in developing countries with a
mortality rate of approximately 98-99 % .8
The number of maternal deaths in Indonesia
itself is still relatively high among other
ASEAN countries which is 223 per 100,000
live births , while the number of deaths in
South Sumatra has increased compared to
previous years , as many as 11 deaths from 30
305 in 2012 to 13 maternal deaths from 29.
415 in 2013.1,5 the mortality rate can be caused
by obstetric complications and were
aggragated by psychological state during
pregnancy such as feelings of worry and
anxiety.4
Pregnancy will cause numerous changes in the
body due to hormone secretion by placenta. It
102
can trigger changes that require adaptation. In
every pregnancy, especially first pregnancy
not only physical canges but also
psychological canges may disrupt and
influence. The newly future mothers and
sometimes are difficult to overcome by the
mothers alone. This may be the explanation
why primigravida possess higher level of
anxiety compared to multigravida. Another
reason in that primigravida may be easier to
fear for child birth process due to myths and
awful stories developed in society. This is in
accordance with the research conducted by
Utami and Lestari that stated that the anxiety
level in prigravida is higher than that in
multigravida..
.
In the third trimester , the majority of pregnant
women will experience severe anxiety due to
increased fears and concerns that arise during
the labor.6 Anxiety can affect the
psychological and physical well being of the
the mother or the fetus if left untreated . High
levels of anxiety can lead to complications
such as preclampsia, eclampsia , the risk of
hypertension in pregnancy and risk of preterm
birth even miscarrieage.4,2 Severe anxiety can
also cause prolonged second stage of labor.13
Nurses are attempted to help the mothers to
overcome this problem, thus nurses have an
important role in this case. Nurses must ve
able to recognize the symptoms of anxiety and
provide coreect information to the pregnant
women. Hence, antenatal class is an effective
way to address this problem. Through
antenatal class, mothers may axquaire
knowledge and may even able to consult their
personal
feelings
or
problems.17
Based on the results of preliminary studies on
the Free Health Center Palembang from
interviews with midwives at health centers it
was known that there are already antenatal
classes but only once or twice a year. The
midwife also stated that many pregnant
women complain of difficulty sleeping
because of worrying about labor process . It is
also supported by the results of interviews
conducted with 3 and 2 primigravida mother
multigravida , which indicates that the
primigravida showed more severe anxiety
symptoms
compared
to
multigravida
mother.Based on this background the
researcher is interested in studying about how
" Effects of Antenatal classes influence the
level of anxiety in the third trimester
primigravida Facing Labor at Merdeka Health
Center Palembang .
MATERIALS AND METHOD
This research is a quantitative study using the
methods of experimental research with preexperimental research design ; group pretest posttest only . The goal is to determine the
differences in levels of anxiety in the third
trimester primigravida face of labor before and
after attending classes at the health center
antental Merdeka Palembang. The sample in
this study amounted to 15 respondents and the
sampling technique is simple random
sampling, which is done by the way of lottery .
In order to prevent data deviation, we
determine the inclusion and exclusion criteria.
Illegible respondents are those who are
primigravida, are not at 3 rd trimester
pregnancy do not develop preeclampsia and
eclampsia , and only pregnant women who
experience mild to severe anxiety. The tools
used in collecting the data in the form of a
questionnaire Hamilton Anxiety Rating Scale (
HARS). Analysis used is Homogenety
Marginal test with significance level of α =
0.05 .
RESULT
1. Univariate Analysis.
1.1. Characteristics of Respondents
A. Reproductive Age
Table 1.1
Primigravida Frequency Distribution by Age
Reproduction Trimester III
n= 15
Frequency
Percentage
Reproductive Age
Healthy
6
40%
reproductive age
Reproductive age is 9
60%
not healthy
Total
15
100%
B. Jobs
Table 1.2
Frequency distribution of the third trimester
primigravida Based Jobs
n = 15
Frequency
Percentage
Jobs
Does not work
11
73,3%
Work
4
26,7%
Total
15
100%
C. Income
Table 1.3
primigravida Based Income
n = 15
Frequency
Percentage
Income
Less
7
46,7%
Enough
8
53,3%
Total
15
100%
103
D.Education
Table 1.4
primigravida by Education
n = 15
Frequency
Percentage
Education
Sedang
10
66,7%
Tinggi
5
33,3%
Total
15
100%
D. Anxiety levels primigravida IIIrd Trimester
Before Following Antenatal Classes
Table 1.5
Frequency Distribution Anxiety Level Results
primigravida in the third trimester Cast
Confronting Before Childbirth Antenatal
Classes
Anxiety level Before
Frequency Percentage
Antenatal Classes
mild anxiety
8
53,3%
Moderate anxiety
5
33,3%
severe anxiety
2
13,3%
Total
15
100%
E. The anxiety level of the third trimester
primigravida After Following Antenatal
Classes
Tabel 1.6
Results Frequency Distribution Level IIIrd
trimester primigravida Anxiety in the
Face of Delivery After Antenatal Class
Anxiety levell Before Frequency Percentage
Antenatal Classes
not to worry
12
80%
mild anxiety
2
13,3%
Moderate Anxiety
1
6,7%
Total
15 100%
F.
Bivariate analysis
Table 1.7
Differences Anxiety Level III trimester
primigravida in the Face Before Following
Childbirth Antenatal and Postnatal Classes
Following Antenatal Classes
Anxiety
Anxiety level After Antenatal
level Before Classes
Antenatal not
mild
Moderate Total P
Classes
Anxious anxiety
anxiety
Value
mild
anxiety
Moderate
anxiety
severe
anxiety
Total
104
8
0
0
8
4
1
0
5
0
1
1
2
12
2
1
15
0,000
DISCUSSION
1. Characteristics of Respondents
A.
Reproductive Age
The results howed that the majority of
pregnant women who were not in healthty
reproductive ager were 6 people (40%). The
anxiety level for this group varied from mild
to severe. In the other hand, the remaining
pregnant women who were in healthy
reproductive age showed only mild anziety
level. It is thought that women who are under
20 years of age have not been ready to
experience pregnancy, thus increasing their
stress level. Meanwhile women who are above
35 years of age may have increased anxiety
level due to their own health condition.
Pregnant women who are above 35 years of
age are more likely to develope more
problems, such as miscarriage, cessarian
section or delivering babies with genetic or
chromosomal abnormalities. These may then
increase their anxiety level. 6
B. Occupations.
The results showed that the majority of
respondents with no occupation were found to
be in 11 people (73.3%). The anxiety level of
this group varied from moderate to severe.
While in the other hand, mothers who are still
on occupation showed only mild level of
anxiety. This may be exsplained by the fact
that those respondents with no occupation tend
to be more focused on fears and worries to
give birth compared to those who still involve
in certain job. 4
C.Income
The results showed that the level of anxiety in
respondents with less earning (46.7 %) ranged
rom moderate to severe while the remaining
53.3% respondents with sufficient income
only showed mild to moderate anxiety level.
This may be due to the fact that pregnancy and
xhild bearing require proper preparation and
xost a lot of money which in turn causing
worry and anxiety for those who earn less. 7
D. Education
The results showed that the majority of
respondents had completed medium/secondary
level of education (66.7%). Less educated
respondents experienced more severe anxiety
level compared to highly educated one. This
may be explained by the fact that the level of
education influences one’s way of thinking in
self development and both in taking action or
decision.15 Lower level of education will cause
individual to experience more stress due to the
lack of information. 2
E. Level III trimester primigravida Anxiety
in the Face Before Following Childbirth
Antenatal Classes
Pre-test showed that out of 14 symptoms
frequently complained by respondents, 60% is
anxiety and feeling of depression and 53.3%
complained of depressed mood. This may be
due to the condition of the respondents who
were all at first time experincing pregnancy. In
antoher hand, physical state changes and the
fact that the mothers are tend to become more
tired also contribute to inceased level of
anxiety.4 Respondents also showed concerns
over labor process and their fetus
development.
Symptoms of too much complained of feeling
depressed by the third trimester primigravida
before attending antenatal classes as many as
53.3 % . This is due to the physical state of the
mother's third trimester to be getting tired
ditmbah with concerns over labor prose that
arise as a result of a complaint with the
enlargement janin.3 This situation results in
feelings of mothers who become depression.13
Pre-test results also showed slight symptoms
complained of by primigravida is a somatic
symptom / physical or sensory . This is
because the symptoms of somatic / physical
usually appear in anxiety levels and heavy
weight , while the results of the study only
13.3 % primigravida who experience severe
anxiety and other than that there are no heavy
anxiety levels , so that the sympathetic
nervous system is not very active and not too
showed symptoms sensorik.18 , 9
F. The anxiety level of the third trimester
primigravida in the Face After Following
Childbirth Antenatal Classes
Post -test
showed that promigravida
experienced not only symptom of anxiety but
also depression. This is because the degree of
anxiety also affects the degree of depression.
More severe anxiety will result in more
severy emotional changes as well.18 In third
trimester of pregnancy, mothers appear to fell
more physical disdcomfort and tend to be
more exhausted and dispirited. These lead to
feelings of depression which can be reduced
even after attending antenatal classes.18,10
After attending antenatal classes, respondents
showed improvements on anxiety symptoms.
Through antenatal classes, mothers were able
to share their expereince to fellow participants
or health workers in addition to learn and get
more knowledge. Both somatic/sensory
symptoms also were decreased after
participating in antenatal classes. We found
that there is no single participant who
experiences severy anxiety anymore after
attending the clasess. Somatic symptoms are
not found anymore for it only appears to
happen
in
severe
anxiety.12,
16
G. Differences primigravida Anxiety Levels
Before and After Antenatal Classes
Results showed that there is a significant
difference of anxiety level between those who
participated in the classess and those who
didn’t. As mentioned before, through classes
participatns may also learn and get knowledge.
This provision may improve the knowledge of
pregnant women so that they can adapt to both
physiological and psychological changes. 17
In case of participants who did not improve
even after attending the classes, memory and
cognitive limitation and lack of interest in
learning may be able to explain that fact.16
CONCLUSION
1. Characteristics of the third trimester
primigravida by age varied from 20-30
years of age as 6 people ( 40 % ) , and were
aged > 30 years were 9 people ( 60 % ) .
Third trimester primigravida job consists of
primigravida who work as many as 4
people ( 26.7 % ) and that did not work as
many as 11 people ( 73.3 % ) . Family
income level of income varies quite as
much as 8 people ( 53.3 % ) and who earn
less by 7 people ( 46.7 % ) . Educational
level primigravida third trimester consists
of highly educated primigravida by 5
people ( 33.3 % ) , and the educated were
as many as 10 people ( 66.7 % ) .
2. Levels of anxiety in the face of anxiety
primigravida prior to attending the course
consists of 8 persons ( 53.3 % )
experienced mild anxiety , 5 ( 33.3 % ) of
people experiencing moderate anxiety and
2 ( 13.3 % ) experienced severe anxiety .
3. Primigravida level of anxiety in the face of
anxiety after following a course consisting
of 12 persons ( 80 % ) did not experience
105
anxiety , 2 ( 13.3 % ) experienced mild
anxiety and 1 person ( 6.7 % ) experienced
moderate anxiety .
4. There is a significant difference in the level
of anxiety in the face of labor primigravida
before and after attending antenatal classes
at the health center with the Merdeka P
value ( 0.000 ) .
RECOMENDATION
It is expected for freedom health
center to implement antenatal class as a
routine program for it can reduce the risk of
pregnant women from getting anxiety which is
dangerous. It is also expected that this research
will trigger many more future studies to
investigate not only the effect of ANC but also
the effect of pregnancy exercise on anxiety
level and other factors that may also contribute
to anxiety level using control group and wider
sample.
REFERENCES
1. ________. The Top of Maternal Mortality
in Indonesia and ASEAN Top. Date of
access
March
20th
2012
http://midwifecare.wordpress.com/2012/0
2/21/sekitar-20-30/: 2012.
2. Astria, Yonne , Nurbaeti, Irma &
Rosidati,
Catur.
Characteristics
relationship
with
third
Trimester
Maternal Anxiety in Polyclinic Obstetrics
and Gynecology Hospital X Jakarta.
Jurnal Vol. 10 No. XIX Oktober 2008 –
Februari 2009, Hal 38 : 2009.
3. Cambell, Stuart dan Mackonochie,
Alison. Pregnancy Day by day. Jakarta.
Erlangga : 2005.
4. Detiana, Prilia. Pregnant Safe and
Comfortable at the Top Age 30 Years.
Yogyakarta. Media Pressindo : 2010.
5. Dinkes Palembang. Health Profile
Palembang 2012. Palembang : 2012.
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6.
Effendi,
Ferry
dan
Makhfudli.
Community Health Nursing Theory and
Practice in Nursing. Yogyakarta.
Salemba Medika : 2009.
7. Farrer, Helen. Maternity Nursing. Jakarta.
EGC : 2001.
8. Gde Manuaba, Ida bagus, et al.
Introduction Lecture Obstetrics. Jakarta.
EGC : 2007.
9. Gunawan, Adi. Hypnosos. The Art of
Subconscious Communication Achieving
Success with the Power of the Mind.
Jakarta. PT. Gramedia : 2005.
10. Hamilton, Persis Mary. Maternity Nursing
Basics, Ed. 6. Jakarta. EGC : 1995.
11. Indriyani, Diyan. Maternity Nursing at
the Antenatal. Yogyakarta. Graha Ilmu :
2013
12. Kementerian
Kesehatan
Republik
Indonesia. Guidelines for Pregnant
Women Class. Jakarta : 2011.
13. Munir, Miftahul.
Relations between
Anxiety Level with Old Mother Maternity
Kala II Midwives in Private Practice
Kabupaten Tegal. Jurnal Sain Med, Vol.
3 No. 2, 46-49 : 2011.
14. Na’im, Jannatun Nur. Support Families
with Level Kecemasn primiparous mother
face Childbirth at Puskesmas Pamulang
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City.
Jurnal
Publikasi : 2013.
15. Notoadmodjo,
Soekidjo.
Health
Education and Behavior. Jakarta. Rineka
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16. Tino, Rafi A. Answering myths
Pregnancy
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Breastfeeding.
Yogyakarta. Medpress : 2013
17. Schott, Judith & Priest, Judy. Nursing
Practice Series: Antenatal Classes, Ed 2.
Jakarta. EGC : 2008.
18. Videbeck, Sheila L. Textbook of
Psychiatric Nursing. Jakarta. EGC :
2008.
ANEMIA IN CONNECTION WITH PREGNANCY TRIMESTER III
POSTPARTUM BLEEDING IN DANDY CLINIC DISTRIC OF MABAR
2014
Sartini Bangun
Departmen of midwifery Poltekkes Kemenkes Medan
ABSTRACT
Maternal mortality rate (MMR) in Indonesia is quite high which is 359 in 100000 live
births.Generally, there is a distinction between a direct maternal death that is the result of a
complication of the pregnancy, delivery, or management of both, and an indirect maternal deatht is
pregnancy-related death in a patient with a preexisting or newly developed health problem unrelated
to pregnancy. Fatalities during pregnancy but unrelated to pregnancy are termed accidental,
incidental, or nonobstetrical maternal deaths. The WHO notes that in 2014 the major direct causes of
maternal deaths globally are severe bleeding/hemorrhage (27%), infections (11%), unsafe abortions
(8%), high blood pressure during pregnancy/pre-eclampsia and eclampsia (14%), obstructed labour
(9%), blood clot/embolism (3%) and pre-existng conditions (28%). In Indonesia 63,5% pregnant
women have anemia and 59% found in Medan city. This research aims to know the relationship
between iron deficiency anemia during 3rd trimester pregnancy and Postpartum haemorrhage (PPH).
This in an analytical research with crosssectional data collection. Population were all women
have given birth, the number of population is 286 people and each individual was chosen randomly
and entirely by chance as many as 83 people. The data were obtained from both primary and medical
records by using guetionaries as the instrument. The data were then analysed by common univariate
and bivariate analysis using chi-square test.
Research showed that out of 83 respondents, 46 women had history of anemia in 3rd
trimester pregnancy and 27 women experienced postpartum hemorrhage (32,53%). 37 women were
found with no history of anemia and still expereinced postpartum hemorrhage are 11 people
(13,25%). Chi-square test with X2 coun>X2 table (6,93 > 3,841) indicates that there is a relationship
between iron deficiency anemia and during 3rd trimester pregnancy and postpartum hemorrhage
(PPH).
To be expected to health workers to improve maternal motivation for regular antenatal health
promotion of nutrition of pregnant women, especially the consumption of foods thet contain enough
iron and vitamin c.
Key words: Pregnancy, anemia of pregnancy, and postpartum hemorrhage
Introduction
One of strategic goals in health
development in 2010-2014 is to reduce
maternal mortality rate from 228 to 102 in
100.000 lives birth. And also to reduce infant
mortality rate from 34 to 24 in 1.000 births (
Republic of Indonesia Health Ministry, 2010).
Based on IDHS 2012, an average of
MMR is 359 per 100,000 live births. In
contrast to the 2007 IDHS AKI reached 228
per 100 thousand live births. This increase is
probably caused by the distribution of health
workers who are less prevalent in every region
in Indonesia and the government made
Jampersal program to reduce the death rate did
not run effectivelyThis is certainly contrary to
the government's target to reduce AKI up to
102 per 100 thousand in accordance with the
2015 MDG targets (Hamadi, 2013).
In the other hand North Sumatra
successfully reduced maternal and infant
mortality rates in 2013, in September 2013, the
maternal mortality rate was 126 inhabitants.
This figures showed a decrease compared to
the end of 2012 in which 274 AKI was found
and the end of 2011 there were 313
inhabitants. Head of North Sumatra Health
Office of Health Care: Kustinah said, that one
of the causes of maternal mortality is due to
bleeding during childbirth. If left untreated,
condition may not be correctable anymore
(DHO Provsu, 2013).
According to the Household Health
Survey of 2001, 90% of the causes of maternal
death is indirectly due to frequent
107
complication
during
childbirth
and
immediately after childbirth. The cause is
known by Trias Classical, ie bleeding (28%),
eclampsia (24%), and infections (11%). While
the indirect causes include pregnant women
suffering from chronic energy deficiency
(CED) 37%, anemia (Hb less than 11 g%)
40%. The incidence of anemia in pregnant
women will increase the risk of maternal
mortality compared to mothers who are not
anemic (Gift, 2011)
Anemia in pregnant women is a health
problem associated with high incidence and
complications that can arise both in the mother
and the fetus. In the world there happens to be
34% of pregnant women with anemia of which
75% are in developing countries (WHO, 2005
in Syafa, 2010). In Indonesia, 63.5% of
pregnant women are with anemia, whereas in
the city of Medan, 59% of pregnant women
are with anemia (Syaifuddin, 2008).
In some studies, anemia is closely associated
with high maternal mortality rate. Anemia
causes low physical ability due to insufficient
oxygen supply to body. In pregnant women,
anemia
increases
the
frequency
of
complications in pregnancy and childbirth.
The risk of maternal mortality, the rate of
prematurity, low birth weight and perinatal
mortality rate increase (Boyle, 2008).
Anemia in pregnancy can also cause
interference his (inersio uteri), straining
strength so the mother becomes weak and
experiences prolonged labor. In addition
anemia in pregnancy can also lead to atonic
uterus and cause PPH (Melisa, 2013).
In Indonesia, there are an estimated 14
million cases of bleeding in pregnancy. Every
year at least 128,000 women bleed to death.
Bleeding, especially post-partum hemorrhage,
occurs suddenly and is more dangerous if it
occur in women who suffer from anemia. A
mother with bleeding can die in less than an
hour (Sembiring, 2010).
Meanwhile, deaths from hemorrhage often
occurs due to a number of obstetric
complications which predispose to bleeding
and subsequent death if treatment is not
available, including proper blood replacement
therapy. The main causes of maternal deaths
are haemorrhage reaches 40% - 60%,
infections
20%
30%,
eclampsia
approximately 20% - 30%, while the indirect
causes of maternal death ie maternal disease
(5.6%) which will get worse with the onset of
108
pregnancy, such as heart disease, kidney or
other chronic disease and iron deficinecy
anemia in pregnant women (Nugroho, 2012).
Based on the survey in the District Dandy
Clinic Mabar year 2012-2014, the total
number of 486 normal delivery childbirth,
where in 2012 the number of women giving
birth normally were 132 people and the
number of mothers experiencing childbirth
bleeding due to anemia is 9 cases, in 2013 the
number of women with normal delivery were
146 people and 12 cases of bleeding due to
anemia was found, and in 2014, 188 cases
were normal delivery and 16 cases were
bleeding due to anemia. Based on the
description above, the writer interested in
conducting research on the relationship of
anemia in the third trimester of pregnancy with
the incidence of postpartum hemorrhage in the
District Dandy Clinic Mabar Year 2014,
research issue is "Is there any relationship with
the incidence of anemia in pregnancy is
postpartum hemorrhage in the District Dandy
Clinic Mabar 2014? ".
Objective: The general is to
investigate the relationship with the incidence
of anemia in pregnancy is postpartum
hemorrhage in the District Dandy Clinic
Mabar 2014.
Hypothesis: There is a relationship of
anemia in the third trimester of pregnancy with
the incidence of postpartum hemorrhage
framework concept
Independent Variables Dependent
Variable anemia in pregnancy, postpartum
hemorrhage, the parity age birth
Operational Definition
1. Anemia in pregnancy is a state of maternal
hemoglobin level less than 11gr% in the third
trimester of pregnancy, which is taken from
the documents of respondents
2. Post Partum Hemorrhage is the amount of
blood that comes out of the birth canal more
than 500 ml after the baby is born, the data
from respondents document.
3. Risk factors for bleeding such as: age, parity
and birth spacing is taken as the characteristics
of respondents.
Special goals
a. To know the prevalence of anemia in
pregnant women in the third trimester at
Dandy Clinic District of Mabar 2014.
b. To determine the frequency distribution of
the incidence of post partum hemorrhage in
the District Dandy Clinic Mabar 2014.
c. To determine the relationship between
anemia in pregnancy with postpartum
hemorrhage in the District Dandy Clinic
Mabar Medan 2014.
4
Anemia TM
III
Anemia
Not
anemia
46
37
55.42
44.58
5
Perdaraha
Postpartu
Perdaraha
Not
Perdarahan
38
45
45.78
54.22
83
100.00
Methods
Frame work study
Anemia
Haemorragia
pergnancy
Age, Parity, Distance
post partum
Birth
Analyt
ical
Cross-sectional study design. The
population is all women giving birth in the
District Dandy Mabar Clinic in 2014 as many
as 284 people, and those with anemia during
pregnancy 286 people.
The sample is calculated using the formula in
theory Notoatmodjo Tarro Yamane (2010), A
large sample of 83 people taken at random
systematic / random sampling.
Analysis of Data was Univariatt
Univariate and Bivariate statistical analysis
using chi square test with a confidence level of
95%.
Results
The number of patients who delivered
recorded in 2014 was 286 people, samples of
83 people with the following caracteristics :
Table 4.1 Distribution Overview Dandy
Mother Maternity Clinic District of Mabar
2014
No Other Factors Frequency Percentage
(N)
(%)
1
2
3
Age
<20 years
20-35
years
> 35 years
28
42
13
Parity
≤ 2 people
> 2 people
32
51
Distance
Birth
<2 years
> 2 years
47
36
33.74
50.60
15.66
Total
From Table 4.1 above it can be seen that the
majority of women giving birth in the age
group of 20-35 years as many as 42 people
(50.60%), and the remaining were in the age
group <35 years as many as 13 people
(15.66%)
Based on parity, the majority of women are
multiparous ie with parity> 2 accounts for 51
people (61.45%), and the remaining with
parity ≤ 2 people as many as 32 people
(38.55%)
The majority of maternal with spacing <2
years were 47 people (56.63%), minority
spacing> 2 years were 36 people (43.37%)
Maternal characteristics based on a history
of anemia of pregnancy, the
majority of women suffer from anemia as
many as 46 people (55.42%), and who do not
have anemia as many as 37 people (44.58%).
Based on the cases of postpartum
hemorrhage were found to be
maternal
bleeding were 38 cases (45.78%) and mother
did not bleed were 45 people (54.22%)
Table 4.2 Relationship Analysis Anemia In
Pregnancy Trimester III With Postpartum
Bleeding Events in Clinical Dandy
District of Mabar 2014
Bleeding events
38.55
61.45
No. Hb BleedingNot
Total%
Mother
bleeding
F
56.63
43.37
1
2
%
F
Statistics Test
Results
X2
X2
arithmetictable
%
Anemia27 32.53 19 22.89 46
Not
11 13,25 26 31,33 37
Anemia
Total 38 45,78 45 54,22 83
55.42 6.931
3,841
44,58 P value = 0,008
100,00
109
From Table 4.2 above, out of 46 mothers who
suffered anemia in the third trimester of
pregnancy, were found to experience PPH as
may as 27 mothers (32.53%) and the
remaining 19 mothers (22.89%) did not
develop PPH. In the other hand out 37 women
who were found with out anemia, 11 were
discovered to experience PPH, while hte other
26 were not (31.33%)
Results of Chi-square test resulted x2 count >
x2 table (6.931> 3.841) with df = 1, p value is
0.008 <0.05 which means that Ho is rejected
and Ha accepted, thus there is a relationship
between anemia in the third trimester of
pregnancy and the incidence of postpartum
hemorrhage
Discussion
Statistical analysis using Chi-Square
test found that there is a relationship between
third trimester pregnancy anemia and
incidence of PPH.
These results is accordance with other
study (Ayu Wurianti,2010) which stated that
there is relationship between 3rd trimester
pregnancy anemia and PPH. This result is also
consistent with the stury by Salis (2004),
stating that there is a significant relationship
between anemia and PPH.
Maternal
anemia
experiencing
postpartum haemorrhage may be due to
inadequate nutritional intake, especially foods
that contain iron. If the iron requirement is not
sufficient then the level of hemoglobin in red
blood cells is reduced. Lack of hemoglobin
levels cause the amount of oxygen bound in
the blood is also reduced, which results
inadequate uterine contractions. Inadequate
contraction will cause bleeding. This is in
accordance with Arisman (2010) who said that
anemia during pregnancy is associated with
less nutritious food, inadequate absorption,
and increased iron demand. Anemia can
reduce the mother's immune system and
elevate the frequency of complications of
pregnancy and childbirth, one of which
increase the risk of postpartum hemorrhage.
Manuaba (2007) disclose any pregnant
women with anemia are at risk for postpartum
hemorrhage. Bodnar research results, et.al.
(2011) The United States claimed that mothers
who are anemic 3 times risk of experiencing
postpartum hemorrhage compared with
110
mothers who did not have anemia. (OR = 2.76;
95% 1,25; 6,12). It is not in accordance with
the research because there are still pregnant
women with anemia but did not experience
postpartum haemorrhage which were 19
people (22.89%) and pregnant women who are
not anemic during pregnancy but expereinced
postpartum hemorrhage as many as 11 people
(13.25%). In the study we found, women with
a history of anemia, but did not experience
postpartum hemorrhage. This is due to the
physical state mother, mothers of reproductive
age are healthy or not included in the high-risk
groups such as being too young or too old, and
maternal hemoglobin level which is not so low
or only presents to be mild anemia.
We also found mothers who didn’t
suffer anemia but still expereinced PPH. This
is due to the weak state of the mother, or have
a history of certain diseases, poor obstetric
history such as previous history of placental
abruption, maternal reproductive age which is
healthy such as being too young (maternal age
<20 years too old or> 35 years, the research is
still Being too young (< 20 years of age) or too
old (>35 years of age) may lead the woman to
higher risk of complication during pregnancy.
In women who are < 20 years of age, the
optimal biologis and psychologis condition
have not been reached. These lead to
prolonged labor that may result in atonic
uterus or other disorders that may lead to
PPH. In the other hand, women who are > 35
years of age usually are weaker and unable to
exert adequate force to push during delivery
that also leads to PPH. This is consistent with
study by aminuddin (2007) that stated that age
is one of predeisposing factors of PPH.
In addition to age, parity also
influences the occurrence of PPH. Women
with history of multiple parity tend to be
inefficdient in every stage of labor which is
the risk factor of PPH (Pritchard, 1991).
Multiparities women tend to experience atonic
uterus due to weaker myometrium, inadequate
muscle tone, causing compression of vessels
failure at the site of placental implantation
which all lead to PPH. This is consistent with
Winkjosastro (2002) which stated that high
parity is one of the risk factors of postpartum
hemorrhage. These results are consistent with
research Pardosi (2009) that also concluded
that parity was significantly associated with
the incidence of postpartum hemorrhage.
Pregnant women with parity of 1 or more than
5 are at risk of postpartum hemorrhage
occurred 3.86 times more likely than pregnant
women with parity 2-5. This research is in
accordance with Salis (2004) and Syriac
(2008) which stated there is a significant
association between parity and postpartum
hemorrhage.
Spacing between births that are too
close can cause pregnancy complications
which will result in a decrease uterine
contractions. According to Moir and
Meyerscough (1972) cited Suryani (2008)
mentions the distance between the birth of a
predisposing
factor
for
postpartum
hemorrhage due to successive deliveries in
short periods of time will lead to decreased
uterine contractions become less good. It take
2-4 years for the mothers to regain their
previously fit condition. According to Yuniarti
(2004) the proportion of cases with spacing
between birth less than 2 years was 41% (OR
= 2.82). This indicates that women with
spacing between birth < 2 years have 2.82
times higher risk of PPH.
Mothers who did not suffer anemia
indicated adequate nutritional status, good
maternal preparation for pregnancy especially
in primigravida, and healthy reproductive age.
According to the authors, maternal anemia
may be due to insufficient iron intake due to
poor nutritional status. Iron defficeincy leads
to low level of hemoglobin leading to
inadequate supply of oxygen to uterus. In
addition, anemia also lowers immune system
which may increase complication during
childbirth. Maternal health status, such as for
being too young or too old for pregnancy also
lead to increased risk of PPH.
Conclusion
1. The number of women giving birth with a
history of anemia in the third trimester of
pregnancy were 46 people (55.42%) and with
out anemia were 37 people (44.58%)
2. The number of mothers who suffered
postpartum hemorrhage were 38 people
(45.78%), and who didn’t suffer PPH 45
people (54.22%).
3. The statistical test Chi - square count
obtained x2 table (6.931> 3.841) or the value
of the probability p = 0.008 <0.05 means that
there is a relationship of anemia in the third
trimester of pregnancy with incidence of
postpartum hemorrhage.
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KNOWLEDGE DESCRIPTION OF THIRD TRIMESTER PREGNANT
WOMEN ON BONDING ATTACHMENT IN SEHAT MATERNITY
CLINIC OF PANTAI CERMIN SUB DISTRICT 2012
1.
Suryani 1, Irmalinda2, Junita Karoiny Pardosi3
Midwifery Departement of Medan Health Polytechnic of Health Ministry
Graduation of Midwifery Department of Medan Health Polytechnic Health Ministry
Author Correspondency (+628126443796; [email protected])
2.
3.
ABSTRACT
Bonding attachment prevents 22 % of infant deaths per year. The estimated number of deaths of
newborns is 89/ 770 per year, or 246 newborns per day.
This study aims to know the overview of pregnant women knowledge about bonding attachment,
maternal characteristics by age, education , resources, and parity in the Sehat maternity clinic of
Pantai cermin in 2012 .
This type of research is descriptive. Population of 37 respondents pregnant women with total
sampling technique. Collected data is primary data with questionnaires as measuring instrument.
The results obtained knowledge about maternal bonding attachment with 70.27 %, a majority of age
20-35 years of 72.41 % and less of age < 20 years with 80 %, the majority of secondary education of
63.63 % and less of primary education of 91.67 %, 72.41 % majority of resources from health care
workers and less of the mass media category of 62.5 %, and the majority of multiparous 77.78 % and
less of scundipara with 68.75 %.
Pregnant women knowledge about bonding attachment was still lacking. For this, it is expected that
health workers through the efforts of counseling and providing information will help mothers increase
their knowledge.
Keywords
References
: Knowledge Pregnancy Third Trimester, Bonding Attachment
: 21 sources ( 20006-2012)
I.BACKGROUND
World Health Organization (WHO) and
United Nations Children's Emergency Fund
(UNICEF) along with the other Scientific
Community highly recommend early initiation
breastfeeding and implementation of skin
contact within one hour after birth ( Lennart ,
2007) .
In Indonesia based on data from the Ministry
of Health in 2007 the infant mortality rate
(IMR) reached 26.9 / 1,000 live births . In
2004, the infant mortality rate was about 30.8 /
1,000 live births (Health Department, 2009),
the mortality rate of newborns (neonates) 20
per 1,000 live births. Meanwhile, the target is
a reduction in IMR of 35 babies per 1000 to
26 babies per 1,000 live births ( Maryunani A ,
2010) .
According to Indonesian Household Health
Survey in 2009, IMR ( aged 0-28 days ) was
20 per 1,000 live births, indicating that the
number of newborn deaths is 89/770 per year,
or 246 newborns per day or 10 newborns per
hour. Meanwhile , the infant mortality rate by
0-12 months. Based on Survey held in 2009
was 35 per 1,000 live births ( Maryunani A ,
2010 ) .
According to the Indonesian Demographic and
Health Survey in 2007, it was estimated that
IMR is 34 per 1,000 live births ( Indonesian
Health Department , 2011) .
The government has established Indonesian
Health Vision to decrease mother mortality
rate (MMR) as one indicator of the final
outcome in assessing health status in
Indonesia. As expected in 2015 , the infant
mortality rate (< 1 year ) was reduced to 17
per 1,000 live births (Department of Health,
2007) .
The Central Bureau of Statistics of North
Sumatra Province, estimated that IMR in 2010
113
in North Sumatra was 24.5 per 1,000 live
births . This figure was better when compared
to the previous year amounting to 26.90 per
1,000 live births ( Syafei C , 2010) .
Delayed breast feeding initiation, even only
after the first day, is shown to contribute to 2-4
times higher risk of mortality. In the other
hand, skin to skin contact must be done
properly as well. A proper skin to skin contact
should not be done in hurry, should not be
disturbed, should be without any cover or
clothes, and must be done as early as possible
after birth and last for an hour ( Elizabeth ,
2012) .
Skin to skin contact or attachment and early
breasffeeding initiation in the first 1 hour after
birth may prevent 22% risk of mortality in
newborns under 1 month. Thus the first hour
in newborns life is very important and both
early breastfeeding and attachment are live
saving action. Prevention of 22% risk of
mortality is equal to saving 21 thousand babies
per year. Hence these actions are for the
survival of thousand babies hours afterwards
(Lennart, 2007) .
Formulation Of The Problem
"How is the knowledge description of third
trimester pregnant on bonding attachment in
Sehat Maternity Clinic of Pantai Cermin sub
district 2012 ? "
Research Aim
To find out knowledge description of third
sehat Maternity clinic of pantai cermin sub
district 2012.
Benefits Of Research
1. To add insight and knowledge of the author
in applying knowledge acquired during the
lectures, especially research methodology
courses .
2. The results of this study can be used as
reading material in the library of Medan
midwifery study program.
II.LITERATURE REVIEW
1. Bonding Attachment
Bonding attachment has become increasingly
popular. The implementation of early initiation
of breastfeeding which coincides with the
establishment of a bond attachment can help to
114
reduce the IMR. Normal infant development
depends on the response of affection between
mothers and babies who are meant to be
united in both psychological and physiological
relationships (Suherni, 2009).
The aim of bonding attachment (Mitayani,
2010) are :
a.To get warmth in infants
b.To prevent infants lose body heat
c.To increase fabric of affection between
mother and baby. Bounding (bonds of
affection) between mother and baby will be
better if being done the first 1-2 hours for the
baby has been ready.
d. To reduce infant mortality due to
hypothermia
e.Mother and babies feel calmer
f.Mother and fathers feel more happier for
they finally meet the baby for the first time.
2. Benefits of Skin Contact from Baby to
Mother
Mother's chest will be appropriately warm
during baby crawling looking to breast. This
will reduce the number of deaths due to cold
(hypothermia) (Mitayani, 2010).
a.Mother and baby will feel calmer. Baby's
breathing and heart rate become more stable.
Baby will cry less frequently, thereby reducing
energy consumption.
b. Exclusive breastfeeding will become easier
that would improve intelligence of the baby.
Babies who are given early opportunities will
become
more
successfully
breastfeed
exclusively and will take longer breastfed.
c.Baby can get colostrums. Colostrum is the
first content of milk with optimum quality and
quantity which are in accordance with the
baby’s ned.
d.First colostrum contains some antibodies
that can prevent infection in infants, thus
ensuring the survival of the baby.
e.The touch of the baby at around its mother’s
nipple and surrounding areas, as well as
baby’s reflex of sucking and licking are useful
to increase the releas of oxytocin which is
importan for :
a. Helping the removal of placenta and
avoiding maternal hemorrhage.
b. Stimulating another hormone that makes
mother becomes more, relaxed and loves her
baby, thus putting the mother to more stable
emotion, increasing endurance to pain and
much more happiness.
c. Stimulating the release of breast milk.
Elements And Methods of Performing
Bounding Attachment
( Mitayani , 2010)
1.Touching
2.Eye Contact
3.Voice
4.Body odor
5.Entrainment
6.Rhythm of life
7.Early contact
8.Body Warmth
9.Rooming in
2.Knowledge Based Education Level
Table 2
Knowledge Distribution of Respondents
About Bonding Attachment Based On
Education Level In Sehat Maternity Clinic
o Pantai Cermin 2012
NoMother Education
Knowledge
Total
Good Enough Less
F %
F %
F %
F %
- 1 8,33 11 91,67 12 32,43
Basic Education
(SD/SMP)
2 Middle
4 18,19 4 18,18 14 63,63 22 59,47
/secondary(SMA/same
level)
3 University
- 2 66,67 1 33,33 3 8,10
Total
4 18,19 7 18,92 26 70,27 37 100
1
III.RESEARCH METHODS
This research is a descriptive study
to
determine knowledge description of third
Sehat Maternity clinic of pantai cermin sub
district 2012 using a questionnaire measuring
instrument.
From Table 2. It is seen that out of 26
respondents who are less knowledgeable the
majority elementary education graduates were
which accounts for 11 respondents (91.67 %),
and the remaining 14 respondents were
secondary education graduates ( 63.63 % ) .
The location was chosen for this study is in
Sehat Maternity clinic of Pantai Cermin 2012.
The research, has been done to complete the
study, which was conducted from March until
July 2014 .
3. Information Sources
The population in this study were all pregnant
women who came to visit Sehat Maternity
clinic of Pantai Cermin 2014 for antenatal
care from June to July of 2014 which accounts
for 37 people .
IV.RESULTS AND DISCUSSION
RESULTS
1. Knowledge Based on Age
Table 1
Knowledge Distribution Of Respondents
About Bonding Attachment Based on
Mother Age In Sehat Maternity Clinic Of
Pantai Cermin 2014
No
Mother
Age
1 < 20
2 20 -35
3 > 35
Total
Good
F %
- 4 13,8
- 4 13,8
Table 3
About Bonding Attachment Based on
Information Sources in Sehat Maternity
Clinic of Pantai Cermin in 2014
Information
Sources
F
1 Mass
1
Media
2 Health
3
Workers
Total
4
No
Knowledge
Total
Good
Enough Less
%
F %
F %
F %
12,5 2 25 5 62,5 8 21,62
10,34 5 17,25 21 72,41 29 78,38
10,81 7 18,92 26 70,27 37 100
From table 3 it can be seen that 21
knowledgeable
respondents
gained
information from health workers (72,41%)
while the remaining 5 (62,5%) less
knowledgeable
respondents
gained
information from mass media..
Knowledge
Total
Enough Less
F %
F %
F %
1 20
4 80
5 13,51
4 13,79 21 72,41 29 78,38
2 66,67 1 33,33 3 8,11
7 18,92 26 70,27 37 100
From Table 1, it can be seen that out of the 26
respondents aged 20-35 years the majority are
( 72.41 %) .
115
4. Knowledge Based on Parity
Table 4
About Bonding Attachment Based on Parity
in Sehat Maternity Clinic of Pantai Cermin
in 2014
No
Parity
Knowledge
Total
Enough
Less
F %
F
%
F
%
1 50
1 50
2 5,40
3 18,75 11 68,75 16 43,24
1 Primipara
2 Scundipara
Good
F %
- 2 12,5
3 Multipara
2 11,11 2 11,11 14 77,78 18 48,65
4 Grandemultipara - 1 100 - 1 2,71
Total
4 10,81 7 18,92 26 70,27 37 100
From Table 4 it can be seen that out of 26 less
knowledgeable
respondents,
14
were
multiparous (77,78%) and 11 were scundipara
(68,75%).
DISCUSSION
1. Respondents Knowledge About Bonding
Attachment
Respondents
in
Sehat
Maternity Clinic in 2014.
Based on the results of the analysis, it is
indicated that the majority of respondents are
less knowledgeable about bonding attachment
which accounts for 26 respondents (70.28 % ).
Knowledge less than 70% is shown to prevent
both breastfeeding initiation and attachment to
be done properly. According to Notoadmojo,
knowledge plays a critical role in interpreting
the results to be obtained.
Thus we believe that the implementation of
breastfeeding initiation and attachment is
positively correlated with information. Thus
information delivery needs to be improved to
increase the maternal knowledge of
breastfeeding inititiation and attachment.
2.Respondents Knowledge About Bonding
Attachment Respondents based on age in
Sehat Maternity Clinic in 2014.
The results showed that out of 26 respondents
by 20-35 years, the majority knowledgeable
about as many as 21 respondents (72.41%).
Results of this study differs from study by Ika
(2011) which suggests less knowledgeable
respondents were at the age of 20-35 years
16.7%.
116
According to Arini (2012), maternal age is
crucial in determining maternal health,
pregnancy condition, child birth and post
delivery condition. Mothers under 20 years of
age are still not ready to face pregnancy,
childbirth & to gsdyrt yhr nsny in yrtmd og
noyh physiologyc and psycologycal matters.
The results are consistent with the theory that
there Siti (2012), which in theory may increase
a person's age, will be more mature in thinking
so more easily understand information to
increase knowledge.
And the authors assume that the lack of
information from health workers affects the
interest of mothers to seek information about
bonding attachment.
3.Respondents Knowledge About Bonding
Attachment
Respondents
based
on
education level in Sehat Maternity Clinic in
2014.
From the result of 26 respondents, the less
knowledgeable respondents were secondary
education graduates which accounts for 14
respondents ( 63.63 ).
It is contrary to Ika’s opinion (2011) which
suggests that the majority of respondents have
less knowledge about the intermediate bonding
attachment were 3.33 % .
According to Arini ( 2012) a low level of
maternal education results in a lack of
knowledge of mothers in dealing with
problems. When mothers have higher
education level, they are generally open to
changes or new things to the maintenance of
health. Education will also make a person
seek experience so that the information
received will be a knowledge .
However, the authors assume that the mother's
lack of interest in knowing about the
importance of the bond is very influential on
the mother's knowledge. From the research we
unfortunately obtained that there were still less
knowledgeable mother who actually have
completed secondary education. From several
questionnaire given to several respondents, it
was found that majority of mothers thought
that bonding or attachment to newborn may
naturally occur, thus it become a matter of
concern to mothers doesn’t. Hence, we suggest
that information access enhancement from
health workers is the corner stone to improve
mothers’ point of view regarding this issue.
The knowledge of the respondents based on
information sources showed on table 3 shows
that out of 26 respondents, 21 were less
knowledgeable and gained information from
health workers.
Based on the opinion of Em Zul Fajri and
Queen April Twilight, information is lighting,
notifications, news about something that
supports the overall meaning of the mandate.
Knowledge may be gained from several other
sources, such as newspaper, radio, movies,
televisions, but we argue that the fact of less
provision of attachment/bonding may come
from the lack of information gained from
health workers. Thus, eventhough there have
been numerous technological advance from
the media when the information isn’t coreect,
then the reepient will be wrong in taking sense
and attitude.
4.Respondents Knowledge about Bonding
Attachment Respondents based on parity in
Sehat Maternity Clinic in 2014
Based on the result, it was shown that out of
26 respondents, the majority of the less
knowledgeable mothers were multiparous as
many as 14 respondents (77.78 %).
The result is consistent with the theory
mentioned by Notoatmodjo (2007), which in
this study the authors get a good knowledge of
what the mother had given birth wherein said
higher parity theory, the more knowledge
about bonding attachment for pregnant
women.
But the authors argue that majority of mothers
thought that bonding to newborns is a natural
thing, in additition to the lack of information
from health workers contribute to the lack of
provisions of newborns attachment.
1. Conclusion
From the research, entitled "Knowledge
Description Of third trimester Pregnant
Women On Bonding Attachment In Sehat
Maternity Clinic Of Pantai Cermin Sub
District 2014" it can be summarized that :
1. From 37 respondents majority have less
knowledgeable , as many as 26 respondents
(70.28 %).
2. Based on age, majority less knowledgeable
respondents aged 20-35 years of the 21
respondents (72.41 %).
3.Based on education, the majority of
respondents are less knowledgeable on
secondary education as much as 14
respondents ( 63.63 %) .
4.Based on sources, the majority of
respondents were less knowledgeable who got
information from health officials as many as
16 respondents (84.20%).
5.Based on parity, the majority of respondents
with less knowledge were multiparous mothers
as much as 14 respondents (77.78%).
2.Suggestions
As for suggestions it can convey to the authors
of this study as follows:
a.For Educational Institutions
The results of this study are useful to broaden
and reading materials for students of
midwifery in library.
b.For Maternal Clinic
For Sehat maternity clinic to be able to work
together with the patient in establishing the
health of mothers and babies to be able to
providing complete information about health
through counseling related to bonding
attachment, early initiation of breastfeeding,
which aims to attract the mother.
c.For Next Researchers
For further research can be performed
descriptive and analytical methode so that the
results obtained are more meaningful as a
source of information related to the bonding
attachment.
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Diakses tanggal 20 juni 2012
http://www.idai.or.id/asi/artikel.asp?
q=2011624154549
EFFECT OF CUTANEOUSSLOWSTROKEBACKMASSAGE
STIMULUSTODECREASEPAININTENSITYIN LOW
BACKPAINPATIENTS INPUSKESBUNDIVISIONII
OF PT.SUCFINDOMATAPAO
SERDANGBEDAGAI
*Dina Yusdiana Dalimunthe
**Mula Tarigan
***Johani Dewita Nasution
*) **) Nursing Department of Poltekkes Kemenkes Medan
***) Keperawatan USU
Abstract
Low back pain (LBP) is pain, aching, stiffness that occurs in the lower back. Lower back pain is not a
disease but a symptom resulting from very diverse causes. The pain can also spread to other areas
such as the upper back and groin. One non-pharmacologic measures to overcome this pain is to use
stimulus cutaneous slow stroke back massage. Mechanism of action of cutaneous stimulus of slow
stroke back massage in reducing pain intensity is by using the principle of gate control theory and the
theory of endorphins. This study aims to determine the effect of cutaneous stimulus slow-stroke back
massage on pain intensity in patients with low back pain. Thus, the design of this study using quasiexperimental design with Pre and Post test Without Control. Analysis of the data by using a paired ttest at 95% confidence level. Samples were patients with LBP in puskesbun Division II PT.Sucfindo
Mata Pao Bedagai Serdang, as many as seven people taken by accidental sampling. The technique of
collecting data by interview and observation. Based on the analysis using a paired t-test values
obtained average (mean) the intensity of pain before administration of cutaneous stimulus slow-stroke
back massage 4.7 (SD = 0.76), whereas the cutaneous stimulus after the slow-stroke back massage
decrease with a value of 3.3 (SD = 0.49). In addition, test results obtained by value p = 0,000
(p≤0,05) which shows the significant difference between before and after the intervention, with a
confidence level of 95% obtained the value t = 7.071 (t> 1.96), which means that the difference can
be received with an average value difference (mean) of 1.43 (SD = 0.53), in which region the
difference is in the range 0.93 to 1.92. It can be concluded that the stimulus cutaneous slow stroke
back massage affects the intensity of low back pain sufferers pain (LBP). Thus, nurses can use this
stimulus to overcome pain as non-pharmacological measures.
Keyword: Slow-Stroke Back Massage, Pain Intensity, Low Back Pain (LBP)
BACKGROUND
Each individual is inseparable from the
activity or work to make ends meet. Most of
the activities and the work requires energy and
muscle strength are large enough to cause a
variety of complaints, one of which is lower
back pain. Lower back pain or low back pain
(LBP) is a pain, aching, stiffness that occurs
below the waist area (Ismiyati, 2007). Lower
back pain is not a disease but a symptom
resulting from very diverse causes (Hakim,
2006).
Almost everyone has experienced low back
pain. Approximately 80% of everyone in his
life has experienced pain in the lower back
area due to postural faults regardless of
gender, social and employment level (Cailiet,
2004).
The incidence of low back pain (LBP), almost
the same in all populations throughout the
world, both in developed countries and in
developing countries (Shocker, 2008). From
the research of Cropcord Indonesia (2004)
showed that patients with LBP on male gender
prevalence was 18.2% and 13.6% in women.
While the population had experienced lower
back pain once and more during his life
between 60% to 90% (Setyohadi, 2005).
According to Rice (2002) in Shocker (2008)
mentions the most common causes that can
lead to LBP is back muscle stiffness and
spasms due to poor body activity and tense
119
posture. In addition, various diseases can also
cause LBP such as osteoarthritis, osteoporosis,
fibromyalgia, scoliosis, and rheumatism.
Ismiyati (2007) stated that there was an error
postural or disproportionate body movements
for a long time and continuously on the muscle
and fascia will cause pain ensued lumbar
muscle spasm and will undergo ischemic
muscle.
According to Setiawan (2008) that about 90%
of all cases of LBP caused by mechanical
factors, namely LBP on normal anatomic
structures are overused or secondary to trauma
or deformities, which cause stress or strain on
the muscles, tendons and ligaments. Moreover,
in terms of anatomical and functional, LBP
also can be caused by abnormalities in the
spine, where the spine is the support structure
of the body and the head is always involved in
various postures and motions so easy to crash.
The absence of painsufferersare oftenafraid
tomake
amovethat
disruptsdailyactivitiesandcan
reduceproductivity.In
addition,
theexperienceof pain, is enough to makethe
patient'sfrustratingto live adaily lifethat
caninterfere withthe qualityof life of patients.
Therefore, the primarytherapyis directedto
deal withthispain(Potter &Perry, 2005).
Pain
managementcan
beperformedwithpharmacological
treatmentandnon-pharmacological
therapy.
Pharmacological
therapyusinginhibitorsof
cyclooxygenase(COX
inhibitors)
often
causeside effects, namely
gastrointestinaldisorders(Kozier, 2004). In
addition, long-term usecan lead tobleedingin
the gastrointestinal tract, peptic ulcer,
perforationandrenal impairment(Daniel, 2006).
Did you mean: Guidelines AHCPR (Agency
for Healthcare Policy and Research) for acute
pain penatalaksanan (1992) mentions that nonpharmacological intervention is appropriate
intervention for patients who do not want to
use drug therapy to overcome the pain and
patients who feel anxious because they feel
pain after using pharmacological therapy.
Cutaneous stimulation, distraction, relaxation,
guided imagery and hypnosis are examples of
non-pharmacological interventions that are
often used in nursing in managing pain (Potter
& Perry, 2005). Stimulus cutaneous
stimulation of the skin is done to relieve the
pain on a scale of 6 or moderate pain by doing
120
massage and touch in the lower back. Massage
and touch a sensory integration techniques that
affect the activity of the autonomic nervous
system (Mook, 2004). If people perceive touch
as a stimulus to relax, then you will see the
relaxation response. Relaxation is crucial in
helping clients to improve comfort and free
themselves from fear and stress due to illness
and pain experienced are not resolved.
Additionally relax also helps reduce anxiety,
thereby preventing menghebatnya painful
stimulus (Long, 2006). One type of cutaneous
stimulus is massage (swabs) slowly lower
back is to perform Slow-Stroke Back Massage
(SSBM) for approximately 15 minutes at a
speed of 60 times per minute and repeated
smears every 4 hours. This massage is an act
of giving comfort, which can ease the tension,
relaxes the patient and improves circulation.
The workings of SSBM causes the release of
endorphins, thus blocking the transmission of
pain stimuli (Potter & Perry, 2005). The
technique for doing SSBM can be done by
several approaches, one method is by rubbing
the skin gently and rhythmically clients by
hand, with a sweep speed of 60 times per
minute. Long and soft sweep can provide
peace and comfort for the patient, while the
short and circular sweep tends to be more
menstimulas This technique is simple and easy
to do, so that every nurse and health
institutions can apply to overcome the problem
of pain, particularly in patients with LBP.
(Caldwell & Hegner, 2003) Advantages of
SSBM is this action can be done at home,
allowing patients and families to make efforts
in controlling pain. This can help the
independence of clients and families in
managing pain, particularly for patients who
are difficult to obtain medical care facilities or
patients who do not want to cope with the pain
by using pharmacological therapy. Besides the
cutaneous stimulus SSBM no need to use
special tools that require huge costs that this
stimulus can be provided to the community
began with the economic level on up to the
public under the economic (Potter & Perry,
2005). As in plantations PT.Sucfindo Mata
Pao Bedagai Serdang area that has as many as
five division, based on data puskesbun 2014,
the number of people in the plantation of 800
heads of households, 650 of them work as
employees of the plantation workers. The
interview with the Head of Mata Pao
PT.Sucfindo Puskesbun Serdang Bedagai
conducted by researchers on January 6, 2014,
of the total population of as many as 65 people
often come for treatment to puskesbun with
complaints of experiencing pain in the lower
back and the more pain when doing activities
such as mendodos palm.
Guidelines AHCPR (Agency for Health Care
Policy and Research) for acute pain
penatalaksanan (1992) mentions that nonpharmacological intervention is appropriate
intervention for patients who do not want to
use drug therapy to overcome the pain and
patients who feel anxious because they feel
pain after using pharmacological therapy ,
Cutaneous stimulation, distraction, relaxation,
guided imagery and hypnosis are examples of
non-pharmacological interventions that are
often used in nursing in managing pain (Potter
&
Perry,
2005).
Stimulus cutaneous stimulation of the skin is
done to relieve the pain on a scale of 6 or
moderate pain by doing massage and touch in
the lower back. Massage and touch a sensory
integration techniques that affect the activity
of the autonomic nervous system (Mook,
2004). If people perceive touch as a stimulus
to relax, then you will see the relaxation
response. Relaxation is crucial in helping
clients to improve comfort and free themselves
from fear and stress due to illness and pain
experienced are not resolved. Additionally
relax also helps reduce anxiety, thereby
preventing menghebatnya painful stimulus
(Long, 2006).
One type of cutaneous stimulus is massage
(swabs) slowly lower back is to perform SlowStroke
Back
Massage
(SSBM)
for
approximately 15 minutes at a speed of 60
times per minute and repeated smears every 4
hours. This massage is an act of giving
comfort, which can ease the tension, relaxes
the patient and improves circulation. The
workings of SSBM causes the release of
pain stimuli (Potter & Perry, 2005).
The technique for doing SSBM can be done by
several approaches, one method is by rubbing
the skin gently and rhythmically clients by
hand, with a sweep speed of 60 times per
minute. Long and soft sweep can provide
peace and comfort for the patient, while the
short and circular sweep tends to be more
menstimulas This technique is simple and easy
to do, so that every nurse and health
institutions can apply to overcome the problem
of pain, particularly in patients with LBP
(Caldwell
&
Hegner,
2003)
Advantages of SSBM is this action can be
done at home, allowing patients and families
to make efforts in controlling pain. This can
help the independence of clients and families
in managing pain, particularly for patients who
2005).
As in plantations PT.Sucfindo Mata Pao
Bedagai Serdang area that has as many as five
division, based on data puskesbun 2014, the
number of people in the plantation of 800
employees of the plantation workers. The
interview with the Head of Mata Pao
PT.Sucfindo Puskesbun Serdang Bedagai
conducted by researchers on January 6, 2014,
of the total population of as many as 65 people
often come for treatment to puskesbun with
complaints of experiencing pain in the lower
back and the more pain when doing activities
such as mendodos palm.
Results of direct observations conducted by
researchers during one week in puskesbun
PT.Sucfindo Mata Pao Serdang Bedagai of
from 6 s / January 11, 2014 the average
number of visits per day as many as 50 people
and 10% of them experienced low back pain
with pain scale 6 or pain being. This number
does not include those who did not check into
Puskesbun for several reasons, such as the
condition Puskesbun far from the settlement,
did not want to take medicine or work that
requires them to work every day so there is no
time
for
treatment.
During this time the employee has been
receiving treatment from a doctor but could
not overcome the perceived low back pain, it
is caused by factors not taking medication as
directed by your doctor on a regular basis and
the fear of chemical drugs. Accordingly the
researchers wanted to examine the provision
121
of SSBM to decrease the intensity of pain in
patients with LBP in Puskesbun Division II
PT.Sucfindo Mata Pao Bedagai Serdang.
METHODOLOGY
This research is a quasi experiment (quasiexperimental), with the draft Pre and Post Test
Without Control (Control yourself sendir) that
this study only intervene on a group without
comparison. This research was conducted in
Puskesmas Division II PT.Sucfindo Mata Pao
Serdang Bedagai in January to October 2014.
The population in this study were all
employees in Puskesbun PT.Sucfindo Mata
Pao Serdang Bedagai many as 650 people
working as plantation laborers. Of the total
number of employees is 65 people often come
for treatment to Puskesbun with complaints
experiencing lower back pain and more pain
during activity mendodos oil. The sample size
in this study was 10% of the population are
already experiencing lower back pain so that
the number of samples obtained as many as
seven people.
Collecting data in this study include primary
data and secondary data. Primary data
obtained by direct interviews with respondents
using questionnaire containing questions about
the experience back pain. Secondary data were
obtained from medical record puskesbun
PT.Sucfindo Mata Pao Serdang Bedagai such
as the number of visits kepuskesbun treatment
of employees, the data diseases suffered by
employees and Puskesbun profile data. The
data was then analyzed using univariate
analysis to analyze the dependent variable
LBP pain intensity before and after the
intervention and bivariate analysis is a
continuation of the univariate analysis to
analyze the influence between two variables
by conducting the tabulation and analysis of
data by using a paired t-test ( Dependent Ttest) at the level of 95%.
RESULT
Univariate Analysis
Based on the research that has been conducted
on 7 patients who had experienced lower back
pain, based on the known age of the
respondents who experienced low back pain
pain an average age of 49 years with more
than half are in the age range 45-48 years
(57.1 %), with the sex of the respondent
approximately two-thirds were women
122
(71.4%), all respondents have tribes Java
(100%) and 100% Muslim. Approximately
two thirds of respondents (71.4%) had a
primary education level, and all (100%)
working as employees of a plantation in
Serdang PT.Sucfindo Mata Pao Bedagai.
Bivariate Analysis
Bivariate analysis aims to determine whether
there is influence cutaneous stimulus Slow
Stroke Back Massage to decrease the intensity
of pain in patients with low back pain in
Division II PT.Sucfindo Puskesbun Mata Pao
Bedagai Serdang.
Pain intensity respondents before granting
intervention cutaneous stimulus slow-stroke
back massage measured using a scale
Bourbanis for 3 days in a row every afternoon
1 times measurement. The results showed that
the respondents perceived pain intensity before
administration of the intervention (100%)
reported moderate pain scale level 6.
After respondents were given intervention
cutaneous stimulus slow-stroke back massage
for 15 minutes, immediately re-measurement
of pain intensity using a scale Bourbanis.
The results showed that pain intensity after
administration of the intervention respondents
cutaneous stimulus slow-stroke back massage
obtained by about two-thirds of respondents
(71.4%) reported mild pain level and more
than a quarter (28.6%) in moderate pain.
Based on the analysis found that pain intensity
score respondent before giving cutaneous
stimulus slow-stroke back massage was 4.7
with SD = 0.76. While the cutaneous stimulus
after a slow-stroke back massage was 3.3 with
SD = 0.49. This showed a decrease in the
value of pain intensity after administration of
cutaneous stimulus slow-stroke back massage.
To determine differences in pain intensity
before and after the intervention (pre-post),
researchers used statistical analysis paired ttest. Results of the analysis obtained by value
p = 0,000 (p≤0,05) which shows the
significant difference between before and after
the intervention, with a confidence level of
95% obtained the value t = 7.071 (t> 1.96),
which means that these differences can be
accepted by value difference average (mean)
of 1.43 (SD = 0.53), in which region the
difference is in the range 0.93 to 1.92.
DISCUSSION
1. Intensity Pain Low Back Pain (LBP) Before
Provision intervention Slow cutaneous
stimulus-Stroke
Back
Massage
Based on the survey results revealed that prior
to the administration of cutaneous stimulation
of slow-stroke back massage on pain of low
back pain to see its effect on pain intensity,
pain intensity was measured by using a pain
scale Bourbanis on all respondents. The result
showed that all respondents (100%) felt pain at
the medium level.
Based on the results of research on
demographic data of respondents found that
the average age of respondents was 49 years
with more than half (57.1%) were in the age
range 45-48 years. Long (1996) mentions that
in adulthood easier to perceive the pain of the
elderly. This is due to the advanced age there
is a decrease in feeling and perceiving pain
caused by degenerative decline in dealer path
of pain and atrophy of nerve endings, so that
the elderly needed more stimulus to evoke
response from the pain in adulthood.
Gender
approximately
two-thirds
of
respondents (71.4%) were female. This shows
that women feel pain more easily than men.
Indeed mechanism of pain in each gender are
equal (Long, 1996). However, Potter & Perry
(2005) mentions that the man expected to be
more daring and resistant to pain than women
despite the situation that causes pain is the
same.
All respondents (100%) working as an
employee (farm workers) who use more power
and a lot of activity, so it is easy to experience
pain in the lower back. Bimariotejo (2009)
mentions that the mechanical trauma and
disruption caused because the muscles do
work or perform activities with a heavy load
can cause lower back pain. In addition, a job
that requires standing and sitting for a long
time can cause low back pain (Klooch 2006 in
Shocker, 2008).
2. Pain Intensity Low Back Pain (LBP) After
cutaneous administration of intervention Slow
Stimulus-Stroke
Back
Massage
After this is done stimulas cutaneous
administration of slow-stroke back massage
for 15 minutes immediately back pain
intensity was measured using a scale
Bourbanis. The results obtained are
approximately two-thirds of respondents
(71.4%) experienced a decrease in pain at mild
levels and more than a quarter of respondents
(28.6%) experienced pain at a moderate level.
These results indicate that the reduction in
pain intensity value of each individual is
different although given the same stimulus.
This difference is due to the subjective nature
of pain and very individual (Mahon, 1994 in
Potter & Perry, 2005), so the response
provided between an individual and the other
individual is not the same, depending on the
factors that influence such as age, gender, past
experience and (Smeltzer & Bare, 2002) as
well as the meaning of pain and coping style
(Potter & Perry, 2005).
A decrease in pain intensity was associated
with a reduction mechanism of gate control
theory of pain, which is decreasing the
intensity of pain occurs because the
transmission of pain impulses are blocked by
activating the A-beta fibers are abundant in the
skin (Kenworthy, 2002 in Potter & Perry,
2005). These fibers will respond when
performing massage on the skin gently
(Guyton & Hall, 1997), so that after
administration of cutaneous stimulus slowstroke back massage decreased pain intensity.
Slow-stroke back massage works by
encouraging the release of endorphins, thus
blocking the transmission of pain stimuli
(Potter & Perry, 2005). But the endorphin
levels in each individual is different so the
same stimuli perceived differently by different
people. These levels are controlled by genes
(Guyton & Hall, 1997; Potter & Perry, 2005).
This causes all the respondents experienced a
decrease in pain after the stimulus cutaneous
administration of slow-stroke back massage.
3. Effect of Stimulus cutaneous Slow-Stroke
Back Massage Against Pain Intensity in
Patients with Low Back Pain (LBP)
Based on the results of statistical tests with
paired t-test, found the difference in pain
intensity
between
before
and
after
administration of cutaneous stimulus slowstroke back massage, where the value of the
intensity of pain before administration of
cutaneous stimulus slow-stroke back massaage
was 4.7 with SD = 0, 76, while the cutaneous
stimulus after the slow-stroke back massaage
decrease in pain intensity with a value of 3.3
with SD = 0.49.
123
Based on the test results of the statistical
analysis paired t-test showed a significant
difference, as evidenced by the value of p =
0.000 (p≤0,05). Based on the 95% confidence
level is obtained the value t = 7.071 (t> 1.96),
which means that these differences can be
accepted with an average difference value
(mean) of 1.43 (SD = 0.53), in which region
the difference is in the range of 0.93 to 1.92. It
shows
that
the
stimulus
cutaneous
administration of slow-stroke back massage
affects the intensity of pain in patients with
low
back
pain
(LBP)
Reduction in pain intensity and a significant
difference is due to the effect of stimulus
cutaneous slow-stroke back massage, in the
form of massage action on the back with a
sweep gently for 15 minutes. With cutaneous
stimulus slow-stroke back massage, can
stimulate the fibers A beta are numerous in the
skin and responds to a light massage on the
skin so that the impulse delivered more
quickly. This stimulation makes the input
comes from the dominant impulse A beta
fibers so that the gate closes and pain impulses
can not be passed on to the cortexThe
incidence oflow back pain(LBP), almost the
sameinallpopulationsthroughout the world,
both in developed countriesand in developing
countries(Shocker,
2008).
From
the
researchCropcordIndonesia(2004)
showedthatpatients
withLBPonmale
genderprevalence was18.2% and13.6% in
women.
While
thepopulationhad
experiencedlower
back
painonceandmoreduringhis lifebetween60% to
90% (Setyohadi, 2005).
According toRice(2002) inShocker(2008)
mentionsthe mostcommoncausesthatcanlead
toLBPisback
musclestiffnessandspasmsdue
topoorbodyactivityandtenseposture.
In
addition,
variousdiseasescan
also
causeLBPsuch asosteoarthritis, osteoporosis,
fibromyalgia,
scoliosis,
andrheumatism.
Ismiyati(2007) stated that
people perceive touch as a stimulus to relax,
then you will see the relaxation response.
Relaxation is crucial in helping clients to
improve comfort and free themselves from
fear and stress due to illness and pain
experienced are not resolved. Additionally
relax also helps reduce anxiety, thereby
preventing menghebatnya painful stimulus
(Long,
2006).
One type of cutaneous stimulus is massage
124
(swabs) slowly lower back is to perform SlowStroke
Back
Massage
(SSBM)
for
approximately 15 minutes at a speed of 60
times per minute and repeated smears every 4
hours. This massage is an act of giving
comfort, which can ease the tension, relaxes
the patient and improves circulation. The
workings of SSBM causes the release of
pain stimuli (Potter & Perry, 2005).
do SSBM can be done by several approaches,
one method is by rubbing the skin gently and
rhythmically clients by hand, with a sweep
speed of 60 times per minute. Long and soft
sweep can provide peace and comfort for the
patient, while the short and circular sweep
tends to be more menstimulas This technique
is simple and easy to do, so that every nurse
and health institutions can apply to overcome
the problem of pain, particularly in patients
with LBP (Caldwell & Hegner, 2003)
Advantages of SSBM is this action can be
done at home, allowing patients and families
to make efforts in controlling pain. This can
help the independence of clients and families
in managing pain, particularly for patients who
2005).
As in plantations PT.Sucfindo Mata Pao
Bedagai Serdang area that has as many as five
division, based on data puskesbun 2014, the
number of people in the plantation of 800
employees of the plantation workers
questionnairescontainingquestionsabout
the
experienceback pain. Secondary data were
obtainedfrommedical
recordpuskesbunPT.SucfindoMataPaoSerdang
Bedagaisuch asthe number of visits to
Puskesbun for treatmentof employees, the
datadiseasessuffered
byemployeesand
Puskesbunprofile data. The data was
thenanalyzed
usingunivariateanalysisto
analyze
thedependent
variableLBPpain
intensitybefore
and
afterthe
interventionandbivariate
analysisisa
continuationofthe
univariate
analysisto
analyzethe influencebetweentwovariablesby
conductingthe tabulationandanalysisof databy
using apairedt-test (Dependen).
Conclusion
The conclusion that can be drawn from this
study
are:
1. The results of measurements of pain
intensity respondents using Bourbanis Scale
(0-10) prior to the administration of cutaneous
stimulation of slow-stroke back massage was
found that all respondents experiencing pain at
a
moderate
level.
2. The results of the measurement of pain
intensity respondents using Bourbonais Scale
(0-10) after stimulation of cutaneous slowstroke back massage obtained by about twothirds of respondents reported pain in mild
level and more than a quarter in moderate
pain.
3. Based on the software analysis using
computerized statistical analysis found that
there were differences in the intensity of pain
before and after the administration of
cutaneous stimulus slow-stroke back massage,
where the value of pain intensity after
administration stimulus respondents cutaneous
slow-stroke back massage lower than during
the prior administration Cutaneous stimulus
slow-stroke back massage. In addition, test
results of statistical analysis paired t test
showed a significant difference, so it can be
concluded that the stimulus cutaneous slow
stroke back massage affects the intensity of
low back pain sufferers pain (LBP).
Suggestion
1. In the implementation of nursing care to
pain, especially low back pain (LBP) nurses
can provide stimulus cutaneous with the
technique of slow-stroke back massage as an
alternative
to
nursing
as
a
nonpharmacological intervention for nurses /
health
professionals
2. For additional information in developing
knowledge in the health institution that aims to
improve the ability (skill) to overcome the
pain
for
healthcare
institutions.
3. The sample in this study perform work
activities (not in a state of rest / bed rest), so
that after administration of cutaneous stimulus
of slow stroke back massage, there are several
samples that have increased the intensity of
back pain. For the expected characteristics of
the sample in the next study is that the sample
does not perform work activities, to be more
visible how the effect of cutaneous stimulus
slow stroke back massage on pain of low back
pain (LBP).
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February
20,
2010
from
.backpainforum.com.
Cadwell, E & Hegner, B R. (2003). Nursing
Assistant:
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Process
Approach Edition 6. Jakarta: EGC.
Daniel. (2006). Conventional NSAIDs Still
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ault.asp.
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Medical
Physiology,
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editor: Irawati Setiawan Edition 9.
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RISK FACTORS INFLUENCING ACUTE RESPIRATORY TRACT
INFECTION (ISPA) IN TODDLER AT PUSKESMAS TANJUNG PAKU
SOLOK CITY 2014
Yulastri
Politeknik Kesehatan Kemenkes Padang
ABSTRACT
This study aims to get a description of risk factors ISPA In Toddlers In Review Of Environmental and
Nutritional Status in Urban Village of Puskesmas Tanjung Paku Solok City, 2014. This is a
descriptive study with populations of all mothers with toddlers ever suffer from ISPA in the village of
Tanjung Paku in the last 3 months of 2014. Samples were taken by systematic random sampling with
the number of samples was 96 respondents.
Data collected by observation, interview and documentation study. Then analyzed by univISPAate.
Based on the research results suggested to the health workers to provide health education to the
respondents who have children to improve access to the air vents in the home, among others, by
opening a window in the morning and afternoon, organize planting trees around the house so as not to
obstruct the air and light, provide balanced nutrition fit the needs of toddlers and set the number of
occupants of rooms according to age in order to prevent the risk of transmission of ISPA.
Keywords
References
: ISPA, Ventilation, Density Residential, Nutritional Status
: 35 (1989-2013)
BACKGROUND
According to the WHO in 2008, acute
respiratory infections (ISPA) is a disease that
often occurs in children. Incidence by age
group toddler estimated 0.29 episodes per
child / year in developing countries and 0.05
episodes per child / year in developed
countries. It shows that there are 156 million
episodes per year in the new world, where 151
million episodes (96.7%) occur in developing
countries. Most cases occur in India (43
million), China (21 million), Pakistan (10
million), Bangladesh, Indonesia and Nigeria
respectively 6 million episodes. (Health
Ministry, 2011).
In Indonesia, ISPA is a health problem in
children because of the high incidence of
respiratory infection, especially in infants.
Each child is estimated to have three to six
ISPA episodes annually and result in
approximately 20-30% of deaths (Mairuhu,
2012). ISPA is a leading cause of patient visits
in health centers (40% - 60%) and treatment
visits at the outpatient and inpatient care in
hospitals (15% - 30%) (Ministry of Health,
2011).
Acute respiratory tract infection is a disease
affecting one or more parts of the respiratory
tract from the nose to the alveoli, including
adnexa tissue, such as the sinuses, middle ear
and pleural cavity (Health Ministry, 2002).
These infections are caused by viruses, fungi,
and bacteria that will invade the host when
ISPA decreased body resistance. Children
aged under five years are groups that have
immune systems that are still susceptible to
diseases (Marhamah, 2013).
In general, there are three risk factors, namely
ISPA environmental factors, individual factors
of children, and behavioral factors.
Environmental factors can be seen from the
factor of air pollution inside the home,
ventilation and occupancy density. Factors
individual child is influenced by age, birth
weight, nutritional status and vitamins. While
the behavioral factors are influenced by the
mother or other family members to the
prevention and control measures respiratory
disease in infants (Maryunani, 2010).
Ventilation allows the availability of fresh air
in the house or room that is needed by
humans, so if a room does not have a good
ventilation system and over crowded it will
lead to a state that can be detrimental to health
(Millatin, 2010). Risk factors that residential
density of a role in the incidence of respiratory
disease is the density residential bedrooms are
generally very vulnerable in developing
127
countries. When the density of occupancy
bedrooms more than 2 people in the room
except the toddlers did not participate as of the
risk of ISPA will increase. Exposure to
infectious agents in the family occurs more
frequently in families that share a bed
(Andayani, 2012: 7). Nutritional status is also
an important risk factor for the occurrence of
respiratory infections, because poor nutritional
status is usually accompanied by poor immune
status thereby increasing the risk of respiratory
infection. (Sukmawati, et al, 2009).
Based on a preliminary study that the
researchers did on January 13, 2014, found the
number of children suffering from ISPA from
October to December 2013, of the four health
centers in the city of Solok, obtained
Puskesmas Tanjung Paku has the most number
of patients with respiratory infection that as
many as 308 people (38 %). Puskesmas
Tanjung Paku consists of four wards. 4
villages of the region, the toddler most
experienced by ISPA as much as 298 peoples
(95.6%).
In the initial survey conducted by researchers
dated January 13, 2014 in the village of
Tanjung Paku, many families who have been
able to have their own homes, but less
attention to vent some even do not have at all.
Some homes are closed all day because the
owners go to work or other daily routines.
How stuffy and moist air in the house.
Because of the lack of land, the house was
built is not proportional to the number of
people who occupy it, so that the house is too
dense. There are habits of the people who still
like to bring other family members to live
together with his family, even though their
home area no longer sufficient to
accommodate many people. Mothers also say
that eating aim is only to eliminate hunger
alone.
RESEARCH METHODS
Research Design
This is a descriptive study in order to see the
risk factors of acute respiratory infection in
infants in terms of environmental and
nutritional status at Puskesmas of Tanjung
Paku Solok 2014.
128
Result
Table 1
Frequency Distribution of Respondents by
Ventilation Houses at Puskesmas Tanjung
Paku Solok 2014
No Ventilation
f
%
1
2
Adequate
Inadequate
Total
8 8,3
88 91,7
96 100
From Table 1 it can be seen that almost all
respondents (91.7%) ventilation is not eligible.
Ventilation is very useful to keep the air flow
inside the house to keep it fresh. This means
the balance of O2 required by the occupants of
the house is maintained. Lack of ventilation
will cause lack of O2 in the house which
means CO2 levels that are toxic for the
residents to be increased. Besides, insufficient
ventilation will cause the humidity in the room
rises due to the process of evaporation and
absorption of fluid from the skin. Humidity is
a good medium for bacteria, pathogens
(bacteria that cause disease) (Notoatmodjo,
2003).
This is consistent with the proposed Jawetz in
Evita Naria et al (2008) that the lack of
ventilation will increase the humidity of the
house. Moist air will cause health problems,
especially respiratory diseases occupants
(Evita Naria, et al, 2008: 4). So ventilation is
required to qualify Menkes RI No.1077 /
Menkes / Per / V / 2011, ventilation of at least
10% of the floor area.
Qualified ventilation can prevent the bad
influence that can harm human health in a
room. Good ventilation will allow wind
movement and exchange of clean air becomes
more smooth (cross ventilation). While the
poor ventilation in the house causing air
exchange less than the maximum. Indoor air
will quickly turn into a stuffy and polluted.
Without adequate ventilation, polluted air can
not go out and replaced new air. Inadequate
ventilation also cause less sunlight into the
house. Without sufficient sunlight, pathogens
in the house will multiply freely. Both of these
increase the incidence of ISPA in Toddlers
who live in homes with poor ventilation (Sri
Andarini, et al, 2010: 7).
This is consistent with research of Lindawaty
in Rahmayatul Fillacano (2012) that children
who live at home with vents that do not
qualify at 3.07 times the risk of experiencing
respiratory infection than children who live at
home with a qualified ventilation (Fillacano,
Rahmatul, 2013).
Table 2
Frequency Distribution of Respondents by
Density House at Puskesmas Tanjung Paku
Solok 2014
Residential
f
%
No.
Density
Not Solid
44 45,8
1.
52 54,2
solid Solid
Jumlah
96
100
From table 2 it can be seen that over the
majority of respondents (54.2%) categorized
occupancy density solid. A healthy home
building area should be sufficient for the
occupants in it, meaning that the building floor
area must be adapted to the number of
inhabitants. Building area that is not
proportional to the number inhabitants will
cause overcrowded. It is not healthy, because
in addition to causing lack of O2 consumption,
also when one family member affected by
infectious diseases, would be easily
transmitted to other family members
(Notoatmodjo, 2003: 151). Then the houses
said solid area of the house is divided when
the number of occupants is <10 m2 / soul. It is
listed in the health requirements of housing RI
No.1077 / Menkes / Per / V / 2011. This is
consistent with research irianto (2006) that
children who live with a solid home occupants
at risk of experiencing ISPA 2.27 times
compared with no solid occupants (Fillacano,
Rahmatul, 2012: 77)
Table 3
Respondents Frequency Distribution Based on
Nutritional Status in Urban Village Puskesmas
Tanjung Tanjung Paku Paku Solok 2014
No.
1.
2.
3.
Total
Nutritional
Status Of
Children
Less
Gizi Kurang
Good
F
%
5
68
23
96
5,2
69,8
24
100
From Table 3 it can be seen that the majority
(69.8%) categorized under five nutritional
status of malnutrition
Good or poor nutritional status describe a
person's nutrient consumption. Nutrients are
needed for the formation of immune
substances such as antibodies. The better
nutrition means better consumed so that the
better nutritional status also immune. Good
immune system causes the body's immune to
the disease (Elyana, 2009: 8)
Toddlers with poor nutritional will be more
susceptible to respiratory infection than
children with good nutrition for endurance
factor is lacking. Infectious diseases alone will
lead to malnutrition. In the state of
malnutrition, children are more susceptible to
severe respiratory infection attacks even
longer (Maryunani, 2010: 15). This is
consistent with research Sukmawati (2010)
that children with recurrent respiratory
infection in infants with more malnutrition
status.
From the description above can be concluded
that most of the risk factors ISPA incidence in
infants coming from the house ventilation
because can not meet the needs and oxygen
circulating properly, then the nutritional status
of children under five with malnutrition and
poor, and the condition of dense residential
home. Based on the research results suggested
to the health workers to provide health
education to the respondents who have
children to improve access to the air vents in
the home between laindengan open the
window in the morning and afternoon,
organize planting trees around the house so as
not to obstruct the air and light, providing
balanced nutrition in accordance the needs of
toddlers and set the number of room occupants
according to age in order to prevent the risk of
transmission of ISPA.
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Ispa Pada Balita Di Kekurahan Ciputat
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dengan Kejadian Ispa Pada Anak Balita
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http://www.library.upnvj.ac.id
diakses
7
januari 2014
131
DESCRIPTION OF ANXIETY LEVELS ON SCHOOL-AGE
CHILDREN DURING HAVING BEEN HOSPITALIZED
IN LOCAL GENERAL HOSPITAL OF DR. DJASAMEN
SARAGIH PEMATANG SIANTAR
*Lisa Elita Rusriyani, ** Farida Linda Sari Siregar
* Bachelor of nursing,Faculty of Nursing USU, ** Lecturer, Faculty of Nursing USU
Email., [email protected]
Abstract
Having been hospitalized in children can cause anxiety and stress on all levels of age.The anxious
children will feel tired because they cry continuously, don’t want to interact with a nurse, act fretfully,
whine to return home, refuse to eat, that can slow the process of healing, decline the spirit to recover
because they act uncooperatively to the care. This research aims to know the anxiety level of school
age children during having been hospitalized. The research design used was descriptive. Sampling
technique used was purposive sampling with a respondent sample of 66. Results of the study showed
the majority of respondents are at a medium level of anxiety with the amount of 35 persons (53,0%)
then had 25 people (37.9 percent) are at a level of anxiety, and 6 persons (9.1 percent) are at a severe
level of anxiety. The research is recommendedto the nurse room to be more sensitive to each
intervention will be awarded particularly on children, so it can minimize the impact of having been
hospitalized in children.
Keywords: Anxiety, School Age Children, Been Hospitalized
INTRODUCTION
Hospitalization in pediatric patients
may cause anxiety and stress at all age levels
(Ambarawati & Nasution, 2012). Sari &
Sulisno (2012) in his research states that
children who are anxious to experience fatigue
because the child continues to cry, do not want
to interact with nurses, cranky, whining to go
home and hold, refuse to eat so slow the
healing process, decreasing the spirit to heal,
and uncooperative towards treatment. Causes
of anxiety are influenced by many factors,
both factors of personnel (nurses, doctors, and
other health workers), new environmental and
accompanying
family
when
treatment
(Ambarawati & Nasution, 2012).
Hospitalization in pediatric patients
may cause anxiety and stress at all age levels
(Ambarawati & Nasution, 2012). Sari &
Sulisno (2012) in his research states that
children who In the school-age children who
are hospitalized will emerge challenges to be
faced such as overcoming a separation,
adjustment to an unfamiliar environment for
him, adjusting to a lot of people who take care
of, and often have to relate and get along with
children who are sick and experience painful
therapy (Supartini, 2004). The reaction of
children to hospitalization in children of
school age are losing control of an impact on
132
the changing role within the family, children
lose their social group because he used to
carry out activities play or social interaction,
fear of death, and their physical weakness
(Deslidel, Hasan, Hevrialni, & Sartika, 2011).
Results of previous studies show that 100% of
children of school age were hospitalized
suffered mild and moderate anxiety
(Purwandari 2009 in Solikhah, 2011). Results
of the study by Sari & Sulisno (2012) in
hospitals Ambarawa reported that the
prevalence of anxiety when the child reaches
75% of hospitalization.
Based on the observation that there are
10 pediatric patients who were treated in
Cempaka
in
dr.
Djasamen
Saragih
Pematangsiantar, 7 of them are not cooperative
to nursing actions given and anxiety are
characterized by issuing a response crying
child if there is a nurse came, showed a
response anxiety, difficulty eating, difficulty
sleeping, kicked, hit when performed invasive,
causing delays in the process of care children.
Parents also said her son became cranky,
restless, often angry, and whine like home.
METHODOLOGY
The method used in this research is descriptive
method. Descriptive study on this research
aims to provide an overview anxiety levels in
children of school age during in
hospitalization. Sampling in this study using
purposive sampling with inclusion criteria:
children aged 8-12 years who were
hospitalized; no history of previous
hospitalization; minimally treated for 2 days;
be able to communicate; children are willing
to engage in research; and obtain permission
from the child's parents. The samples used in
the study were as many as 66 respondents.
Analysis performed in this study is the
univariate analysis. Results of univariate
analysis is presented in the form of a
frequency distribution table and percentages.
2.Anxiety
Results of research on anxiety in school-aged
children hospitalization. Appropriate signs and
symptoms kecamasan found that the majority
of respondents are afraid of seeing syringes /
other hospital equipment with a percentage of
62.1%. Then the results of the study also
found that the second most appropriate signs
and symptoms of anxiety that 43.9% (29
people)
of
school-age
children
in
hospitalization restless and often wake up at
night. Of the 66 school-age children were in
hospitalization, the third most appropriate
signs and symptoms of anxiety 39.4% (26
people)
of
school-age
children
in
hospitalization cry when left parents while
being treated.
Research Result
1.
Characteristics
of
Respondents
Data obtained showed that the majority of
Table. 2 Distribution Frequency and
respondents aged 12 years (27.3%). Gender
Percentage Anxiety During School
male and female same number as many as 33
Age Children in hospitalization in
(50%) of male respondents and 33 (50%) of
dr.
Djasamen
Saragih
female respondents. The majority of Muslim
Pematangsiantar
respondents (42.4%) and Christians (42.4%).
f
(%)
Anxiety
40.9% of respondents had undergone
yes no
yes
no
hospitalization for 3 days.
1. Crying when left parents
26
40
39,4
60,6
Table1.Frequency Distribution Characteristics
and Percentage of Respondents
Characteristics of
f
(%)
Respondents
Age
8 years
13
19,7
9 years
14
21,2
10 years
9
13,6
11 years
12
18,2
12 years
18
27,3
Gender
male
33
50%
Female
33
50%
Religion
Islam
28
42,4
Chatolic
10
15,2
Christian
28
42,4
Long day care
2 day
19
28,8
3 day
27
40,9
4 day
13
19,7
5 day
2
3,0
6 day
5
7,6
2. Pay the nurse checks
3. Trembling when a nurse
checking
4. Kicking when the treatment
action
5. Anxious and often wake
6. bedwetting when treated
7. Sucking thumbs
8. Lazy talk / silent
9. Refuse to play
10. Feeling uneasy when
doctors / nurses ask or
explain something
11. Feeling tense when
doctors / nurses ask or
explain something
12. stuttering speech / dashed
when talking with doctors
/ nurses
13. The speech quickly when
talking with doctors /
nurses
14. Fear of seeing syringes /
other hospital equipment
11
55
16,7
83,3
18
48
27,3
72,7
10
56
15,2
84,8
29
5
7
21
20
37
61
59
45
46
43,9
7,6
10,6
31,8
30,3
56,1
92,4
89,4
68,2
69,7
22
44
33,3
66,7
17
49
25,8
74,2
4
62
6,1
93,9
5
61
7,6
92,4
41
25
62,1
37,9
3.Level of Anxiety
The results showed anxiety levels in
of school age during hospitalization
majority of respondents are at the
anxiety
was
53.0%
(35
children
that the
level of
people).
133
Table 3. Percentage Frequency Distribution
and Anxiety Levels During School
Age Children in hospitalization in
dr.
Djasamen
Saragih
Pematangsiantar
Anxiety
f
(%)
Mild Anxiety
25
37,9
Moderate anxiety
35
53,0
Weight Anxiety
6
9,1
Discussion
Anxiety
The results showed that children who
experience child hospitalization in wards
Cempaka
in
dr.
Djasamen
Saragih
Pematangsiantar majority are at the level of
anxiety was the number of 35 people (53.0%).
This is consistent with several studies that,
according Supartini (2004) which states that
during the process of hospitalization of
children can experience a variety of events
indicated by the experience very traumatic and
stressful, a variety of feelings that often
appears in children, the anxiety, anger, sadness
, fear, and guilt. The feeling can arise due to
face something new and have never
experienced before, insecurity and discomfort,
feelings of losing something unusual
happened, and something that feels painful.
the results of the study aidar (2011) which
found that the majority of children in
hospitalization are at moderate levels of
anxiety (61.1%). In his research also states that
during hospitalization can be a stressor factors
in children. A child when facing a new
environment is known to be experiencing
feelings of fear and anxiety. The same opinion
was also expressed by the research Solikhah
(2011) which states that patients who have
school-age children will experience anxiety
hospitalization with an average are at
moderate levels of anxiety. This was shown by
the change in behavioral responses such as
anxiety and tremors are an indicator of the
level of anxiety in children.
Results showed signs and symptoms of
anxiety in the majority of school-age children
are at hospitalization was afraid to see syringes
/ other hospital equipment with a percentage of
62.1% (41 people). This is in accordance with
Keliat (2006) in Muafifah (2013) which says
that the causes of stress in children such as
hospital environment itself as building
hospitals, wards, tools (syringes), white
134
clothing of health workers and social
environment such interactions among pediatric
patients. This condition is a source of stress
(sterssor) which may affect the psychological
condition of a child who at a certain level can
cause a child to fall on the condition of
anxiety, worry either mild, moderate, severe
and panic.
From the results of the study also showed that
43.9% (29 people) of school-age children in
hospitalization restless and often woke up at
night. This is in accordance Stuart & Laraia
(1998) which says that someone who
experienced anxiety will look at changes in
affective responses as easily distracted,
impatient, restless, tense and frightened.
Sundari (2005) also says that anxiety is a state
that shake because of the threat to health that
is characterized by cold fingers, the faster the
heart rate, sweating, headache, decreased
appetite, not sleeping soundly, shortness of
breath and chest.
Of the 66 school-age children were in
hospitalization, indicating appropriate signs
and symptoms of anxiety 39.4% (26 people) of
school-age children in hospitalization cry
when left parents while being treated, it is
according to Wong, Hockenberry, Wilson,
Winkelstein, & Schwartz (2008) who
explained that anxiety in school-age children
is anxiety due to separation, injuries on the
body and the pain and loss of control can also
cause anxiety.
The results showed that the majority of schoolage children were in hospitalization are at the
level of anxiety was the number of 35 people
(53.0%), the results of the study also found
that 6 people (9.1%) were hospitalized schoolage children experience severe anxiety , Based
on the results of research which found that
school-age children who experience severe
anxiety mostly aged 8 to 9 years. This is
according to Wong, Hockenberry, Wilson,
Winkelstein, and Schwartz (2008) who said
that the younger children showed greater fear,
anxiety higher than children greater. In
general, older children have to learn coping
methods to deal with discomfort, such as
holding tightly, clenched fists or teeth, or try
to act boldly with"grimace".
From the results of the study also found that
children of school age in hospitalization
anxiety. There are many factors that make the
child fall in a state of anxiety, anxiety either
mild, moderate, severe, and some of them
panicked hospital environment, the nurse on
duty, and medical equipment. Anxiety
responses of children aged 8-12 years are
related hospitalization during the study
dilakukannnya child is seen crying when left
parents while being treated, a child kicking /
hitting nurses who will perform nursing
actions, the child will only be accompanied by
his family, the child looks gloomy, taciturn,
and did not want to talk. At the time of the
study the parents say that when children have
trouble sleeping the night and often wake up at
night, the child's parents also say that his child
wetting the bed while in the hospital when at
home when the child is not wetting the bed
again. This sejalalan with the results Pratama
(2012) which says that the response of
children's anxiety related to hospitalization
generally arise when the child first came to be
hospitalized, at the time of the study
dilakukkannya screaming child while doing
nursing actions, crying and does not want to
approachable, searching parents, cries when
parents leave the room on an errand, reject and
even send away others who considered
foreign, always want the company and refused
the company of others, do not want to move
and tend to nap alone, and children also looks
gloomy.
CONCLUSION
The majority of respondents are at the level of
anxiety was with the majority of anxiety
symptoms fear of seeing needles Hence it is
expected that children are more sensitive to
room nurse at every intervention that will be
given, especially in pediatric patients in order
to minimize the anxiety levels of children
against the dreaded care measures such as
conditions hospitalization, afraid to see
syringes / other hospital equipment, and fear
ofpain.
BIBLIOGRAPHY
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dengan tingkat kecemasan anak usia
sekolah (6-12 tahun) yang mengalami
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umum dr. Pirngadi Medan.Skripsi.
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Fakultas
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(2012).Buku
askep
bayi
&
balita.Yogyakarta: Cakrawala Ilmu.
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Y. (2011). Buku ajar asuhan neonatus,
bayi & balita. Jakarta: Penerbit EGC.
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E.
B.
(2004).
Psikologi
perkembangan: Suatu pendekatan
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jiwa & psikiatrik (3th ed.), Jakarta:
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musik klasik mozart terhadap tingkat
kecemasan pada anak. Skripsi.
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Ilmu-ilmu Kesehatan Universitas
Jenderal
Soedirman.
From
http://keperawatan.unsoed.ac.id/conte
nt/durasi-pemberian-terapi-musikklasik-mozart-terhadap-tingkatkecemasan-pada-anak, 25 Oktober
2013.
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terhadap
kecemasan
akibat
hospitalisasi pada pasien anak usia
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Banyumas.Skripsi.
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Kesehatan
Universitas
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anak Saat hospitalisasi anak.Jurnal
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usia sekolah dan remaja yang
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EGC
135
THE EFFECTS OF GUIDED IMAGERY ON DYSMENORRHOEA
INTENSITY AND HEMOGLOBIN LEVELS
Hotma Sauhur Hutagaol
Prodi Kebidanan Padangsidimpuan
Abstract
Menstruation is the defined as the periodic efflux of the sloughed endometrium and blood out of the
uterine cavity into the vagina and ultimately outside of a woman’s body. Irregular menstrual cycle
length or number of days of menses may affect the levels of hemoglobin (Hb). Menstrual pain is pain
during menstruation is felt in the lower abdomen and appear before, during or after menstruation.
Guided Imagery is a relaxation technique guiding some one to focus in pleasant images to reduce
pain. The aim of this study is to analyze whether the guided imagery is an effective technique for
reduce dysmenorrhoea and maintain hemoglobin levels during menstrual cycle. This research is a
quasy-experimental research with pre-test and post-test control goup. Data were analyzed using
Mann_Whitney test, and the p-value of <0.05 was considered statistically significant. A total of 32
adolescents were studied (16 in treatment group, 16 in control group). After guided imagery,
dysmenorrhoea reduced significantly in the treatment group (4.8 ± 0.8 to 2.6 ± 0.5, p=0.001) and
there was no change in control group (4.6 ± 0.6). There was significant difference between the two
groups (p=0.001). Decrease in hemoglobin levels were lower in treatment group (10.9 ± 0.5 gr% to
10.8 ± 0.4 gr%) compared to the control group (11 ± 0.6 gr% to 10.6 ± 0.5). However there was no
significant difference between the two groups. This study concluded that guided imagery effective in
reduce dysmenorrhoea and maintain hemoglobin levels.
Keywords:Guided Imagery, Dysmenorrhoea Intensity, Hemoglobin Level
INTRODUCTION
Menstruation is the defined as the
periodic efflux of the sloughed endometrium
and blood out of the uterine cavity into the
vagina and ultimately outside of a woman’s
body. Irregular menstrual cycle length or
number of days of menses may affect the
levels of hemoglobin. Hemoglobin is the part
of blood that contains iron, carries oxygen
through the body, and gives blood its red
color. Hemoglobin in unpregnancy female is
present normally in blood to the extent of 11 to
12 grams in 100 milliliters. Menstrual cycles
often are irregular through adolescence,
particularly the interval from the first to the
second cycle (Johnston, 2014).
According to the World Health
Organization’s international and multicenter
study of 3,073 girls, the median length of the
first cycle after menarche was 34 days, with
38% of cycle lengths exceeding 40 days.
Variability was wide: 10% of females had
more than 60 days between their first and
second menses, and 7% had a first-cycle
length of 20 days. Most females bleeds for 2-7
days during their first menses (17-19 year).
Normal menstrual cycle interval in young
136
female typically 21 – 45 days. Menstrual flow
length 2 – 7 days (ACOG, 2006).
During menstruation, the muscles of
the uterus contract in response to hormone-like
substances called prostaglandins, produced by
the lining of the uterus. The levels of the
prostaglandins increase prior to menstruation,
and peak at the start of the menses. The levels
decline again as a woman menstruates,
resulting in less uterine discomfort or cramps
after the first few days of the menstrual period
(Johnston, 2014). The level of Prostaglandin in
female with dysmenorrhoea is ten times higher
compare to female without dysmenorrhoea
(ACOG, 2006).
Most women experience some pain or
discomfort during the menses. However, some
experience dysmenorrhoea (painful periods) or
“difficult menstrual flow”, which may present
as moderate to severe cramps or pain in the
lower abdomen or lower back, diarrhoea or
constipation, heavy menstrual flow, frequent
urination, nausea, vomiting, headache or
dizziness. Primary dysmenorrhoea refers to
recurrent, crampy lower abdominal pain that
occurs during menstruation in the absence of
other underlying conditions / disease
(Johnston, 2014).
Dysmenorrhoea is also more prevalent
in women who suffer from premenstrual
syndrome (PMS) (Poornima, 2015).
Several studies among American and
Australian adolescents, have shown that
adolescents with dysmenorrhea report that it
affects their academic performance and social
and sports activities, a distressing finding
given the availability of effective medications
(Eman, 2012).
In Polytechnic of Medan Health
Ministry,
Midwifery
Campus
at
Padangsidimpuan, estimated 35% student with
dysmenorrhoea and about 5% can not do usual
activities due to menstrual pain.
Relaxation is more than a state of
mind; it physically changes the way your body
functions. When your body is relaxed
breathing slows, blood pressure decrease and
increase oxygen consumption, and some
people report an increased sense of well-being.
This is called the “relaxation response.” Being
able to produce the relaxation response using
relaxation techniques may counteract the
effects of long-term stress, which may
contribute to or worsen a range of health
problems including depression, digestive
disorders, headaches, high blood pressure, and
insomnia (ACOG, 2006).
Relaxation
is
an
independent
intervention to reduce pain intensity, improve
pulmonary ventilation and increases blood
oxygenation. Skeletal muscle relaxation is
believed to reduce pain by relaxing the
muscles, there are many evidence that show
the effectiveness of relaxation in relieving
pain. (Smeltzer, 2002).
Relaxation in general as the most
effective method, especially in patients who
experience pain. Guided imagery is one of
relaxation technique, that focus on pleasant
images, through storytelling or descriptions
designed to suggest mental images (also called
visualization) to replace negative or stressful
feelings and relax (NCCAM, 2013).
So the aim of this study is to analyze
the effects of guided imagery to reduce
dysmenorrhoea and maintain hemoglobin
levels.
METHODS
1. Statement of the problem
To analyze the effects of guided imagery to
reduce
dysmenorrhoea
and
maintain
hemoglobin levels.
2. Operational Definition
Dysmenorrhoea. Dysmenorrhoea can be
defined as recurrent, crampy lower abdominal
pain that occurs during menstruation in the
absence of other underlying conditions/
disease.
Guided imagery. Guided imagery can be
defined as relaxation technique, that focus on
pleasant images to replace negative or stressful
feelings and relax.
Hemoglobin Levels: Hemoglobin levels can
be defined as the levels of hemoglobin in
blood.
3. Hypothesis
a. There is significant difference of
menstrual pain (Dysmenorrhoea) between
intervention and control group after
guided magery
b. There is significant difference of
hemoglobin levels between intervention
and control group after guided magery
4. Research design
A quantitative paradigm was used in the study.
A quasi-experimental design which involves
both pre-test post-test control group design, an
experimental group was used to study the
effect of the intervention on dysmenorrhoea
and hemoglobin levels and no intervention in
control group.
5. Sample
The sample chosen for the study was 32
female college students in the age group of 18
to 22 years with dysmenorrhoea. Sample size
by Sastroasmoro formula with the value of SD
from previous study is 1,17. 16 participants
were assigned to the intervention group and 16
to the control group. The sample was chosen
based on convenience sampling by
approaching
college
students
from
Padangsidimpuan midwifery academy that
showed dysmenorrhoea based on observation
form.
6. Tool used
NRS (Numerical Rating Scale) : The
Numerical Rating Scale Form by Potter and
Perry (2005) was used to see the intensity
dysmenorrhoea of Participants.
7. Procedure
College
students
of
Padangsidimpuan
midwifery academy were approached by the
researcher for participation in the study
through interview. Female students were asked
whether they experienced dysmenorrhoea in
relation to their menstrual cycle. These
students were given NRS (Numerical Rating
137
Scale) to identified their pain intensity. The
participants were enrolled for the study based
on their pain intensity of menses. 32
participants with moderate and severe pain of
Dysmenorrhea were be selected and 16
participants were assigned to the intervention
group and 16 to the control group respectively.
Participants whose menstrual phase fell around
the same time of the month were included so
that the intervention can be given accordingly.
Informed consent was be obtained from the
participants. The researcher gave the
participants the guide to do guided imagery
and teach them until they can do it by
themselves. The intervention consisted of the
participants doing guided magery 15 minutes a
day by 7.30 o’clock in the morning. The
intervention began on the first day of
dysmenorrhoea and ended on the last day of
the menstrual cycle. The participants recorded
their pain intenstity form by the first day of
dysmenorrhoea and the last day of menses.
The control group was not given any
intervention. However they completed the
NRS form, from the first day of
dysmenorrhoea and the last day of menstrual
cycle.
DATA ANALYSIS
Mann_Whitney-test was used to compare the
intervention group and control group data.
Results
Table 1 showing the characteristic of the
intervention group and control group
Character Interventio Control
Sig
istic
n Group
Group
Mean±SD
Mean± SD
Age
18,7 ± 1,0
18,7 ± 0,5
p>0,05
Age of
13,0 ± 1,1
13,5 ± 1,2
p>0,05
Menarche
Pain
4,8 ± 0,8
4,6 ± 0,6
p>0,05
intensity
Hemoglob 10,9 ± 0,5
11 ± 0,6
p>0,05
in levels
Table 2 showing the results of mann_whitney
test of post-test total score of guided imagery
between intervention group and control group
on intensity of dysmenorrhoea
Dysmenorrhoea
Mean ± SD
p
Intensity
Intervention Group
2.6 ± 0.5
0.001
Control Group
4.6 ± 0.6
There is a significant difference between the
intervention group (M=2.6 ± 0.5) and control
group (M= 4.6 ± 0.6) on the post-test of
guided imagery on the dysmenorrhoea
intensity; p = 0.001.
5
4
3
2
1
0
Intervention Group
Control Group
figure 1. Mean of dysmenorrhoea intensity
post test between intervention group and
control group.
Table 3 showing the results of mann_whitney
test of post-test total score of guided imagery
between intervention group and control group
on hemoglobin levels
Mean ± SD
Hemoglobin levels
Sig
Intervention Group
10,8 ± 0,4
0,2
Control Group
10,6 ± 0,5
There is no significant difference between the
intervention group (M=10,8 ± 0,4) and control
group (M= 10,6 ± 0,5) on the post-test of
guided imagery on the hemoglobin levels; p =
0.2.
11
10.8
There is no significant difference of
characteristics between the the intervention
group and control group.
10.6
10.4
10.2
Intervention Group
138
Control Group
figure 2. Mean of hemoglobin levels post test
between intervention group and control group.
DISCUSSION
The purpose of the present research
was to study the effectiveness of guided
imagery on the intensity of dysmenorrhoea
and hemoglobin levels.
The results of the study indicate that
guided imagery has had a significant effect on
the intervention group, Leading to a reduction
in the intensity of dysmenorrhoea.
Lower reduction of hemoglobin levels
compare to control group, However there is no
significant difference between the two grup.
Table 1 and 2 shows that the pre-test
scores of the participants in the intervention
group on dysmenorrhoea intensity is higher
than the post-test scores, indicating a reduction
in the dysmenorrhoea intensity after the
intervention. The post-test scores between the
intervention group is lower compare to the
control group and with the Mann_Whitney test
, statistically siginificant. Based on this, the
hypothesis which states that there is significant
difference in the dysmenorrhoea intensity of
the participants in the intervention group
compare to control group is accepted.
Hence, based on these results, a
conclusion can be drawn that guided imagery
has a significant effect on the reduction of
dysmenorrhoea intensity.
Previous studies showed that guided
imagery have an effect on the reduction severe
dysmenorrhoea on three participants to mild
dysmenorrhoea (Novarenta, 2013).
Relaxation can control the pain by
minimizing sympathetic activity in the
autonomic nervous system. Adolescence can
increase the activity of the parasympathetic
nervous
vegetative
components,
simultaneously. The technique can reduce the
sensation of pain and control the intensity of
adolescent reaction to the pain. Hormones
adrenaline and cortisol that causes stress will
decrease,
adolescence
can
improve
concentration and feel at ease making it easier
to regulate breathing through respiratory
frequency of less than 60-70 x / min. PaCO2
levels will increase and decrease the PH so
that it will increase oxygen levels in the blood
(Potter and Perry, 2005)
In the relaxed condition, the body will
stopthe production of adrenaline hormones
and all hormones that is required when stress
occured. Because of the sex hormones
(estrogen and progesterone) and the stress
hormone (adrenaline) are produced from the
same chemical building blocks, when we
reduce stress then will reduce the production
of the sex hormone. Thus, the need for
relaxation to provide an opportunity for the
body to produce hormones that are important
to get menstrual pain free (Sigit, 2010)
The main principle of pain relief by
relaxation lies in the physiology of the
autonomic nervous system, which is part of
the peripheral nervous system that maintains
homeostatic internal environment of indvidu.
At the time of the release of mediators such as
bradikilin and prostagandin, would stimulate
the
sympathetic
nerve,
causing
vasoconstriction which ultimately increases
muscle tone that cause various effects such as
muscle spasms that eventually suppress the
blood vessels, reducing blood flow and
increasing the speed of muscle metabolism
that causes impulse transmission pain from the
spinal cord to the brain will be perceived as
painful (Tamsuri, 2007).
Table1 and 3 shows that the reduction
of hemoglobin levels is lower in the
intervention group compare to control group.
indicating a maintaining of the hemoglobin
levels after menstruation. However there is no
significant difference on the hemoglobin levels
between the two groups. The hypothesis which
states that there is significant difference in the
hemoglobin levels of the participants in the
intervention group compare to control group is
rejected.
Hence, based on these results, a conclusion
can be drawn that guided imagery has a
significant effect on the reduction of
dysmenorrhoea intensity.
Menstrual cycle length or number of
days of menses may affect the levels of
hemoglobin. Short cycle and excessive
menstrual flow automatically increase blood
loss. In this study both of the intervention
group and the control group have a normal
menstrual cycle interval and menstrual flow
length. According to Smith (2007), each a
human took 20.96% oxygen with a tidal
volume 350 ml, then in a second a human took
the oxygen about 73.36 ml. By maximizing the
development of lung, then obtained maximal
inspiration volume until 3000 ml, and the
hemoglobin will bind oxygen with estimates
1.34 ml oxygen x hemoglobin/gram percent,
139
when hemoglobin levels are 14 x 350 ml =
6566 gram of oxygen per second are carried
by the blood throughout the body.
Hemoglobin is found in the red blood
cells of the body. Each red blood cell (RBC)
contains
approximately
280
million
hemoglobin molecules. The main function of
hemoglobin is to transport oxygen from the
lungs to the tissues and then transport CO2
back from the tissues to the lungs. Therefore,
guided imagery as one of relaxation technique
is useful as distraction, so that the patient's
mind shifted focus from pain and at the same
time optimizing oxygen inhalation for the
stress cells. With the increase in oxygen
uptake so the hemoglobin levels to bind
oxygen will also increase.
CONCLUSION
Thus the hypotheses which stated that there is
significant difference between the intervention
group and the control group on were accepted.
However, the hypotheses which stated that
there is significant difference between the
ntervention group and control group on
hemoglobin levels were rejected. Thus, it can
be concluded from the results of the present
study that guided imagery has a significant
effect in reducing the menstrual pain
(dysmenorrhoea) and an optional choice to
maintain hemoglobin levels in menstrual
cycle.
REFERENCES
ACOG, 2006, Menstruation in girls and
adolescents: using the menstrual cycles
as a vital sign. ACOG Committee
Opinion Number 349, 2006.
Alimul A. 2006. Pengantar Kebutuhan Dasar
Manusia. Surabaya: Salemba Medika.
Eman, 2012. Epidemiology of Dysmenorrhea
among Adolescent Students in Assiut
City, Egypt. Life Science Journal; 9(1).
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National Center For Complimentary and
Alternative Medicine (NCCAM), 2013.
Relaxation Techniques For Health. US.
NIH.
Novarenta A, 2013. Guided Imagery Untuk
Mengurangi
Rasa
Nyeri
Saat
Menstruasi. Jurnal Ilmiah Psikologi
Terapan. ISSN: 2301-8267 Vol 01,
No.02 Agustus, 2013. Fak Psikologi
Univ.Muhammadiyah Malang
Perry, AG, Potter PA .2005. Buku Ajar
Fundamental
Keperawatan;Konsep,
Proses dan Praktik , Vol.2 Alih Bahasa.
Editor Monica Ester Dkk, Jakarta : EGC
Poornima, 2015. The Effects of Classical
Music based Chakra Meditation on the
Symptoms of Premenstrual Syndrome.
The International Journal of Indian
Psychology ISSN 2348-5396 (e) | ISSN:
2349-3429 (p) Volume 2, Issue 3.
Priharjo, R. 2003. Perawatan Nyeri. Jakarta.
EGC
Sastroasmoro
S.
2011.
Dasar-dasar
Metodologi penelitian klinis. Jakarta:
CV.Sagung seto.
Smeltzer & Bare 2002. Keperawatan Medikal
Bedah. Edisi 8. Vol 1. Alih Bahasa
Agung Waluyo. Jakarta. EGC
Sigit NP. 2010. Konsep dan Proses
Keperawatan Nyeri. Edisi 1. Graha
Ilmu. Yogyakarta
Tamsuri
A,
2007.
Konsep
dan
Penatalaksanaan Nyeri. Jakarta. EGC
Wirya I, Sari MD, 2013. Pengaruh Pemberian
Masase Punggung Dan Teknik
Relaksasi Nafas Dalam Terhadap
Penurunan Intensitas Nyeri Pada
Pasien Post Appendiktomi Di Zaal C
Rs HKBP Balige Tahun 2011, Jurnal
Keperawatan HKBP Balige, Vol.1
No.1, Juni 2013 ISSN 2338-369091
THE EFFECTIVENESS OF LAVENDER AROMATHERAPY IN
REDUCING PAIN INTENSITY OF PATIENTS WITH BREAST
CANCER IN RB2 RSUP HAJI ADAM MALIK MEDAN
2014
Nurlama Siregar, Masnila, Marlisa
Lecturers of Nursing Department of Politeknik Kesehatan Kemenkes Medan
Abstract
Aromatherapy defines as a method to cure a disease by using fragrance which is come from
the oil of floral essential, commonly the fragrance smell good, aromatic and relaxing, it commonly
calls essential oil. Almost all of breast cancer patients feel pain.
Pain is unpleasant sensory perception. Aromatherapy is one of non pharmacological methods
to reduce pain.
This study was conducted by a pretest-posttest design, a pretest applied priory before
applying an intervention. After applied an intervention, a posttest was conducted. It had 27 samples.
The data was taken from medial record and observation sheet.
The findings showed that before applied lavender aromatherapy, there are 22 respondents
(81,5%) who had severe pain intensity and after applied the lavender aromatherapy, mostly 24
respondents (88,9%) had mild pain. The statistic test result that there was a significant reducing in
pain intensity with value p =0,00 and mean 0,851.
Key words : lavender aromatherapy, reducing pain, breast cancer
INTRODUCTION
Breast cancer is a cold-blooded killer for
women. Wolrd health Organization (WHO)
stated that about 8-9% women in the world
have had breast cancer, and it is the second
largest numbers that Indonesian women had
(Wenny Artanty, 2011). Globally it predicts
that there are about 1.401.400 cases of cervix
cancer in the last five years and 3.860.300
breast cancer in the last five years. Based on
the cases, noticeably the incidence of breast
cancer is dominant than cervix cancer.
(Wijaya, 2010).
The signs and symptoms of breast cancer
is commonly pain, and including lumps and
swelling in the breast which it cannot be
moved from the breast tissue.
Pain is a sensory and emotional perception
which is not unpleasant because of the actual
and potential damage tissue. Nurses spend
more time with painful patients compare
beside the other medical staff and they have
chances to help the painful patient reducing
their pain and the harmful effect (Brunner &
Suddarth, 2008).
The pain can be reduced by a
treatment both pharmacologically and
non-pharmacologically.
Pharmacologically it involves the use of
opioids (narcotics), non-opioids, adjuvant
analgesic
and
co-analgesic.
Nonpharmacologically it covers physical
treatments, such as distraction, relaxation
technique and therapeutics (Tamsuri,
2012). Aromatherapy is one of nn
pharmacological treatment because it
contains positive effect such as anti
inflammatory, anti septic,
analgesic,
immunostimulant, stimulating circulation,
stimulating appetite, diuretic, hormonal
and others benefits. The essential oil has
many different advantages, the aromatic of
lavender evoke
serenity, balancing,
comfort, reducing pain and reducing
stress. The lavender can be used to reduce
pain because of its analgesic nature
(Koensoemardiyah, 2009).
Based on prior survey, medical record of
RSUP Haji Adam Malik Medan in 2013
showed that the numbers of visiting were
1.145 times and the numbers of patients in the
wards of RSUP Haji Adam Malik in 2013
141
were about 345 patients (Medical Record
RSUP Haji Adam Malik Medan).
The formulation of the problem in this
study defined as the following: ”How is the
effectiveness of lavender aromatherapy in
reducing pain intensity of breast cancer
patients in Rindu B2 A RSUP Haji Adam
Malik Medan in 2014”.
RESEARCH METHOD
This study was conducted by queasy
experimental method with pretest and posttest
design. The populations were all breast cancer
patients in RB2 A RSUP Haji Adam Malik
Medan, they are about 345 patient in each
year. The samples were 27 patients.
The samples were selected by
purposive sampling technique. The study
collected the primary data. The data were
taken by spreading observation sheet. The data
were analyzed by editing process, scoring and
tabulating. It applied univariate data analysis
which used distribution analysis, frequency,
and descriptive statistic to analyze the level of
pain of breast cancer patient before and after
applied lavender aromatherapy and bivariate
data analysis with T-test
Table 4.3
Frequency Distributions of Pain Intensity
Before Lavender Aromatherapy Treatment
No Pain Intensity
1
Mild
2
Moderate
3
Severe
Total
No Pain Intensity
1
Mild
2
Moderate
3
Severe
Total
No Age in Years
1
< 30 tahun
2
31-40 tahun
3
> 41 tahun
Total
Frequency
(%)
0
0
12
44,4
15
55,6
27
100
Table 4.2
Frequency Distributions Based on
Respondent’s Academic Level
No Academic Level
1
SD
2
SMP
3
SMA
4
PT
5
TS
Total
142
Frequency
11
6
8
1
1
(%)
40,7
22,2
29,6
3,7
3,7
27
100
F
(%)
2
7,4
24 88,9
1
3,7
27 100
Table 4.5
Before and After Lavender Aromatherapy
Treatment
Pain
Intensity
Mild
Table 4.1
Frequency Distributions Based on Age
(%)
0
18,5
81,5
100
Table 4.4
After Lavender Aromatherapy
Pre
FINDINGS AND DISCUSSION
A. Findings
F
0
5
22
27
Moderate
Severe
Post
F
%
F
%
0
0
2
7,4
5
18,5
24
88,9
22
82,5
1
3,7
27
100
27
100
Total
B. Discussion
After observing the findings, it showed that
majority respondents who had breast cancer in
RB2 A RSUP Haji Adam Malik Medan had
severe pain before applied lavender
aromatherapy treatment. Based on physiologic
responds, mostly respondents had red face,
grimace, easy to get mad, and anxious. It is in
line with the theory which stated almost all
breast cancer patients feel pain.
The findings showed that, mostly pain
intensity
before
applied
lavender
aromatherapy were severe pain about 22
respondents (81,5%)
and after applied
lavender aromatherapy for 10-15 minutes,
only 1 respondents (3,7%) felt severe pain.
The data found that pain intensity decreased
after applied lavender aromatherapy. And the
result of mean of two samples (paired sample
t-test) that were used to showed the pain
intensity before and after applied lavender
aromatherapy were significantly different, they
are p=0.00 (p<0.05), it meant that Ho is
rejected and and Ha is accepted. It is
concluded
that
applying
lavender
aromatherapy was effective in reducing pain
intensity of breast cancer patients with an
average value of reducing 0.851.
Therefore the nurses who spend much time
with patients, they should collaborate only
with professionals but they may directly apply
nursing intervention such as applying lavender
aromatherapy.
CONCLUSION
The result of the study indicated that:
1. Applying aromatherapy is effective on
reducing pain intensity of breast cancer
patients in RB2 A RSUP Haji Adam
Malik Medan 2014.
2. Pain intensity of respondents before
applied lavender aromatherapy to breast
cancer patients in RB2 A RSUP Haji
Adam Malik Medan were mostly severe
about 22 respondents (81,5%).
Pain intensity of respondents after applied
lavender aromatherapy to breast cancer
patients in RB2 A RSUP Haji Adam
Malik Medan were mostly moderate
about 24 respondents (88,9%).
3. Ha is accepted and Ho is rejected, it
meant lavender aromatherapy was
effective on reducing pain of breast
cancer patients. The statistic test showed
that pain intensity before and after applied
lavender aromatherapy were significantly
different with the value p=0.00 (p<0,05).
SUGGESTION
1. To Respondents
It is suggested to breast cancer patients to
apply lavender aromatherapy to reduce
their pain, so they do not depend on
analgesic drugs because the dosage of the
analgesic become more and more
2. To the Hospitals
Hospitals should applied an intervention
such
as
lavender
aromatherapy
intervention to relieve or to reduce pain
intensity of breast cancer patients.
3. To The Educational Institution
It is also suggested to educational
intuitions to improve students’ knowledge
and ability more about the importance of
non pharmacological therapy especially
applying lavender aromatherapy to the
breast cancer patients.
4. To the further researcher
It is suggested to further researcher to
make this study as preliminary data and a
source of information for the cultivation
of further research about the effectiveness
of lavender aromatherapy on reducing
pain intensity of breast cancer patients.
REFERENCES
Adiyati, Sri. 2010. Pengaruh Aromaterapi
Terhadap Insomnia Pada Lansia Di
PSTW Unit Budi Luhur Kasongan
Bantul Yogyakarta, diunduh Januari
2014,
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http://www.academia.edu.ac.id
Alimul, A. 2007. Riset Keperawatan Dan
Teknik Penulisan Ilmiah. Jakarta:
Salemba Medika
Amelia, Sherly. 2008. Efektifitas Aromaterapi
Lavender
Terhadap
Penurunan
Intensitas Nyeri Persalinan Kala I,
diunduh
Januari
2014,
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Andarmoyo, Sulistyo. 2013. Konsep dan
Proses Keperawatan Nyeri. Yogyakarta:
Ar-ruz Media
Artanty, Wenny. 2011. Bahaya Kanker
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Brunner & Suddarth 2008. Keperawatan
Medikal Bedah. Jakarta: EGC
Dean, Sarah. 2007. Aromaterapi. Jakarta:
Karisma
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Khasani & Amriyah. 2012. Pengaruh
Aromaterapi Terhadap Nyeri Pada
Pasien Post Operasi Sectio Caesarea Di
RSUD Kajen Kabupaten Pekalongan,
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Januari
2014,
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Koensoemardiyah. 2009. A-Z Aromaterapi
Untuk Kesehatan, Kebugaran, dan
Kecantikan. Yogyakarta: Andi
Notoatmodjo, Soekidjo. 2005. Metodologi
Penelitian Kesehatan. Jakarta: Rineka
Cipta
Sugiyono.
2013.
Metode
Penelitian
Pendidikan. Bandung: Alfabeta
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Tamsuri,
Anas.
2012.
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Dan
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Kanker Payudara. Yogyakarta: Bukubiru
Purwoastuti, 2008. Kanker Payudara.
Yogyakarta: Tanisius
Prima, Iga 2011. Aromaterapi Lavender
Sebagai Media Relaksasi. Diunduh
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2014,
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http://www.portalgaruda.org.com
Sharma, Sumeet. 2009. Aromaterapi. Jakarta:
Karisma
Wijaya, D. 2010. Pembunuh Ganas Itu
Bernama Kanker Serviks. Yogyakarta:
Sinar Kejora
PARENT COMMUNICATION RELATIONSHIP AND EXPOSURE
FORNOGRAFI KNOWLEDGE OF YOUTH ON SEXUAL BEHAVIOR
IN ADOLESCENT IN SMA AL-ABDI BAHLIAS EMPLASMENT, PT.
PP. LonSum 2014
Renny Sinaga, Kandace Sianipar
Poltekkes Medan Prodi Midwifery Pematangsiantar Jl. Pane No. 36 Pematangsiantar
According to WHO (World Health Organization) approximately one-fifth of the world's
population are adolescents aged 10-19 years. About 900 million are in developing countries. The
demographic data in the United States shows the number of adolescents aged 10-19 years about 15%
of the population. In the Asia Pacific region where the population is 60% of the world population,
one-fifth are adolescents aged 10-19 years. In Indonesia, according to the Central Bureau of Statistics
10-19 years age group is about 22%, consisting of 50.9% boys and 49.1% girls (Soetjiningsih, 2010)
.In Indonesia sex behavior is increasingly rising , as a result of such behavior is a pregnancy outside
marriage, rape, prostitution outbreak among teenagers, abortion, sexually transmitted diseases, sexual
abuse, sexual perversion etc. There are a lot of the background events free sex in adolescents, such as
lack of knowledge of sexuality, fornografi exposure in the mass media is very easy to access and lack
of communication berkualitasnya parents and children.
This research is a quantitative research, aims to determine the relationship of exposure
fornografi, parent communication and knowledge of adolescents with adolescent sexual behavior in
high school at Al-Abdi Bahlias Emplasment, Pt. Pp. Lonsum, population in this study is the
student4grade XI in SMA AL-ABDI as many as 44 people. The whole population sampled. Analysis
of the data used is descriptive statistics and inferential statistics. The results showed characteristics of
the respondents is as follows, the majority of respondents had a number of relatives more than one
person, the first communication about sex once in the can after 12 years old, parents work the
majority of respondents are employees of the garden. Results of statistical test Chi Square with the
results obtained fornografi exposure is not significantly associated with adolescent sexual behavior
with the value ρ = 0.115. The next variable is the knowledge teens also not significantly associated
with adolescent sexual behavior towards value ρ = 0.467, frequent communication of parents with
teenagers, were significantly associated with adolescent sexual behavior. Schools are advised to
further expand students' understanding of sexual health by adding knowledge about sexual health in
the curriculum and with a more in-depth counseling.
Keywords: Adolescent. fornografi, sexual behavior
1. BACKGROUND.
According to WHO (World Health
Organization) approximately one-fifth of the
world's population are adolescents aged 10-19
years. About 900 million are in developing
countries.The demographic data in the United
States shows about 15% of the population is
adolescents aged 10-19 years. In Asia Pacific
region where 60% of the world population,
one-fifth are adolescents aged 10-19 years. In
Indonesia, according to the Central Bureau of
Statistics about 22% are aged 10-19 years
consisting of 50.9% boys and 49.1% girls
(Soetjiningsih, 2010).
In Indonesia, Free Sex is increasingly
rising, that cause Outside marriage pregnancy,
Rape, prostitution outbreak among teenagers,
abortion, sexually transmitted diseases, sexual
abuse, sexual perversion, etc.There are a lot of
things that cause free sex in adolescents, such
as lack of knowledge of sexuality,
Pornography exposure in the mass media is
very easy to access and lack of communication
quality between parents and children.
Pornography problem in adolescents
often worried parents, educators, officials,
governments, experts, and so on. In every
second, 28. 285 people in the world viewing
pornography on the Internet. Number of
pornographic Web pages in the world reached
420 million. 70% of internet users are leading
to pornographic sites. From various studies
show that sexual behavior has a correlation
with adolescent attitudes toward sexuality.
Sexual behavior research in 4 cities shows that
145
in Surabaya 3.4%, Kupang
31.1% ,
Jogyakarta 8.5%
and Medan 3.6% of
adolescents have been actively involved
sexually active (Soetjiningsih 2010 ).
In Bali, Wingkie Pangkahila examined
the sexual experiences of the students noted
that 102 of 375 boys (27.2%) and 53 of 288
girls (18.4) said they had sex with his own
friend or commercial sex workers (CSWs ).
They often have sex as they watch so often in
porno videos (Soetjiningsih, 2010).
North Sumatra itself, is the third area
accessed pornographic sites after Yogyakarta
and Bandung. There are still many places in
Siantar that are often encountered by students
doing nasty Such as, Binaling or Flora inn.
Knowing his daughter was in Flora Inn, a
parent of Junior high student in Siantar,M, was
angry. Even her daughter stayed with her
boyfriend for two days. Then the old man
made a report of complaints that M and her
boyfriend was taken to the Central Police
Services Integrated room with reasons have
been abusing the child (Sumatra info, 2012).
Parent communication identified as a
protective factor to against the Adolescent
sexual behavior that has a risk in reproductive
health.
Results
showed
that
parent
communication is an aspect that can
strengthen the close relationship between
parents and teenagers. (Martino et al, 2008)
and also the norm internalization of values,
beliefs, attitudes and expectations of parents
on teenage (Forehand, R, et al , 2007) In
addition to parental attitudes that are still not
open about sex, parents also often do not
understand the subject matter of this one.
Nevertheless, parents remain the most
powerful influence in shaping the moral teens
about sex (Sarwono, 2012).
Knowledge of adolescents about
reproductive health is still very low. Only
17.1% of women and 10.4% of men who
know the true about the fertile period and the
risk of pregnancy, young women and men
aged 15-24 years who know the chances of
getting pregnant by having sex only once each
totaled 55, 2% and 52% (Kumalasari,
Andhyantoro, 2012). The things mentioned
above makes the writer interested in
conducting research on the relationship among
Pornografi exposure, Parent communication
and Knowledge of adolescents with
Adolescent sexual behavior in high school AlAbdi Bahlias Emplasment, PT, PP. Lonsum,
2014.
146
II. RESEARCH METODE
The type of research used is
quantitative research with cross sectional
design. The location study was SMA Al-Abdi
Bahlias Emplasment, Pt. Pp. Lonsum, first
survey conducted in February 2014 and the
research will be conducted in April-June 2014.
The location is selected because the high
school students are a group of adolescents and
according to research objectives, in SMA AlAbdi Bahlias Emplasment, Pt. Pp. Lonsum had
never done research on "Relations Exposure
pornography, parents communication and
knowledge of adolescent with Sexual
Behavior". The population in this study is 44
student as student in class 1 SMA AL-ABDI .
Whole population as sampled. In this study,
the instrument that researchers used is a
questionnaire containing closed questions
about the variables to be studied, the
frequency
of
exposure
pornography,
knowledge adolescents, parent communication
and adolescent sexual behavior variables.
The Analysis used is descriptive
statistics and inferential statistics. Descriptive
statistics were used to display data frequency
pornographic
media
exposure,
parent
communication, knowledge of adolescent and
adolescent sexual behavior. In this case, the
data is displayed in the form of frequency and
percentage. Chi square test is used to
determine the relation between frequency of
exposure
pornographic,
parent
communication, knowledge of adolescents
with adolescent sexual behavior. Pearson Chi
Square calculated at the time of crosstabulation between frequency of media
exposure to pornography with parent
communication, knowledge of juvenile and
adolescent sexual behavior.
III. RESULTS AND DISCUSSION
1. Characteristics of Respondents
Characteristic Frequency Distribution of SMA
AL-ABDI Student in Bahlias Emplasment, PT.
PP. Lonsum, Bandar district .
No Characteristic
Gender
- Male
- Female
Total Number
Sib
- 1 ps
- > 1 ps
Total Number
N
Percentage (%)
18
26
44
40.9
59,1
100
19
25
44
43,2
56,8
100
Occupation
1. Farmer
2. Business
3. Gardener
10. Civil Servant
4. Pensions
11. Etc
First communication
of Sex
1. Age > 12 tahun
2. Age <12 tahun
Total Number
Parents monitoring
- Poor
- Good
5
5
25
1
7
1
11,4
11,4
56,8
2,3
15,9
2,3
36
8
44
81,8
18,2
100
10
34
22,7
77,2
Source: Data Primer June 2014
In this study the total population is 44
people that all students in the class 1 SMA Al
Abdi, Emplasmen PT.PP Lonsum. The
majority gender of respondents were female
(59.1%) and the majority of respondents have
Sib more than one person. The most of
respondent’s parents has job as PT. PP
Lonsum gardener and the minority was a civil
servant. Questions about how old was
responders get first information about the
sexual, the majority of respondents (81.2, %)
answer is after more than 12 years old. Parent
behavior to children has impact for the
perception and adolescent sexual behavior
(Pangkahila 2007)
2. Sexual Behavior
Sexual behavior in this study defined as sexual
behavior carried out in conjunction with the
others ranging from dating, hugging, kissing,
petting, touching genitals and sexual
intercourse undertaken without matrimony.
Categories in this study were free sex with the
high risk sex behavior with low risk.
Indicating a high risk sex behavior made more
dangerous, may threaten the possibility of
pregnancy outside of marriage. Free sex with a
low risk indicates sex actions undertaken
merely ordinary things, such as a date, holding
hands, kissing cheeks and forehead kiss,
seduce and hug the shoulders.
Table 4.2
Distribution Student / I Based on the sexual
behavior of SMA AL-ABDI Bahlias
Emplasment PT. PP. Lonsum , Bandar
Simalungun District March
to June 2014 Period
No
1
2
Sexual behavior
N
Percentage
(%)
Low risk
32 72,7
High risk
12 27,3
Total
44 100
Source: Primary Data June 2014
Based on table 4.2, from 44
respondents 32 respondents classified their
sexual behavior in the low risk category and
12 respondents (27.3%) sexual behavior with a
high risk category. the result of McDonald
Utomo research (2009) indicate premarital
sexual behavior is caused by continuous
stimulation through sexual material in the print
media, the Internet, and through peer (peer).
Teens start having sex before marriage is
caused by various factors and factors that are
important are situations that favor the
occurrence of premarital sex.
According Paikoff, (1995) adolescent
premarital sex due to the situation or occasion
teens together in a private room and the
condition is called "situations of sexual
possibility". In addition, adolescents declared
that sex is done occasionally or rarely, so it is
difficult to predict. Therefore, the reasons
teens start having sex before marriage more is
unknown, other than because of desire or
sexual drive. Sex is considered to reflect the
freedom, maintaining relationships, closeness,
intimacy, or love. Curiosity and peer pressure
and the pair may increase the incidence of
premarital sex.
3. Exposure pornography with sexual behavior
147
Table 4.3
Cross-tabulation pornography exposure
with sexual behavior in high school
students Abdi Bahlias Emplasment PT. PP.
Lonsum ,Bandar Simalungun
DistrictMarch to June 2014 Period
Variable
Sexual Behavior
Low risk
High risk
F
%
F
%
Exposure Exposed 1982,6
4
17,4
pornograp
hy
Unexpos 1361,9
8
38,1
ed
Numbe
r
ρ
Value
23
115
21
In this study, exposure pornography is
defined, namely the frequency of adolescents
viewing pornography containing elements in
the media, be in printed media (newspapers,
magazines) and electronic media (television
and internet). If teens always see pornography
more than 1 time per month categorized
adolescents are exposed to pornography and if
only once or not at all never see categorized
with unexposed pornography.
The results showed the number of
respondents exposed to the unexposed not
much different. 82.6% of adolescents who are
exposed to pornography admitted having
sexual behavior considered low risk. The
Commission on Obscenity and Pornography
states that although erotica brief exposure can
arouse sexual desire in both men and women.
Moreover, it can cause emotional reactions
such as restless, impulsive, aggressive and
agitated (Rachmat, 2003).
According
to
Santrock
(2003),
adolescents who are exposed to pornography
media continuously, has the greater sexual
desire. Pornography is drawings, sketches,
illustrations, photographs, text, voice, sound,
moving
pictures,
animation,
cartoons,
conversation, gestures, or other forms of
messages through various forms of
communication media and or performances in
public, which contains obscenity or sexual
exploitation which violate the norms of
decency in society (Law No. 44, 2008).
According Wallmyr and Welin (2006)
adolescents who are often exposed to
pornography media (more than 1 x per month)
has a different idea about how to obtain
information about sex with teens who had
never exposed to pornographic media and
youth media are rarely exposed to
pornography (1 x per month) , Teenagers who
rarely and never exposed to the media and
148
regards information about sex does not have to
be obtained from pornographic media because
the information can be obtained by asking
friends, teachers and parents. From the test
results using a chi-square statistic obtained ρ
value 0,115> α = 0.05, so that H1 is rejected.
The conclusion was that there is no correlation
between the frequency of exposure to
pornographic media with a frequency of
adolescent sexual behavior in high school AlAbdi Bahlias Emplasment 2014. It showed
even though teens admitted often exposed to
pornography but they do not make risky sexual
behavior cause gestation
Research is not in line with the
research Santrock (2003), adolescents who are
exposed to pornography media continuously,
the greater sexual desire. Adolescents
receiving sexual messages from the media
consistently pornography in the form of
kissing, petting, even pre-marital sexual
relations, but rarely explained as a result of
sexual behavior that served as pregnant
outside of marriage or an unwanted pregnancy.
This makes teens do not think long to emulate
what they saw. Teens consider their expertise
and sexual satisfaction is in accordance with
what they see. Similar thing also expressed by
Zilmann and Bryan (2002) which states that
when a person is repeatedly exposed to
pornography, they will show a tendency to
have a deviant perception about sexuality and
also an increase in demand for the type of
pornography that is more loud and distorted.
Pornography can produce physiological and
emotional arousal and increasing the level of
stimulation is likely to produce some form of
sexual behavior such as kissing, petting,
masturbation or sexual intercourse.
4. Parent Communications Premises
Adolescent Sexual Behavior
Parent
communication
is
defined
frequency parents always give information
and advice on sexually to adolescents.
Categorized by good communication if the
communication is done with a frequency more
and worse if the communication is only once a
month or not at all.
Table 4.4
Cross tabulation parent communication
with sexual behavior in high school students
Abdi Bahlias Emplasment PT. PP. Lonsum
District of Bandar SimalungunPeriod from
March to June 2014
Variabl
e
Commu Good
nication Poor
Sexual behavior
Number
ρ
Low risk
High risk
Value
F
%
F %
F %
10 55,6 8 44,4 18 40,9 0,038
22 84,6 4 15,4 26 59,1
The results showed 59.1% of respondents
said communication with parents is rarely
performed and 40.9% of respondents said that
communication is often done. Communication
between parents and children can be a parental
guidance that includes meeting the needs of
children, providing motivation, religious
education in the family. The purpose of
communication between parents and children
is to understand himself and the environment,
make decisions carefully, to control impulses
or desires that are less good and help in
dealing with life in general so that teenagers
do not fall into deviant behavior. Good
are expected to be able to sort out which one is
good and which are bad about sex for himself.
When parents are actively listening to the child
the child's ability to express feelings and his
heart is stimulated and increased. Thus the
has a very important influence in the formation
of attitudes and sexual behavior of
adolescents.
In this study, although the teen said
communication with poor people, but they
tend to be low-risk sexual behavior. From the
statistical test using chi-square value obtained
0.038 ρ <α = 0.05, so that H1 is accepted. The
conclusion was that there is a relationship
between the frequency of communication of
parents with adolescent sexual behavior in
high school Al-Abdi Bahlias Emplasment
PT.PP.Lonsum 2014. This study is in line with
the opinion of Fisher (in Kadarwati et al:
2008)
which
suggests
that
through
communication parents have considerable
influence on adolescent sexual attitudes and
behavior. If the parents are willing to talk
about sex with both teens tend to delay first
sexual intercourse and develop an attitude
similar to the tuanya.Sayang according to
Hurlock (1980) only a few teenagers who wish
to know the ins and outs about sex from their
parents.
Communication between parent and
child can prevent teens from premarital sexual
behavior, it is because there is established
intensive communication between parents and
child, sharing and problem solving together
(Laily and Matulessy, 2004). In adolescence
curiosity about sexual problems is very
important in the formation of a new, more
mature relationship with the opposite sex.
Whereas adolescence information about
sexuality issues should be started so teens do
not seek information from another person or
from sources that are not clear or even wrong
at all. Giving information about sexual
problems is important given to adolescents
because it is associated with hormoneinfluenced sexual drive and often do not have
enough information about their own sexual
activity. Of course, it would be very dangerous
for the formation of adolescent life, if he does
not have the right knowledge and information.
5. Knowledge of adolescent sexual behavior
In this study operationalized knowledge is the
ability of students to understand about
premarital sexual behavior and the impact of
premarital sex. Knowledge categorized on 2
categories: knowledge of good and less. Good
knowledge level if respondents correctly
answered questions via a questionnaire of
more than 60% and less knowledge level if the
respondents answered less than 60%.
Table 4.4
Cross-tabulation knowledge of sexual
behavior in adolescents with high school
students Abdi Bahlias Emplasment PT. PP.
Lonsum, Bandar Simalungun District
March to June 2014 period
Variable
Sexual Behavior
Low risk
High risk
F
%
F
%
Knowled Good 19
70,4
8
29,6
ge
Poor 13
72,7
4
23,3
Total
32
72,7
12
27,3
Numbe
r
ρ
F % Value
27 10 0,467
0
17 10
0
44 100
From the table above were found
knowledge of adolescents about sexual
majority that 21 respondents (61.4%) are in
Good category and 38.6% of respondents are
in the Poor category. From 17 respondents
who have poor knowledge, 13 people (72.7%)
admitted having sex with a low risk, and of the
27 respondents who are knowledgeable both
149
19 respondents (70.4%) of respondents
admitted with low-risk sexual behavior. From
the test results using a chi-square statistic
obtained ρ value 0,467> α = 0.05, so the
conclusion is rejected H1 adolescent
knowledge was not significantly associated
with adolescent sexual behavior in high school
Al-Abdi Bahlias Emplasment PT.PP.Lonsum
2014, although not statistically associated but
when viewed from the cross tabulations, we
can know that, the better knowledge of youth,
the less risky sexual behavior against him.
Knowledge associated with adolescent
premarital sexual behavior (p value = 0.022
<0.05). According Notoatmodjo (2003),
knowledge is the result of know, and this
occurred after people perform sensing on a
particular object. Good knowledge supported
by the level of knowledge of good parents in
providing information about premarital sex
(Hurlock, 2004). According Syafrudin (2008),
knowing a half is even more dangerous than
not know at all. Formation of knowledge itself
is influenced by internal factors, namely the
individual way in response to external
knowledge and a stimulus to transform this
knowledge into better again. According to
Prayitno (2008), A good knowledge is when
respondents understand and know about
premarital sex. According Amrillah (2006),
the higher the reproductive health knowledge
possessed, the lower adolescent has premarital
sexual behavior, conversely the lower the
reproductive health knowledge possessed if
the higher adolescent has premarital sexual
behavior. Knowledge is influenced by level of
education, age, experience, occupation,
income, culture, and association. Knowledge
that
is
not
appropriate,
unrealistic
expectations, low self-esteem, fear of not
being successful or pessimistic, showing that
teens have an immature personality and
emotional instability, so easily influenced
doing negative things, such as premarital sex.
Good knowledge of sexuality could make
teens have healthy sexual behavior and
responsible. A false understanding of sexuality
in adolescents make them try to experiment on
the issue of sex without realizing the dangers
of his actions, and when the problems posed
by the sexual behavior began to emerge, teens
are afraid to express these problems to the
parents.
V. CONCLUSION
150
1. In this study, there is no correlation
between the frequency of exposure to
pornographic media with a frequency
of in high school Al-Abdi Bahlias
Emplasment
2014.Fornografi
exposure for class 1 student in SMA
AL- Abdi PT.PP Lonsum adolescent
sexual behavior
2. The communication of parents has a
significant impact to adolescent sexual
behavior in high school Al-Abdi
Bahlias Emplasment PT.PP.Lonsum
2014.
3. Adolescent knowledge was not
significantly
associated
with
adolescent sexual behavior in high
school Al-Abdi Bahlias Emplasment
PT.PP.Lonsum 2014.
VI. SUGGESTION
a. For School
This study can be reference for increasing
students understanding about Sexual health by
adding Sexual study in Curriculum.
b. For Student
Student can improve their knowledge about
premarital sex, parent communication and the
effect of pornography.
BIBLIOGRAFI
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151
ANALYSIS PREPAREDNESS OF GENERAL
HOSPITAL Dr. FL. TOBING SIBOLGA IN IMPLEMENTATION
OF ASSURANCE NATIONAL HEALTH POLICY 2014
Siti Marlina 1, Juanita 2, Siti Zahara Nasution 2
1
Alumni Program Pascasarjana FKM-USU, Medan
2
Staf Pengajar FKM-USU, Medan
ABSTRACT
The enforcement of Law No. 40/2004 on SJSN (National Social Assurance System) and Law
No. 24/2011 on BPJS (Social Assurance Provider Board) needs complete preparedness by a hospital
as health assurance provider. Dr. FL. Tobing General Hospital, Sibolga, is one of the hospitals which
provide SJSN.
The objective of the research was to find out the preparedness of Dr. FL. Tobing General
Hospital, Sibolga, in implementing the policy in the National Health Assurance, in 2014. The
research used qualitative method with ten informants who were regarded as the qualified persons
who understood the preparedness in implementing health assurance program. The data were
gathered by conducting interviews, observation, and documentation.
The result of the research showed that socialization had been conducted by the management
of the hospital and by BPJS Sibolga Branch. There was no preparedness in health facilities because
of the lack of health equipment, human resources were ready both quantitatively and qualitatively,
disposition of the implementation of health care in the hospital was good, and coordination between
the structure of hospital bureaucracy and BPJS had been done well.
The conclusion of the research was that the management of the hospital had no preparedness
in health facilities for the implementation of the National Health Assurance Program. It is
recommended that the management the hospital should complete and improve its facility and
infrastructure, the government should pay more attention to the implementation of JKN program, and
socialization to public should be optimized.
Keywords: Implementation of Policy, National Health Assurance, Hospital
INTRODUCTION
The National Health Insurance (JKN)
is part of the National Social Assurance
System (BPJS) held by using the mechanisms
of social health insurance which is compulsory
(mandatory) based on Law No. 40 of 2004 on
National Social Assurance System with the
aim to meet the basic needs of a decent public
health which is given to every person who has
paid dues or dues paid by the government.
JKN starting from 1 January 2014, which
gradually
toward
thorough
coverage
(Kemenkes RI, 2013).
JKN purpose generally is easier for
people to access health services and obtain
quality health services. Changes in the
financing system toward a comprehensive
coverage is a good thing but it has side effects
and risks. Inequality availability of health
facilities, health workers and geographical
152
conditions, give rise to new problems in the
form of inequity between community groups
Social Assurance Provider Board
(BPJS) is an institution established to
administer social assurance programs in
Indonesia, according to Law No. 40 of 2004
and Law No. 24 of 2011. In accordance with
Law No. 40 of 2004 on the Social Assurance,
BPJS a non-profit legal entity. Under Law No.
24 In 2011, BPJS will replace a number of
existing social assurance institutions in
Indonesia, namely PT Health Insurance
Agency. Askes Indonesia became BPJS Health
and social assurance institutions manpower
PT. Jamsostek into BPJS Employment
(Sijabat, 2012).
Transformation PT Askes and PT
Jamsostek into BPJS done gradually. In early
2014, PT Askes will be BPJS Health, then in
2015 the turn of PT Jamsostek into BPJS
Employment (Ariyanti, 2013).
The principle of social assurance
benefits is usually the form of cash and the
value of health services appropriate basic life
needs such as food, clothing, shelter and basic
medical needs. Provision of social assurance
benefits is based justice in the sense that
benefits provided applies to all citizens of the
rich countries, poor or nearly poor, because
social assurance is a permanent lifetime. The
third principle is the cornerstone in the
implementation of the social assurance system
sustainable (Kemenkes RI, 2012).
In
order
to
materialize
the
implementation of a sustainable social
assurance system, the social assurance held
nationwide by forming an independent BPJS
based social assurance law. Social assurance
guarantees provide certainty for the
community in order to achieve the fulfillment
of basic life evenly as mandated by Article 28H of paragraph (1) of the Constitution of the
Republic of Indonesia Year 1945 has affirmed
that every person has the right to obtain
medical care, and in Article 34 paragraph (3)
shall be declared the state responsible for the
provision of health care facilities and public
service facilities are decent (Kemenkes RI,
2012).
As stated in Article 2 of Law of the
National Social Assurance System (SJSN), the
Social Assurance organized by the principles
of humanity, the principle of benefit and the
principle of social justice for all Indonesian
people. If the implementation of the Social
Assurance is not based on the three principles,
then there is a violation of that law. Or
negligence in covering and serving the health
insurance for the poor, including poor people,
basically a violation of the principle of
humanity. Then, the principle of social
assurance benefits in the design should
provide
significant
benefits
for
the
participants, not least to guarantee the
fulfillment of basic needs for participants
including a comprehensive health services,
while the principle of fairness in the
administration of the Social Assurance applies
to all levels of society, rich, medium or poor
order created the principle of cooperativeness
(Purwoko, 2012).
Social Assurance System is a system
of social protection for all citizens. Social
protection has a strategic role to address the
vulnerability due to the risk of natural and
economic risks. As we know that Indonesia is
one of the disaster-prone areas and the impacts
of disasters resulting relocate the budget
required to rebuild the damaged infrastructure.
The disaster also left many families losing
possessions and life, so it is quite difficult in
an effort to improve people's welfare (Zaelani,
2012).
One health care provider JKN
program in Sibolga City is General Hospital
Dr. FL. Tobing Sibolga which is the General
Hospital of Class B Non Education, seeks to
provide health services as much as possible in
accordance with the facilities and tools
available, have 204 beds 204, Human
resources 338 people, medical services include
specialist outpatient services, inpatient care
and support services for the installation of
medical services. In general, any type of
outpatient services take place every weekday
and is open to any public or patient health
insurance (ASKES) / poor family health
insurance (ASKESKIN) / Community Health
Insurance (JAMKESMAS) with or without a
referral.
Medical record data General Hospital
Dr. FL Tobing Sibolga (2012) shows the value
of Bed Occupancy Rate (BOR) 50% (national
standard of 60% -80%), and Length Of Stay
(LOS) was 4 days (standard 2 days) with the
highest proportion of patient visits askes 45.24
%, ie 40.06% of patients general, and 13.5%
of patients jamkesmas. This condition shows
that the public interest to come for treatment to
the General Hospital Dr. FL Tobing Sibolga
still low.
Viewed
from the
aspect
of
management at the General Hospital Dr. FL
Tobing Sibolga, still encountered problems of
lack of services in accordance with Standard
Operating Procedure in every unit of services,
such as nursing care and midwifery care. This
is indicated by the lack of reports on the
development of nursing care of patients and
the patients are still many complaints against
the availability of drugs and consumables in
hospitals.
Based on the results of the initial
survey conducted by researchers in January
2014, it is known from the aspect of the
facility is very adequate hospital, where
medical support units also function optimally
as radiology, laboratory and blood services
unit. But the results of a brief interview with
153
the head of medical services and treatments
suggested that health services for participants
JKN still not well served, it is seen from the
limited socialization JKN program for service
providers in hospitals, as well as the still weak
coordination with BPJS in the claiming
process.
Currently the General Hospital Dr. FL Tobing
Sibolga also preparing health care participants
of the National Health Insurance. Based on the
above, the authors are interested in knowing
the extent of readiness of the General Hospital
Dr. FL. Tobing Sibolga in the implementation
of the National Health Insurance Policy 2014.
Based on the background described, the
problems in this research are: how Readiness
General Hospital Dr. FL. Tobing Sibolga in
the implementation of the National Health
Insurance Policy 2014.
This research aimed to analyze
readiness General Hospital Dr. FL. Tobing
Sibolga in the implementation of the National
Health Insurance Policy 2014. The benefits of
this research are:
1. This research is expected to be input for
the Hospital of the readiness of the
implementation of the National Health
Insurance policy so that it can be taken
into consideration in improving the
implementation of National Health
Insurance.
2. It is expected that this research can be
used as an additional reference regarding
health policy and learning materials as
well as contribute ideas in preparation for
Insurance policy at the hospital.
3. This research can increase knowledge and
scientific insights scientific author on the
readiness
of
hospitals
in
the
Insurance policy
RESEARCH METHODS
The method used in this research is
qualitative research. This research therefore
only describe how analysis Readiness General
Hospital FL Tobing Sibolga in the
Implementation of the National Health
Insurance Policy 2014. Qualitative research is
a type of research that revealed the objective
conditions of the phenomenon that occurs with
the approach of in-depth interviews
(Sugiyono, 2006).
154
Research conducted at the General
Hospital dr. FL. Tobing Sibolga. The choice of
location is based on the consideration of the
research has not been done the same with this
research, because the policy is still relatively
new JKN as of 1 January 2014. The research
began by surveying beginning in January
2014, the collection of data with in-depth
interviews and observations conducted in July
2014.
Qualitative research is not intended to make a
generalization of research. Therefore, in
qualitative research, is not known for the
sample population. The subject of research
became an informant who will provide the
necessary information during the research
process (Maleong, 2002), informants are
people who used to give information about the
situation and condition of background
research.
Informants in research in all the elements
that are involved in policy implementation
JKN program in General Hospital Dr. FL
Tobing Sibolga consisting of:
1. Components General Hospital Dr. FL.
Tobing Sibolga
a. Director of the General Hospital Dr.
FL Tobing Sibolga
b. Head of Medical Services and
Treatments
c. Head of Planning and Development
d. Chairman of the Medical Committee
e. Head of Pharmacy Installation
2. Components branch BPJS Sibolga the
head unit hospital services.
3. Inpatients and outpatients at the General
Hospital Dr. FL Tobing Sibolga.
Based on the above, the research
determines informants using purposive
sampling and snowball sampling are.
Sampling with purposive sampling technique
means that the sampling technique based on
certain considerations namely, informants
authors choose are the ones who are involved
directly to the issues being studied. Snowball
Sampling The samples are still provisional
data sources and will develop later after
researchers in the field. (Sugiyono, 2005).
Snowball sampling is used when in the process
of data penggumpulan there's more varied
opinion, the researchers will look for another
informant so that the necessary data is
sufficient to describe the phenomena related to
the objectives of this research .
Data analysis in qualitative research is
rather complicated because the data are quite a
lot of variety and there is no standard pattern.
According to Bogdan, who was quoted by
Sugiyono (2005), data analysis is the process
of systematically searching for and compiling
the data obtained from interviews, field notes
and other materials that can be easily
understood and the findings can be
communicated to others. Data analysis was
performed by organizing the data, translate it
into the units, synthesize, organize into a
pattern, choose what is important and what
will be learned and make inferences that can
be passed on to others.
Sugiyono (2005), citing the opinion
Spradley, also argued that the analysis in the
research of any kind, is a way of thinking,
relating to systematically test for something to
define the part, the relationship between parts,
and its relationship to the whole. Thus, the
analysis is to look for a pattern.
Based on the statement of the experts,
Sugiyono (2005) concluded that the data
analysis is the process of systematically
searching for and compiling the data obtained
from
interviews,
field
notes,
and
documentation, by way of organizing data into
categories, describe into the units, perform
synthesize, organize into a pattern, choose
what is important and what will be learned and
make conclusions so easily understood by
myself and others.
According Sugiyono (2005) Miles and
Huberman cites the opinion that the activity in
qualitative data analysis is done in an
interactive and takes place continuously at
every stage of research so as to completion,
and the data until saturated.
Readiness Communications
Communication is one of the means to
disseminate information or orders from
superiors
to
subordinates
and
from
subordinates to superiors. The information
provided should be clear, accurate in time
delivery of information and information
submitted must be consistent or significant
permanent or not plus-added or subtracted.
According to Hovland, Janis & Kelley
communication is a process through someone
(communicator) deliver stimulus (usually in
the form of words) with the aim of changing or
shaping the behavior of others (Riswadi,
2006).
While
Harold
Laswell
said
communication is basically a process that
describes the "who" says what channel what to
whom, and with what result or outcome.
Laswell
paradigm
indicates
that
communication includes five elements, namely
communicator, message, media, communicant
and effect.
JKN program policies made by the
central government in this case the Ministry of
Health are socialized to other interested parties
through a socialization program JKN. JKN
socialization at the General Hospital Dr. F.L.
Tobing is done in cooperation with BPJS
Sibolga, socialization is done by creating a
meeting / conference or delivered at the time
the apples or the circular letter to the hospital
management, all nurses, specialists, general
practitioners, and all associated with the
hospital and the patient. Dissemination to
patients conducted by the Health Office of
Sibolga City and BPJS.
General Hospital Dr. FL. Tobing
Sibolga is a hospital into a referral health
services on the west coast of North Sumatera,
where the policy JKN with BPJS as the
responsible person must be involved in the
program. In general, the communication
between the hospital with BPJS no problem.
BPJS which holds the mandate of the laws
directly apply JKN automatically on January
1, 2014, including in cooperation with health
care is the hospital. General Hospital Dr. FL.
Tobing Sibolga with BPJS branches can work
together with effective communication and
better coordinate with each other.
Effective implementation will be
realized if the implementation of policy
implementation to know what will be done.
George Edward III suggests three variables
that can measure the success of the first
communication, namely the transmission or
distribution of information. Distribution of
good information will produce good policy
implementation as well. In this research , the
distribution of information is good.
Information about JKN received by the
hospital received. This is due to the special
meeting held to discuss the program with the
BPJS JKN.
The second variable is the clarity of
the information received by the policy
implementer of policy makers should be clear
and not confusing or ambiguous. In the results
155
of this research showed that the informant
was aware of the policy implementation JKN
unknown content of information disseminated
in the form of policy regulations, regulations
on JKN, a presidential decree, the minister of
health regulations, the method of payment
(contribution), referrals, benefit from JKN, the
membership of the National Health Insurance,
national formulary, e-catalogs, and the
Compendium alkes and others concerning the
JKN program, while the content (content)
submitted by BPJS is PT. ASKES changes to
BPJS
health.
The third variable is the consistency. The
information
disseminated
via
the
communication must be consistent, the
information disseminated should be fixed and
unchanging. Message JKN program has
consistently delivered good message to
implementing policy and to the parties
concerned. This means that the individual is
given the same message without any changes.
It can be seen with the statement by the
informant for the delivery of organizational
communication socialization and mass
communication in which media organizations
to produce and disseminate widely the
message to the public is through the media of
radio, television, newspapers and leafleat and
banners. This research is in line with research
Lilian (2013) which is a form of socialization
of health insurance programs carried out
through leaflets and direct socialization
kepadapasien who came for treatment at the
health center Batua Makassar. Socialization
among hospitals with BPJS done by a meeting
between the leadership and the vision to unite
the common goal for this JKN program. The
unification of this vision should be able to
bring the constitutional mandate JKN not to
the interests of a particular institution.
Therefore, strong leadership can
encourage impelemntasi policies to conform
with the original purpose as by USAID (2010),
which states that leadership is a very
substantial factor in policy implementation.
Leaders at the top level is policy makers,
technical breaker, which decided to cooperate
or not on the institution they leads. Therefore,
the leadership could be a solution to overcome
the problems of communication between
institutions
that
could
impede
the
implementation of this JKN.
Good communication occurs for two
reasons, first the intensity in establishing
156
coordination and collaboration between the
two institutions. The second is the lack of
clarity in implementing this program. This
happens because prior to the enactment of the
JKN General Hospital Dr. FL. Tobing Sibolga
has been implementing the program
JAMKESMAS and other health insurance
programs.
The involvement of hospitals in the
delivery of programs JKN the key factor in the
success of the program. When linked existing
socialization field are performed only at the
device level only, while for the public to very
little or very minimal. This is in line with
research Muliaddin et al (2005) and research
Riegel et al (2013) which states that the
dissemination to the public still needs to be
done and further optimized to provide insight
to the public about the benefits of the health
insurance program. In contrast to research
Hastuti (2010) that the socialization conducted
by the health department regarding the health
program in health centers Magelang district is
considered good enough.
Readiness Resources
In the implementation of the policy
should be supported by the resources both
human resources, material and regulations or
guidelines. Goals, objectives and policy
content, despite being communicated clearly
and konsiten, but if the lack of resources to
implement the, then the implementation will
not
run
properly.
The existence of factor resources in order to
implement policies JKN Program plays an
important role in the success of the policy
inplementasi, without adequate resources,
what is planned will not be the same as what is
ultimately
implemented.
Indicators
of
resources in the implementation of existing
policy 3 that policy instrument that is the
source of funds, human resources, and
facilities.
Policy instruments related to the dissemination
of information. No policy information in two
forms, namely information relating to the way
of doing policy implementation and
compliance of information regarding the
implementation of the implementing rules and
laws that have been established. Policy
instruments is one form of information that
describes the program or activity that must be
done in order to implement the policy, from
the data informant mind that they have a
policy instrument JKN program that is the
president of the Republic of Indonesia
regulation No. 12 Year 2013 on Health
Insurance, regulation Repubik health minister
of Indonesia Number 71 of 2013 on health
care in the National Health Insurance.
Regulation No. RI health minister 28 2014 on
guidelines for the implementation of JKN
program, health minister's decision No. 328 /
Menkes / IX / 2013 on the national formulary,
health ministerial regulation No. 59 of 2014
concerning the standard rates of health
services in the administration of the program
JKN, health ministerial regulation No. 27 2014
on technical guidelines Indonesian system
Base Case Group (INA-CBGs) and others.
Funds or financial aspect is a very
important
aspect
in
supporting
the
implementation of policies JKN. Based on the
survey results revealed that the financial
resources in the implementation of JKN
program in General Hospital Dr. FL. Tobing
Sibolga prepared with the payment system
(claiming) INA CBGs where hospitals are
already doing education and training on
computerized data management INA CBGs
held in Jakarta. Based on the above statement
can be concluded that the health resources or
health personnel in the General Hospital Dr.
FL. Tobing Sibolga classified prepared in
providing health services in JKN program.
Human resources are not only talking
about the number of health workers alone. Due
to successful implementation of policies is
also strongly influenced by the ability of
(quality) of these resources. This is according
to Edward III which states that the principal
amount in analyzing the resources needed for
the implementation of the policy is to analyze
the magnitude and quality.
It was found that the availability of
health workers in health service delivery in the
era of JKN according to the informant is
sufficient or adequate, but instead according to
researchers both in terms of the amount still
lacking, it can be seen from the number of
available 204 bed compared with the amount
Source its human General Hospital Dr. FL
Tobing Sibolga which is about 338 people
consisting of basic medical personnel (doctors
and dentists), specialist doctors, nursing and
midwifery personnel, medical support staff
and
non-medical
support
personnel.
Human Resources for specialist doctors in the
General Hospital Dr. FL Tobing Sibolga
suffice as many as 17 people, just not all the
medical specialists are / live in the city of
Sibolga so if suddenly required will hinder the
process of work in the General Hospital Dr.
FL. Tobing Sibolga. This is in accordance with
the opinion of informants stated that for
anesthesia personnel just one person, if the
doctor is unable to attend the hospital will be
shorthanded.
Nursing staff at the General Hospital
Dr. FL. Tobing Sibolga also inadequate seen
from the number of nursing personnel, only
164 people while 204 bed, based Pemenkes
no. 340 / Menkes / Per / III / 2010 that the
ratio of nursing staff and the bed was 1: 1, it is
compared with the opinion of the informants
who said that the nursing staff at the General
Hospital Dr. FL. Tobing Sibolga is enough.
Informants stated that education and training
had been conducted by a team at the hospital
JKN held in Jakarta for the management of
computer data for INA CBGs. Training is
needed not only for the power that would
operate a computer for recording and reporting
administration, but also health workers need to
do the training, including the hospital director.
Director of the General Hospital Dr. FL.
Tobing Sibolga has never participated in the
training because the director of the General
Hospital Dr. FL. Tobing Sibolga only is the
task of implementing the newly served by June
2014.
Observation and in-depth interviews
to health facilities for aspects of the physical
appearance of a physical building standard is
good, the location is easy to reach the
community, well-organized health services,
medicines and consumables sufficient, for
there are still some health facilities are lacking
because of broken tools and still in
improvements, such as a HD yet prepared at
and planned to be prepared in 2014, for the
infrastructure still not ready because medical
equipment is lacking and needs to be
completed.
This research
is in line with research
conducted Luti et al (2012), which states that
the condition of the facilities and infrastructure
of health services in the district of Lingga
archipelago area pretty much inadequate, eg
medical
devices,
drugs,
facilities,
transportation, and communication tools so
that access to reach or reach people is still
inadequate.
157
Assessing the adequacy of health
workers is not an easy thing. Differences in
rural and urban areas in terms of sociological,
geographic, demographic, infrastructure gives
trouble to create a standard of how the need
for health workers in the hospital.
Based on the above it can be
concluded that the information resources,
funds, human and infrastructure related to one
another. Although the policy instruments
already owned by the informant, still required
the deployment and administration of the
instrument more so that implementers can find
the National Health Insurance program as a
whole. Funding for health insurance programs
using INA CBGs and hospitals no difficulty
because the existing hospital management
training. Human resources already owned
General Hospital Dr. FL. Tobing is sufficient
and abilities they have been good. Facilities
and infrastructure are still very limited,
coupled with a tool is still inadequate.
Disposition Readiness
Other factors that are considered
influential on policy implementation is the
attitudes
and
perceptions
of
policy
implementation to the task and its
responsibility. If the executor behave like
honesty, commitment to the democratic nature
of a particular policy then it is likely they give
support to the policy (Winarno, 2012).
Integration of the characteristics of the
structures. Patterns of behavior, interests,
education, capabilities, and potential of a
person.
Disposition is one important factor in
the implementation of effective policies. If the
policy implementers have a tendency or a
positive attitude in the implementation of the
policy implementation is likely to be run in
accordance with the original purpose. And if
the policy implementers to be negative then
the implementation of the policy will not run
effectively or even the implementation of the
policy will fail.
Based on the research results get that
from the disposition in the running policy were
quite prepared JKN obtained from interviews
to patients at the General Hospital Dr. FL.
Tobing Sibolga well treated in inpatient and
outpatient in the room stated that the attitude
of specialist doctors, general practitioners,
nurses, midwives and administrators in
providing good health services, does not
158
discriminate with other patients. The same
thing was also stated by the head of medical
services and treatments as well as chairman of
the medical committee that they look
objectively attitude of health workers in
providing better health services.
Referring to the above regarding the
attitude of the implementers in the General
Hospital Dr. FL. Tobing Sibolga, research
findings show a positive attitude and support
towards the implementation of JKN, the
General Hospital Dr. FL. Tobing Sibolga
Sibolga with BPJS branches have the same
commitment
to
the
program
JKN.
Commitments related parties is strongly
needed in strengthening the implementation of
this JKN. Hospital as health services are wellprepared mengintegasikan themselves with
this JKN program. BPJS constitutively already
very ready to apply JKN, though always in the
process of refinement.
Commitment is a predisposing factor
in self impelementator a policy, then it is
proper implementation of this JKN supported
by the commitment of all parties concerned.
Even if there are problems that commitment
should be able to solve these problems by
improving communication and coordination.
When, in principle, all parties want to fix this
JKN the operational constraints should also be
addressed.
In applying JKN program director of the
hospital should be able to have a positive
attitude and be able to compile and
menetapkankan staff appropriately and
selectively. A positive attitude shown by the
ability to carry out their duties with full
responsibility. A positive attitude held by the
director of the hospital will affect the staff to
be positive as well to the program, so that the
staff are motivated and doing their best to
carry out his duties. Proper staffing would also
ensure the implementation of good policies.
Someone will perform optimally when placed
on the specialty.
Bureaucratic Structure Readiness
Although the resources to implement a
policy of sufficient and implementers of what
and how to do it, and they have a strong desire
to do so, the implementation could be
ineffective
because
ketidakefisiensinya
bureaucratic structure.
The policies are so complex demands
the cooperation of many people, when the
bureaucratic structure is not conducive to the
policy, then this will lead to resource becomes
ineffective and impede the course of policy.
Bureaucracy as implementing a policy must be
able to support policies that have been decided
by way of a well coordinated. In this research ,
the standard bureaucratic structure that is
intended is Standard Operating Procedure
(SOP).
Based on the results of the research
showed that the standard operational at the
General Hospital Dr. FL. Tobing Siboga in the
implementation of this JKN ready. It can be
seen from the secondary data that the author
can General Hospital Dr. FL. Tobias has been
carrying out accreditation and obtain the value
of
"B".
An operational standard-setting concrete
efforts in maintaining the quality of health
services. Various countries are implementing
national
health
insurance
implement
operational standards for the implementation
of health care. For example in Ghana to
implement that facility health care providers
should provide standardized equipment and
services. Later in the Philippines which sets
standards that health care must have been
operating for 3 years and is accredited and
must conform to the standards Phil Healths
especially in the relationship between human
resources, equipment, and physical structure
(Hsiao, 2007).
CONCLUSION
Based on the results of this research
concluded that:
1. Readiness Communications
Communication about JKN already quite
ready and well established where hospitals
in the dissemination of cooperation with
BPJS to socialize in hospital visits from
their banners installed in some parts of the
hospital.
2. Readiness Resources
a. Health manpower resources in running
JKN program can’t meet the health
care has not been effective due to the
quantity and quality of resources
available health workers have not been
adequate.
b. The readiness of health facilities in the
program so far have not seen JKN
readiness due to the infrastructure that
still need to be completed
3. Readiness Disposition
Commitment as one form of disposition in
carrying out policies JKN ready. Overall
the parties have agreed and are committed
to implement JKN as well as possible.
4. Readiness Bureaucratic Structure
Coordination of JKN program in General
Hospital Dr. FL. Tobing BPJS Sibolga
Sibolga to run properly. Hospitals as
health care providers are ready to provide
services and BPJS as the giver of the
budget prepared by claiming system.
ADVICE
1. Communication
Expected to hospitals and BPJS order to
improve socialization JKN with clear
information dissemination and provide
technical guidance JKN in order to
provide information and socialization
completely and correctly to all employees
and staff in the hospital.
2. Resources
a. Expected to hospitals in order to meet
the human resource needs by
proposing health workers and improve
the quality of health personnel in
accordance with the needs of patients
through training.
b. Recommended to the hospital to pay
more attention and increase more
facilities facilities and infrastructures
in accordance with the strategic plan
of the hospital.
3. Disposition
Expected to hospitals to be able to
maintain a good commitment to conduct
regular meetings, and carry out monitoring
and evaluation in order to improve JKN
services at the General Hospital Dr. FL.
Tobing Sibolga
4. Structure of Bureaucracy
Expected hospital with BPJS can maintain and
improve the coordination for the smooth
implementation of JKN in Sibolga City
159
THE EFFECT OF ISOTONIC WATER TO THE ACTIVE PHASE
OF PRIMIPAROUS UTERINE CONTRACTIONS
Delmaifanis, Dra.Maryanah, Karningsih
Jurusan Kebidanan Poltekkes Kemenkes Jakarta III
ABSTRACT
Nutrition and hydration is very important during the delivery process to ensure adequate energy and
maintain normal fluid and electrolyte balance for mother and baby. One of the symptoms of
dehydration are fatigue and it can interfere with the progress of labor and make it difficult for the
mother to be more motivated and active during labor. One alternative rehydration on maternity is the
provision of isotonic water .
The purpose of this study was to determine the Effect of Isotonic Water to the Active Phase of
Primiparous Uterine Contractions.
The study design used a quasi - experiment . The population of this study were all birth mothers in the
maternity ward of the pimary health care Cengkareng , West Jakarta , the sample is partially
primiparous women giving birth in the delivery room PHC Cengkareng 2014. The sampling technique
uses accidental sampling technique which amounts to 30 mothers who were divided into groups and
group intervention control . The results showed there are Effect of Isotonic Water to the Active Phase
of Primiparous Uterine Contractions.
independent t -test , p value 0.000 < α ( 0.05 ) . Suggested for midwives to provide isotonic drinks on
maternity as an alternative rehydration that adequate maternal contraction , so that labor can run
well
Key word : primiparous, uterine contraction, isotonic water
Some factors that cause uterine contractions in
adequate because the secondary factors,
among others: the bladder is full, the influence
of drugs, lying position, inadequate intake of
food and drinks ahead of labor, exhaustion and
dehydration.
Many attempts to streamline the technique of
uterine
contractions,
among
others,
ambulation, change position, emptying the
bladder, nipple stimulation, and feeding and
drinking. Food consumption suggested in the
group of mothers at delivery was bread,
biscuits, vegetables, fruits, low-fat yogurt,
soups, isotonic drinks, and fruit juices
(O'Sullivan et al, 2009).
Kubli et al (2002), conducted a study of the
effect of isotonic drinks compared to drinking
only mineral water during labor at random, at
60 Capital in London. At the end of the first
stage of labor, the mother who is only drinking
water experienced a state of ketosis and
lowering serum glucose levels. The volume of
the stomach, vomiting and the incidence of
vomiting in the second volume of the same
group. There is no difference between the two
groups on the results of labor. However,
160
isotonic drinks are advised to avoid the
occurrence of ketosis in the mother during
childbirth
The purpose of this Research to determine the
effect of isotonic drinks to quality maternal
uterine contractions in primiparous in the first
stage of the active phase
Method
Study design
This research was a quasi experiment with a
"cohort" using partograf. Administration of
isotonic drinks during childbirth performed in
the first stage of the active phase as much as
200 ml per hour. The research was done at the
Public health center Cengkareng, West Jakarta
in June - December 2014. Data collection
using interviews and direct observation to the
respondents. The instrument used is partograf
sheet, and check list.
Subjects
The number of samples in this study were 30
Mother Maternity primiparous taken by
purposive sampling were divided into two
groups, 11 cases and 19 controls. Subject
criteria were: maternal age 21-30 years,
Estimated fetal weight 2500-3500 grams,
Table 1. shows the characteristics seen in the
two groups of respondents is almost the same,
based on the age of women giving birth there
are 2 people aged 30-35 years in the group not
given isotonic (control), general education
level educated respondents junior high
schools, high schools, there is one person who
had elementary school, and 1 college. Most of
the birth mothers are housewives
physiological pregnancy, no accompanying
diseases, not drink isotonic water in the last 24
hours, antenatal care four times, height> 145
cm, did not follow gymnastics pregnant
regularly.
Analysis
All data were analyzed by using independent ttest to compare the average duration of uterine
contractions in cases and controls
Table 2. The results of T-test at the beginning
of the observation showed that respondents
with normal distribution value is 0.608, greater
than 0.05. While the length of his long time
there was no significant difference p> 0.05
Table 3. Results of T-test at the end of the
observation showed that respondents with
normal distribution t value is 0.872, greater
than 0.05. While his long duration significant
difference p <0.05
RESULTS
Limitations of this study is that a minimum
number of samples and the ratio of the amount
of the treatment group and the control is
lacking, so that respondents drawn less
representative of the population. Besides, to
see the quality of uterine contractions do not
use tools that can really measure his strength is
Cardiotocografi (CTG) but only by observing
the length of his, it is consistent with the
observation that there is in partograf.
Variabel
Umur
 30 - 35 tahun
 20 – 30 tahun
Pendidikan
 SD
 SMP
 SMA
 PT
Pekerjaan
 Tidak Bekerja
 Bekerja
Not given isotonic Given
isotonic Jumlah
drinks (n=19)
drinks (n=11)
%
%
f
f
f
%
2
18
100
64,3
0
10
0
35,7
2
28
6,7
93,3
0
9
9
1
0
61,1
45,7
100
1
2
8
0
100
38,9
54,3
0
1
11
17
1
3,3
36,7
56,7
3,3
14
5
63,6
62,5
8
3
36,4
37,5
22
9
71
29
Table 1. Characteristics of respondents by group
Long contraction of the uterus early observations
T test
n
Mean
SD
SE
0,608
Eksperimen
11
33,64
7,77
2,344
Control
19
31,84
6,91
1,586
Table 2. Duration of uterine contractions before being given isotonic drinks
Group
P value
0,518
Long end of the observation of uterine contractions
T test
P value
n
Mean
SD
SE
0,872
0,000
Eksperimen
11
52,27
3,43
1,03
Control
19
46,58
3,36
0,77
Table 3. Long contraction of the uterus in the first stage after the treatment in PHC Cengkareng 2014
Group
161
Discussion
Based on the results of the study showed that
there are differences in the length of his
maternal active phase of the first stage
between the intervention group (given isotonic
drinks) and control group (given sweet tea and
mineral water) visible from the average length
of his. Monitoring results at the end of the
duration of his observations showed the
intervention group over the 53 seconds
compared to the control group 46 seconds. In
addition, the results of the statistical test p
value of 0.05 ˂ thus it can be concluded there
is a significant correlation between the
administration of isotonic drinks on the quality
of his at birth mothers when one phase of PHC
active in Cengkareng, West Jakarta
Isotonic drinks are beverages that can help
replace fluids and electrolytes lost in
conjunction with human perspiration. Isotonic
drinks needed by the body to maintain the
condition of the body's cells in a state of
homeostasis. When the body is in a state of
homeostasis, all processes in the body to run
well. Meanwhile, if the body is dehydrated, it
will affect the entire organ work and processes
in the body (Winarti, 2006)
According to the study, dehydration makes the
body more tired. This fatigue occurs because
inhibition of glycogen breakdown process
changes into energy. The lactic acid should be
used as a power, does not work because the
body is dehydrated. The content of sodium,
potassium, contained in an isotonic drink has
an important role in maintaining the balance of
the liquid electrolyte, so the body does not
easily lose fluid and become dehydrated.
Additionally, sodium and potassium also plays
a role in nerve transmission, regulation of
enzymes, and muscle transmission
Muscles may contract due to the release of
energy available in the form of ATP in the
muscle cells. ATP in the cell are limited and
can be used as an energy source in just 1-2
seconds. Muscle contraction will persist if the
ATP that has been reduced reshaped. The reestablishment of ATP can be derived from
creatine phosphate, glucose, glycogen, and
fatty acids. Prolonged contraction of muscles
can cause muscle fatigue. This is due to the
inability of the process of muscle contraction
and cell metabolism. Solving process energy
162
for muscle contraction in an anaerobic cell
known as the Kreb cycle, where the glycogen
or glucose will be split into pyruvic acid to
produce energy in the form of ATP and
NADH2. Then pyruvat acid is converted to
acetyl Co A is then entered into the
mitochondria for complete oxidized into CO2
and H2O to produce great energy
If the shortage of ATP, the action potential of
muscles and nerves become weak, if it occurs
in the smooth muscle of the uterine
myometrium resulting kontrakasi weak and
inadequate. Barriers blood flow to the muscles
that are contracted also resulted in muscle
fatigue. Fatigue is caused by lactic acid
product. This product is produced from anaerobic process. Therefore, at the time of
delivery in addition to the need for ion
replacement drinks, then sought the metabolic
pathway to produce ATP are aerobic
If maternal dehydrated, there will be a
disruption in the body's systems, including
fatigue and lack of energy in straining. Lack of
energy, fatigue, and dehydration can cause
uterine contractions mother becomes weak, it
can hinder the delivery process because it can
cause birth complications, such as prolonged
labor, and obstructed. By administering
isotonic beverages, is expected to prevent
dehydration, and accelerate the process of
formation of energy in the mother so that the
mother still has enough power to meneran and
delivery process can be run quickly and
smoothly, without any complications
This study is also in line with research
conducted by Nurlailis taken from Surabaya
university journal in 2010 that examined the
effect of sweat pocari against labor
contractions in the region of PHC Gemarang,
Madiun. From the statistical test can be
concluded that there is a significant difference
between the intensity of pain before
intervention and after intervention (p <0.05).
From the results of this study are known to
exist pocari effect of sweat on labor
contractions
Conclusions And Suggestions
It was found that statistically there is the effect
of isotonic drinks on the quality of his (the
duration of his) maternal primipara in the first
stage in the active phase of PHC Cengkareng
2014
Suggestion
1. Isotonic drinks can be a good alternative in
order to fulfill the maternal fluids, for birth
attendants can encourage the birth mothers to
use isotonic fluids during labor, especially first
stage so that labor can run more smoothly.
2. It is recommended to do more research on
the effectiveness of isotonic drinks in
maternal, with better research design,
sampling more and more representative so that
the results can be generalized and used in
general
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163
ACCEPTABILITY PURPLE SWEET POTATO BUTTER CAKE
AND CARBOHYDRATE ANALYSIS FOR DIABETICS SNACK
Cindy Novilia, Fitri, Yessi Alza
Departement of Nutrition, Politeknik Kesehatan Kementrian Kesehatan Riau
ABSTRACT
Purple sweet potato is a functional food, containing high anthocyanins, fiber, amylose and
low glycemic index. Sweet potato is one of carbohydrates source that potentially as local resources for
an effort of staple food diversification. Cake is popular bakery products that have sweet taste and soft
texture. Butter cake gives distinctive aroma of butter and savory favored. In Indonesia, patients with
diabetes mellitus have increasing from 1.1% (2007) to 1.5% (2013). Snack for diabetics must have
appropriate nutritional value and can control blood glucose to prevent the risk of complications in
patients with diabetes mellitus. Diabetics need snacks that have appropriate nutritional value that does
not cause hypo/hyperglycemia.
This study is based on experimental research design using a randomized block design (RAK)
with 3 formula substitution of wheat flour and purple sweet potato and 1 control, organoleptic
(sensory) test and analysis of carbohydrates. Organoleptic (sensory) data were analyzed using One
Way ANOVA, and carbohydrate test data were analyzed using Luff Schrool methods. Our result in
the research on the acceptability purple sweet potato butter cake showed significant real difference of
the sensory score included flavour, aroma, colour and texture by used 75% concentration of purple
sweet potato and also increases the sensory scores of the product, resistant starch content and
acceptability of cake. The carbohydrates analysis of purple sweet potato butter cake showed that the
starch in butter cake with 75% concentrate of purple sweet potato is 27.77%.
Keywords : butter cake, sweet potato, carbohydrate, diabetics
Introduction
Diversification of daily food is still
not in accordance with the pattern of the ideal
food contained in the food pattern of hope
(PPH). Based on the National Socioeconomic
Survey (2009-2013) found that the rate of
sweet potato consumption had decreased
18.20% from 2011 to 2013. The consumption
level of rice exceeds the recommended limits,
conversely the rate of sweet potato
consumption
is
smaller
than
the
recommended, that is < 36kg / capita / year
(Ariani, 2010).
Sweet potato is alternative food
ingredient in Indonesia (Andrianto, 2004).
Purple sweet potato is functional foods
(Winarno, 2004). Sweet potato is one source
of carbohydrates that potentially as local
resources in an effort to diversification of
staple food. Therefore, due to the high
productivity potential and easily obtained on
the local market, regional and international.
Sweet potato price levels are low and
affordable by all segments of society can be
164
one
important
factor
to
encourage
diversification (Anjak, 2010).
Purple sweet potato contains the
pigment anthocyanins higher than other types
of sweet potato (Aripnur, 2010). Anthocyanins
have the potential to reduce blood sugar levels
(anti hyperglycemia) (Richana, 2012) and can
be a natural colorant for food (Suprapta,
2003). Purple sweet potatoes have high levels
of dietary fiber that is 4.72% per 100 grams
(Nintami, 2012). Cake is popular bakery
products that have sweet taste and soft texture.
Butter cake give distinctive aroma of butter
and savory favored (Ardiarini, 2012).
In Indonesia, patients with diabetes
mellitus have increasing from 1.1% (2007) to
1.5% (2013) (Badan Litbangkes, 2013).
Diabetics need snacks that have appropriate
nutritional value that does not cause
hypo/hyperglycemia (Aviaty, 2013).
Our objective was attempt a novel
approach that effort increasing variations food
processing with purple sweet potato as the
main ingredient and study the effect of purple
sweet potato in butter cake as snack for
diabetics. The aim of this study was to
investigate the best product and carbohydrate
value of purple sweet potato butter cake.
Methods
This study is based on experimental
research design using a randomized block
design (RAK) with 3 formula substitution of
wheat flour and purple sweet potato and 1
control, hedonic test and analysis of
carbohydrates.
Organoleptic (sensory) evaluation of
the product to determine the texture, flavour,
aroma and colour of the product. The test
score were analyzed using One Way ANOVA
to find the best product. The best product was
further analyzed with Luff Schrool methods.
Cake formulation and preparation
The ingredients for this cake were
used corn sugar and milk flour for diabetics.
The cake ingredients were weighed using an
analytical balance. First, eggs were manually
broken and yolk was separated from albumen.
Butter and sugar were mixed at high speed
until uniform, the yolk was added at a steady
rate (about 3 min) and after that the purple
sweet potato was added, mixed well. The flour
and milk flour were added, the cake batter was
further mixed at a steady rate (about 5 min).
The albumen was mixed at high speed in other
bowl (about 3 min). After all the albumen was
added into cake batter and stir well. Filled
cake batter (30 g) into cupcake cup and baked.
Four butter cake purple sweet potato
have different containing variable purple sweet
potato and wheat flour concentrations : 0%,
25%, 50%, 75% and were baked at 120ºC
temperatures for 40 min. The cake were
cooled on a wire racks at 27 ºC for 35 minutes
before organoleptic (sensory) and chemical
evaluation.
Organoleptic (sensory) evaluation
Twenty five member panelists
comprising of students from Politeknik
Kesehatan Kementrian Kesehatan Riau
evaluated the samples using the 5 points
hedonic scale method. Scores were given to
the scales: (5) Like very much, (4) Like
slightly, (3) Like moderately, (2) Dislike
moderately, (1) Dislike very much. The coded
samples were presented to panelist to evaluate
for the attributes : flavour, colour, aroma and
texture.
Evaluation of the cake was conducted
1 hour after baking. Sensory testing was done
on all 4 types of cake. Each panelist was
presented with 4 coded randomized samples.
Each sample was coded with three random
digit numbers and the positions of the samples
were randomized. Panelists were seated in
individual sensory booths. The score were
analyzed by ANOVA.
Statistical analysis
Data were analyzed with SPSS version
16.0 using one – way Analyzed of Variance
(ANOVA). Significant differences were tested
using the Duncan Multiple Range Test. Two
replications were used for chemical
evaluation.
Chemical Analysis
Carbohydrate was determined based
on Luff Schrool Method.
Results
Sensory evaluation
Result of these studies with ANOVA
indicated that there is significant difference
(p<0.01) between each samples in terms of
flavour, colour, aroma and texture.
Table 1. Results of sensory evaluation of four
types of cake
Control
Flavour
Colour
Aroma
Texture
3.60 ±
0.913
4.16 ±
0.554
4.16 ±
0.554
3.76 ±
0.879
Purple Sweet Potato
25%
3.40 ±
0.816
2.92 ±
0.862
3.88 ±
0.600
3.24 ±
0.831
50%
3.76 ±
0.663
3.28 ±
0.792
4.00 ±
0.707
3.92 ±
0.702
75%
4.72 ±
0.542
4.80 ±
0.408
4.48 ±
0.586
4.72 ±
0.458
*Mean values in the same row which are
not followed by the same letter are
significantly different (p<0.01). Mean ±
standard deviation (n = 25)
Results for the flavour were around 84
– 100% showed in Fig 1. This indicated the
high scored of flavour is product with 75%
purple sweet potato concentrate.
165
Figure 1. Flavour result of sensory test. Note n = 25; 5 hedonic scale
Results for the colour were around 64 – 100% showed in Figure 2. This indicated the high
scored of colour is product with 0% and 75% purple sweet potato concentrate.
Figure 2. Colour result of sensory test. Note n = 25; 5 hedonic scale
Results for the aroma were 100% showed in Fig 3. This indicated that all types of product
have high scored.
Figure 3. Aroma result of sensory test. Note n = 25; 5 hedonic scale
166
The sensory result for the texture showed in Table 4. Results for the texture were 80-100%.
This indicated that all the types of product were the favorite product.
Figure 4. Texture result of sensory test. Note n = 25; 5 hedonic scale
The sensory score of the cookies was
presented in Table 1. Cake prepared from
purple sweet potato with 75% concentrate
were rated high in flavour, colour, aroma, and
texture with significant difference (p<0.01) as
compared to control, and the cake were scored
high by the panelist. The aroma of purple
sweet potato butter cake gives distinctive
aroma of butter and savory favored. The
colour of purple sweet potato butter cake with
75% concentration are shown in purple colour
that really give eye-catching. The texture of
purple sweet potato butter cake have soft
texture and sweet taste from corn sugar and
milk flour for diabetics.
Purple sweet potatoes attracted
interest as a healthy food additive and a
potential source of natural food colorants due
to their high level of anthocyanins
(Winterhalter, 2011) and also the sweet potato
anthocyanins have antioxidant activity
(Hardoko, 2010). Purple sweet potatoes have
high levels of dietary fiber that is 4.72% per
100 grams (Nintami, 2012).
Resistant starch
Result indicated that resistant starch of
purple sweet potato butter cake with 75%
concentrate is 27.776% with two replication.
The main content of purple sweet potato is a
starch. Sweet potato starch content consists of
30 – 40% of amylose and 60 - 70% of
amylopectin (Nintami, 2012).
At the metabolic level, the effect of
resistant starch on glucose delivery is likely to
have a positive impact on insulin responses
and that gives effect for the utilization of fat
which stored, that may influence appetite
signals (Tapsell, 2004).
Conclusions
Incorporation of purple sweet potato
on baking cake process did not change the
functional properties but increases the sensory
scores of the product, resistant starch content
and acceptability of cake, especially for butter
cake.
References
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dan Kentang. Absolut. Yogyakarta.
Anjak, 2010. Prospek Pengembangan Ubi
Jalar Mendukung Diversifikasi Pangan
dan Ketahanan Pangan. Diakses
dihttp:
//pse.litbang.deptan.go.id/ind/pdffiles/
anjak_2010_10.pdf
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Tepung Ketan Hitam. Universitas
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Pangan
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Swasembada Beras. Prospiding Pekan
Serealia Nasional. Balai Pengkajian
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Teknologi Pertanian Banten. ISBN :
978-979-8940-29-3
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2010.
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http://www.banjar-jabar.go.id. Diakses
tanggal 25 Juni 2010
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Jalar,
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2013.
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www.litbang.depkes.go.id/sites/.../rkd
2013/Laporan_Riskesdas2013.PDF
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Ubi
Jalar
Ungu
(Ipomoea batataws L. Poir) Sebagai
Pengganti Sebagian Tepung Terigu
dan Sumber Antosianin pada Roti
Tawar. Jurnal Teknologi dan Industri
Pangan, 21 (1).
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Serat, Aktivitas Antioksidan, Amilosa
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dan Uji Kesukaan Mi Basah Dengan
Substitusi Tepung Ubi Jalar (Ipomoea
batatas var Ayamurasaki) Bagi
Penderita Diabetes Melitus Tipe 2.
Jurnal of Nutrition College, 1(1).
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Nuansa Cendekia. Bandung.
Suprapta, 2003. Pengaruh Lama Blanching
Terhadap Kualitas Stik Ubi Jalar
(Ipomoea batatas L.) dari Tiga
varietas. Prospiding Temu Teknis
Nasional,
Tenaga
Fungsional
Pertanian.
Tapsell, Linda C., 2004. Diet and metabolic
syndrome : where does resistant starch
fit
in?.
Journal
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Winarno, F.G., 2004. Kimia Pangan dan Gizi.
Penerbit Gramedia. Jakarta
Winterhalter, Peter, et al., 2011. Anthocyanins
in Purple Sweet Potato (Ipomoea
batatas L.) Varieties. Global Science
Books.
EFFECTS OF BREASTFEEDING COUNSELING SELF-EFFICACY
(BSE) IN PREGNANT WOMEN TOWARDS IMMEDIATE
BREASTFEEDING AND GIVING THE COLOSTRUM IN
INDEPENDENT PRACTICE MIDWIVES,
PEMATANGSIANTAR
Tengku Sri Wahyuni, Juliani Purba, Sri Hernawati Sirait
Prodi Kebidanan Pematangsiantar Poltekkes Kemenkes Medan
Jln. Pane no 36 Kel. Tomuan Kec. Siantar Timur Kota Pematangsiantar
ABSTRAC
Breast milk is the best food for babies. The success of breast feeding is influenced by
environmental factors, physical, social, economic, political, and psychological. The psychological
factor is related to the attitude of mothers towards breastfeeding process which is influenced by
confidence about the ability of mothers to breastfeed is described as self-efficacy.
This quasi experimental research a prospective cohort study, aims to analyze the effect of
BSE on counseling pregnant women trimester III towards immediate breastfeeding and feeding of
colostrum. Sampling is determined by means of consecutive sampling, divided into two groups who
received counseling BSE and not given individual counseling reponden. 44. Analysis of the wear test
bivariat chi-square (χ2), with a level of significance of 0.05 and p < CI (95%) while the multivariate
analysis using multiple logistic regression.
Bivariat analysis results showed that parity is associated with immediate breastfeeding with a
value of p = 0.005; RR: 1.67; CI = 1.10-2.53 and administering colostrum with value p = 0,038; RR =
1.54; CI = 0.98-2.44. BSE is associated with immediate breastfeeding with a value of 0.001 p <; RR =
2.36; CI = 1.36-4.08 and administering colostrum with value p = 0,013; RR: 1,77; CI = 1.04-2.99.
Results of the multivariate analysis indicates that BSE is the most dominant variable influenced by
immediate implementation of breastfeeding with a value of 0.001 p <; RR = 8,26; CI = 2.78-24,51
and so is by administering colostrum with value p = 0,019; RR = 3,17; CI = 1.21-8.34.
The midwife is expected to provide more intensive counseling about should BREAST FEED
and ought to follow training about counseling of exclusive breast milk. Braest milk counselor to
become so as to enhance the achievement of exclusive BREAST MILK
Key word : counseling, BSE, Immediate Breastfeeding, early initiation, administering colostrums.
Introduction
The United Nation International
Children's Emergency Fund (UNICEF) and the
World
Health
Organization
(WHO)
recommended exclusive breast feeding up to a
6 month old baby (American Academy of
Pediatric, 2005). The Ministry of health has
been targeting exclusive breast feeding in
infants 0-6 months amounting to 80% by 2014
(Kemenkes, 2013). According to the results of
the Susenas 2010 in quotation in the Health
profile of 2011 brings coverage of exclusive
breast feeding in infants 0-6 months nationally
is 61,5% while the Northern Sumatra Province
only 56,6% (Ministry of HEalth, 2012). In the
town of Pematangsiantar's achievements for
the exclusive BREAST MILK in the year 2012
is
only
34,78%
(Health
Office
Pematangsiantar, 2013)
Based on studies Entwistle et al
(2010) in multiple causes of the research
results from maternal factors don't provide
BREAST MILK among others are:
experience, socioeconomic status, smoking
habit, the attitude of the mother, the support
from health care providers, spouse and
mother's self-confidence (self-efficacy) to
provide breast milk. The importance of selfefficacy for breastfeeding has been proven in
several studies.
BSE is counseling needs to be done to
be able to motivate pregnant mothers so that
they can successfully deliver BREAST MILK
exclusively. Results of the study and
RahmawatiHusna (2008) States that what if
pregnant mothers are given counseling III
169
The sample in this study all pregnant
women trimester III checks the pregnancy and
childbirth aid in getting 15 BPM
Pematangsiantar on the following; 1) inclusion
criteria are willing to be sampled in the study
until the specified deadline since pregnant in
the 3rd trimester until 3rd day of post-partum 2)
Has been getting ASI counseling of midwife
4)spontaneous vaginal type of birthing. 4)
Singleton pregnancies with gestational age 37
weeks or more 5)Baby birth weight of 2,500 –
4,000 grams, and exclusion criteria are: 1) the
mother has an anatomic abnormality 2) mother
with obstetric complications (such as bleeding
post!, hypertension) 3) baby asphyxiation and
there are signs of infection 4) congenital
abnormalities with the Baby, such as
labioschizis or labiopalatoschizis.
Data analysis was carried out through
the 3 stages: univariate, bivariat use statistical
test of chi-square (χ2), with a level of
significance of p < 0.05 and Confidence
Interval (95%). Relative risks (RR) were
calculated using a 2 x 2 table and multivariate
logistic regression, using multiple (logistic
regression).
trimester
exclusive
BREAST
MILK
intensively, then 23,92 more likely to conduct
immediate breastfeeding and giving the
colostrum in the first three days of the birth of
the baby than mothers who get counseling
about BREAST MILK exclusively is not as
intense.
Research Methods
This type of research this includes
observational prospective cohort design in
quantitative, aiming to analyze the effect of
BSE on immediate breastfeeding counseling
and giving the colostrum. These studies
compare the intervention group counseling
BSE on pregnant women trimester III with the
control group, so there are two groups of
subjects.
This research use questionnaire
instruments adopted from researchdone by
Zakiah (2011), where the self efficacy
questionnaire obtained by use of a
questionnaire
being
translated
from
breastfeeding self efficacy scale questionnaireshort form (SF-BSES) as many as 14 item
questions.
Results and discussion
Results
Table 1 characteristics of Respondents with Relationship Counseling BSE in Pematangsiantar
2014
No
Characteristic
Respondents
Konseling BSE
Yes
1.
2.
3.
4.
170
Age
Healthy reproduction (2035 years)
Unhealthy reproduction
(<20 and >35 years)
Parity
Multipara
Primipara
Education Level
High(SMA-PT)
Low (SD-SMP)
Occupation
Employee
Unemploye
No
Value
p
RR
95%CI
0,74
0,90
(0,50-1,62)
Total
n
%
50,6
77
100
5
45,5
11
100
54,4
41,9
26
18
45,6
58,1
57
31
100
100
0,26
1,29
(0,80-2,09)
42
2
51,2
33,3
40
4
48,8
66,7
82
6
100
100
0,67
1,53
(0,48-4,85)
7
37
46,7
50,7
8
36
53,3
49,3
15
73
100
100
0,77
0,92
(0,51-1,65)
n
%
38
49,4
39
6
54,5
31
13
Table 2 BSE Counseling Relationship towards BSE in Pematangsiantar 2014
No
1
2
Counseling of
BSE
Yes
No
BSE
Low
High
n
36
25
%
81,8
56,8
n
8
19
Total
%
18,2
43,2
n
44
44
%
100
100
Value
P
RR
95%CI
0,011
1,44
(1,07-1,93)
Table 3 characteristics of the Respondentst's relationship with towards Immediate
Breastfeeding in Pematangsiantar by 2014.
N
o
1.
2.
3.
4.
Characteristic
respondents
Age
Healthy
reproduction (20-35
years)
Unhealthy
reproduction
(<20 and >35 years)
Parity
Multipara
Primipara
Education Level
High(SMA-PT)
Low (SD-SMP)
Occupation
Employee
Unemploye
Immediate Breastfeeding
Yes
No
Total
n
%
n
%
n
Value
p
RR
95%CI
%
50
64,9
27
35,1
77
100
1,000
1,02
7
63,6
4
36,4
11
100
43
14
75,4
45,2
14
17
24,6
54,8
57
31
100
100
0,005
1,67
(1,10-2,53)
52
5
63,4
83,3
30
1
36,6
16,7
82
6
100
100
0,418
0,76
(0,51-1,12)
9
48
60,0
65,8
6
25
40,0
34,2
15
73
100
100
0,671
0,91
(0,58-1,42)
(0,63-1,64)
Table 4 relationship of Characteristics of respondentsts by administering Colostrum in
Pematangsiantar by 2014.
N
o
1.
2.
3.
4.
Characteristic
respondents
Age
Healthy reproduction
(20-35 years)
Unhealthy
reproduction (<20
and >35 years)
Parity
Multipara
Primipara
Education Level
High(SMA-PT)
Low (SD-SMP)
Occupation
Employee
Unemploye
Administering theColostrum
Yes
No
Total
n
%
N
%
n
Value
P
RR
95%CI
0,751
0,87
(0,53-1,43)
%
43
55,8
34
44,2
77
100
7
63,6
4
36,4
11
100
37
13
64,9
41,9
20
18
35,1
58,1
57
31
100
100
0,038
1,54
(0,98-2,44)
48
2
58,5
33,3
34
4
41,5
66,7
82
6
100
100
0,396
1,75
(0,55-5,52)
7
43
46,7
58,9
8
30
53,3
41,1
15
73
100
100
0,383
0,79
(0,44-1,40)
171
Table 5 Relationship BSE Respondents withImmediate Breastfeeding
Pematangsiantar in 2014
N
o
1
2
Yes
No
Total
BSE
High
Low
n
48
9
%
78,7
33,3
n
13
18
%
21,3
66,7
61
27
n
Value
P
%
100
100
0,000
RR
95%CI
2,36 (1,36-4,08)
Table 6 Relationships BSE Respondents by Administering Colostrum in Pematangsiantar 2014
Administering the colostrum
N BSE
Value
RR
NO
Yes
Total
o
P
95%CI
n
%
n
%
n
%
1 High
40
65,6
21
34,4
61
100
0,013
1,77
(1,04-2,99)
2 Low
10
37,0
17
63,0
27
100
Table 7 the final results of the logistic regression analysis of double effect of BSE On Counseling
pregnant women Trimester III towards Immediate Breastfeeding in Pematangsiantar 2014.
No
Variable
Coefficient Value p
Exp (B)
95%
(B)
CI for Exp (B)
1.
Parity
1,466
0,007
4,33
1,49 - 12,52
2.
BSE
2,112
0,000
8,26
2,78 - 24,51
Constanta
- 1,921
-
Table 8 the final results of the double logistic regression analysis effect of BSE Counseling on
Pregnant Women III Trimester towards The administering of Colostrum in Pematangsiantar
2014
No
Variable
Coefficient
Value p
Exp (B)
95%
(B)
CI for Exp (B)
1.
Parity
0,919
0,052
2,50
0,99 - 6,34
2.
BSE
1,156
0,019
3,17
1,21 - 8,34
Constanta
-0,971
Discussion
Characteristics Of Respondents
a. Age
Of the 77 respondents aged healthy
reproduction (20-35 years) there were 50
respondents (64,9%) was doing immediate
breastfeeding, there are 43 respondents
(55.8%) of colostrum that gives, and of the 11
respondents aged reproduction is not healthy
(< 20 and > 35 years) there are 7 respondents
(63,6%) that do immediate breastfeeding
colostrum that gives Results and statistical
tests show that age does not relate to conduct
172
Immediate
Breastfeeding
and
feeding
colostrum with (p = 1,000) and (p =
0,751).Administering
colostrum on this
research is not related to age, this might be due
to mothers who become the respondents in this
study already understand the importance of
giving of colostrum they get counseling on
BSE for the respondent who got the treatment
as well as counselling on BREAST MILK
given by a midwife at the time gave the
pregnancytreatment. BSE counseling and
counseling BREAST MILK given to
respondents without differentiating the age of
respondents.
Giving BREAST MILK is a very complex
interaction between mechanical stimulation,
the nerve, and various hormones. At the age
of healthy reproductive hormone produced
naturally is still pretty much stable. In
addition, the formation of breast glands
histologically and biochemistry that is affected
by the hormones estrogen and progesterone
called mammogenesis already underway since
the fetus and will have formed a perfect
pregnancy age on the healthy reproduction
(Suradi, 2007).
b. Parity
Research results get 57 respondents
(64,8%) with multipara parity, it is also found
on the research of Rahmawati (2009) about
number of respondents with parity multipara
as much (65,45%) in Makasar.
Chi-square test result indicates the parity is
related to perform immediate breastfeeding
with a value of p = 0.005. The relative ratio
obtained amounted to 1.67 with 95% CI: 1.102.53. As well as administering colostrum
shows parity is associated with giving the
colostrum (p = 0,038). The relative ratio of
1.54 obtainable with 95% CI: 0.982.44.Multiple logistic regression test results
obtained immediate breastfeeding related
parity (p = 0.007), relative ratios obtained
amounted to 4.33 with 95% CI: 12,52-1.49,
whereas for the grant of colostrum unrelated
parity (p = 0,052).
The experience of successful breastfeeding may boost confidence, as well as a
strong desire in the mother to breastfeed her
baby.
Achievement
(performance
accomplihment) in nursing is the first factor
influencing BSE (Dennis, 2003). Wardani
(2012) in the results of his research also says
that breastfeeding success experience,
knowledge and understanding of nursing
techniques become important factors of selfefficacy. Results of research from Muaningsih
(2013) reported that the experience of
breastfeeding was formerly the most
influential factors towards the value of BSE.
Experience the events that ever lived,
experienced, and perceived either long-or just
happened. Experience can occur in any person,
good experience sad, uplifting, and boasts.
Mothers who breastfeed successfully before
having a joyous experience and boast. Mothers
who breastfeed have previously failed a sad
experience. Breastfeeding experience is
certainly only a mother obtained at multiparity
(Muaningsih, 2013).
In the current study might experience as
a multipara mother breastfeeding experience is
a good way. The experience of motherhood
may be the success of breast feeding in early
labor, experience the success of exclusive
breast feeding, the experience of getting the
growth and development of infants with breast
feeding may also experience so even its
economic if given breast milk. All good
experiences perceived mother certainly had an
impact on the value of BSE's mother. The
value of high BSE-related implementation of
immediate administering colostrum and
breasfeeding.
Research in Lebanon finds mother
multipara has the possibility of 2.6 times more
likely to provide exclusive BREAST MILK
compared to primipara. The higher the number
the more parity increase success rate of
exclusive breast feeding (Al-Sahab et al,
2008). The success of exclusive breast feeding
may be preceded by implementing immediate
breastfeeding and administering of colostrum.
c. Education
For variables of education 82 respondents
with higher education in mind there are 52
respondents (63,4%) was that do immediate
breastfeeding and from 6 respondents with low
education there are 5 respondents (83,3%) was
that do immediate breastfeeding. There are 48
respondents (58,5%) that provide the
colostrum from the 6 respondents with low
education there were 2 respondents (33.3
percent) that provide the colostrum. Chisquare test results indicate that education does
not relate to conduct Immediate Breastfeeding
colostrum feeding andvalue p respectively
0,671 and 0,396.
Education is not related to the
implementation of immediate breasfeeding
and administering colostrum. This may be due
to the knowledge of the ASI could've obtained
from different media and with a language that
is easily understood by all levels of education.
Easy to acquire this information will certainly
affect the level of BSE mother regardless of
level of education.
Research in Brazil in 2005 found a mother
who received primary and secondary
education with duration of education has 9
years < risk to stop breast feeding as many as
1.2 times. The lower the mother's level of
173
education is also the lower the success rate of
exclusive breast feeding (Mascarenhas, 2006).
Immediate breastfeeding is one of the factors
that affect the probability of breast feeding
success in the newborn (Fikawati, 2010)
d. Occupation /Jobs
For variables of the work of the 15
respondents who worked there (60.0%) of
respondents
9
that
do
immediate
breastfeeding, there are 7 respondents (46,7%)
of colostrum and giving of the 73 respondents
who don't work there are 48 respondents
(65,8%) that do immediate breastfeeding as
well as there are 43 respondents (58,9%) is
giving the colostrum. Chi-square test result of
work unrelated to do immediate breastfeeding
(p = 0,671) and is not related to give colostrum
(p = 0,383).
Mothers who are not working may be more
have the opportunity to carry out immediate
breastfeeding and administering colostrum
because they have the time and opportunity
more in preparing for the laktasinya. Whereas,
working mothers may not heed the immediate
implementation of breastfeeding and feeding
colostrum because of his work situation will
accelerate the use of infant formula milk.
In this research the status of a job does
not affect the implementation of immediate
breasfeeding, this might be due to working
mothers have also been able to plan well
during lactation to be traversed. Mothers can
already anticipate a short maternity leave with
the preparation time of lactation is good, the
way time works on BREAST MILK storage
and fulfillment needs BREAST MILK for her
baby while moms working
.
The results showed that more
respondents are implementing immediate
breastfeeding i.e. 57 respondents (64,8%).
This immediate breastfeeding figures higher
than obtained by Rahmawati (2009) only
(57,3%) respondennya that implement
immediate breastfeeding.
High results the implementation of
immediate breasfeeding in this study may be
due to the success of the BSE counselling has
been given intensive support of midwife
birthing
support
helper
program
IMD/immediate breasfeeding.
A baby at the age of less than 30
minutes should be immediately disusukan to
174
his mother, in this case not for giving nutrients
but to learn nursing mother's breast is
preparing to start producing breast milk.
Feeling happy to see baby can breastfeed and
satisfaction will stimulate the glands secretes
oxytocin posterior hipofisis to speed up
spending on ASI (Lawrence and cit Ac
Fikawati, 2003). In addition, immediate
breastfeeding needs to be implemented
because the movement to suck in the newborn
will culminate at the time was 20-30 minutes,
so in late lactation reflex will be reduced and
weakened (Roesli and Fikawati, 2003).
Breastfeeding is a start toward
immediate
success
of
breastfeeding
exclusively. immediate breastfeeding mom can
make sure to breastfeed. Research results
Fikawati dkk, (2010) found that the important
factors that led to the failure of the exclusive
BREAST MILK because the mother was not
facilitated doing immediate breastfeeding. A
newborn baby was given only BREAST
MILK since the beginning had great
opportunities to successfully BREAST FEED
exclusively.
Administering Colostrum
For granting this research on colostrum,
obtained 50 respondents (56,8%) of colostrum
that gives only the first 3 days and this result is
slightly lower than that obtained Rahmawati,
(2009) is gaining (57,2%).
On the results of this research
administering of colostrum is lower than the
results of the implementation of immediate
breasfeeding. This may be caused because
mothers who carry out immediate breasfeeding
not necessarily give colostrum only up to 3
days post-partum. The least amount of
colostrum produced may lead to the
assumption that the mother's colostrum
insufficient food/fluid requirements needed by
the baby.
Colostrum is very important for the baby
a lot more because it contains antibodies 10 –
17 times compared to mature BREAST MILK
and can provide protection for infants until the
age of 6 months. Colostrum is the first fluid
secreted by the glands of the breast, contains
tissue debris and residual material contained in
the alveoli and the ducts of the breast glands
before and after the period of puerperium.
Colostrum is thick viscous liquid with a
yellowish color, more yellow than with ASI
matur, secreted on the first day until the 3rd or
4th. Composition from day to day is always
changing (Roesli, 2009).
Breastfeeding Self-Efficacy (BSE)
The results of this research to get
respondents who have breastfeeding selfefficacy is high i.e. 61 respondents
are(69,3%).
From 61 respondents rated high BSE
there are 48 respondents (78,7 percent) that do
immediate breastfeeding, and there were 40
respondents (65,6%) that provide the
colostrum. Of the 27 respondents who have a
low value of BSE there are 9 respondents
(33.3 percent) that do immediate breastfeeding
and there are 10 respondents (37%) which
gives the results of statistical tests with
colostrum test chi-square indicates that BSE is
related to perform Immediate Breastfeeding (p
< 0.001). The relative ratios of gained 2.36
with a 95% CI: 1.36-4.08 and relate to give
colostrum (p = 0,013). The relative ratio
obtained for 1,77 with 95% CI: 1.04-2.99
Multiple logistic regression test results
obtained the BSE-related variables (p <
0.001). Based on the value of the coefficient
(B) it can be seen that the variables associated
with parity do immediate breastfeeding. Of the
relationship of the variables can be viewed
from the value exp (B) or RR by 8,26 with
95% CI: 2.78-24.5. As well as administering
colostrum, BSE-related variables obtained
grant of colostrum (p = 0,019). Of the
relationship of the variables can be viewed
from the value exp (B) or RR 3,17 with 95%
CI: 1.21-8.34.
There is a difference between people
who have a low and high self efficacy. A
person with low self-efficacy will tend to feel
helpless, unable to do the settings on the
circumstances that happened in her life by the
time they mengahadapi barriers, they will
quickly give up, when on the first attempt had
been wound up. A person with low selfefficacy will not make any attempt to address
existing barriers, because they believe that the
actions that they do will not bring any
influence. Low self efficacy can undermine the
motivation, lower cognitive ability, interferes
with aspirations, and indirectly may affect
physical health (Schultz 2005)
On the other hand, a person with high
self-efficacy believe they can cope with events
and situations effectively. They have high
confidence with regard to their capabilities as
compared to people who have low self
efficacy and they only showed little doubt
against myself. They see the difficulty that
exists as something that is challenging, than
as something threatening, they are also
actively seeking to find a new situation. High
self efficacy reduces the fear of failure,
increase aspirations, as well as improving how
problem solving and analytical thinking ability
(Schultz, 2005).
In General, venture capital and readiness
to provide BREAST MILK can be seen from
the value of BSE's mother. The value of
mothers high BSE make efforts and readiness
to give BREAST MILK are also high BSE
towards the mother to give BREAST MILK
has a very big role. The role determines
selection behavior. The role of self efficacy, as
the determining the amount of effort and
endurance in overcoming obstacles and
circumstances that are wonderful to give
breast milk in the future (Kingston,2007).
Mother Self-efficacy to give BREAST
MILK has a very big role. First determine the
role the selection behavior. The second role of
self efficacy as a determinant of the amount of
effort and endurance in overcoming obstacles
and circumstances that are wonderful to give
breast milk. The third role affects the mindset
and emotional reactions. Mothers who have
low self efficacy for breastfeeding has always
considered himself less able to handle the
current situation as well as in anticipation of
the coming situation. The fourth role as
prediction for further behavior. (Spaulding,
2007; Kingston dk, 2007)).
Conclusion
Maternal characteristics (parity) is associated
with immediate breastfeeding with a value of p
= 0.005; RR = 1.67 CI = 1.10-2.53 and
administering colostrum with value p = 0,038;
RP = 1.54; CI = 0.98-2.44, while age, parity,
education and employment are not related.
Bivariat analysis BSE affect immediate
breastfeeding with a value of p = 0.000; RR =
2.36; CI = 1.36-4.08, and also giving the
colostrum to BSE with a value of p = 0,013;
RR = 1,77; CI = 1.04-2.99.
Multivariate analysis of BSE is the most
dominant variable influenced by immediate
implementation of breastfeeding with a value
of 0.001 p <; RR = 8,26; CI = 2.78-24,51 and
175
so is by administering colostrum with value p
= 0,019; RR = 3,17; CI = 1.21-8.34.
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Banjarmasin.Tesis : Fakultas Kedokteran
Universitas Padjajaran, Bandung
EFFECT OF MUSIC THERAPY ON THE STRESS OF SCHOOL AGE
CHILDREN WHO EXPERIENCE HOSPITALIZATION AT THE
HOSPITAL dr. PIRNGADI MEDAN
*Tryonita Debora, **Nur Asnah Sitohang
*student in the faculty of nursing USU
** lecturer in the faculty of nursing
Email: nur75 [email protected]
ABSTRACT
Stress due to hospitalization of children is a response to situations that cause stress, changes, claims
adjustment, care delivery by an unknown person and loss of independence. Children who are
hospitalized are not comfortable with the state of the environment, separation from parents and peers,
limitation of activity, injury and bodily pain and fear of pain it self. Stress can be overcome by giving
the management of psychotherapy, such as music therapy. Music therapy can also improve mental
function, speed healing, increase the sense of well-being. The purpose of this study was to determine
the effect of music therapy on the stress of hospitalization in children of school age in hospitals
dr.Pirngadi Medan. Research design using a quasi-experimental with pre-post test design. The
sampling technique is total sampling and number of samples 31orang. Data were analyzed using the
Wilcoxon test. Results of research before given music therapy average score of stress a child is11.61
and a standard deviation of 2.155. After being given music therapy 1.16 average and standard
deviation of 3.606. Statistical test results obtained P value of 0.000 concluded that there was an effect
of music therapy on the stress of hospitalization in school age children. This study proves that music
therapy can reduce stress in children. It is advised to apply this therapy as one of the interventions in
providing nursing care to the child.
Keywords: music therapy, stress, hospitalizations, school-age children
INTRODUCTION
School-age children, vulnerable to
disease and ultimately children required
hospitalization. Illness and hospitalization are
often the first crisis faced by children (Wong,
2008). Hospitalization is a crisis situation that
requires children hospitalized or stayed in the
hospital for intensive treatment, which causes
a change in the child's psyche. In Indonesia,
30% of 180 children between 3 to 12 years had
experience with the hospital. Most children
received treatment in hospital less than six
days. And the time needed to care for sick
children 20-45% more than at the time to treat
adults (Wong, 2008).
The hospital environment is certainly
very different from the environment in the
home, different shapes and atmosphere. The
response that occurs when a child is treated
like fear, decreased appetite, even children
often cry, do not want to drink milk or eat
foods that are given. Response occurred
because the hospitalized child care is a
stressful experience for both the child and
parents. Stress comes from the child itself and
from outside, namely environmental factors.
Stress faced by individuals can be affected by
physical, emotional, intellectual, social and
spiritual (Wong, 2008).
School-age
children
who
are
hospitalized will have some problems like
experiencing a separation, the adjustment to
the new environment, adjustments to the
nurses who take care of it and hang out with a
sick child. Parting is the biggest stress that
caused the hospitalization of children. One of
the factors that affect the stress of
hospitalization was losing control. Many
hospital situation which decreases the amount
of control felt by the child. Lost control in
children are caused by changes in routine, and
dependency that must be obeyed. One of the
problems of children is centered on boredom
(Wong, 2008). Stress in children is one of the
effects of psychological changes occur due to
a stress or crisis in children. Child reaction to
the crisis was influenced by their
177
developmental age, their previous experience
with illness, separation from families, pain and
hospitalization. They acknowledged losing his
routine and feel worried that they are not able
to adjust. If a child is hospitalized, then the
child will easily run into crisis because: (1)
children experience stress as a result of
changes in the health status and the
environment in the habit, and (2) the child has
a number of limitations to menyeselesaikan
problems coping mechanisms and events are
pressing (Wong, 2008).
Stress can be overcome by giving the
management of psychotherapy, psychotherapy
is one of music therapy. Not only adults need
music to calm down, children also need to
listen to music with a certain rhythm to
exercise patience, and can lower the stress. For
this purpose needed quiet room (Young &
Koopsen, 2007).
Music has become a place for
expression and communication, and without us
knowing music is also used to manipulate
feelings. Music is also one of the ways to
make the child be quiet. The skills that
children get from the music leads to the belief
of the larger, better language skills, fine motor
skill acquisition, temporary consciousness,
creativity, and increased concentrations of.
Music therapy can also improve mental
function, speed healing, increase the sense of
well-being. Music is a useful tool for someone
to find harmony within himself. It is necessary
also because of the presence of harmony
within oneself and it will be easier to cope
with stress, and pain (Djohan, 2009).
Music is widely used for healing,
calming and improve the physical and
physiological conditions. Listening to music
can alter moods and can be raised or lowered,
and give room for reflection (Sheppard, 2007).
Data obtained from medical records
Dr.Pirngadi Hospital Medan, school-age
children who experience hospitalization in the
period January 2013 to January 2014 as many
as 322 people
Research conducted Farida (2010) that
had the aim to determine the effectiveness of
music therapy on postoperative pain reduction
of school-age children in the department of
human rights, the results obtained in the
control group, the effect of music therapy on
postoperative pain intensity was not
significant, while in the intervention group
178
therapy music has a significant influence on
the intensity of pain. Thus inferred music
therapy is effective against post-surgical pain
intensity in children.
The purpose of this study was to
determine the effect of music therapy on stress
as a result of hospitalization in children of
school age in hospitals Dr.Pirngadi Medan.
RESEARCH METHODOLOGY
The research design was quasi experimental
with pre post test design approach. This study
only tested a group of subjects where the
group observed before the intervention and
then observed again after intervention. The
population in this study were children aged 612 years as many as 31 children in April-May
2014. The sampling technique using total
sampling method. Inclusion criteria were:
children aged 6-12 years; willing to be the
respondent; has been hospitalized at least 2
days; can speak Indonesian well; the level of
awareness compos mentis; do not suffer from
hearing loss and pronunciation; parents agree
their children to be the respondent. Exclusion
criteria of the study was children with special
needs (autism, hydrocephalus disease,
hyperactivity, tunagarahita, were in isolation
rooms); patients taking anti-stress medications
and anxiety. This study was conducted from
15 April to May 15, 2014 at the inpatient unit
jasmine and roses. This research was carried
out by considering the ethics of research. The
questionnaire consisted of demographic data
and stress questionnaire consisting of 21
questions. Data collection is done in the room
Bed and Rose. Data analysis using Wilcoxon
statistical test.
3.RESULTS AND DISCUSSION
3.1.Result
The
results
based
on
the
characteristics of respondents, the majority of
the male sex as many as 19 people (61.3%),
aged 12 years as many as 7 people (22.6%),
Batak tribe as many as 20 people (64.5%),
Islam as much as 18 people (58.1%), never
cared for as many as 18 people (58.1%), and
length of hospital for 2 days as many as 15
people (48.4%).
b. Stress characteristics of children before
being given music therapy
Table 1
Distribution of respondents by stress children
before being given music therapy in hospitals
dr. Pirngadi Medan 2014
Variable
Mean
Median
SD
Stress
11,61
12,00
2,155
Based on research results gained an average of
score stress respondent before being given
music therapy 11.6,standard deviation 2.155
and median 12.00.
b. Stress children after
therapy
being given music
Table 2
Stress children after being given music
therapy The Hospital Dr. Medan Pirngadi
2014
(n=31)
Variable Mean Median SD
Stress
1,16
0,00
3,606
Based on research results gained an
average of score stress respondent after being
given music therapy 1.16, standard deviation
of 3.606 and the median 0.00.
c. Effect of music therapy on stress due to
hospitalization in school age children
Statistical analysis showed after being
given music therapy, 27 children has
decreased and 4 children alike stress before
and after music therapy. P values = 0.000 , it
can be concluded that there is a significant
effect of music therapy on children who
experience stress of hospitalization.
3.2.Discussion
Based on the results obtained from the
data the majority of respondents aged 12
years. The older age of the child, a person's
level of stress and increasingly constructive
force in the use of coping with the problems
encountered. School-age children who are
hospitalized will normally arise fear of doctors
and nurses, because in their shadow that the
nurses would be hurt by injecting. The home
environment is certainly very different from
the atmosphere and forms with treatment
rooms.
In addition, children also have limited
activities such as day-to-day activities with
their peers and family. Stress in children of
school age are stress due to separation from
his Max
peer group, suffered injuries on the body
and pain,
12 and loss of control can also lead to
stress (Wong, 2008).
The results based on experience
hospitalized in the hospital the majority of 18
people (58.1%) had experienced. This is in
accordance with the opinion of Wong (2008)
that strongly influence individual experiences
stress response because it can be used as a
learning experience in dealing with a problem.
Diminishing stress response when compared to
someone who first hospitalized and face the
problem.
Children are not familiar with the
hospital environment and medical procedures
will be undertaken. Child for the first time
experienced a hospitalization there was
initially very difficult to interact with other
people even with strangers. The response
appears, the child tends to cry or get angry
when approached, even he did not hesitate to
sulk on his parents. For the assistance of a
parent who is always there beside the child, all
obstacles can be overcome with good. Some
children who have 4-5 days of treatment tend
to interact well.
Emotional reaction at school-age
children often cry, angry and bereaved as a
healthy form in overcoming stress due to
hospitalization (Elfira, 2011).
Listening to music in children can be
trying to find internal harmony, increase selfconfidence, develop skills to deal with
problems and pain and relaxation. This will be
easier to cope with stress, tension, pain and
various disturbances or negative emotions
experienced. In addition to music through the
sound can also change the frequency is not
harmonious vibrations back to normal, healthy
and can restore normal circumstances (Djohan,
2006).
4. Conclusions and suggestions
Research shows that music therapy can reduce
stress in children who are hospitalized. For it
was suggested to the nurse who served in the
179
children's ward be able to use them as one
interventions to improve child welfare
REFERENCES
Aidar, N. (2011). Hubungan peran keluarga
dengan tingkat kecemasan anak usia
sekolah (6-12 tahun) yang mengalami
hospitalisasi di ruang III Rumah Sakit
Umum Dr. Pirngadi Medan. Medan :
FKEP
USU
http://repository.usu.ac.id/handle
/123456789/27095.
Bassano, M. (2009). Terapi Musik dan Warna.
Yogyakarta : Rumpun.
Djohan.(2009). Psikologi Musik. Yogyakarta :
Galang Press.
Farida, A. (2010). Efektifitas terapi musik
terhadap penurunan nyeri post operasi
pada anak usia sekolah di RSUP Haji
Adam Malik Medan. Medan : FKEP
USU.
http://repository.usu.ac.id/handle/12345
6789/20095.
Foster, R.L.R., Hunsberger, M.M., Anderson,
J.J.T. (1989). Family-Centered Nursing
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Care of Children. Philadelphia : W.B.
Saunders Company.
Natalina, D. ( 2013). Terapi Musik Bidang
Keperawatan. Jakarta : Mitra Wacana
Media.
Schulte, E.B., et al. (2001). Thompson’s
Pediatric Nursing 8 th edition.
Philadelphia :
W.B. Saunders
Company.
Sheppard, P. (2007). Music Makes Your Child
Smarter. Jakarta : PT Gramedia Pustaka
Umum.
Sunaryo.
(2004).
Psikologi
Untuk
Keperawatan. Jakarta : EGC.
Wong, D.L., Kasprisin, C.A., Hess, C.S.
(2008). Buku Ajar Keperawatan
Pediatrik Edisi 4 (Editor : Egi Komara
Yudha). Jakarta : EGC.
Patricia. (2008). Buku Ajar Keperawatan
Pediatrik Edisi 6 volume 1 (Editor : Egi
Komara Yudha). Jakarta : EGC.
Young, C., Koopsen. C.(2007).Spritualitas,
Kesehatan dan Penyembuhan.Medan :
Bina Media Perintis
THE EFFECTIVENESS OF BEETHOVEN’S “FUR ELISE’ AS CLASSICAL MUSIC
THERAPY ON LOWERING STROKE CLIENTS’ BLOOD PRESSURE IN THE INPATIENT
ROOMS OF DR. PIRNGADI REGIONAL GENERAL HOSPITAL, MEDAN, IN 2014
Afniwati, Amira Permata Sari Tarigan, Endang Susilawati
Instructors of Nursing Department, Poltekkes Kemkes, Medan
ABSTRACT
Music therapy is a therapy that uses a systematic, controlled, and directed music to heal, rehabilitate,
educate, and train children and adults who suffer from physical, mental or emotional ailments. A
steady rhythmic music which gives a regular rhythm will give balance to a person’s heart beat and
pulse that can lower his blood pressure.
This study is a quasi-experimental design of one group pre-post test, which aims to find out the
effectiveness of Beethoven classical music therapy on lowering stroke patients’ blood pressure at Dr.
Pirngadi Regional General Hospital. The population was all stroke patients caused by hypertension
and treated in Dr. Pirngadi Regional General Hospital, and 23 of them were used as the samples,
taken by using purposive sampling technique. The data were gathered by using observation sheets,
before and after music therapy intervention and analyzed by using pair t-test at the significance level
of 95%.
The results of the research showed that after classical music therapy intervention, systolic blood
pressure had a significant reduction. The average content of systolic blood pressure before the
intervention was 157,5 mmHg. 5 minutes after the intervention it was 154,7 mmHg , 10 minutes after
the intervention it was 149,2 mmHg, and 15 minutes after the intervention it was 145, 8 mmHg at pvalue < 0.001. The average diastolic blood pressure before the intervention was 98,4 mmHg, 5
minutes after the intervention it was 94.3 mmHg, 10 minutes after the intervention it was 91.8 mmHg,
and 90.5, and 15 minutes after the intervention it was 90.5 mm/Hg at p-value < 0.001. It is
recommended that Beethoven Classical music should be needed for health care and a policy for the
provision of complementary therapies should be set in the Inpatient Rooms, especially in the Stroke
Unit.
Keywords : Music Therapy, Blood Pressure
1. Background
Stroke is an acute neurological dysfunction
which is caused by blood circulation disorder
and it occurs abruptly (in seconds) or at least
swift (in hours) with the symptoms and token
which are in line with disturbed brain focal
area (World Health Organization, 2005).
The number of stroke patients tends to
increase each year, not only attacks old people
but also young and productive people.
Nowadays, Indonesia is recognized as the
country with the largest number of stroke
patients in Asia (Yastroki, 2009).
Stroke ranks the third in causing death in
the United States. Referring to the report of the
American Heart Association, about 795,000
people in the United States are attacked by
stroke each year. Of that number, 610,000
people undergo the first stroke while 185,000
of them undergo relapses.
Nowadays, there are four million people in
the United States live in physical disability
because of stroke and 15% to 30% of them
suffer from permanent defect (Centers for
Disease Control and Prevention, 2009).
In Asia (Thailand and China) there are
more rates of incidence of bleeding. In the last
few years, there was a tendency for life span
of the people who were affected by stroke to
be longer (Hamzah, 2006).
This rate becomes worse by the shift of
ages in stroke patients since stroke now begins
to attack younger and more productive people,
and even more than that, it also attacks
teenagers (Gemari, 2008).
Economically, the incidence of stroke has
bad effect because of defect, for it will
decrease the productivity and economic
capacity of the people and the Nation
(Yastroki, 2009).
According to the survey in 2004, stroke is
the number one killer in public hospitals
throughout Indonesia. It is estimated that
500,000 people are affected by stroke. Of that
number, one third of them return to normal,
and the other one third undergo mild until
181
moderate functional disorder, while the
remaining one third undergo serious functional
disorder which forces them to continuously
stay on bed (HIMAPID FKM UNHAS, 2007).
Stroke is a health problem which needs to be
paid specific attention.
Based on Riskesdas (Basic Health
Research), it was found that stroke is the cause
of death, and the principal physical disability
in almost all hospitals in Indonesia. The rate of
the incidence of stroke is increasing from year
to year. In every seven people who die in
Indonesia, one of them is affected by stroke
(DEPKES, 2011).
Hypertension is one of the causes of 17.5
million cases of stroke all over the world. It is
the condition in which blood pressure
increases.
There are many factors which can
influence the incidence of blood pressure; they
are, among others, age, stress, medication,
obesity, smoking, and alcohol.
The relapse of human blood pressure can
be warded off by using pharmacological
therapy such as anti-hypertension medicines
and non-pharmacological medicines which
include healthy life behavior and music
therapy.
Music therapy is a type of therapy by using
systematic, controllable, and guided music in
curing, rehabilitating, educating, and training
children and adults who suffer from physical,
mental, and emotional disorder. Music which
consists of the combination of rhythm,
harmony, and melody has been believed to
have the influence on healing ailments.
Stable rhythmical music which gives
harmonious rhythm will provide harmony for
human heartbeat and pulse (Natalina, 2013).
The use of music as a therapy has been
known since the ancient Greece era and it
began to be applied during World War I and
World War II. The use of music as the
medium of therapy in hospitals also has been
developed in the last few years.
A research conducted by Chavin in 2004
revealed that listening to classical music could
decrease the level of apprehensiveness and
stress so that one’s body undergoes relaxation
which would bring about the lowering in blood
pressure and pulse.
The result of the research conducted by
Asrin et.al showed that music therapy which
has dominant moderate frequency is
182
significant for controlling blood pressure
response of primary hypertension patients.
Sarayar et.al indicated that there was the
influence of classical music on the lowering in
blood pressure of pre-hemodialysis patients in
Dahlia BLU Room of RSUP Prof. Dr. R.D.
Kandou, Manado at p-value = 0.00 (α = 0.0).
The result the preliminary research in the
Inpatient Rooms of Dr. Pirngadi Regional
General Hospital, Medan, showed that there
were 144 patients affected by stroke from
October until December, 2013. In general,
stroke is caused by hypertension.
Based on the background above, the
researcher was interested in studying the
effectiveness of music therapy on the lowering
in stroke patients’ blood pressure in the
General Hospital, Medan, in 2014.
1.1. Objective of the Research
1.1.1. General Objective
To find out the influence of the
therapy of Beethoven classical music
on blood pressure of stroke patients
which were given music therapy in the
Inpatient Rooms of Dr. Pirngadi
Regional General Hospital, Medan.
1.1.2. Specific Objectives
a. To find out the average of blood pressure
of stroke patients before they were given
music therapy in the Inpatient Rooms of
Dr. Pirngadi Regional General Hospital,
Medan.
b. To find out the average of blood pressure
of stroke patients after they were given
music therapy in the Inpatient Rooms of
RSUD Dr. Pirngadi, Medan.
c. To analyze the disparity in the average of
blood pressure of stroke patients before and
after they were given music therapy in the
General Hospital, Medan.
1.2. Formulation of the Problems
How far was the effectiveness of the
therapy of Beethoven classical music on the
lowering in blood pressure of stroke patients in
the Inpatient Rooms of Dr. Pirngadi Regional
General Hospital, Medan?
1.3 Hypothesis of the Research
Beethoven classical music therapy was
effective in lowering blood pressure of stroke
patients.
1.4 Significance
1.4.1 Patients/Families and People
Increasing the outlook and the science on
music therapy in lowering blood pressure so
that patients/families and people could apply it
in their homes to control blood pressure.
1.4.2 Hospitals
The management of the hospital attempted to
determine
the
policy
in
applying
complementary therapy for stroke patients
besides the therapy of anti-hypertension
medicines.
2. Research Methodology
2.1. Types of Research
The type of the research was quasi
experiment, using one group. Pre and post
tests would be conducted in order to measure
the success in the intervention by the design
model as follows:
O1
X
O2
Explanation:
O1 = Blood pressure of stroke patients before
intervention
X = Intervension of Beethoven classical
music therapy
O2 = Patients’
blood
pressure
after
intervention
2.2. Conceptual Framework
Pre Test
Blood
Pressure
Stroke
Patients
Post Test
of
Music Therapy
Blood Pressure
of Stroke
Patients
Picture 3.1. Conceptual Framework of the
Research
Independent variable in the research was
music therapy and dependent variable was
blood pressure of stroke patients.
2.3. Location and Time of the Research
The research was conducted in the
General Hospital, Medan. The data were
gathered from September until October, 2014
2.4. Population and Samples
The population was all stroke patients
caused by hypertension who were treated in
the Inpatient Rooms of Dr. Pirngadi Regional
General Hospital, Medan.
The samples were taken by using Lameshow
formula as follows:
Explanation:
n
= minimum number of samples
Z1-/2 = value of table Z at  5 % = 1,96
Z1- = value of table Z at  10% = 1,28

= standard deviation (can be taken
from the research conducted by
Sarayar et.al = 14,24)
1-2 = variance of mean value pre and posttest (=12)
Based on the calculation of the samples in this
research, the minimum number of samples was
15 respondents. At the time the data were
gathered, the samples were 23 respondents.
The samples were taken by using purposive
sampling technique which was determined by
the following criteria:
1. Adults
2. Diagnosed medically as affected by nonhemorrhagic stroke which was caused by
hypertension.
3. Treated in the Stroke Unit of Dr. Pirngadi
Regional General Hospital, Medan.
4. Fond of music
2.5 Definition of Operational
What it meant by Operational was:
3.5.1. Music therapy: A type of medication
which was done by having the
respondents listen to classical music,
Beethoven, with moderate frequency
(750-3,000 Herzt).
3.5.2. Blood pressure of stroke patients
was the result of measurement on the
pressure undergone by blood in
systolic and diastolic blood vessel
systemically in human body at mmHg;
tensimeter of Nova brand was used as
measuring device.
2.6. Data Gathering Process
The activities in data gathering in this
research began by measuring respondents’
183
blood pressure, followed by their listening to
Beethoven relaxing classical music in 15
minutes, using phonograph record, ‘Websong.’
They wore headsets in listening to the music.
After that, their blood pressure was measured
again by using tensimeter, ‘Nova’. The
measurement was conducted three times: 5
minutes, 10 minutes, and 15 minutes after the
intervention.
2.7. Processing Plan and Data Analysis
The data were processed by using
computer in order to find out the average
blood pressure of the stroke patients, using
univatriate analysis and to find out the
influence of Beethoven classical music therapy
on respondents’ blood pressure, using
bivatriate analysis and paired t-test at the
significance level of 95%.
3. Result of the Research
3.1. Description of the Research Location
Dr. Pirngadi Hospital was established on
August 11, 1928 by the Dutch Colonial
Government. It was named “GEMENTA
ZIEKEN HUIS.” The laying down of its
cornerstone was conducted by a ten year-old
girl, Maria Constantia Macky, the daughter of
Medan Mayor, Dr. W. Bays, who was
appointed as the Director of the hospital.
During the Japanese occupation, the
hospital was expropriated and changed its
name to “SYURITSU BYUSONO INCE.” An
Indonesian by birth, Dr. RADEN PIRNGADI
GONGGO PUTRO, was appointed as the
director of the hospital, and his name has been
inaugurated as the name of the hospital until
now.
After
Indonesia
proclaimed
its
independence on August 17, 1945, Dr.
Pirngadi Hospital was expropriated and taken
care by the RIS (Interim Republic of
Indonesia) of East Sumatera Partition State.
By the rapid political upheaval at that time, on
August 17, 1945 all RIS partition states were
abolished and changed to NKRI (Unitary State
of the Republic of Indonesia). Dr. Pirngadi
Hospital was also expropriated and taken care
by the central government/the Ministry of
Health in Jakarta.
In the period of 1950 to 1952 Dr. Pirngadi
General Hospital played an important role in
the historical process of the establishment of
the Medical School (the Faculty of Medicine),
University of Sumatera Utara because one of
the requirements for establishing the Faculty
184
of Medicine, University of Sumatera Utara,
was that the faculty had to own a hospital as
the supporting facility. Besides that, the
faculty had to have instructors (usually
doctors), either Dutch or native Indonesian,
who worked at Dr. Pirngadi General Hospital.
Since the establishment of the Faculty of
Medicine, University of Sumatera Utara, on
August 20, 1952, Dr. Pirngadi Hospital has
been automatically become the Teaching
Hospital which was used as the Clinical
Secretariat for the medical students of the
University of Sumatera Utara.
RSU (General Hospital) H. Adam Malik
became the Teaching Hospital of the Faculty
of Medicine, University of Sumatera Utara, in
January 1993, Dr. Pirngadi General Hospital
changed its status from the Teaching Hospital
to the Hospital for Teaching so that by this
status Dr. Pirngadi General Hospital with its
facilities and capacity was not only used as the
education place for aspirant doctors from the
Faculty of Medicine, University of Sumatera
Utara, but also the aspirant doctors from other
faculties in North Sumatera, West Sumatera,
and Lampung.
There are no correct data which indicate
when Dr. Pirngadi General Hospital was
handed its ownership from the central
government to the North Sumatera Provincial
Administration.
In
line
with
the
implementation of Regional autonomy, Dr.
Pirngadi General Hospital was handed its
ownership from the North Sumatera Provincial
Administration to Medan City Administration
on December 27, 2001.
After Dr. Pirngadi General Hospital
belonged to Medan City Administration, the
latter paid serious attention to develop the
hospital by rehabilitating and improving it in
all fields. The effort was realized by the
Regional Regulation of Medan No. 30/2002 on
September 6, 2002 on Institutional Change
from Dr. Pirngadi General Hospital to the
Health Care Service of Dr. Pirngadi General
Hospital, Medan. In consequence, there was
the organization, personnel, and management
restructuring, and Dr. H. Sjahrial R. Anas,
MHA was appointed as its Director. This was
followed by the improvement of facility,
infrastructure and the procurement of
sophisticated devices as the support for the
service. In this era, history recorded a big and
bold move of Medan Mayor when he built the
extension of 8 (eight) stories, furnished by
sophisticated facilities. Its cornerstone laying
was performed on March 4, 2004, and the
building was operated on April 16, 2005.
Based on the human resources, facilities,
and infrastructure of Dr. Pirngadi General
Hospital in implementing education, its status
was then changed from the Hospital as the
Place for Education to the Education Hospital.
Based on the recommendation from IRSPI
(Indonesian Education Hospital Association),
feasibility study on the Dr. Pirngadi General
Hospital, Medan, to become the Education
Hospital was conducted. The assessment
(visitation) team consisted of Director of
Specialist Medical Care, Director General in
charge of Medical Care, the Head of Legal and
Organizational Bureau, the Secretary General
of the Department of Health, the Chairperson
of the Education General Hospital Association
and the Head of Legal and Organization
Department, and the Secretary of Directorate
General of Medical Care. Finally, on April
10, 2007, Health Care Service of Dr. Pirngadi
General Hospital, Medan, officially declared
that the hospital became the Education
Hospital, based on the Decree of the Minister
of Health of the Republic of Indonesia No.
433/Menkes/SK.IV/2007.
3.2. Univatrate Analysis
3.2.1. Respondents’ Characteristics
There were 23 respondents in this
research. Their characteristics could be seen in
the following table:
Table 3.1. Respondents’ Characteristics Related to the Effectiveness of Music Therapy in
Lowering Blood Pressure at Dr. Pirngadi Regional General Hospital, Medan.
Karakteristik
n
%
Age
Younger Adult 26-35 years old
Older Adults 36-45 years old
The Young Elderly 46-55 years old
Middle Aged 56-65 years old
Old People > 65 years old
3
8
8
4
13,0
34,8
34,8
17,3
Sex
Male
Female
14
9
60,9
39,1
Ethnic Group
Acehnese
Bataknese
Javanese
Karonese
Malayunese
Padangnese
2
8
5
4
3
1
8,7
34,8
21,7
17,4
13,0
4,3
Occupation
Government Employee
Indonesian National Army/Police Force
Teacher
Entrepreneur
Private Company Employee
Farmer
Rickshaw Driver
Housewife
5
1
2
4
2
4
1
4
21,7
4,3
8,6
17,3
8,7
17,3
4,3
17,3
Total
23
100
185
ebelum
tervensi
Based on Table 3.1 above, it was seen that
the majority of the respondents’ characteristics
were as follows: 39.1% of the respondents
were 50 to 59 years old, 60.9% of them were
males, 34.8% of them were Bataknese, 73.9%
of them were Moslems, and 21.7% of them
were government employees.
3.2.2. Respondents’ Lifestyle
Respondents’ lifestyle and habit could be
seen from their smoking habit, their
consumption of meat, and their physical
exercises. The frequency of respondents, based
on their lifestyle could be seen in the
following table.
Tabel 3.2. Respondents’ Lifestyle Related to the Effectiveness of Music Therapy on Lowering
Blood Pressure in Dr. Pirngadi Regional General Hospital, Medan, in 2014
Lifestyle
n
%
Smoking
Yes
No
15
8
65,2
34,8
Meat Consumption
Each Week
Each Month
Sometimes
Hari Raya/New Year
8
4
9
2
34,8
17,4
39,1
8,7
Physical Exercises
Every Day
Twice a Week
Each Week
Sometimes
Never
1
2
10
3
7
4,3
8,7
43,5
13,1
30,4
Total
23
100
From the table above, it could be seen that, in general, respondents had the habit of smoking (65.2%),
the habit of sometimes consuming meat (39.1%), and the habit of doing physical exercises each week
(43.5%).
3.2.3. Description of the Respondents’ Average Blood Pressure before and after
the Intervention
Tabel 3.3. The Average of Respondents’ Systolic Blood Pressure before and after the
Intervention of Beethoven Classical Music Therapy
Before
5 Minutes
10 Minutes
15 Minutes
Intervention
After
After Intervention After
Intervention
Intervention
157,5 mmHg
154,7 mmHg
149,2 mmHg
145,8 mmHg
Based on the table above, it could be seen that the average value of respondents’ blood pressure
became lower after 15 minutes of the intervention (145.8 mmHg).
186
Tabel 3.4. The average of Respondents’ Diastolic Blood Pressure before and after the
5 Minutes
10 Minutes
15 Minutes
Before
After
After Intervention After
Intervention
Intervention
Intervention
98,4 mmHg
94,3 mmHg
91,8 mmHg
Table 3.4 above showed that the average
value of respondents’ diastolic blood pressure
became lower after 15 minutes of giving music
therapy than that after giving 5 and 10 minutes
of music therapy.
3.3. Bivatriate Analysis
3.3.1. The Effectiveness of Beethoven
Classical Music Therapy on the
Lowering in Stroke Patients’ Blood
Pressure in Dr. Pirngadi Regional
General Hospital, Medan
The effectiveness of Beethoven classical
music therapy on the lowering in respondents’
systolic blood pressure was viewed from the
average disparity of respondents’ systolic
blood pressure before the intervention and
after the intervention in the 5th, 10th, and 15th
minutes by using paired t-test because all
variables had normal distribution of data (the
result of Kolmogorov Smirnov test).
Tabel 3.5. The Average Disparity of
Respondents’ Systolic Blood Pressure before
and after the Intervention of Beethoven
Classical Music Therapy
Systolic
Mean
SD
P Value
Before Intervention
After 5 Minute Intervention
157,5
154,7
149,2
145,8
10,4
9,6 0,000
9,6 0,000
9,7 0,000
90,5 mmHg
From Table 3.5 above, it could be seen that
there was significant average disparity of
systolic blood pressure between before the
intervention and after the intervention, either
in the 5th minute (p-value < 0.001), the 10th
minute (p-value < 0.001), and the 15th minute
(p-value < 0.001).
In the 5th minute after the intervention,
there was the lowering in blood pressure of 2.8
mmHg, in the 10th minute there was the
lowering in blood pressure of 8.3 mmHg, and
in the 15th minute there was the lowering in
blood pressure of 11.7 mmHg.
3.3.2. The Effectiveness of Beethoven
Classical Music Therapy on the Lowering
in Respondents’ Diastolic Blood Pressure
in Dr. Pirngadi General Hospital, Medan
The effectiveness of Beethoven classical
music therapy on respondents’ diastolic blood
pressure was viewed from the average
disparity of respondents’ diastolic blood
pressure before and after the intervention in
the 5th, 10th, and 15th minutes by using paired ttest.
Tabel 3.6 The Average Disparity of Respondents’ Diastolic Blood Pressure before and after the
Diastolic
Before Intervention
Mean
98,4
94,3
91,8
90,5
It could be seen that there was the average
disparity of diastolic blood pressure before and
after the intervention in the 5th minute (p-value
< 0.001), in the 10th minute (p-value < 0.001),
and in the 15th minute (p-value < 0.001).
In the 5th minute after the intervention,
there was the lowering in diastolic blood
SD
2,6
2,7
2,8
3,1
P Value
0,000
0,000
0,000
pressure of 4.1 mmHg, in the 10th minute there
was the lowering in diastolic blood pressure of
6.6 mmHg, and in the 15th minute there was
the lowering in diastolic blood pressure of 7.9
mmHg.
187
4. DISCUSSION
4.1. Discussion
This research was conducted on stroke
patients, caused by hypertension; they were
given Beethoven classical music therapy,
entitled “Fur Elise.”
Before the
intervention of classical music therapy, the
result of the patients’ blood pressure was high:
their systolic blood pressure was in the
average range of 157.5 mmHg, and their
diastolic blood pressure was in the average
range of 98.4 mmHg. Blood pressure of
190/110 was undergone by a respondent who
was 53 years old. This indicated that the age
factor did not always influence on the increase
in an individual blood pressure; there were
other factors such as lifestyle which was
undergone by a respondent who was 53 years
old. He used to smoke and was overweight.
After the patients were given music
therapy, there was the lowering in their blood
pressure; it could be seen from the result of the
measurement. In the first five minutes, after
the music therapy had been given, there was
no significant lowering in the blood pressure.
There was only a lowering in the respondents’
systolic blood pressure in three respondents
from 150 mmHg to 140 mmHg (two
respondents) and from 170 mmHg to 160
mmHg (one respondent) so that the average
value was 154.7 mmHg.
In the second ten minutes, respondents’
systolic blood pressure was measured again.
The result indicated that there was the
lowering in blood pressure of 19 respondents.
The lowering occurred in the systolic blood
pressure of 10 mmHg from the previous blood
pressure so that the average value was 149.2
mmHg.
The lowering in systolic blood pressure
was clearly seen in 15 minutes after the
intervention so that the average value was
145.8 mmHg.
Diastolic blood pressure also lowered, like
what happened to systole blood pressure. In
the beginning, respondents’ diastolic blood
pressure was 80 - 100 mmHg. Diastolic blood
pressure only occurred in one respondent.
Five minutes after the intervention,
diastolic blood pressure lowered to 10 mmHg.
It was continuously stable until 15 minutes
after the intervention, starting from the first
day to the third day. The same was true to the
average value. The average value of diastolic
188
blood pressure in five minutes after the
intervention was 94.3 mmHg. The next ten
minutes the average value of diastolic blood
pressure was 91.8 mmHg, and the next 15
minutes diastolic blood pressure was 90.5
mmHg. The result of statistic paired t-test at
the significance level of 95% showed that
there was the significant result in the first 5
minutes, 10 minutes, and 15 minutes after the
intervention at p-value = 0.000 from the first
day until the third day when this research was
conducted. It was found that music therapy
could decrease a person’s level of stress so
that there was a relaxation to the physiological
response when music was listened to by a
person who had hypertension. Besides that,
music therapy could heal man physically and
psychologically.
Some researchers from The Neuro,
through MRI scan proved that brain released
dopamine substance (hormone which is related
to brain system, gives comfort and strength
to motivate a person proactively to do a certain
activity).
The music therapy could also decrease
andrenocorticotropic hormone (ACTH), a
stress hormone (Djohan, 2005). Through
music, a person can also release his hidden
emotion and bad memory. It is also very
effective to make human body relaxed because
body, emotion, and soul release sigh of
relieve.
This condition is in line with the result of
the research by Chavin (2004) which stated
that listening to music could decrease the level
of apprehensiveness and stress so that human
body would relax and would bring about the
lowering in blood pressure and pulse.
Music is able to trigger strong feeling and
release it from the body like poison which is
discharged from a wound (Merrit, 2003).
The spread of music is very potential to
give resonance of its listener’s feeling from
negative to positive feeling and to increase the
feeling of delight and peacefulness (Salapessy,
2001).
Besides that, through music a person can
make an effort to find internal harmony (inner
metabolism of human body so that the process
can run properly. With better metabolism,
human body will be able to build better antibody system so that it will be guarded against
any disease (Satiadarma, 2001)
Therefore, music is a beneficial device for
a person to find a harmony in his soul. This is
important because by harmony in one’s self,
he will easily cope with his stress, tense, pain,
and various types of disturbance or negative
emotion (Ortiz, 1997). Besides that, music,
through its sound, can change unharmonious
frequency to come back to normal and healthy
vibration so that it can recede to the normal
condition (Salampessy, 2001).
Music therapy is therapeutic which means
that it can cure ailments. One of the reasons is
that music produces rhythmical response
caught through ears and processed in the body
nervous system and gland in the brain which
reorganizes the interpretation of the sound to
the internal rhythm of his sense of hearing.
This internal rhythm influences.
Asrin et.al showed that music therapy which
dominantly in moderate frequency was very
significant to handle the response of blood
pressure in primary patients.
Sarayar et.al showed that there was the
influence of classical music therapy on the
decrease in blood pressure of pre-hemodialysis
patients in Dahlia BLU Room of RSUP Dr. R.
D. Kandou, Manado at p-value < 0.05 (p <
0.01).
4.2. Limitation of the Research
In this research, there was no control
group; the control was blood pressure before
the intervention. Besides that, this research
was conducted by ignoring participating
disease and medical therapy of antihypertension which was given to respondents.
The researcher was afraid if it would be bias in
this research.
5. CONCLUSION AND SUGGESTION
5.1. Conclusion
The conclusion of the research was that
music therapy was effective in decreasing
blood pressure of stroke patients caused by
hypertension. It was indicated by the result
of statistic paired t-test which indicated that
there was significant result at p-value < 0.05 (p
< 0.001) for 5 minutes, 10 minutes, and 15
minutes after the intervention of Beethoven’s
“Fur Elise” classical music therapy.
should be facilitated by classical music
therapy as a complementary therapy in
lowering their blood pressure.
5.2.2. Health Service
It is recommended that a policy should
be made in providing the facility for music
therapy in the Inpatient Rooms where stroke
patients are being treated, especially the
facility for music therapy in the Stroke Unit.
REFERENCES
Asrin, et.,al., 2009, Upaya Pengendalian
Respon Emosional Pasien Hipertensi
Dengan Terapi Musik Dominan
Frekuensi Sedang Kerja Puskesmas
Purwokerto Timur Banyumas., accessed
on April 1 2014.
Brunner & Suddart. 2002, Buku
Ajar
Keperawatan Medikal
Bedah
(Vol.2).Jakarta: EGC.
Chang, E, etl, 2010, Patofisiologi ; Aplikasi
Pada Praktik Keperawatan, EGC,
Jakarta
Djohan, 2006, Terapi Musik ; Teori dan
Aplikasi, Galang Press, Jakarta
Goldszmit A, 2013, Stroke Essensial, Indeks,
Jakarta
Junaedi
I,
2011,
Stroke,
Waspadai
Ancamannya, CV. Andi Offset,
Yogyakarta
Natalina, D. 2013. Terapi Musik Bidang
Keperawatan, Mitra Wacana Media,
Jakarta
Sastroasmoro, S. et.al., 2010. Dasar-Dasar
Metodologi Penelitian Klinis, Jakarta :
Sagung Seto.
Sarayar, et.al,. 2013. “Pengaruh Musik Klasik
Terhadap Penurunan Tekanan Darah
Pada Pasien Pra-Hemodialisis Di Ruang
Dahlia BLU RSUP. Prof. Dr. R. D.
Kandou Manado,” ejournal keperawatan
(e-Kp) Volume I. Number 1. August
2013 accessed on March 27, 2014.
Sylvia, P, 2006, Patofisiologi ; Konsep Klinis
Proses-Proses Penyakit, Volume 1,
EGC, Jakarta
Yudoyono, S.
et.al.,
2011, Cara Jitu
Mengatasi
Hipertensi,
Copyright,
Yogyakarta
5.2. Suggestion
5.2.1. Patients/Families/People
It is recommended that stroke patients, caused
by hypertension,
189
FACTORS ASSOCIATED WITH NUTRITIONAL STATUS
STREET CHILDREN IN THE CITY PEMATANGSIANTAR
Desprin Sinulingga*, Diana**
*Alumni of the public health, STIKes Sumatera Utara, Indonesia
**Public Health, STIKes Sumatera Utara, Indonesia, [email protected]
ABSTRACT
Street children are a group at risk of malnutrition because of the life they lead are likely to
behave at risk. Nutritional problems of street children is influenced by several factors such as age,
gender, activity, shelter, health care utilization, and diet.
This research is analytic. The sample used in this study were street children in the city where
the sample is taken Pematangsiantar acidental sampling during the months from October to December
2013. Methods of data collection is done by using the primary data and secondary data.
The results showed that there were 13.2% more nutritional status of street children, 52.8%
good nutritional status, nutritional status 30.2% less and 3.8% severe malnutrition. There is no
correlation between age and nutritional status of street children p = 0.973. No association with gender
nutritional status of street children p = 0.208. There is a relationship between activity and nutritional
status of street children there is a relationship p = 0,012.Tidak residence and nutritional status of street
children p = 0,059.Tidak no association between health service utilization and nutritional status of
street children p = 0,733.Ada the relationship between diet nutritional status street children p = 0.002.
Suggested to Pematangsiantar of Regional Government and relevant agencies to pay more
attention to the health of street children through education about nutrition and the provision of health
services for street children, either in the form of supplementary feeding and drugs, and to the parents
should pay attention to food consumption serves children with diverse wide and varied menu every
meal.
Keywords: street children, nutritional status
Background Of The Problem
Increasing the number of street
children will improve nutrition and health
issues. This is due to street kids who fall into
the category of children and adolescents in
need of good nutrition and good health to
support its growth. According to UNICEF
(2008) children are still growing and
developing so that children are more
susceptible than adults to the poor living
conditions such as poverty, non-fulfillment of
health care, nutrition, clean water, shelter, and
environmental pollution. The influence of
disease, malnutrition, and poverty threaten the
future of the children and the communities in
which they live.
According
Moeliono
(2001)
operationally it can be said that street children
are children aged 5-18 years who spent more
than four hours of his time on the streets either
for work or other activities. One of the health
problems that occur in the state of street
190
children are malnourished due to irregular
eating behavior. The state of malnutrition is
one of the factors that cause a person easily
susceptible to infectious diseases, it is because
the natural immune system owned .In addition
weakened health status of poor street children
can also cause nutritional status becomes bad
(Indriani, 2006).
In Makassar in 2012 conducted
research that street children have nutritional
skinny because activity on the streets who
spent 4-8 hours per day, do not take advantage
of good health care, do not live with their
parents, and generally those who have thin
nutrition over the age of 13 years and male sex
(indina et al, 2012).
Today the growth of street children in
Indonesia increasing Pematangsiantar for
example, which is very easy to see street
children in various streets in the city
Pematangsiantar. Among them, in the way
Sutomo, the tax department Horas, Merdeka,
Tomuan area, Parluasan station, Marihat,
corner 2, the area Tanjungpinggir. Of the
whole place, according to the city Department
of Social Pematangsiantar, overall street
children who often move in the region - the
region amounted to 113 people. In everyday
life, street children interact with various social
elements that are in the way, both among
children and adults with various backgrounds
activity. When they've been on the road, all the
resources they have deployed to brief
earn.Street singers the form of money, shining
shoes, to beg is a favorite work that occupied
by street children there.
In 2012 the NGO Fokrat in town
Pematangsiantar held free medical treatment to
street children and of the results of the
examination disebutkn that the majority of
street children have malnutrition.
Based on the description above, the
writer interested in conducting research
entitled " factors associated with the
nutritional status of street children in the city
Pematangsiantar " .
Types Of Research
This type of research is analytic aims
to determine what are the which affects the
nutritional
status
street
children
in
Pematansiantar
Location Research
The study was conducted in the city
Pematangsiantar.
Population Research
The population of street children in
the city Pematangsiantar totaling 113 people
consisting of about 23 people Sutomo street,
neighborhood pajakHoras 15 people, Merdeka
17 people, 13 people Tomuan area, Parluasan
station 15 people, Marihat 10 people, local
intersection 2 as many as 5 people, and the
Cape region edge 15 people. Obtained a
sample of 53 street children in the city of
Causeway siantar consisting of Jalan Sutomo
10 people, 8 horas Tax, Freedom 10, Tomuan
5 people, Parluasan 5 people, Marihat 5
people, Simpang2 5 people, Tanjungpinggir 5
people.
acidental
sampling
technique
sampling.
Method Of Collecting Data
The collection of primary data include
age, gender, residence, activities, health
service utilization, and eating is done with the
interview. While nutritional status by using the
gauge height and weighing in to street
children.
Data Analysis Methods
Univariate analysis is used to see each
distributed frequency variable and bivariate
analysis to examine the relationship between
the variables of age, sex, place of residence,
activity, and utilization of health services and
nutritional status, diet by using chi squere.
Results And Discussion
Based on research conducted in the
city Pematangsiantar about the nutritional
status of street children then obtained as a
result of the following:
Table 1. Relationship Age With Street Children Nutritional Status
No Age
1
14-16
2
17-18
Total
More
F %
4 57,1
3 42,9
7 100
Nutritional status
Good
Less
F %
F %
15 52
7 47
14 48
8 53
29 100 15 100
Bad
F %
1 50
1 50
2 100
Total
F
27
26
53
%
Prob
%
50,9
p 0,973
49,1
100
191
Based on statistical test obtained by
value p = 0.973 (P> 0.05), meaning Ho
accepted meaning no correlation between age
on nutritional status of street children. This is
in line with research conducted by Yunita
(2008) on street children under the care of
NGOs YAKMI that street children aged 14-16
years and 17-18 years old there are also severe
malnutrition. It is caused by factors from both
inside and outside child jalanan.Factor from
within like some of them in his time had
experienced infectious diseases such as
diarrhea, respiratory infections, and there is
also affected by tuberculosis who often
colaps.Where circumstances such as This can
have a negative impact on health and nutrition
mereka. Than external factors, ie the majority
of them also have bad habits such as smoking,
drinking alcohol as drinking wine, beer, etc.
Not only that there are also street children who
use illicit drugs such as drugs, where
circumstances can also have a negative impact
on their health and nutrition. (Arisman, 2002).
This is in line with the opinion Jessor (1996),
which says that adolescence is a period of risk
to health, so at this time of great need for
nutrients
Table 2. Relationship Sex With Street Children Nutritional Status
Nutritional Status
More
Good
Less
Bad
Total %
Sex
No
F %
F %
F %
F %
F
%
Prob
1
Male
6 85,7 18 62
13 87
2 100 39
73,6
2
Female
1 14,3 11 38
2 13
0 0
14
26,4 p 0,208
Total
7 100
29 100 15 100 2 100 53
100
Based on statistical test obtained by value p = 0.208 ( P > 0.05 ), meaning Ho accepted
meaning there is no relationship between gender and nutritional status of street children . As well as
research conducted by Yunita (2008 ) that the street child sex more men who are not good nutritional
status compared with street women children.The sex is due to habits they were not as good as
smoking and drinking alcohol will not affect either the health and nutritional status of the only street
children. Male doing more activity than street children who are women like driving around for
busking , polish , and begging that should street children male sex more requires good nutrition than
women because they are more active than women. ( Arisman , 2004) .
Table 3. Activity Relationship With Street Children Nutritional Status
Nutritional Status
More
Good
Less
Bad
Total %
No Activity
F %
F %
F %
F %
F
%
Prob
Heavy
1
Work
2 28,6 13 45
13 87
2 100 30
56,6
2
Light Work 5 71,4 16 55
2 13
0 0
23
43,4 p 0,012
Total
7 100
29 100 15 100 2 100 53
100
Based on statistical test obtained by value p = 0.012 (P <0.05), meaning that Ho refused
meaning there is a relationship between activity and nutritional status of street children. According to
research conducted by the Bagong 2000, in the city of Semarang on the activities of street children,
street children have a high activity. While long working street children varied, where street children
work 6-8 hours per day, 9-12 hours to 13 hours This is because there are too few of them were living
with their parents so that their nutritional intake enought.Not only that portion among them are also
able to meet their own food needs from the singing, shining shoes and begging so that the frequency
of eating three times a day enough so that the need and be well nourished because as we all know the
more severe the longer the activity and we do these activities hence the need nutrients that would be
even greater. (Guthrie, 2005).
192
From the analysis it also appears that there also appeared to respondents who were not
strenuous activity but has poor nutritional status, this happens because of their bad habits such as
smoking, alcoholism, and drug abuse that affect their health and nutritional status (Arisman, 2004)
Not only that there are also some of those who have a habit - eating habits are not as good as just skip
two meals and prefer food snack. As we know most of the snack is not just empty calories but contain
few nutrients. Snacked in fact not prohibited, as long as know how to choose snacks that will
nutrients. (Arisman, 2004).
Table 4. Relationship With Nutritional Status Shelter for Street Children
Nutritional Status
Total %
Prob
More
Good
Less
Bad
No Shelter
F %
F %
F %
F %
F
%
1
Good
5 71,4 22 76
7 47
0 0
34
64,2
2
Not Good
2 28,6 7 24
8 53
2 100 19
35,8 p 0,059
Total
7 100
29 100 15 100 2 100 53
100
Based on statistical test obtained by value p = 0.059 ( P > 0.05 ) , meaning Ho accepted
meaning there is no relationship between the nutritional status of children living on the streets. And
the results of the analysis can also be seen that there is also street children who live not good but
turned out to have a good nutritional status , it is because some of them can meet the needs of their
own meal from the singing , shining shoes and begging so they do not miss the 3 meals a day so it
needs to be nourished in activity although they have quite severe because as we all know the more
severe the longer the activity and we do these activities , the need for nutrients that would be even
greater . ( Guthrie , 2005) .
Table 5. Relationship With Health Care Utilization Street Child Nutritional Status
Nutritional Status
Health
More
Good
Less
Bad
Total %
Care
No Utilization
F %
F %
F %
F %
F
%
Prob
1
Good
3 42,9 10 35
5 33
0 0
18
34
2
Not Good
4 57,1 19 66
10 67
2 100 35
66
P:0,733
Total
7 100
29 100 15 100 2 100 53
100
Based on statistical test obtained by value p = 0.733 (P> 0.05), meaning Ho accepted means
there is no relation between the utilization of health services on the nutritional status of street children.
From the results of this research is that there are street children a good health service utilization
appears to have no good nutritional status, this is because some of them were exposed to tuberculosis
in which the disease treatment should be sustainable but they do not follow up treatment provided by
the health service such as buying prescription medicine given by a midwife or doctor because of their
inability and to check the state of their health back like a check back to the lab so that when their
health declines will have an impact on the nutritional status of their own. (Indriani, 2006).
Table 6. Eating Behaviour Relationships With Street Children Nutritional Status
Nutritional Status
Total %
Prob
More
Good
Less
Bad
Eating
NO Behavior
F %
F %
F %
F %
F
%
1
Good
7 100 22 76
4 27
1 50
34
64,2
2
Not Good
0 0
7 24
11 73
1 50
19
35,8 p 0,002
Total
7 100 29 100 15 100 2 100 53
100
193
Based on statistical test obtained by
value p = 0.002 (P <0.05), meaning that Ho
refused meaning there is a relationship
between eating behavior and nutritional status
of street children From the analysis it can be
seen that street children good eating behavior
turns nutritional status is not good, it is due to
street children generally consume more junk
food (junk food) because they think the food is
easy to obtain, in addition to more.The call
junk food because very little (in fact there is
none at all) contain calcium, iron, folic acid,
vitamins A and C, while the content of
saturated fat, cholesterol, and high sodium.
(Arisman, 2004). From the analysis it also
appears that there are street children who
despite eating behavior are not well turned out
good nutritional status, this is due to their
lifestyle which is as good as rarely smoke and
rarely drank alcoholic beverages. In addition,
street children eating behavior is not good but
good nutritional status do not have heavy
activity because they do not get around but
only in one place to do activities streets.
Conclusion
From the research we concluded that
there was no relationship between age and
nutritional status of street children, there is no
relationship between gender and nutritional
status of street children, there is a correlation
between activity and nutritional status of street
children, there is a relationship between the
nutritional status of children living on the
streets, not there is a relationship between the
use of health services and nutritional status of
street children, there is a relationship between
eating behavior and nutritional status of street
children.
Suggestion
To the Regional Government to pay
more attention Pematangsiantar health of street
children through education about nutrition and
the provision of health services for street
children, either in the form of supplementary
feeding and medication, the parents should pay
attention to food consumption serves children
with diverse and varied menu every meal. This
study is expected to be useful for other
researchers, so that further research could
explore other factors that may be associated
with nutritional status of street children.
194
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195
RELATIONSHIP BETWEEN MATERNAL AGE WITH SEVERE
PREECLAMPSIA IN MARZOEKI MAHDI HOSPITAL BOGOR
Dodoh Khodijah, Mumun Munigar
Prodi Kebidanan Pematangsiantar Poltekkes Kemenkes Medan
Jurusan Kebidanan Poltekkes Kemenkes Jakarta I
ABSTRACT
Background: Preeclampsia and eclampsia are the leading cause of death after bleeding and infection.
Severe preeclampsia is a joint complication and cause of Maternal mortality ranges between 9.8% 25.5%.
Objective: To determine maternal age relationship with the incidence of severe preeclampsia in
Maezoeki Mahdi Hospital Bogor in 2013.
Method: survey with a cross sectional approach. Data was obtained from the patient medical record.
The population in this study was all women giving birth at Marzoeki Mahdi hospitals Bogor in 2012,
with a sample of 94 people.
Results: The prevalence of mothers delivered with severe preeclampsia in Marzoeki Mahdi Hospital
Bogor as much as 24.5%. Mother age who has a significant relationship with the incidence of severe
preeclampsia, whereas parity, gestational age and a history of pre-eclampsia do not show a significant
association.
Conclusion: Maternal age who has a significant relationship with the incidence of severe
preeclampsia.
Suggestion: To examine the ANC regularly, at least four times during pregnancy can prevent severe
preeclampsia.
Keyword: Age and Severe Preeclampsia.
Introduction
National development is essentially the
integral human development, one of which is
development which is aimed at improving the
ability of health and quality of life of healthy
people in order to manifest optimal health
status. One indicator of the health of a country
is the Maternal Mortality Rate (MMR) and
Infant Mortality Rate (MMR). This was due to
the mother and baby are groups which have a
large degree of vulnerability to disease and
death.
The current status of maternal and child
health in Indonesia is far from being the
expected, characterized by high MMR and
IMR. Based on the Indonesian Demographic
and Health Survey (IDHS) 2007 MMR data
obtained at 228 per 100,000 live births, this
figure is still high when compared with
neighboring countries such as Malaysia (62
per 100,000 live births), Sri Lanka (58 per
100,000 live births), and the Philippines (230
196
per 100,000 live births). As for the data IMR
in Indonesia for 32 per 1,000 live births (IDHS
2012). But this rate is still relatively high when
compared with the ASEAN countries such as
Singapore (3 per 1000 live births), Brunei
Darussalam (8 per 1000 live births), Malaysia
(10 per 1,000 live births), Vietnam (18 per
1,000 live births), and Thailand (20 per 1,000
live births).
From all provinces, West Java ranks first
for Maternal Mortality Rate and Infant
Mortality Rate, followed by Central Java, East
Nusa Tenggara, Banten and East Java. Bogor
District Health Office reported that from
January to November 2010, there were 60
mothers died during childbirth. According to
data from the Child Health Program Reports of
West Java Province Year 2010 - 2012, the
number of neonatal deaths was reported in
West Java reached 3624 and infant mortality
reached 4,650.
The main causes of maternal deaths in
Indonesia are
haemorrhage,
infection,
eclampsia, obstructed labor and complications
of abortion (Anwar, 2010). Eclampsia is the
most common disease causing maternal
mortality rates ranged from 9.8% -25.5%
while the higher infant mortality is 42.2% 48.9%. (Wiknjosastro, 2006).
The placental ischemia is main cause of
preeclampsia, according to theory. However,
this theory cannot explain all things related to
the disease. Apparently not just one factor, but
many factors that leads to preeclampsia and
eclampsia (multiple causation). Factors that
are often found as a risk factor among others
nulliparous, multiple pregnancy, age less than
20 years old or over 35 years, has a history of
descent, and obesity (William, 2002)
The incidence of severe preeclampsia in
hospital Marzoeki Mahdi Bogor increased by
3.23% in 2010 and increased to 8.04% in
2011. From these data, the authors wanted to
determine the relationship of maternal age on
the incidence of severe preeclampsia in
Marzoeki Mahdi Hospital Bogor.
patients. The population for this study is all
mothers who were hospitalized Marzuki
Mahdi in 2012 with a sample size of 94 people
are the whole mothers who suffer from severe
preeclampsia. The analytical method used
univariable and bivariable by using Chisquare.
Research Result
Univariable Analysis
Table 1.
Frequency Distribution of Age, Parity, Age of
Pregnancy and History of Preeclampsia Marzoeki
Mahdi Hospital Bogor
Nu
Variable
1
Age
2
Parity
3
Gestational age
4
History
of
severe
preeclampsia
Categories
High risks
Low risks
High risk
Low risk
High risk
Low risk
Yes
No
Frequency
27 (28,7%)
67 (71,3%)
60(63,8%)
34(36,2%)
84(89,4%)
10(10,6%)
8 (8,5%)
84 (91,5%)
Bivariable Analysis
At this stage bivariable analysis to
determine the relationship of the independent
variables with the dependent variable, external
variable freely and external variables with the
dependent variable. The statistical test used is
Chi-Square. Results of the analysis are
presented in the following table.
Method
This study uses an observational study
with a cross sectional approach to look at the
relationship of independent variables and the
dependent
variable
being
measured
simultaneously. The data in this study using
secondary data from medical records of
Table 2.
Relationship Respondent Characteristics with Severe Preeclampsia
(n = 94)
Variable
Maternal Age
High Risk
Low Risk
Parity
High Risk
Low Risk
Gestational Age
Aterm
Preterm
History of Preeclampsi
Yes
No
Information :
2 = Chi-Square
RP = Ratio Prevalens
Severe Preeclampsia
Yes (%)
No (%)
2
p
RP
95%
CI
15 (55,6)
12 (17,9)
12 (44,4)
55 (82,1)
13,32
0,01*
5,73
1,04-1,55
18 (30,0)
9 (26,5)
42 (70,0)
25 (73,5)
0,03
0,867
1,19
0,78-1,22
22 (26,2)
2 (20,0)
62 (75,8)
8 (80,0)
2,30
0,129
1,41
0,92-1,54
4 (57,1)
23 (26,4)
3(42,9)
64(73,6)
7,79
0,01*
3,7
1,07-1,57
p = p-value
CI = Confidence Interval
* = significant
197
From the above data can be seen in the
incidence of high-risk severe preeclampsia at
the age of 15 people (55.6%) and those who
have a history of previous severe preeclampsia
(57.1%).
Statistical
analysis
showed
significant correlation between maternal age
and previous history with events severe
preeclampsia with OR of 5.7: 3.7 This case
illustrates that mothers who lived (20 years />
35 years) have a risk of severe preeclampsia 5,
7 times when compared to maternal age 20-35
years, and women who have a history of
previous severe preeclampsia had 3.7 times the
odds for the severe preeclampsia.
Parity variable prevalence as high risk (30%),
low risk parity group of (26.5%) and at the
gestational age ≥ 37 weeks of (26,27%).
Statistical analysis showed no significant
correlation between parity and gestational age
with the incidence of severe preeclampsia.
DISCUSSION
The prevalence of severe preeclampsia.
Based on the overall results of the study found
the incidence of birth mothers with severe
preeclampsia in 2012 were 112 respondents of
1393 mothers who gave birth at the Hospital
Marzoeki Mahdi or by 8.04%. This figure
increased compared to the incidence of severe
preeclampsia in the previous year 50 people
(3.23%) of the 1548 severe preeclampsia
mother. High incident at the hospital may be
caused Marzoeki Mahdi Marzoeki Hospital is
a referral from health centers and private
practices surrounding midwives,
Relationship Dependent
Independent Variables
Variable
and
1. Maternal Age
severe preeclampsia highest prevalence by age
is at high risk age group is 55.6%. Results of
calculation of statistical test showed no
association with the incidence of maternal age
severe preeclampsia, with OR = 5.73, this
illustrates that birth mothers aged <20 years /
35 years had 5.73 times the risk factors for
preeclampsia occurs when compared to
maternal age 30-35 years. This is according to
research conducted by Koeswarsono et al
(1991) in the RSU Gunung Wenang, Manado
(1991) reported that the highest frequency of
patients with eclampsia are at the age of 15-20
198
years, while the highest frequency severe
preeclampsia occurs at age> 35 years, Agus (
2001) also reported the results of his research
found that age <20 years have a risk of severe
preeclampsia 1.75 times and 2.47 times at the
age of> 35 years.
Septi (2007) reported in RSUPN Dr.
Cipto Mangunkusumo also found the highest
proportion
of
patients
with
severe
preeclampsia was highest at age <20/35 years
as much as 37.5% and Sudhaberata (2001)
said the same thing. Cunningham also said in
his maternal age> 35 years increases the
likelihood of severe preeclampsia. severe
preeclampsia high incidence in the age group
<20 years due to the growth in terms of
biological and reproductive development is not
yet fully ready or mature, the young woman is
not ready to bear the moral burden that the
lack of awareness of prenatal care (Astuti,
2002) and contrary on maternal age> 35 the
year in which the health condition and
reproductive decline and degenerative diseases
that already exist.
2. Parity
severe preeclampsia highest prevalence of
patients at high-risk groups, namely maternal
P1 / P≥4 as much as 30% compared with
maternal P2 / P3 are as much as 26.5%. The
test results were not statistically significant
relationship. This is not in accordance with the
results of research conducted by Agus (2001)
reported that the first parity has occurred
severe preeclampsia risk was 0.62 times
compared to the second and third parity.
Research conducted by Septi (2007) in
RSUPN Dr. Cipto Mangunkusumo also
reported patients with severe preeclampsia in
maternal parity first or fifth as much as
21.15% higher than the second and fourth
parity is 6.00%. He concluded that the first or
fifth parity had 4.2 times the risk of severe
preeclampsia occurs. It is also inconsistent
with the theory that the first pregnancy
increases the risk of preeclampsia ten times
more
frequently
(Chapman,
2006).
Cunningham argued renal biopsy results of
women with preeclampsia and find
gromerulonefritis krinik at 205 nullipara.
Manuaba (2007) also found a higher risk
primigravid
has
to
happen
severe
preeclampsia.
Adequate nutrition and regular ANC can
reduce the risk of preeclampsia in maternal as
proposed by Manuaba (2007) which says that
the provision of adequate calcium in the diet
may reduce the occurrence of preeclampsia.
3. Gestational Age
Univariable analysis results obtained severe
preeclampsia patients mostly in the age group
of high-risk pregnancies (≥37 weeks) as many
as 22 people (26,27%), while in the group of
gestational age <37 weeks only 2 people
(20%). OR = 1.41. This case illustrates that
birth mothers with gestational age 37 weeks
had 1.41 times the risk of SEVERE
preeclampsia when compared with birth
mothers with gestational age <37 weeks.
Results of calculation of statistical test showed
no significant relationship. This is not in
accordance with the theory that the more her
pregnancy affects normal placental changes
such as thickening of blood vessel walls and
villi which accelerate the process of
preeclampsia and hypertension that generally
occurs in the third quarter (Wiknjosastro,
2005). The theory put forward by Manuaba, et
al (2005) that in general. Preeclampsia and
eclampsia develop after the 20th week of her
pregnancy and increasingly more likely onset
of preeclampsia.
Regular antenatal care in accordance with the
policy of a minimum program of antenatal
visits carried out at least four times during
pregnancy can recognize early complications
that could be pursued early detect the presence
of severe preeclampsia.
Conclusion
1.
Prevalence severe preeclampsia occurs
at age the age at high risk (71.3%) and the risk
parity (P1 / ≥P4) which (63.8%), with the
highest risk for gestational age (89.4%), while
for the variable history of preeclampsia
genetically contained the highest proportion in
the age group is not at risk.
2.
There is a significant relationship
mother's age and history of the events severe
preeclampsia, parity and gestational age do not
have a meaningful relationship.
Suggestion
1.
Provide counseling to the EFA to plan
a pregnancy on maternal age 20-35 years.
2.
Early detection severe preeclampsia at
the time of the ANC, especially mothers who
have a family history of the severe
preeclampsia.
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factors. Results of calculation of statistical test
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preeclampsia.
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Situmorang, S. 2008. Hubungan Karakteristik
Ibu Bersalin dengan Kejadian Preeklamsi
Berat Atau Eklamsi Di RSUPN Dr. Cipto
Mangunkusumo
Periode
Ilmiah
Politeknik Kesehatan Jakarta I.
Sukandar, A. 2001. Gambaran Epidemiologi
kejadian Preeklamsi-eklamsi serta faktor-
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faktor yang berhubungan di RSUP Dr.
Hasan Sadikin Bandung 1999-2000.
Skripsi fakultas Kesehatan Masyarakat
Varney, H. 2007. Buku Ajar
Asuhan
Kebidanan. Vol I . Jakarta : EGC.
Widyastuti, Palupi. 2002. Modul Eklamsia:
Materi Pendidikan Kebidanan/WHO.
Jakarta: EGC
Winkjosastro, dkk. 2006. Ilmu Kebidanan.
Jakarta : Yayasan Bina Pustaka Sarwono.
FACTORS AFFECTING KNOWLEDGE OF PREGNANT WOMEN
ABOUT NUTRITION DURING PREGNANCY IN PORTIBI SUB
DISTRICT 2012
1
Ida Nurhayati 1
Nutrition Department, Medan Health Polytechnic of Health Ministry
ABSTRACT
Malnutrition in pregnant women can cause risks and complications in the mother. Many pregnant
women, especially in early pregnancy, not yet aware that pregnancy causes an increase in energy
metabolism. In Indonesia (SUSENAS and UNICEF Survey) reported that of the approximately 4
million pregnant women, half of whom suffered anemia and a million other chronic energy
deficiency. This study aims to determine the factors that affect the mother's knowledge about nutrition
during pregnancy in the district Portibi 2012.
This type of research is descriptive correlative with cross sectional approach. The population of
pregnant women in Portibi sub district as many as 205 people. Samples taken as many as 51 people.
Techniques using simple random sampling. The study was conducted in March until July 2012.
The results obtained at most pregnant women are less knowledgeable of 28 people (54.90%), most
aged 20-35 years is 34 people (66.67%), most have 2-4 parity as much as 29 people (56.87 %), the
most widely by the third trimester of pregnancy in which 23 people (45.10%), at most get information
about nutrition during pregnancy from the environment (friends, family, parents) that 22 people
(43.14%). Chi-square test results showed no significant correlation between maternal age (X2count =
1.6975) parity (X2count = 0.9937), gestational age (X2count= 0.1888), resources (X2count = 1.422)
with mother's knowledge about nutrition during pregnancy.
Expected to health workers, especially in Portibi sub district to be more active in holding counseling
on nutrition during pregnancy so that she can increase the level of knowledge.
Keywords : Factors That Influence, Knowledge, Nutrition of Pregnant Women
References
: 27 (2002-2011)
I. BACKGROUND
World Health Organization (WHO) (2005)
reports that there were 52 % of pregnant
women suffer from anemia in developing
countries. In Indonesia ( SUSENAS and
UNICEF Survey) reported that of the
approximately 4 million pregnant women, half
of whom suffered anemia and a million other
were chronic energy deficiency (Samhadi,
2007). Maternal Mortality Rate (MMR) and
Infant Mortality Rate (IMR) is one of the
indicators to assess the success of health
services in a country. MMR in North Sumatra
in 2008 was 290 / 100,000 live births, the rate
is still high when compared with the national
MMR were 228/ 100,000 live births. MMR is
already experiencing a decline compared to
2006 was 315 / 100,000 live births (North
Sumatra Health Profile , 2008) .
A total of 40.7 % of women aged 15-49 years
consume energy below the minimum
requirement and as much as 37.1 % for protein
consumption below minimum requirements. In
North Sumatra , the figures were respectively
show the 43,1 % and 22.3 % ( Riskesdas
(Basic Health Research) , 2010).
The contribution of carbohydrate consumption
of Indonesian society towards energy
consumption is 61 % , slightly above the
recommended figure of General Guidelines for
Balanced Nutrition. While the contribution of
protein to energy consumption is only 13.3 %,
and the contribution of fat to energy by 25.6 %
(Riskesdas, 2010).
Studies in Maros, North Sulawesi who studied
the diet and hemoglobin levels in pregnant
women showed a decrease in the number of
pregnant women who have severe anemia
201
from the first trimester (1.6 % to 0 % in the
second trimester).
Pregnant women suffering from anemia was
increased in the second trimester of 8.6 %
which is the first trimester was 12.5% to 21.1
% in the second trimester, and decreased in the
third trimester to be 15.4 %. Similarly with
mild anemia from 18.8 % in the first trimester
increased to 24.4 % in the second trimester,
and decreased in the third trimester to be 21.1
% (Fatima , 2011) .
Based on research conducted to Simanjuntak
(2009) in Rantauprapat (North Sumatra) of 86
pregnant women who are anemic obtained
77.9% aged 20-35 years and 64.47% had a
history of one or more parity than4.
Wahyudi et al. (2009) in his research in Kulon
Progo, Yogyakarta claimed nutritional status is
influenced by the amount and type of food
consumed, the individual household income
and mother's knowledge of health and
nutrition.
From the initial survey conducted by the
author in the Portibi Julu sub district on 24-25
March 2012 found that from 10 pregnant
women, there are only two people who know
about the increased nutritional needs of the
mother during pregnancy and no one knows
clearly how much balanced nutrition it needs.
II. RESEARCH METHODS
Design of this research is correlative with the
aim to identify factors of maternal age, parity,
gestational age and resources to influence
mother knowledge about the mother's nutrition
during pregnancy in the Portibi sub district
2012.
This research was conducted in the Portibi sub
district on March-July in 2012. Population and
sample of this research is all pregnant women
in Portibi sub district as many as 205 people
while the sample is 25% of the population of
as many as 51 peoples with simple random
sampling technique. Data were collected
through questionnaires and analyzed using
univariate and bivariate.
III . RESULTS AND DISCUSSION
UNIVARIATE ANALYSIS
Univariate analysis based on maternal age,
parity, gestational age, maternal source of
202
information and knowledge about nutrition
during pregnancy is described as follows :
1. Knowledge
Chart 1
Distribution of Respondents Knowledge
About Nutrition During Pregnancy in
Portibi sub district in 2012
Knowledge
23
person
28
person
Good
Less
From the above chart it can be seen that the
respondents' knowledge about nutrition during
pregnancy majority with less knowledge as
much as 28 respondents (54.90 %) and a good
knowledge of minority respondents as many as
23 respondents ( 45.10 % ).
2. Mother Age
Chart 2
Age distribution of Respondents in Portibi
SubDistrict in 2012
Mother Age
0
25.49 %
23.53 %
50.98 %
< 20 years
20-35 years
> 35 years
Based on the above chart can be seen that
majority of pregnant women aged 20-35 years
were as many as 26 people (50.98 % ) and the
least was < 20 years as many as 12 people (
23.53 % ) .
3. Parity
Chart 3
Parity distribution of Respondents Portibi
in Portibi Sub District in 2012
5. Sources of Information
Chart 5
Sources of Information of Respondents in
Portibi Sub District in 2012
Sources of Information
Parity
0
19.61
(>4)
33.33 (01)
22 %
37.25 %
Health Workers
19.61 %
47.06 %
2-4
Mass Media
Environment
Based on the above chart can be seen the
majority of respondents parity is 2-4 as many
as 24 people (47.06 %) and most minorities
are > 4 as many as 10 people (19.61 %) .
4. Gestational Age
Chart 4
Gestational Age Distribution of
Respondents in Portibi Sub 2012
Gestational Age
1st Trimester
0
45.1 %
27.45 %
27.45 %
2nd
Trimester
3rd Trimester
Based on the above chart can be seen in the
majority of the gestational age of the
respondents was the third trimester as many as
23 people (45.10 %), while for the first
trimester and second trimester have the same
amount of respectively 14 people ( 27.45 % ) .
Based on the above chart can be seen in the
majority of resources for environmental
respondents came from as many as 22 people
(43.14 %) and the minority comes from the
mass media as many as 10 people (19.61 %) .
BIVARIATE ANALYSIS
Bivariate analysis to determine the influence
of knowledge, maternal age,parity, gestational
age and maternal resources about nutrition
during pregnancy is described as follows :
1. Knowledge Respondents according to
Mother Age
Based on the research conducted, the
distribution of respondents' knowledge about
nutrition during pregnancy by maternal age
can be seen in the chart below:
Table 1
Distribution Of Respondents Knowledge
About Nutrition During Pregnancy
According to Mother Age In Portibi Sub
District in 2012
Knowledge
No Parity Good
Less
F %
F %
6 35,29 11 64,71
1 0-1
12 50
12 50
2 2-4
5 50
5 50
3 >4
Total 23 45,10 28 54,90
Total
F
17
24
10
51
X2
X2
Count Table
%
33,33
47,06 0,994 5,991
19,61
100
203
From above table can be seen that from 12
respondents were aged < 20 years the majority
have less knowledge of 8 people (66.67 %), of
the 26 respondents were aged 20-35 years the
majority of knowledgeable well as 14 people (
53.85 %), from 13 respondents were aged > 35
years the majority of no less knowledgeable of
8 people ( 61.54 %) .
Chi - square test results stating Ho is rejected
if the X2 count > of X2 table , which means no
significant effect . Instead Ho accepted if X2
count < than X2 table , which means there is
no significant influence . Results of analysis
with chi-square test with df = 2 , X2 count
(1.697 ) < from X2 table ( 5.991 ), then Ho is
accepted, it means that there is no significant
relationship between age and the mother's
knowledge about nutrition during pregnancy.
2. Respondents Knowledge According to
Parity
nutrition during pregnancy is based on parity
can be seen in the table below:
Table 2
About Nutrition During Pregnancy Based
on Parity in Portibi Sub District in 2012
No Mother
Knowledge
Age Good
Less
F
%
F
4
33,33 8
1 <20
2 20-35 14 53,85 12
5
38,46 8
3 >35
Total
23 45,10 28
Total
%
66,67
46,15
61,54
54,90
F
12
26
13
51
X2
X2
% Count Table
23,53
50,98 1,697 5,991
25,49
100
Based on the above table it is known that out
of 17 respondents who have a 0-1 parity
majority knowledgeable about 11 people
(64.71%), of the 24 respondents who have
parity 2-4 and 10 respondents who have
parity> 4 each 12 people (50%) and 5 (50%)
were either knowledgeable or less.
Chi-square test results stating Ho is rejected if
the X2 count > of X2 table, which means no
significant effect. Instead Ho accepted if X2
count < than X2 table, which means there is no
significant influence. Results of analysis with
chi-square test with df = 2, X2 count (0.994) <
from X2 table (5.991), then Ho is accepted, it
means that there is no significant influence
between the number of parity which is owned
by the mother's knowledge about nutrition
during pregnancy.
204
Gestational Age
Based on the research conducted , the
nutrition during pregnancy is based on
gestational age can be seen in the table below:
Table 3
About Nutrition During Pregnancy Based
on Gestational Age in Portibi Sub District
2012
No
1
2
3
Gestational
Age
1st
Trimester
2nd
Trimester
3rd
Trimester
Total
Knowledge
Total
X2
X2
Good
Less
F
%
F
%
F
% Count Table
6
42,86 8 57,14 14 27,45
0,189 5,991
7
50
7 50
14 27,45
10
43,48 13 56,52 23 45,10
23
45,10 28 54,90 51 100
Based on the above table it is known that from
the 14 respondents in the first trimester of
pregnancy were less knowledgeable, majority
there are 8 people ( 57.14 % ) , of the 14
respondents who are in the second trimester of
pregnancy there are 7 people ( 50 % ) were
knowledgeable good, and of 23 respondents
with the majority of the third trimester of
pregnancy there were 13 people are less
knowledgeable ( 56.52 % ).
the X2 count > of X2 table , which means no
count < than X2 table , which means there is
no significant influence. Results of analysis
with chi-square test with df = 2 , X2 count (
0.189 ) < from X2 table ( 5.991 ), then Ho is
accepted, it means that there is no significant
relationship between gestational age at
maternal knowledge about nutrition during
pregnancy .
Information Sources
nutrition during pregnancy based on
information resources can be seen in the table
below.
Table 4
About Nutrition During Pregnancy
Based on Information Sources in Portibi
Sub District 2012
No
1
2
3
Information Knowledge
Sources
Good
Less
F %
F %
Health
7 36,84 12 63,16
Workers
Mass Media 6 60
4 40
Environment 10 45,45 12 54,55
Total
23 45,10 28 54,90
Total
F
19
10
22
51
X2
X2
Count Table
%
37,25
1,422 5,991
19,61
43,14
100
Based on the above table it is known that from
the 19 respondents who received information
about pregnancy from a majority of health
personnel knowledgeable about 12 people
(37.25%), of the 10 respondents who use the
mass media as the source of the majority
infoermasi good knowledge there are 6 people
(60%) , and of the 22 respondents who use the
environment as a source of information less
knowledgeable majority of 12 people
(54.55%).
the X2 count > of X2 table, which means no
count < than X2 table, which means there is no
significant influence. Results of analysis with
chi-square test with df = 2, X2 count (1.422) <
from X2 table (5.991), then Ho is accepted, it
means that there is no significant relationship
between resources with knowledge of mothers
about nutrition during pregnancy.
DISCUSSION
1. Relationship between Respondents
Knowledge About Nutrition During
Pregnancy to Mother Age in Portibi Sub
District in 2012
Based on the results, the mother at the age of
20-35 years a majority of well knowledgeable
as many as 14 people (53.85%). Chi-square
test results showed no significant difference
between maternal age with knowledge of
mothers about nutrition during pregnancy.
This is indicated by X2 count (1.697) < from
X2 .
Results of this study did not show any
significant relationship between maternal age
with knowledge of the mother can be caused
by many other factors not examined include
geographic factors, sample size, socioeconomic circumstances and so forth.
This study is also in line with research by
Syska Dwi (2010) in Singapore with titles
relationship between the characteristics of
pregnant women with knowledge about
pregnancy stating that the absence of a
significant relationship between age and
knowledge of pregnant women.
2.Relationship of Respondents Knowledge
About Nutrition During Pregnancy to
Parity in Portibi Sub District in 2012
Based on the results of research conducted
mothers who have a good knowledge of the
majority in the 2-4 parity as many as 12 people
(50%), the same thing also happens to mothers
with less knowledge. While minorities either
good or less knowledgeable having parity > 4
are each as many as five people (50%). Results
of analysis with chi-square test was not a
significant difference between the number of
maternal parity owned with knowledge about
nutrition during pregnancy by X2 count value
(0.994) < from X2.
Results of this study are not consistent with
previous research by Rida Wahyuli Sirait
(2011) in Medan, where the research results
revealed a significant relationship between the
number of parity with the knowledge of
pregnant women.
According to the author assuming no
significant effect between maternal parity
possessed with knowledge about nutrition
during pregnancy due to a different place of
study, the number of samples, research time
and other factors that are not known by
researchers.
3.Relationship between Knowledge to
Gestational Age During Pregnancy in
Portibi Sub District in 2012
Each trimester in pregnancy have different
nutritional needs. Based on the results of 51
respondents majority in the third trimester and
at most have less knowledge of as many as 13
people (56.52%) and the minority in the first
trimester with a good knowledge of as many
as 6 people (42.86%).
Results of analysis with chi-square test df = 2
shows the value X2 count (0.189) <from X2
table (5.991) which means there is no effect of
pregnancy on the mother's knowledge about
nutrition during pregnancy.
previous research by Maulina Mawaddah
(2011) in the field that states the existence of a
significant relationship between gestational
age with a knowledge of pregnant women.
205
4.Relationship of Respondents Knowledge
About Nutrition During Pregnancy to
Information Sources in Portibi Sub District
in 2012
Based on the results of 51 respondents the
majority of resources took the information
from environment as much as 22 people
(43.14%) and the minority of the mass media
as many as 10 people (19.61%). Results of
analysis with chi-square test with df = 2, show
the value X2 count (1.422) < from X2.
previous research by Yulia Lilis Suryani
(2003) in Yogyakarta, which stated that there
was a significant relationship between
resources with knowledge. According to the
authors these differences could be due to many
factors such as geographical conditions,
sample size, study time, and other variables
that are not included in this study.
According to the assumption of the authors of
the above results show that knowledge about
nutrition of pregnant women during pregnancy
included in the poor category, and this is
because the majority of women get
information from the environment (family,
friends, parents) where information is limited
and less accurate when compared to
information from health professionals or the
mass media. Knowledge is linked to exposure
to the mass media (television, radio,
magazines) and interaction with the
environment. Mother obtain information from
various sources, and for resources in rural
areas most frequently used are environment
such as friends, family and people who
believed as community leaders or religious
leaders, health workers also.
CONCLUSION
1. Knowledge of pregnant women most is less
by 28 respondents (54.90%) and the results
of chi-square test with df = 2, 95%
confidence level, α = 0.05 showed no
significant difference between maternal age
( X2 count (1.697) < X2 table (5.991)),
parity (X2 count (0.994) < X2 table
(5.991)), gestational age (X2 count (0.189)
< X2 table (5.991)), resources (X2 count (
1.422) < X2 table (5.991)) with knowledge
of mothers about nutrition during
pregnancy.
206
2. Based on the mother's age, most aged 20-35
years as many as 26 people (50.98%).
3. Based on parity, parity 2- 4 at most have as
many as 24 people (47.06%) and there are
those who have parity > 4 as many as 10
people (19.61%).
4. Based on gestational age, most in the third
trimester as many as 23 people (45.10%).
5.Based on resources, most of the
environmental gain as many as 22 people
(43.14%)
SUGGESTION
1. For head of portibi and health centers in the
Portibi sub district
Especially expected to elements of society
to health workers in the sub district of
Portibi must improve further education and
health promotion particularly about
nutrition during pregnancy so that the
knowledge of pregnant women are getting
better at keeping her pregnancy.
2. For other researchers
Similar research is needed further with
larger samples and using other methods.
REFERENCES
Aizid, Rizem. 2010. Menu-menu Murah dan
Sehat Ibu Hamil. Buku Biru:
Yogyakarta
Arikunto, S. 2006. Prosedur Penelitian, Suatu
Pendekatan Praktek.Edisi Revisi .
Rineka Cipta : Jakarta
Arisman. 2009. Gizi dalam Daur Kehidupan :
Buku Ajar Ilmu Gizi. Edisi 2.
EGC
:Jakarta
Badan
Penelitian
dan
Pengembangan
Kesehatan Departemen Kesehatan RI.
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Dasar 2007. Jakarta
___________________.2011. Laporan Hasil
Riset Kesehatan Dasar 2010. Jakarta
Dewi, Syska. 2010. Hubungan Antara
Karakteristik Ibu Hamil Dengan
Pengetahuan Tentang Kehamilan. Stikes
Dharma Husada : Bandung
Dinas Kesehatan Provinsi Sumatera Utara.
2009. Profil Kesehatan Provinsi
Sumatera Utara Tahun 2008. Medan
Ellya, Eva Sibagariang. 2010. Gizi Dalam
Kesehatan
Reproduksi.
TIM
:
Jakarta
Erfandi. 2009. Faktor - Faktor yang
Mempengaruhi
Pengetahuan
(http://www.google.com/search/faktor
- faktor - yang – mempengaruhi pengetahuan/) diakses pada tanggal 15
Juni 2012 pukul 16.05 WIB
Fatimah, St., Veni Hadju, Burhanuddin Bahar,
Zulkifli Abdullah. 2011. Pola Konsumsi
dan Kadar Hemoglobin pada Ibu Hamil
di Kabupaten Maros, Sulawesi Selatan.
Makara Kesehatan : Makassar
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Yusrawati.2011.Diktat
Biostatistika. Medan
Hunter, Hannah Hulme, dan Dodds,
Rosemary. 2005. Makanan yang Aman
untuk
Kehamilan. Penerbit Arcan:
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Hurlock, Elizabeth B. 2002. Psikologi
Perkembangan, Edisi Kelima. Erlangga :
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Kementrian Kesehatan RI. 2011. Profil
Kesehatan Indonesia 2010. Jakarta
Mawaddah, Maulina.
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Hamil Tentang
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Antenatal Care di Desa Laut Dendang
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207
EFFECT OF COUNSELING
ANXIETY IN DEALING WITH LABOR PRIMIGRAVIDA
IN THE COMMUNITY HEALTH CENTERS BUKET HAGU
LHOKSUKON NORTH ACEH
Idau Ginting¹ , Dina Indarsita² , Evi Desfauza¹ , Nurul Asma¹
Department of obstetric¹ , Department of nursing²
ABSTRACT
Anxiety is a psychological problems facing labor that is often experienced primigravida, research
Salfariani (2012) showed that 59.1 % primigravida of 22 maternal choose sectio caesarea labor
without medical indication for anxiety normal delivery. Mei and Huang (2006) showed that anxiety
can lead to prolonged labor and cause Post Partum Haemoragic, Suririnah (2005) concluded that to
overcome the anxiety necessary counseling / counseling regarding preparations for the birth mother to
change perceptions about childbirth.
The purpose of this study was to determine the effect of counseling on anxiety facing labor in
primigravida.
This type of research is pre experiment with the design of one group pretest - posttest design . A
sample of 40 people is primigravida third trimester of gestation 28-32 weeks in Puskesmas bouquet
Hagu. The independent variable in this study is the counseling, the dependent variable is anxiety
facing labor. Data collected using a questionnaire. Data analysis using t - tests dependent test (paired t
- test).
The results of bivariate analysis showed a significant effect of counseling on reducing anxiety facing
labor in primigravida (p = 0.00).
The study concluded counseling can minimize anxiety primigravida face childbirth , so that
counseling can be used as a model or an alternative treatment for overcoming and preventing anxiety
facing labor.
Keywords : Counseling , anxiety , preparation for childbirth.
INTRODUCTION
Maternal mortality is still a big issue where
around 800 women die every day throughout
the world due to pregnancy or birth
complications. In 2010, 287,000 women died
during and after pregnancy and childbirth. The
ratio of maternal mortality in developing
countries is 240 per 100,000 births compared
to 16 per 100,000 in developed countries
(WHO, 2012).
Indonesia
is
a
developing
country.
Demographic and Health Survey 2012 showed
the maternal mortality rate increased sharply
compared to a survey in 2007. The survey
found that as many as 359 maternal deaths per
100,000 births increased from the 2007 survey
where the maternal mortality rate is only 228
deaths per 100,000 live births (Sufa, 2013, 1).
208
The Indonesian government began in 2013 to
implement the Gold Program or Expanding
Maternal and Newborn Survival in
cooperation with the United States government
to reduce maternal mortality rate which is still
high in Indonesia (Wardah, 2013, 9) in
addition to realizing the Millennium
Development Goals (MDGs) in 2015 for
reducing the MMR to 102 / 100,000 live births
(Ministry of Health Affairs, 2011a). Estimates
of the Indonesian population health
development program targets in 2014 from
252.124.458 of the total population, there are
5.290.235 of pregnant women and 5.049.770
of birth mothers (Health of Department RI ,
2011).
Pregnancy is a challenge of the turning point
of family life and is usually followed by stress
and anxiety, whether expected or unexpected
pregnancy. For starters family, pregnancy is a
period of transition from childhood to
parenthood with the permanent characteristic
and have a responsibility (Susanti, 2008, p.15).
Bobak et al. (2005, p.125) describe the growth
requires mastery of certain developmental
tasks in receiving pregnancy, identifying the
role of the mother, rearranging the relationship
between mothers and daughters and between
her and her partner, building a relationship
with the unborn child, and preparing to face
childbirth experience.
Many women, especially primigravida and
nullipara, will actively prepare for childbirth
(Bobak et al., 2005, hal.130). Experienced
mothers have a tendency to tell their stories for
new mothers, whether about its profit or risky,
but the report always describes about pain
(Perkins, 1980 in Mander, 2004, p.99).
Anxiety can arise due to fears of a safe
delivery for herself and her child (Rubin, 1975
in Bobak et al., 2005, p.131). Dick-Read
(1920-1950) taught his patients that if
someone fear the childbirth, she will become
tense and make her sense the pain more severe
(Simkin, 2008, p.147).
Kurniawati and Wahyu’s research (2007) of
the 30 samples showed primigravida anxiety
more higher than multigravida when facing
labor which from 15 primigravida mother; 4
women experience mild anxiety; 3 people
experience moderate anxiety, and 1 mother
experience severe anxiety, while from 15
multigravida mother; only 1 woman
experience severe anxiety and 1 mother had
moderate anxiety.
Another study showed anxiety is very
influential on labor. Mei and Huang’s research
(2006) showed the influence of anxiety and
depression primigravida mother in facing the
labor may lead to prolonged labor and caused
postpartum hemorrhage. While Michel
Odent’s observation in Simkin and Ancheta
(2005) showed anxiety in the mother is a
response of 'fight or escape' during childbirth.
It causes excessive catecholamine levels at
one time which result in increasing length of
time. .
The results of the study mentioned above
shows the anxiety is one of the factors that can
affect a person in facing the labor which can
not be ignored. Crowe and Von Bayer (1989)
in Mander (2004, p.102) survive to teach the
reality of childbirth can be done which
research shows that women who taught in
realistic anxiety about childbirth experience
less labor pain.
Suririnah (2005,3) suggested that the mother
who will face delivery, have different
experiences, depending on who and how the
mother responded, the best suggestion is every
mothers prepare themselves with knowledge
and mental readiness that childbirth is a
natural process. This can be overcome by
doing a counseling or counseling. Issues that
need to be addressed are aspects of the
physiology of pregnancy, birth, emotional
changes that occur during pregnancy and
family planning in the future.
Hastuti’s research on November 2007 until
August 2009 regarding counseling of reducing
anxiety and achievement of primiparous
maternal coping mechanisms on the study of
the levels of cortisol, uterine contractions, and
long maternity on 218 pregnant mothers
sampled research at Puskesmas Tegalrejo and
Mergangsang, Yogyakarta clarify that
counseling can minimize maternal anxiety at
first childbirth (primiparous).
Salfariani’s research (2012) at The Bunda
Thamrin Hospital Medan on 22 maternal also
showed 59.1 % primigravida and do not have
experienced in previous maternity choose
sectio caesarea labor without medical
indication for normal delivery anxiety, so that
researchers in the study concluded the need for
counseling and counseling before the labor is
to determine the choice carefully in taking a
childbirth action.
Estimates of the population of Aceh by
targeted health development program in 2014
there were 4,731,705, which consists of
111,991 pregnant women and 106,901 birth
mothers (Health of Department RI, 2011b).
Observations from the study site was observed
from
Pemantauan
Wilayah
SetempatKesehatan Ibu dan Anak (PWS-KIA) at The
Community Health Centers Buket Hagu
Lhoksukon North Aceh recorded in 2013 there
were 443 pregnant women targeted. Recording
up to December 2013 show from 35 villages in
209
the region of the health centers, there are 58
third trimester pregnant women, where 40
people are primigravida.
health centers, hospitals and birth centers as
preventive measures to reduce the level of
primigravida anxiety in facing the labor.
Preliminary observations which researchers
observe when visiting the integrated services
posts held at Dayah village end of December
2013 there are three primigravida of five third
trimester pregnant women tell her anxiety
about childbirth to the village midwife. The
primigravida anxiety at the thought of
childbirth process later, because of
inexperienced as well as they generally have
the same understanding that delivery was a
daunting process, creepy, and painful, and the
fear of not being a good mother to baby.
RESEARCH METHODS
On the basis of various theories regarding the
effectiveness of counseling and the results of
previous studies showing the effect of
counseling can reduce anxiety when facing the
labor, researchers interested in applying
counseling
on
reducing
anxiety
in
primigravida at Puskesmas bouquet Hagu to
determine the extent of the effect of
counseling can reduce anxiety in facing the
labor on primigravida mothers, as an
appropriate counseling needs to be done on
every obstetric services.
Formulation Of The Problem
Based on the description of the background
issues above, the problem can be formulated
as follows : whether there was an effect of
counseling on anxiety facing labor in
primigravida ?
Research Purposes
1. To determine the effect of counseling on
anxiety facing the labor in primigravida.
2. To know the anxieties facing the labor
before given counseling on primigravida.
3. To know the anxieties facing the labor after
given counseling on primigravida.
4. To determine the effect of counseling on
anxiety facing the labor in primigravida.
1. Can contribute to policy-makers in
designing a program of counseling to reduce
anxiety in pregnant women in facing the labor.
2. Can provide information and inspiration for
medical workers to implement counseling in
210
This type of research is pre-experimental
research design with one group pretest posttest means to determine causation by
involving a group of subjects. The group of
subjects was observed prior to the
intervention, and then observed again after
intervention (Nursalam, 2003).
Population
The population is all primigravida In The
Community Health Centers Buket Hagu
Lhoksukon North Aceh and meet the inclusion
and exclusion criteria .
a. Inclusion criteria :
1) Mother primigravida.
2) Pregnant women 28-32 weeks.
3) Willing to participate in the study.
4) Residing in Puskesmas bouquet Hagu.
b. Exclusion criteria, namely mothers with a
history of adverse pregnancy :
1) The presence of diseases that accompany
pregnancy is a disease that affects the mother
before pregnancy, such as heart disease,
kidney.
2) The presence of complications in pregnancy
are abnormalities that arise during pregnancy,
such as bleeding.
Samples
The sample in this study were taken overall
primigravida Trimester III In The Community
Health Centers Buket Hagu Lhoksukon North
Aceh using saturated sample method or the socalled total population, where the entire
population in this study were sampled, with a
population of 40 people.
Place Research
Place this study is The Community Health
Centers Buket Hagu Lhoksukon North Aceh.
The working area is a rural health center
transmigration. Researchers used two villages
to facilitate this research; Meucat village and
Ulee Tanoh village.
Time Research
This study was conducted from October 2013
to June 2014.
Data processing
Processing of the data in this study performed
quantitatively. Data processing was performed
with computerized and then analyzed.
According Hastono (2007, p.6) there are four
stages in the processing of data that must be
passed, namely :
a. Editing is an activity to check the content of
form or questionnaire to know its answer is
complete, clear, relevant , and consistent.
Respondents’ answer in the questionnaire of
this study are in accordance with the purpose
of research.
b. Coding is an activity to change data shaped
letters into data numbers. Encoding performed
on the data characteristics of the respondents,
while variable coding research is not done
because it is a numeric data.
c. Processing is an activity to process the entry
data so that it can be analyzed, the entry is
done by clicking on the data from the
questionnaires into a computer program
package.
d. Cleaning is an activity rechecking data that
already have been re-entry so that there are no
errors. After checking, there are no errors in
the data research.
Data Analysis
After processing data is done, then performing
data analysis using a computerized. According
Notoatmodjo (2005, p.188) phases of data
analysis are as follows :
a. univariate analysis
Univariate analysis performed on each
variable of the results of research and this
analysis produces distribution and percentage
of each variable. In this study, univariate
analysis was conducted to determine the
distribution of respondents' characteristics and
anxiety before and after given counseling.
b . bivariate analysis
Bivariate analysis conducted on two variables
are allegedly associated or correlated. In this
research, bivariate analysis was conducted to
determine the effect of anxiety in facing the
labor in primigravida with a statistical test t -
tests dependent (paired t - test). This statistical
test comparing the average respondents
anxiety before and after given counseling, see
the standard deviation, and hypothesis testing
(p-value). The value of p is to see statistical
significance, when the value of p < 0.05
considered as there are significant influence
between these variables. If the opposite where
the value of p > 0.05, it can be said that there
is no influence of these variables.
Research Result
Univariate analysis was used to describe the
characteristics of the respondents, the average
respondents anxiety before and after given
counseling, as well as the respondents'
answers.
Respondents
characteristic
distributed by age, education, and work. The
number of respondents consisted of 40 people
primigravida third trimester with gestation
around 28-32 weeks which measured anxiety
in facing the labor before and after the given
counseling, then also calculated the frequency
distribution of respondents' answers to
questionnaire about their anxiety.
Table 1 Distribusi Frequency Characteristics
Of Respondents
In The Community Health Centers Buket
Hagu Lhoksukon North Aceh Tahun 2014
(n=40)
Characteristics of respondents
Ages
17 years
18 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
Education
Colledge
Senior High School
Junior High School
Elementary School
Work
Government Employees
Private
Merchant
Does Not Work
f
%
1
2
4
6
3
6
9
5
2
1
1
2,5
5
10
15
7,5
15
22,5
12,5
5
2,5
2,5
11
14
10
5
27,5
35
25
12,5
7,5
15
10
67,5
3
6
4
27
Analysis of the results showed that most of the
respondents were in the age group 24 years as
much as 22.5%. The majority of respondents
35% of high school graduates.
A total of 27 respondents (67.5%) did not
work.
211
Table 2 Distribution of Respondents by Anxiety Before And After Given Counselling
In The Community Health Centers Buket Hagu Lhoksukon North Aceh Tahun 2014
( n = 40 )
Mean
variables Research
SD
Min-Max
95% CI
Median
Anxiety
Before
Given
23,8
4,1
17-34
22,5-25,1
Counseling
24
Anxiety After Given
Counseling
21,4
21,5
The analysis showed an average score of
anxiety primigravida before counseled 23.8
(95% CI=22.5 to 25.1), the median score of 24
with a standard deviation of 4.1. Low anxiety
scores of 17 and 34. The highest interval
estimation results can be concluded that 95%
believed the average score of anxiety
primigravida before counseled between 22.5 to
25.1. The higher anxiety scores are more
higher than after counseled where the average
score of anxiety primigravida after counseled
21.4 (95% CI=20.6 to 22.5), the median score
of 21.5 with a standard deviation of 3.5. Low
anxiety scores of 16 and 30. The highest
interval estimation results can be concluded
that 95% believed the average score of anxiety
primigravida before counseled between 20.6 to
22.5.
2. bivariate analysis
Bivariate analysis is used to observe the effect
of independent variables (counseling) with the
dependent variable (anxiety in the face of
labor). Statistical analysis showed a significant
effect of counseling on reducing anxiety in the
third trimester primigravida in facing the labor
because it has a value of p < 0.05, which
means primigravida anxiety can be minimized
by providing counseling. The results in detail
can be seen in Table 3 below.
Table 3 Effect of Counseling Against Facing
Anxiety Childbirth in primigravida
In The Community Health Centers Buket
Hagu Lhoksukon North Aceh 2014
( n = 40 )
Variabel
Mean
SD
Anxiety before
given counseling
23,8
4,1
Anxiety after
being given
counseling
21,4
3,5
212
Beda
Mean
SD
p
2,4
2,3
0,00
3,5
16-30
20,6-22,5
Statistical analysis showed a decrease in
anxiety in primigravida before and after the
given counseling, where the average of anxiety
before counseled 23.8 with SD 4.1 after
counseled the average of anxiety primigravida
21.4 with SD 3.5. The average difference of
the anxiety primigravida before and after
counseled 2.4 with SD 2.3. The p-value = 0.00
indicates a statistically significant effect of
counseling on reducing anxiety in the face of
labor in primigravida.
Discussion
a. Anxiety facing labor in primigravida before
given counseling
The results of this study at the beginning of the
questionnaire distributed obtained an average
score of primigravida anxiety when facing
labor 23.8. Lowest score obtained by
respondents from scale measuring anxiety item
17 while the highest score 34. Generally
anxiety experienced primigravida looks from
sleep disorders, which in this study almost all
respondents (85 %) experienced insomnia,
often woke up in the middle night, even
nightmares in medium scale. Even in small
amounts there is also primigravida who
experience tension, fear, and heavy physical
symptoms (2.5%) due to anxiety.
This shows that anxiety does exist and can not
be removed, which can be done only by
minimizing it. Anxiety is a natural response of
the body indicated when thinking about a
matter that can be life-threatening. Anyone can
experience anxiety no exception primigravida.
The first pregnancy is something that is
awaited by every newly married woman, but
the process of pregnancy with various changes
which sometimes unsettling of girlhood and
the state of labor is already envisioned as a
painful process makes young mothers feel
anxiety and fear when
approached
interpretation of birth date.
Anxiety is already being felt by pregnant
women from the beginning of pregnancy, but
the mother’s physical condition who gradually
stable and robust to ensure the threat of
abortion does not exist, then the anxiety
disappears by itself. But upon entering the
three trimesters of pregnancy that grew big
accompanied by physical discomfort, the
anxiety is emerged and peaked. It is often
feared by mother who pregnant for first time
usually feel labor pain.
This fact is consistent with the theory
expressed by Janiwarty and Pieter (2013,
p.263) psychological conditions that often
accompany the mother before the birth of a
baby is a sense of fear and anxiety. Susanti
(2008) added at the end of three trimesters, the
mother worried about things in which the
health and safety of childbirth. In more detail
Laderman (1984) in Susanti (2008, p.38)
explains that primigravida is worry about
painful childbirth or cutting of the perineum.
These results are also consistent with research
Azizah et al. (2013) which shows, from 31
respondents, 11 primigravida (35.5%) had
severe anxiety before being given treatment.
Research Kurniawati and Wahyu (2007) even
clarify primigravida anxiety when compared
with mothers who have given birth which 15
sample of primigravida appear 4 women
experience mild anxiety, 3 people experience
moderate anxiety, and 1 mother experiences
severe anxiety. It is much higher than the 15
multigravida which only 1 mother experiences
severe anxiety and 1 mother experiences
moderate anxiety.
b . Anxiety face of labor in primigravida after
given counseling
The results of further research is the result
from post-test which is done by distributing
the same questionnaires in interval of one
month later, which is expected in the time
interval. Results of lasting interventions still
leave a trace in primigravida long-term
memory. Respondents’ anxiety after being
given counseling obtained a score of 21.4.
Lowest anxiety scores obtained from
primigravida is 16 while the highest score is
30.
Results of analysis of these studies showed
there is change of anxiety in facing the labor
on primigravida. There is an average decline
in respondents’ anxiety, with an average
difference of 2.4. Judging from anxiety scores
obtained from primigravida there is also
appears a decrease in respondents’ anxiety.
The things which worried by the respondents
are not much different with anxiety before
given counseling. The majority of respondents
(85%) still having trouble sleeping in the
medium scale, while there is a change anxiety
in the weight once scale, it appears there is no
longer fear experienced by primigravida.
Decreased anxiety occurs because the
respondents
gained
knowledge
from
counseling. Counseling provides information
to primigravida which can change the
perception of new mothers who become
pregnant the first time about delivery. The
high initial anxiety about delivery can be
minimized. This is in line with the theory put
forward Simkin et al. (2008) many
predisposing factors can reduce or increase
the anxiety felt by a woman, including one of
knowledge about delivery. In this study,
respondents'
knowledge
gained
from
counseling can reduce primigravida anxiety,
according to the statement Pieter (2012) one of
the counseling function is the function of
development, namely increasing client’s
knowledge which is able to change the wrong
perception about herself.
The results of this study are also consistent
with research Azizah et al. (2013) of 31
respondents, 11 respondents ( 35.5%) had
severe anxiety before being given counseling
which showed that almost half primigravida
experience anxiety when they will face the
labor, compared to after being given
counseling 14 respondent (45.2%) had mild
anxiety.
c. Influence of counseling to anxiety facing
labor in primigravida
Analysis of the results obtained by value
p=0.00 which means that the value is smaller
than 0.05. The final result of these studies we
can conclude there is the influence of
213
counseling to anxiety facing labor in
primigravida, the given counseling in this
study can minimize anxiety in primigravida.
Anxiety primigravidas before being given
counseling seem higher than after being given
counseling could have been affected by the
respondent's own characteristics.
Respondents were generally aged 24 years,
which according to Santrock (2003, p.26) that
age is early adulthood which may become a
factor in influencing higher baseline anxiety.
Mappiare Becker (1983) in Zulkaida (2010)
reveals one of the characteristics that stand out
in this period are the presence of emotional
tension.
Purwanto (1999, p.72) adds emotion
experienced by adults will be different with
the emotional events experienced by children,
it is because adults are more influenced by
various experiences in their emotions as a
result of interaction with the social
environment so that these emotions can be
useful for health and can also interfere with
physical and behavior health, which one is
anxiety (Purwanto, 1999, p.74).
Primigravida’s education in this study were an
average of high school graduates (27.5%)
could be increase the anxiety by affecting the
experience gained by early adult women from
the social environment as expressed Purwanto
(1999). Primigravidas that do not have their
own experience of childbirth will learn about
the labor from mothers who have been through
the labor. The reality in the field, from the
story of multigravida who already captured by
respondent is delivery is a long and painful
process. This is in line with the theory put
forward Perkins (1980) in Mander (2004,
p.99) experienced mothers have a tendency to
tell their stories for new mothers, whether
about its profit or risky, but the report always
describes about pain.
Young mothers who mostly just graduated
from high school, where, according to Papalia
et al., 2011 (hal.675) currently high school
graduates alone can not be categorized as
students. Mothers who just graduated to high
school will just adopt the experience in
herself, that she was also going through a
painful labor and this is certainly inverse ratio
with educated early adulthood, as explained
214
Papalia et al. 2011 (hal.675) they will use
printed and written information to be active in
society and to develop their knowledge. Surely
the experience gained from the environment
will be compared with academic information
and then find a solution.
The location of this research which is the rural
resettlement, where they still adopts a common
concept. The young mothers innocently
receive any information obtained from
mothers who had experienced labor at the
village, especially if that person is trustwhorty
or influential in the environment, it is a true
story and should be trusted. It is also showed
evident in the antenatal classes which formed
once a week by midwife, was forced to
rescheduled twice a week, by combining
several nearby villages are also still appears
empty, or sometimes just some mother who
attend.
Other possibilities that make anxiety of young
mothers in this study seem high before being
given the counseling were the majority of
respondents who also not working (67.5%)
where their chance of finding a right solution
from the problems solving, such as a visit to a
health facility is very limited because it
depends on their husband financial, also affect
anxiety. Their habits in reaching the health
facilities only when they feel pain or physical
discomfort, whereas many physical discomfort
arises due to maternal anxiety which is getting
closer to labor.
The analysis above is disclosed in accordance
with the theory of David A. Tomb (1993) in
Riyadi and Purwanto (2009, p.43) anxiety is a
unpleasant sensation of fear and can not be
justified which often accompanied by
physiological symptoms and when combined
with the understanding of anxiety in
existential-humanistic approach in which
anxiety is a basic of human characteristic
(Corey, 2010, p.76), then those two theories
can be deduced as anxiety is human
characteristic that has a form of tension against
anything that threatens which accompanied by
the physiological changes.
People who have the introvert characteristics
(closed), they will be harbored insecurities,
while the anxiety felt by primigravid will give
impact on the fetus, this situation eventually
causes anxiety and are often not expressed to
midwife, so the midwife only diagnose it only
as a physical disorders, without paying
attention to pregnant women’s psychological.
This is in line with the theory put forward
Aprilia and Ritchmond (2011) which shows
the anxiety has a major influence pain on the
mother in late pregnancy, where anxiety and
stress indirectly makes the brain work and
secrete Corticotrophin-Releasing Hormone
(CHR) which is the master of stress hormones
that will trigger the release of stress hormones
glucocorticoids. Stimulation of the excess
production of glucocorticoid from the mothers
would cause muscle tension and stiffness.
Laderman (1984) in Susanti (2008, p.38)
clarify the fact that he thinks primigravida
anxiety sometimes is not stated, but the
midwife must know its gesture / sign. The fact
in the field nowadays, the midwife generally
has been able to understand the sign and to
reduce primigravida anxiety in facing the
labor, most midwives had been advised
mothers and teached the right preparation of
labor, which can be said in counseling.
Generally, performed counseling is curative,
midwives give the counseling after the anxiety
has an impact on physical disturbance.
In this research to reduce the anxiety of
respondents counseling is done with group
dynamics approach is preventive. 40 young
mothers stimulated to tell their anxiety about
childbirth. Results of the discussions showed
their anxiety arise when they imagine labor
pain and fear can not have a normal delivery.
It is concluded and made the discussed topic.
To support the results of the discussion, the
researcher displays video of labor, researchers
showed a picture of labor pain that would be
felt by the mother. Some mothers seem to
wince at the expression on the face of the
mother in video that shows tremendous pain
during straining, but the mothers will grinned
when the baby borns, feel as happy as the
mother in the video. This fact that according to
the theory put forward Laderman (1984) in
Susanti (2010, p.38) mothers should be given
education / counseling about appropriate
behavior during childbirth. The best
preparation for childbirth is to realize a healthy
reality of pain, balance the risk with a sense of
happy and desire for the ultimate prize in the
form of a baby.
Further analysis of the results in this study are
consistent with research Hastuti on November
2007 until August 2009 regarding counseling
in reducing anxiety and achieving the
primiparity maternal coping mechanisms on
the study of the levels of cortisol, uterine
contractions, and long maternity on 218
pregnant women who become research
samples in PHC Tegalrejo and Mergangsang,
Yogyakarta which indicates counseling can
minimize maternal anxiety at first childbirth
(primiparous).
Other studies that show the positive effect of
counseling performed by Crowe and Von
Bayer (1989) in Mander (2004, p.102) who
consistent to teach the reality of labor can be
done which it shows that women who taught
in realistic about labor anxiety through
counseling experienced less delivery pain.
Ridgeway and Matthews (1981 ) and Wallace
(1984 ) in Susanti (2008, p.21) concludes that
the intervention on anxiety has a beneficial
effect, namely through one of preparation to
face the anxiety include anticipation,
education / counseling, knowledge and
strategy.
Conclusion
Based on the results of research and discussion
can be concluded as follows :
1. Primigravidas anxiety before counseled
obtained an average score of anxiety 23.8
(95% CI = 22.5 to 25.1), the median score of
24 and a standard deviation of 4.1.
2. Primigravidas anxiety after counseled
obtained an average anxiety score of 21.4
(95% CI = 20.6 to 22.5), the median score of
21.5 and a standard deviation of 3.5.
3. There was a significant effect of counseling
on the decreased anxiety in facing the labor in
primigravida (p = 0.00).
Suggestion
Based on the conclusions that have been
suggested, then the suggestion that can be
given as an act of anticipative and corrective
as follows :
1. For Health Policy Makers
The results could be used as a consideration
for the local health department to make a
concrete policy regarding counseling as an
215
obligation activity which health care
institutions must done in order to reduce the
risk of death from childbirth in addition to the
service of clinical skills, such as required
midwives to have counselor certificate.
2. For Health Care Agencies
The process and the results of this study can
serve as a model or an alternative treatment to
overcome and prevent the occurrence of
anxiety in facing the childbirth, which can be
applied in health centers Hagu bouquet, more
health centers, hospitals, and other maternity
clinic.
3. For the next Researcher
This study should be followed by next
researcher using individual counseling so that
they can be compared with the results of this
study which uses group counseling methods,
thus it can be concluded that the counseling
methods can reduce effectively the
primigravida anxiety.
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ANDI
217
THE INFLUENCE OF TYPE COOKING ON LEVELS OF CRUDE
FIBER FROM WATER SPINACH BOILED AND STEAMED
Mustikawati, Alkausyari Aziz, Hesti Atasasih
Department of Nutrition, Politeknik Kesehatan Kementerian Kesehatan Riau.
ABSTRACT
Fiber is part of a carbohydrate, largely derived from plant cell walls contain cellulose,
hemicellulose and lignin. The role of dietary fiber on health began to emerge after the experts
compare the high incidence of colon cancer in advanced industrial countries that consumption of fiber
is low compared to developed countries. Based on the results of research conducted in America,
Africa and Asia found that people with a Western diet is generally low in fiber, many people who
have found the incidence of colon cancer (Kusharto, 2006). The average fiber consumption of
Indonesian society was 10.5 g / day, which is still below the recommended nutrients, ie 20-30 g / day.
The largest source of fiber found in vegetables, one of the vegetables that contain fiber are
water spinach. The research results, Rahayu (1998) in Hery (2001) shows the dietary fiber in
vegetables after cooking changes. For it is necessary to study the fiber content of water spinach that
has undergone a cooking process to determine the effect of cooking on the type of crude fiber content
(Crude Fiber) water spinach boiled and steamed. Crude fiber content research will be carried out by
methods Apriyanto (acid hydrolysis method) with two trials (Duplo).
From the results obtained crude fiber content in 100 grams of water spinach namely by
boiling (5,12%), steamed (2,38%) and then the water spinach with the untreated / fresh (1,33%).
Keywords: Fiber, Water Spinach, Boiled, and Steamed
INTRODUCTION
Among the various substances in food,
fiber is non nutritional substances most widely
discussed benefits to health. Fiber is part of a
carbohydrate, largely derived from plant cell
walls contain cellulose, hemicellulose and
lignin. The chemical composition of dietary
fiber varies depending on the composition of
the producing plant cell walls. Dietary fiber is
divided into two groups, namely:
1. Dietary fiber soluble (soluble dietary
fiber), are included in this fiber is pectin
and gum is the inside of the cell vegetable
food. The fiber found in many fruits and
vegetables
2. Insoluble fiber (insoluble dietary fiber),
are included in these fibers are cellulose,
hemicellulose and lignin, which are found
in cereals, legumes and vegetables
According Astawan and Wresdiyati
(2004) in Dyah (2011), Dietary fiber can not
be digested and absorbed by the human
digestive tract, but it has a very important
function for health maintenance, disease
prevention and as an important component in
nutrition therapy. For school age children, the
fiber is also important because it will provide
health effects on adult life, in order to prevent
degenerative diseases such as coronary heart
218
disease, diabetes mellitus, and colon cancer
(Puspamika, 2014).
The average fiber consumption of
Indonesian society was 10.5 g / day, which is
still below the recommended nutrients, ie 2030 g / day. Source of dietary fiber that is very
easy to be found is on vegetables and fruits.
Vegetables is a menu that is almost always
present in the daily dish of Indonesian society,
both in the raw state (fresh vegetables) or after
processed into various forms cuisine. One of
the vegetables that contain fiber are water
spinach. Water spinach is always of vegetables
produced in Indonesia. From the survey of
vegetable production in Indonesia in 19972013 conducted by Badan Pusat Statistik said
that the production water spinach in 2013
amounted to 308477.2 tons (Badan Pusat
Statistik, 2014). IPB student research results,
Rahayu (1998) in Hery (2001) shows the
dietary fiber in vegetables changes after
cooking.
Spinach is not the type of vegetables
consumed in a raw state (fresh vegetables) so
that the vegetables water spinach will do the
cooking process. With the ripening process the
vegetables it will affect the fiber content
contained in these vegetables. The results
Rahayu (1998) in Hery (2001) shows the
dietary fiber in vegetables changes after
cooking. In this study samples of the type
cooking water spinach will be limited, which
kind of cooking water spinach is boiling and
steaming. While crude fiber content of
research will be done with Apriyanto method
(method Hidolisis Acid) with two trials
(Duplo).
MATERIALS AND METHODS
Time and Place Research : This study was
conducted in March 2014. The experiments
were conducted at the Laboratory of Chemical
Integrated Basic in Politeknik Kesehatan
Kementerian Kesehatan Riau.
Materials : Water spinach, H2SO4 0.325 N,
NaOH 1.25 N, dan Aseton / Alkohol.
Instrument : Erlenmeyer, flask, Spray Bottle,
chemical glass, Petridisk, Hot Plat, Funnel,
Spatula, Autoclave, Whatman filter paper 41,
Oven, Analytical Scales, Pipette Volume,
Stove, Knives, Test Sieve 60 Mesh, Waring
Blender, and Thermometer.
Sample Preparation
Fresh water spinach sorted and
washed, then finely chopped and separated
into three sections. The first part steamed (T =
100 ° C, t = 7 min), the second part is boiled
with water temperature of 100 ° C for 3
minutes, while the third part is not done any
treatment. Then the whole water spinach dried
in an oven (T = 60 °C, t = 6-12 hours) with a
separate container. Once dried, milled water
spinach with waring blender and sifted 60
mesh.
Determination of Levels of Crude Fiber
A total of 2 gram sample of free water
was added to 500 ml Erlenmeyer flask and add
100 ml of H2SO4 0.325 N. The mixture is
hydrolyzed in an autoclave for 15 minutes at a
temperature of 105°C and cooled and 1.25 N
NaOH is added 50 ml. Then do the hydrolysis
back in the autoclave for 15 minutes.
Examples filtered with filter paper that has
been dried and known weight. The filter paper
was washed successively with hot water, 25
ml of 0.325 N H2SO4, hot water and finally
using acetone / alcohol 25 ml. The filter paper
is dried in the oven at 105°C for 1 hour and
continued until the weight.
RESULT
Sample was identified in the
Laboratory of Botany Department of Biology,
State University of Riau with the identification
type / species as follows:
Kingdom
: Plantae
Division
: Magnoliophyta
Class
: Magnoliopsida
Nation
: Solnales
Tribe
: Convolvulaceae
Marga
: Ipomea
Species
: Ipomoea reptan Poir
Local Name
: Kale
Crude fiber are plant fibers that are not
soluble in water. Insoluble fiber is considered
as fiber healthy intestinal. This fiber does not
dissolve in water, so the this fiber passes
through the gastrointestinal tract relatively
intact, and accelerate food trip and waste
through the intestines. Insoluble fiber is very
beneficial for our body, because it helps
smooth
bowel
movement
reducing
constipation and diarrhea. Insoluble fiber also
helps to remove toxins from the colon, and
reduce the risk of colon cancer because
insoluble fiber helps maintain the pH (degree
of acidity) of the intestines (Wibowo, 2012).
Based on the test results crude fiber
content that has been done using acid
hydrolysis method (Apiyantono, 1988) it is
known that the crude fiber content of 3 types
of treatment on the sample is a sample control,
sample boiled and steamed samples can be
seen in Table 1.
Table 1. Crude Fiber Content Research Results
Types of treatment
Crude fiber
content in 100 g
1,33%
Water spinach Control
5,12%
Boiled Water spinach
2,38%
Steamed Water
spinach
Based on the table can be seen that
there are differences in the content of crude
fiber content between water spinach from each
treatment. High crude fiber content of most of
the research that has been done is water
spinach with this type of trial, namely by
boiling (5,12%), steamed (2,38%) and then the
water spinach with the without trial / fresh
(1,33%). Water spinach has a manifold fiber
hemicellulose, so the water spinach include
219
sources of insoluble fiber. Boiled water
spinach has a higher fiber content caused by
cooking medium used. At the time of boiling,
water spinach directly in contact with water
for 3 minutes at a temperature of 100°C,
thereby it will reduce levels of soluble fiber
which then will increase levels of insoluble
fiber.
While the steamed water spinach has a
lower fiber content than the boiled water
spinach because of steamed water spinach has
a cooking medium in the form of water vapor
so the water spinach is not directly in contact
with water, thereby decrease of the soluble
fiber is not as much as steamed water spinach
water spinach stew. Water spinach without
treatment has a lower fiber content than the
other treatments because the water spinach is
not cooked so that the levels of soluble fiber
does not experience many changes.
CONCLUSIONS
There are differences of crude fiber
content in water spinach after cooking process
of each treatment. High crude fiber content of
most the research that has been done is water
spinach with this type of treatment, namely by
boiling (5.12%), steamed (2,38%) and then the
water spinach with the untreated / fresh
(1,33%).
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221
THE IMPACTS OF BREASTFEEDING COUNSELINGBYKADER
KESEHATAN (LAY HEALTH WORKERS) ON THE FIRST MONTH
EXCLUSIVE BREAST FEEDING (E1) AMONG BREAST FEEDING
WOMEN IN DARUL IMARAH SUB-DISTRICT
1.
Nurlaili Ramli,1PutriSanty1
Midwifery department of healthpolytechnic Kemenkes Aceh. [email protected]
ABSTRACT
Background: The coverage of exclusive breastfeeding in Aceh Province is still low, with a median of
0.6 months (BPS & Macro International, 2007), while in DarulImarahSub-District, the figureis 0.5%
(Aceh Besar District Health Office, 2011). The involvement of kaderkesehatan (lay health workers) in
the programs of maternal and child health is very effective in reducing morbidity and mortality
through the promotion of breastfeeding practices.
Objective: To determine the impacts of counselinggiven by kaderkesehatan (lay health workers) on
the first month exclusive breastfeeding (E1) among breastfeedingwomen in DarulImarahSub-district.
Methods: This study was an experimental study with a controlled trial design. The subjects were the
third trimester pregnant women in DarulImarahSub-districttaken with two stage sampling technique.
Sixteen womenwere selected for each the intervention group and the control group. The primary data
collection was done by the health workers and enumerators to obtain data on exclusive breastfeeding
done at birth, one week after birth and during 1 month after birth. Data analysis usedStatasoftware
program, chi-square test, and RR (95% CI).
RESULTS: The proportion of the firstmonth exclusive breastfeeding was higher in the intervention
group compared with that in the control group. The statistical analysis showed that the
counselinggiven by the health workers influenced the provision of exclusive breastfeeding (P = 0.01;
CI: 1.11 to 6.84).
Conclusion: The provision of breastfeeding counseling by the health workers influenced the success
of exclusive breastfeeding (E1) in DarulImarah Sub-district.
Keywords: breastfeeding counseling, health workers, exclusive breastfeeding
INTRODUCTION
Breastfeeding is a way of providing adequate
nutrition for the newborn’s growth and
development.Colostrum administeredat the
first hours after birth is the perfect food for the
newborn. Breastfeeding is subsequently given
until the child is two years old. The Indonesian
government changed the recommendation of
exclusive breastfeeding from four months
tosix months in 2003.1
Exclusive breastfeeding is given to newborns
up to the age of 6 months and continued with
supplement feeding.2 The WHO and UNICEF
recommended exclusive breastfeeding as an
effort to decrease morbidity, mortality in
infants and under-five children.1Exclusive
breastfeeding can reduce the risk of acute and
chronic
diseases,
including
diarrhea,
respiratory tract infections, urinary tract
infections, otitis media and asthma. Shorter
and less intensive breastfeeding period will
222
cause the baby to be less protected. The
development of cognitive value for infants
breastfed for 6 months or more will increase
when compared to the infants who are never
breastfed.3-4 Breastfeeding is also one of the
factors that can prevent obesity in the baby’s
next life period.5 A research in 2005 found that
13 % of women stopped breastfeeding their
babies in the first month due to the babies who
were unable to be breastfed and the
perceptions thatthe breast milk production was
not enough to their babies.6 During the period
beforethe milkwasproduced, the babies
weregiven breast milk substitute, for example,
water, tea, and honey untilthe breast
milkcameout.7-8
A survey conducted in groups of women in
England and Wales with differences in social
status showedthat the prevalence of
breastfeeding at birth was 71% and would
decline to 54% atthe first two weeks after
birth, 44% at six weeks and 28% at fourth
month.
This
decreased
prevalence
causeddisadvantage for mothers and infants as
a result of the termination of breastfeeding
practices faster than the time expected.9
The Indonesian government has set a policy of
exclusive breastfeeding in the Decree of the
Minister of Health of the Republic of
Indonesia No. 450 / Menkes / SK / IV / 2004
and it has been amended by the Government
Regulation No. 33 in 2012.10 However, the
patterns and trends of breastfeeding in
Indonesia are getting worse every year, the
duration of breastfeeding becomes shorter and
theweaned age of baby is sooner. Data of
Indonesian Demographic and Health Survey
(IDHS) in 1997 showed that the coverage of
exclusive breastfeeding was 52% and in the
2002-2003 it decreased to 40% and decreased
again to 32% in2007. The figure was still
lower than the figure worldwide that was 38%
and lower than the target coverage of
exclusive breastfeeding in Indonesiaby
80%.11This suggests that the practice of
exclusive breastfeeding be continuously
decreasing caused by modernization lifestyle.
This decline will negatively affect child
morbidity and mortality, andother problems of
maternal and child health willincreasingly be
faced.1,12
This phenomenon requires a change of
mindset on how to improve the factors that
influence the practice of breastfeeding in
Indonesia. The decisions of breastfeeding
babies are influenced by factors of mothers
and family. Appropriate support and direct
advice can positively affect the initiation of
breastfeeding
and
the
sustainabilityof
breastfeeding.13
The WHO publications and systematic review
of breastfeeding promotion program involving
communities have proven to increase
breastfeeding compared to the promotion
carried out by health professionals.14-16
Breastfeeding promotion and communitybased support are one of the key components
of a comprehensive program to improve the
practice of breastfeeding.17
The involvement of Lay Health Workers
(LHWs) in maternal and child health programs
is very effective in reducing morbidity and
mortality through the promotion of
breastfeeding practices. Usually, LHWsonly
receive informal job training without a formal
professionaleducation but are often involved
whether getting paid or doing the job
voluntarily.18A research in the US showed that
the counseling provided by the outreach health
workers could improve knowledge and
promote changes in health behavior in women
fromminority ethnic groups.19 In Indonesia,
the outreach health workers are better known
askaderkesehatan (lay health worker).20Kader
kesehatanis local people selected and reviewed
by the community to work voluntarily.21
Counseling is a process of assistance carried
out by the counselor to the individual in order
to solve a problem or optimize potential
owned.22The provision of breastfeeding
counselors in health care facilities and public
facilities is one of the responsibilities of the
local government in an effort to increase the
coverage of exclusive breastfeeding in
community.10
A study using the outreach health workers
showed that this had effectively enhanced the
promotion of the improvement of exclusive
breastfeeding for breastfeedingwomen.23-24,18
However, a Randomized control trial study
showed
that
breastfeeding
counselors’supportsdid
not
significantly
increase the exclusive breastfeeding in the
intervention group.25
The average duration of breastfeeding practice
in Indonesia is 20.7 months, while in Aceh
Province the median of breastfeeding is 19.7
months and the median duration of exclusive
breastfeeding is 0.6 months.1 Exclusive
breastfeeding in Aceh Province in 2010 was
4.30 percent26 while in Aceh Besar Districtthe
exclusive breastfeeding was 1.1 percent and in
DarulImarohSub-district it was 0.5% .27
Such data showed that exclusive breastfeeding
was
still
not
in
line
with
expectations;therefore,the researchers were
challenged to conduct this research on the
impacts of breastfeeding counseling by the
kaderkesehatan in improving exclusive
breastfeeding for breastfeedingwomen in
DarulImarahSub-district ofAceh BesarDistrict.
This study is expected to give consideration
for the Health Office of Aceh BesarDistrict for
decision-making in an effort to increase
coverage of exclusive breastfeeding.
RESEARCH METHODOLOGY
This was an experimental study with a
controlled trial design, which compared an
intervention to another intervention or by the
comparison. The research saw the effect of
223
two kinds of intervention to the women so that
there would be two groups of research
subjects, each of which would receive
different
interventions.28
Group
A
(intervention) received get a leaflet and
breastfeeding
counseling
from
the
kaderkesehatanon exclusive breastfeeding and
Group B (control group ) only got a leaflet.
The study was conducted in DarulImarahSubdistrict on July 16 to October 15, 2012.
DarulImarahSub-district has 32 villages
andthe chosen villages by purposive sampling
technique as the intervention group
wereLampeneuen,
LampenerutGampong,
Lamsidaya, Lamkawe, Deunong, KutaKarang,
Leugeu, and Payaroh while the villages as the
control
group
wereLamcot,
Bayu,
LamblangManyang,
Lambheu,
LamblangTrieng, Punie, Lamreung and
Lamsidaya. The reason for choosing the
location of this studywas because the coverage
of exclusive breastfeeding was low at 0.5%,
compared with itscoverage in theDistrict
(1.1%).
The population in this study was all third
trimester pregnant women in DarulImarahSubdistrict that met the criteria for inclusion. The
sampling was done by two stage sampling
method, by modifying the purposive sampling
and total sampling technique.29The sampling
stages conducted were as follows: 1) the
purposive sampling technique was based on
the consideration that, from 32 villages in the
Sub-district of DarulImarah,16 villages were
taken based onthe low coverage of exclusive
breastfeeding, the highest total of V4 and the
same characteristics and 2) using the total
population to determine the research subjects
included in the intervention group and the
control group.
The data collected were the primary
data,i.e.,data obtained directly from the field
by spreading questionnaire containing
questions on the respondents’characteristics.
Breastfeeding counseling was conducted by a
kaderkesehatanin the gestational age of ≥ 36
weeks, shortly after birth, when the baby was
1 week old and when baby was 1 month old.
The exclusive breastfeeding data were
obtained by direct interviews to the
womenshortly after birth, when the baby aged
1 week and 1 month. In the intervention
group,observation 1, 2 and 3 wasdone by the
kaderkesehatan, whereas for the control group,
the data collection was done by enumerators
224
who had been trained on how to fill out the
questionnaire.
The research instrument used in this study was
a questionnaire. The variable ofexclusive
breastfeeding was measured by interviewing
the women immediately after birth, 1 week
and 1 month after birth using research
instruments from the Community Nutrition
and Research Laboratory of UGM.
The intervention in the intervention group was
breastfeeding counseling and leaflets by
cadres, while the control group was given only
a leaflet by the kaderkesehatan. The
counseling was given for 1 hour to the women
before birth, with a due date estimation in
July.
Before
the
kaderkesehatan
providedcounseling, they were giventraining
on exclusive breastfeeding. The training was
organized by the researchers in collaboration
with Breastfeeding CounselingFacilitator
Coach Team, Department of Midwifery,Aceh
Health Polytechnic. Training activities were
held for 3 days or 21 course hours based on
implementation guidelines of breastfeeding
counseling
training
and
breastfeeding
counseling facilitators.30Thematerials of the
training were adjusted to the counseling
training module for the participants.31
The training for the kaderkesehatan was
carried out on July 16-18, 2012 attended by 8
people. The trained kaderkesehatanwere from
Lampeneuen,
LampenerutGampong,
Leugeu, and PayarohVillage.
The characteristics of kaderkesehatan
The number of kaderkesehatanused in this
study was 8 people, coming from
Lampeneuen,
LampenerutGampong,
Leugeu, and Payaroh Village. Of 8
kaderkesehatan, 1 (8%) was 20 years old and
7 kaderkesehatanwere 30-40 years old (92%).
Half of the kaderkesehatan had higher
education background and the other
fourgraduated from high school.
The characteristics of the respondents
Research subjects in this study were 32
respondents consisting of 16 respondents in
the intervention group and 16 respondents in
the control group. The results of homogeneity
test showed no difference in age, education,
and parity in both the intervention group and
the control group with p valueof > 0.05.
The impacts of breastfeeding counseling by
the kaderkesehatanonone month exclusive
breastfeeding
The research was conducted from July 16 to
October 15, 2012 to 16 villagesin the working
area of DarulImarah Health Center of Aceh
Besar District. At the time of this research
after the selection process, there were32
pregnant women (16 in intervention group and
16 people in control group). The results
showed a decrease in the frequency of
exclusive
breastfeeding
between
the
intervention groups and the control group.
There were changes in the frequency of
exclusive breastfeeding from at birth to the
baby was one month old. In the intervention
and control groups, the frequency of
breastfeeding shortly after birth was
respectively 81.25% and 75% while the
frequency of breastfeeding when the baby was
one month old wasrespectively 68.75% and
25%.
The results of the data analysis on the impacts
of breastfeeding counselinggiven by the
kaderkesehatanon the first month exclusive
breastfeedingshowedthat the intervention
group gave exclusive breastfeeding almost 3
times higher than the control group (RR = 2.75
95% CI: 1.11 to 6.84). The statistical analysis
showed the presence of differences in the
proportion of the first month exclusive
breastfeeding between the intervention group
and the control group (p <0.05). This proved
that the intervention in the form of
breastfeeding counseling given by the
kaderkesehatan
increasedexclusive
breastfeeding almost 3 times in the
intervention group.
Discussion
The results of the statistical analysis showed
that the independent variables were proved to
be significantly to the firstmonth exclusive
breastfeeding (E1) among thebreastfeeding
women (p <0.01). This study showed that
breastfeeding counselingfor the intervention
group carried out by the kaderkesehatancould
affect the first month exclusive breastfeeding
by 2.75 times compared with the control group
who were only given leaflets. Around 68.7%
in the group that got leaflets and breastfeeding
counselinggave exclusive breastfeeding to
their babies than those who were given only
the leaflet, ie,25%. This result was consistent
with the literature review, indicating that the
interventions
made
by
the
health
workers/kaderkesehatanwere 2.78 times more
effectively toincreaseexclusive breastfeeding
practices.18
A research in Congo showed that, the
intervention group who received health
promotion, 57.7% respondents gaveexclusive
breastfeeding compared to 2.7% in the the
control group who gave their babies exclusive
breastfeeding. In addition,a research in
Glasgow showed that the prevalence of
breastfeeding was higher in the group given
both counselingand leaflet compared tothose
who were given leaflet alone although
statistically the results of the study were not
significant.32Support provided by counselorsis
most effective matter in increasing the
duration of exclusive breastfeeding.16
Support given by a counselor functions as a
process of giving aid done against individuals
in order to solve a problem or to optimize
her/his potential, which is called counseling.22
Breastfeeding
counselling
given
by
kaderkesehatancan make a woman continue
exclusive breastfeeding up to the age of 6
months.23 This study showed that 68.75% of
women continued to provide exclusive
breastfeeding to their babies up to the age of
one month after being given counseling by the
kaderkesehatan. The researchers of this
studystated
thatthe
visits
done
the
kaderkesehatanto provide counseling on
breastfeeding would make the womencontinue
breastfeeding their babies, because they knew
the difficulties or obstacles in the process of
breastfeeding so that they were able to
overcome problems that came up in
accordance with the information provided by
the kaderkesehatan.
Breastfeeding
counselingshould
begiven
during pregnancy; thus, itis expected shortly
after the birth,a womancan breastfeed
immediately. Childbirth is the right time for
the baby to get breast milk. Breast milk is a
nutrient that is able to meet all the nutritional
elements for the development of the baby to be
healthy and intelligent children in the future.
Exclusively breastfed infants will decrease
gastrointestinal infections and atopic eczema
at the age of 1 year.34
The results of this study showed that the in the
intervention group there were 31.25% of
225
breastfeeding women whodid not breastfeed
their babies exclusively. This happened due to
several factors, including the assumption that
the baby was crying because of hunger so that
the baby was given formula milk and the
culture of the people of Aceh who fed their
babies withbanana to avoid the baby not to be
fussy because of starvation. The percentage of
prelactealfeeding was higher in the control
group than in the intervention group, ie, 75%
vs. 31.25%. Prelacteal food provided in both
the intervention group and the control group
was formula milk, honey and bananas.
Exclusive breastfeeding was breastfeeding
only without additives drinks and food such as
formula milk, orange juice, honey, tea, water,
bananas, papaya, milk porridge, biscuits, and
rice porridge except medicines and vitamins if
needed.34
A research in China also mentioned that
failure in exclusive breastfeeding was due to
traditional beliefs that existed in China and
early provision of formula feeding to the
babies.35Substitutive food such as formula
milkfor a baby was given if there were barriers
to breastfeeding, either because the baby
refused to drain the milk or becausethe
women’s breast was ill.36
The results of this study also showed a
decrease in exclusive breastfeeding from at
birth to the baby was 1 month old in both the
intervention group and the control group.The
decrease in the first month exclusive
breastfeeding was more common in the control
group than in the intervention group. A
research carried out in Germany also showed a
decrease in exclusive breastfeeding; 90% of
women gave exclusive breastfeeding shortly
after birth and this declined to 44.7% at two
months later.37We concluded that the declinein
the practices of exclusive breastfeeding was
due to the information that was not given
repeatedly to the control group;leaflets were
only given when the gestational age was ≥ 36
weeks. For the intervention group given
leaflets and visited 3 times after birth, 68.75%
were still exclusively breastfeeding their
babies at the age of 1 month. This happened
because the women always got information
about the solution of problems that might
occur during the process of breastfeeding as
well as family that supported them to be able
to breastfeed exclusively. The women who
receive information about breastfeeding are
226
more interested and have a high confidence in
breastfeeding their babies.38
In this study there wasstill some shortages,
among others,predisposing factors consisting
of women’s knowledge, beliefs, values,
attitudes, beliefs and psychology that were not
analyzed. Likewise, we also did not analyze
theenabling and reinforcing factors that came
from family. A qualitative approach was also
not performed in this study, so that factors
related to the success of breastfeeding were
not studied in depth.
Conclusion
Practically and statistically there wasan
influence of breastfeeding counseling given by
the kaderkesehatanin the first month exclusive
breastfeeding (E1) in DarulImarahSub-district
and the proportion of the first month exclusive
breastfeeding was higher in the intervention
group that was given leaflets and counselingon
breastfeeding than those who were given only
leaflets.
Suggestion
Health Office of Aceh Besar District is
suggested to empower the kaderkesehatan in
providing breastfeeding counseling in order to
increase
the
coverage
of
exclusive
breastfeeding in DarulImarahSub-district.
Further researchshould examine other factors
such as women’s knowledge and education
and should conduct a qualitative approach in
order to gain more information about the main
factors that influence the practices of exclusive
breastfeeding.
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ANALYSIS PREPAREDNESS OF GENERAL HOSPITAL
Dr. FL. TOBING SIBOLGA
IN IMPLEMENTATION OF ASSURANCE NATIONAL HEALTH
POLICY 2014
Siti Marlina 1 , Juanita 2, Siti Zahara Nasution 2
1
Alumni Program Pascasarjana FKM-USU, Medan
2
Staf Pengajar FKM-USU, Medan
ABSTRACT
The enforcement of Law No. 40/2004 on SJSN (National Social Assurance System) and Law
No. 24/2011 on BPJS (Social Assurance Provider Board) needs complete preparedness by a hospital
as health assurance provider. Dr. FL. Tobing General Hospital, Sibolga, is one of the hospitals which
provide SJSN.
The objective of the research was to find out the preparedness of Dr. FL. Tobing General
Hospital, Sibolga, in implementing the policy in the National Health Assurance, in 2014. The
research used qualitative method with ten informants who were regarded as the qualified persons
who understood the preparedness in implementing health assurance program. The data were
gathered by conducting interviews, observation, and documentation.
The result of the research showed that socialization had been conducted by the management
of the hospital and by BPJS Sibolga Branch. There was no preparedness in health facilities because
of the lack of health equipment, human resources were ready both quantitatively and qualitatively,
disposition of the implementation of health care in the hospital was good, and coordination between
the structure of hospital bureaucracy and BPJS had been done well.
The conclusion of the research was that the management of the hospital had no preparedness
in health facilities for the implementation of the National Health Assurance Program. It is
recommended that the management the hospital should complete and improve its facility and
infrastructure, the government should pay more attention to the implementation of JKN program, and
socialization to public should be optimized.
Keywords: Implementation of Policy, National Health Assurance, Hospital
INTRODUCTION
The National Health Insurance (JKN)
is part of the National Social Assurance
System (BPJS) held by using the mechanisms
of social health insurance which is compulsory
(mandatory) based on Law No. 40 of 2004 on
National Social Assurance System with the
aim to meet the basic needs of a decent public
health which is given to every person who has
paid dues or dues paid by the government.
JKN starting from 1 January 2014, which
gradually
toward
thorough
coverage
JKN purpose generally is easier for
people to access health services and obtain
quality health services. Changes in the
financing system toward a comprehensive
coverage is a good thing but it has side effects
and risks. Inequality availability of health
facilities, health workers and geographical
conditions, give rise to new problems in the
form of inequity between community groups
Social Assurance Provider Board
(BPJS) is an institution established to
administer social assurance programs in
Indonesia, according to Law No. 40 of 2004
and Law No. 24 of 2011. In accordance with
Law No. 40 of 2004 on the Social Assurance,
BPJS a non-profit legal entity. Under Law No.
24 In 2011, BPJS will replace a number of
existing social assurance institutions in
Indonesia, namely PT Health Insurance
Agency. Askes Indonesia became BPJS Health
and social assurance institutions manpower
PT. Jamsostek into BPJS Employment
(Sijabat, 2012).
Transformation PT Askes and PT
Jamsostek into BPJS done gradually. In early
2014, PT Askes will be BPJS Health, then in
2015 the turn of PT Jamsostek into BPJS
Employment (Ariyanti, 2013).
229
The principle of social assurance
benefits is usually the form of cash and the
value of health services appropriate basic life
needs such as food, clothing, shelter and basic
medical needs. Provision of social assurance
benefits is based justice in the sense that
benefits provided applies to all citizens of the
rich countries, poor or nearly poor, because
social assurance is a permanent lifetime. The
third principle is the cornerstone in the
implementation of the social assurance system
sustainable (Kemenkes RI, 2012).
In
order
to
materialize
the
implementation of a sustainable social
assurance system, the social assurance held
nationwide by forming an independent BPJS
based social assurance law. Social assurance
guarantees provide certainty for the
community in order to achieve the fulfillment
of basic life evenly as mandated by Article 28H of paragraph (1) of the Constitution of the
Republic of Indonesia Year 1945 has affirmed
that every person has the right to obtain
medical care, and in Article 34 paragraph (3)
shall be declared the state responsible for the
provision of health care facilities and public
service facilities are decent (Kemenkes RI,
2012).
As stated in Article 2 of Law of the
National Social Assurance System (SJSN), the
Social Assurance organized by the principles
of humanity, the principle of benefit and the
principle of social justice for all Indonesian
people. If the implementation of the Social
Assurance is not based on the three principles,
then there is a violation of that law. Or
negligence in covering and serving the health
insurance for the poor, including poor people,
basically a violation of the principle of
humanity. Then, the principle of social
assurance benefits in the design should
provide
significant
benefits
for
the
participants, not least to guarantee the
fulfillment of basic needs for participants
including a comprehensive health services,
while the principle of fairness in the
administration of the Social Assurance applies
to all levels of society, rich, medium or poor
order created the principle of cooperativeness
(Purwoko, 2012).
Social Assurance System is a system
of social protection for all citizens. Social
protection has a strategic role to address the
vulnerability due to the risk of natural and
economic risks. As we know that Indonesia is
230
one of the disaster-prone areas and the impacts
of disasters resulting relocate the budget
required to rebuild the damaged infrastructure.
The disaster also left many families losing
possessions and life, so it is quite difficult in
an effort to improve people's welfare (Zaelani,
2012).
One health care provider JKN
program in Sibolga City is General Hospital
Dr. FL. Tobing Sibolga which is the General
Hospital of Class B Non Education, seeks to
provide health services as much as possible in
accordance with the facilities and tools
available, have 204 beds 204, Human
resources 338 people, medical services include
specialist outpatient services, inpatient care
and support services for the installation of
medical services. In general, any type of
outpatient services take place every weekday
and is open to any public or patient health
insurance (ASKES) / poor family health
insurance (ASKESKIN) / Community Health
Insurance (JAMKESMAS) with or without a
referral.
Medical record data General Hospital
Dr. FL Tobing Sibolga (2012) shows the value
of Bed Occupancy Rate (BOR) 50% (national
standard of 60% -80%), and Length Of Stay
(LOS) was 4 days (standard 2 days) with the
highest proportion of patient visits askes 45.24
%, ie 40.06% of patients general, and 13.5%
of patients jamkesmas. This condition shows
that the public interest to come for treatment to
still low.
Viewed
from the
aspect
of
management at the General Hospital Dr. FL
Tobing Sibolga, still encountered problems of
lack of services in accordance with Standard
Operating Procedure in every unit of services,
such as nursing care and midwifery care. This
is indicated by the lack of reports on the
development of nursing care of patients and
the patients are still many complaints against
the availability of drugs and consumables in
hospitals.
Based on the results of the initial
survey conducted by researchers in January
2014, it is known from the aspect of the
facility is very adequate hospital, where
medical support units also function optimally
as radiology, laboratory and blood services
unit. But the results of a brief interview with
the head of medical services and treatments
suggested that health services for participants
JKN still not well served, it is seen from the
limited socialization JKN program for service
providers in hospitals, as well as the still weak
coordination with BPJS in the claiming
process.
Currently the General Hospital Dr. FL Tobing
Sibolga also preparing health care participants
of the National Health Insurance. Based on the
above, the authors are interested in knowing
the extent of readiness of the General Hospital
Dr. FL. Tobing Sibolga in the implementation
of the National Health Insurance Policy 2014.
Based on the background described, the
problems in this research are: how Readiness
General Hospital Dr. FL. Tobing Sibolga in
Insurance Policy 2014.
This research aimed to analyze
readiness General Hospital Dr. FL. Tobing
Sibolga in the implementation of the National
Health Insurance Policy 2014. The benefits of
this research are:
4. This research is expected to be input for
the Hospital of the readiness of the
Insurance policy so that it can be taken
into consideration in improving the
implementation of National Health
Insurance.
5. It is expected that this research can be
used as an additional reference regarding
health policy and learning materials as
well as contribute ideas in preparation for
Insurance policy at the hospital.
6. This research can increase knowledge and
scientific insights scientific author on the
readiness
of
hospitals
in
the
Insurance policy
RESEARCH METHODS
The method used in this research is
qualitative research. This research therefore
only describe how analysis Readiness General
Hospital FL Tobing Sibolga in the
Implementation of the National Health
Insurance Policy 2014. Qualitative research is
a type of research that revealed the objective
conditions of the phenomenon that occurs with
the approach of in-depth interviews
(Sugiyono, 2006).
Research conducted at the General
Hospital dr. FL. Tobing Sibolga. The choice of
location is based on the consideration of the
research has not been done the same with this
research, because the policy is still relatively
new JKN as of 1 January 2014. The research
began by surveying beginning in January
2014, the collection of data with in-depth
interviews and observations conducted in July
2014.
Qualitative research is not intended to make a
generalization of research. Therefore, in
qualitative research, is not known for the
sample population. The subject of research
became an informant who will provide the
necessary information during the research
process (Maleong, 2002), informants are
people who used to give information about the
situation and condition of background
research.
Informants in research in all the elements
that are involved in policy implementation
JKN program in General Hospital Dr. FL
Tobing Sibolga consisting of:
4. Components General Hospital Dr. FL.
Tobing Sibolga
a. Director of the General Hospital Dr.
FL Tobing Sibolga
b. Head of Medical Services and
Treatments
c. Head of Planning and Development
d. Chairman of the Medical Committee
e. Head of Pharmacy Installation
5. Components branch BPJS Sibolga the
head unit hospital services.
6. Inpatients and outpatients at the General
Hospital Dr. FL Tobing Sibolga.
Based on the above, the research
determines informants using purposive
sampling and snowball sampling are.
Sampling with purposive sampling technique
means that the sampling technique based on
certain considerations namely, informants
authors choose are the ones who are involved
directly to the issues being studied. Snowball
Sampling The samples are still provisional
data sources and will develop later after
researchers in the field. (Sugiyono, 2005).
Snowball sampling is used when in the process
of data penggumpulan there's more varied
opinion, the researchers will look for another
informant so that the necessary data is
sufficient to describe the phenomena related to
the objectives of this research .
Data analysis in qualitative research is
rather complicated because the data are quite a
lot of variety and there is no standard pattern.
According to Bogdan, who was quoted by
231
Sugiyono (2005), data analysis is the process
of systematically searching for and compiling
the data obtained from interviews, field notes
and other materials that can be easily
understood and the findings can be
communicated to others. Data analysis was
performed by organizing the data, translate it
into the units, synthesize, organize into a
pattern, choose what is important and what
will be learned and make inferences that can
be passed on to others.
Sugiyono (2005), citing the opinion
Spradley, also argued that the analysis in the
research of any kind, is a way of thinking,
relating to systematically test for something to
define the part, the relationship between parts,
and its relationship to the whole. Thus, the
analysis is to look for a pattern.
Based on the statement of the experts,
Sugiyono (2005) concluded that the data
analysis is the process of systematically
searching for and compiling the data obtained
from
interviews,
field
notes,
and
documentation, by way of organizing data into
categories, describe into the units, perform
synthesize, organize into a pattern, choose
what is important and what will be learned and
make conclusions so easily understood by
myself and others.
According Sugiyono (2005) Miles and
Huberman cites the opinion that the activity in
qualitative data analysis is done in an
interactive and takes place continuously at
every stage of research so as to completion,
and the data until saturated.
Readiness Communications
Communication is one of the means to
disseminate information or orders from
superiors
to
subordinates
and
from
subordinates to superiors. The information
provided should be clear, accurate in time
delivery of information and information
submitted must be consistent or significant
permanent or not plus-added or subtracted.
According to Hovland, Janis & Kelley
communication is a process through someone
(communicator) deliver stimulus (usually in
the form of words) with the aim of changing or
shaping the behavior of others (Riswadi,
2006).
While
Harold
Laswell
said
communication is basically a process that
describes the "who" says what channel what to
whom, and with what result or outcome.
232
Laswell
paradigm
indicates
that
communication includes five elements, namely
communicator, message, media, communicant
and effect.
JKN program policies made by the
central government in this case the Ministry of
Health are socialized to other interested parties
through a socialization program JKN. JKN
socialization at the General Hospital Dr. F.L.
Tobing is done in cooperation with BPJS
Sibolga, socialization is done by creating a
meeting / conference or delivered at the time
the apples or the circular letter to the hospital
management, all nurses, specialists, general
practitioners, and all associated with the
hospital and the patient. Dissemination to
patients conducted by the Health Office of
Sibolga City and BPJS.
General Hospital Dr. FL. Tobing
Sibolga is a hospital into a referral health
services on the west coast of North Sumatera,
where the policy JKN with BPJS as the
responsible person must be involved in the
program. In general, the communication
between the hospital with BPJS no problem.
BPJS which holds the mandate of the laws
directly apply JKN automatically on January
1, 2014, including in cooperation with health
care is the hospital. General Hospital Dr. FL.
Tobing Sibolga with BPJS branches can work
together with effective communication and
better coordinate with each other.
Effective implementation will be
realized if the implementation of policy
implementation to know what will be done.
George Edward III suggests three variables
that can measure the success of the first
communication, namely the transmission or
distribution of information. Distribution of
good information will produce good policy
implementation as well. In this research , the
distribution of information is good.
Information about JKN received by the
hospital received. This is due to the special
meeting held to discuss the program with the
BPJS JKN.
The second variable is the clarity of
the information received by the policy
implementer of policy makers should be clear
and not confusing or ambiguous. In the results
of this research showed that the informant
was aware of the policy implementation JKN
unknown content of information disseminated
in the form of policy regulations, regulations
on JKN, a presidential decree, the minister of
health regulations, the method of payment
(contribution), referrals, benefit from JKN, the
membership of the National Health Insurance,
national formulary, e-catalogs, and the
Compendium alkes and others concerning the
JKN program, while the content (content)
submitted by BPJS is PT. ASKES changes to
BPJS
health.
The third variable is the consistency. The
information
disseminated
via
the
communication must be consistent, the
information disseminated should be fixed and
unchanging. Message JKN program has
consistently delivered good message to
implementing policy and to the parties
concerned. This means that the individual is
given the same message without any changes.
It can be seen with the statement by the
informant for the delivery of organizational
communication socialization and mass
communication in which media organizations
to produce and disseminate widely the
message to the public is through the media of
radio, television, newspapers and leafleat and
banners. This research is in line with research
Lilian (2013) which is a form of socialization
of health insurance programs carried out
through leaflets and direct socialization
kepadapasien who came for treatment at the
health center Batua Makassar. Socialization
among hospitals with BPJS done by a meeting
between the leadership and the vision to unite
the common goal for this JKN program. The
unification of this vision should be able to
bring the constitutional mandate JKN not to
the interests of a particular institution.
Therefore, strong leadership can
encourage impelemntasi policies to conform
with the original purpose as by USAID (2010),
which states that leadership is a very
substantial factor in policy implementation.
Leaders at the top level is policy makers,
technical breaker, which decided to cooperate
or not on the institution they leads. Therefore,
the leadership could be a solution to overcome
the problems of communication between
institutions
that
could
impede
the
implementation of this JKN.
Good communication occurs for two
reasons, first the intensity in establishing
coordination and collaboration between the
two institutions. The second is the lack of
clarity in implementing this program. This
happens because prior to the enactment of the
JKN General Hospital Dr. FL. Tobing Sibolga
has been implementing the program
JAMKESMAS and other health insurance
programs.
The involvement of hospitals in the
delivery of programs JKN the key factor in the
success of the program. When linked existing
socialization field are performed only at the
device level only, while for the public to very
little or very minimal. This is in line with
research Muliaddin et al (2005) and research
Riegel et al (2013) which states that the
dissemination to the public still needs to be
done and further optimized to provide insight
to the public about the benefits of the health
insurance program. In contrast to research
Hastuti (2010) that the socialization conducted
by the health department regarding the health
program in health centers Magelang district is
considered good enough.
Readiness Resources
In the implementation of the policy
should be supported by the resources both
human resources, material and regulations or
guidelines. Goals, objectives and policy
content, despite being communicated clearly
and konsiten, but if the lack of resources to
implement the, then the implementation will
not
run
properly.
The existence of factor resources in order to
implement policies JKN Program plays an
important role in the success of the policy
inplementasi, without adequate resources,
what is planned will not be the same as what is
ultimately
implemented.
Indicators
of
resources in the implementation of existing
policy 3 that policy instrument that is the
source of funds, human resources, and
facilities.
Policy instruments related to the dissemination
of information. No policy information in two
forms, namely information relating to the way
of doing policy implementation and
compliance of information regarding the
implementation of the implementing rules and
laws that have been established. Policy
instruments is one form of information that
describes the program or activity that must be
done in order to implement the policy, from
the data informant mind that they have a
policy instrument JKN program that is the
president of the Republic of Indonesia
regulation No. 12 Year 2013 on Health
Insurance, regulation Repubik health minister
of Indonesia Number 71 of 2013 on health
233
care in the National Health Insurance.
Regulation No. RI health minister 28 2014 on
guidelines for the implementation of JKN
program, health minister's decision No. 328 /
Menkes / IX / 2013 on the national formulary,
health ministerial regulation No. 59 of 2014
concerning the standard rates of health
services in the administration of the program
JKN, health ministerial regulation No. 27 2014
on technical guidelines Indonesian system
Base Case Group (INA-CBGs) and others.
Funds or financial aspect is a very
important
aspect
in
supporting
the
implementation of policies JKN. Based on the
survey results revealed that the financial
resources in the implementation of JKN
program in General Hospital Dr. FL. Tobing
Sibolga prepared with the payment system
(claiming) INA CBGs where hospitals are
already doing education and training on
computerized data management INA CBGs
held in Jakarta. Based on the above statement
can be concluded that the health resources or
health personnel in the General Hospital Dr.
FL. Tobing Sibolga classified prepared in
providing health services in JKN program.
Human resources are not only talking
about the number of health workers alone. Due
to successful implementation of policies is
also strongly influenced by the ability of
(quality) of these resources. This is according
to Edward III which states that the principal
amount in analyzing the resources needed for
the implementation of the policy is to analyze
the magnitude and quality.
It was found that the availability of
health workers in health service delivery in the
era of JKN according to the informant is
sufficient or adequate, but instead according to
researchers both in terms of the amount still
lacking, it can be seen from the number of
available 204 bed compared with the amount
Source its human General Hospital Dr. FL
Tobing Sibolga which is about 338 people
consisting of basic medical personnel (doctors
and dentists), specialist doctors, nursing and
midwifery personnel, medical support staff
and
non-medical
support
personnel.
Human Resources for specialist doctors in the
General Hospital Dr. FL Tobing Sibolga
suffice as many as 17 people, just not all the
medical specialists are / live in the city of
Sibolga so if suddenly required will hinder the
process of work in the General Hospital Dr.
FL. Tobing Sibolga. This is in accordance with
234
the opinion of informants stated that for
anesthesia personnel just one person, if the
doctor is unable to attend the hospital will be
shorthanded.
Nursing staff at the General Hospital
Dr. FL. Tobing Sibolga also inadequate seen
from the number of nursing personnel, only
164 people while 204 bed, based Pemenkes
no. 340 / Menkes / Per / III / 2010 that the
ratio of nursing staff and the bed was 1: 1, it is
compared with the opinion of the informants
who said that the nursing staff at the General
Hospital Dr. FL. Tobing Sibolga is enough.
Informants stated that education and training
had been conducted by a team at the hospital
JKN held in Jakarta for the management of
computer data for INA CBGs. Training is
needed not only for the power that would
operate a computer for recording and reporting
administration, but also health workers need to
do the training, including the hospital director.
Director of the General Hospital Dr. FL.
Tobing Sibolga has never participated in the
training because the director of the General
Hospital Dr. FL. Tobing Sibolga only is the
task of implementing the newly served by June
2014.
Observation and in-depth interviews
to health facilities for aspects of the physical
appearance of a physical building standard is
good, the location is easy to reach the
community, well-organized health services,
medicines and consumables sufficient, for
there are still some health facilities are lacking
because of broken tools and still in
improvements, such as a HD yet prepared at
and planned to be prepared in 2014, for the
infrastructure still not ready because medical
equipment is lacking and needs to be
completed.
This research
is in line with research
conducted Luti et al (2012), which states that
the condition of the facilities and infrastructure
of health services in the district of Lingga
archipelago area pretty much inadequate, eg
medical
devices,
drugs,
facilities,
transportation, and communication tools so
that access to reach or reach people is still
inadequate.
Assessing the adequacy of health
workers is not an easy thing. Differences in
rural and urban areas in terms of sociological,
geographic, demographic, infrastructure gives
trouble to create a standard of how the need
for health workers in the hospital.
Based on the above it can be
concluded that the information resources,
funds, human and infrastructure related to one
another. Although the policy instruments
already owned by the informant, still required
the deployment and administration of the
instrument more so that implementers can find
the National Health Insurance program as a
whole. Funding for health insurance programs
using INA CBGs and hospitals no difficulty
because the existing hospital management
training. Human resources already owned
General Hospital Dr. FL. Tobing is sufficient
and abilities they have been good. Facilities
and infrastructure are still very limited,
coupled with a tool is still inadequate.
Disposition Readiness
Other factors that are considered
influential on policy implementation is the
attitudes
and
perceptions
of
policy
implementation to the task and its
responsibility. If the executor behave like
honesty, commitment to the democratic nature
of a particular policy then it is likely they give
support to the policy (Winarno, 2012).
Integration of the characteristics of the
structures. Patterns of behavior, interests,
education, capabilities, and potential of a
person.
Disposition is one important factor in
the implementation of effective policies. If the
policy implementers have a tendency or a
positive attitude in the implementation of the
policy implementation is likely to be run in
accordance with the original purpose. And if
the policy implementers to be negative then
the implementation of the policy will not run
effectively or even the implementation of the
policy will fail.
Based on the research results get that
from the disposition in the running policy were
quite prepared JKN obtained from interviews
to patients at the General Hospital Dr. FL.
Tobing Sibolga well treated in inpatient and
outpatient in the room stated that the attitude
of specialist doctors, general practitioners,
nurses, midwives and administrators in
providing good health services, does not
discriminate with other patients. The same
thing was also stated by the head of medical
services and treatments as well as chairman of
the medical committee that they look
objectively attitude of health workers in
providing better health services.
Referring to the above regarding the
attitude of the implementers in the General
Hospital Dr. FL. Tobing Sibolga, research
findings show a positive attitude and support
towards the implementation of JKN, the
General Hospital Dr. FL. Tobing Sibolga
Sibolga with BPJS branches have the same
commitment
to
the
program
JKN.
Commitments related parties is strongly
needed in strengthening the implementation of
this JKN. Hospital as health services are wellprepared mengintegasikan themselves with
this JKN program. BPJS constitutively already
very ready to apply JKN, though always in the
process of refinement.
Commitment is a predisposing factor
in self impelementator a policy, then it is
proper implementation of this JKN supported
by the commitment of all parties concerned.
Even if there are problems that commitment
should be able to solve these problems by
improving communication and coordination.
When, in principle, all parties want to fix this
JKN the operational constraints should also be
addressed.
In applying JKN program director of the
hospital should be able to have a positive
attitude and be able to compile and
menetapkankan staff appropriately and
selectively. A positive attitude shown by the
ability to carry out their duties with full
responsibility. A positive attitude held by the
director of the hospital will affect the staff to
be positive as well to the program, so that the
staff are motivated and doing their best to
carry out his duties. Proper staffing would also
ensure the implementation of good policies.
Someone will perform optimally when placed
on the specialty.
Bureaucratic Structure Readiness
Although the resources to implement a
policy of sufficient and implementers of what
and how to do it, and they have a strong desire
to do so, the implementation could be
ineffective
because
ketidakefisiensinya
bureaucratic structure.
The policies are so complex demands
the cooperation of many people, when the
bureaucratic structure is not conducive to the
policy, then this will lead to resource becomes
ineffective and impede the course of policy.
Bureaucracy as implementing a policy must be
235
able to support policies that have been decided
by way of a well coordinated. In this research ,
the standard bureaucratic structure that is
intended is Standard Operating Procedure
(SOP).
Based on the results of the research
showed that the standard operational at the
General Hospital Dr. FL. Tobing Siboga in the
implementation of this JKN ready. It can be
seen from the secondary data that the author
can General Hospital Dr. FL. Tobias has been
carrying out accreditation and obtain the value
of
"B".
An operational standard-setting concrete
efforts in maintaining the quality of health
services. Various countries are implementing
national
health
insurance
implement
operational standards for the implementation
of health care. For example in Ghana to
implement that facility health care providers
should provide standardized equipment and
services. Later in the Philippines which sets
standards that health care must have been
operating for 3 years and is accredited and
must conform to the standards Phil Healths
especially in the relationship between human
resources, equipment, and physical structure
(Hsiao, 2007).
CONCLUSION
Based on the results of this research
concluded that:
1. Readiness Communications
Communication about JKN already quite
ready and well established where hospitals
in the dissemination of cooperation with
BPJS to socialize in hospital visits from
their banners installed in some parts of the
hospital.
2. Readiness Resources
a. Health manpower resources in running
JKN program can’t meet the health
care has not been effective due to the
quantity and quality of resources
available health workers have not been
adequate.
b. The readiness of health facilities in the
program so far have not seen JKN
readiness due to the infrastructure that
still need to be completed
3. Readiness Disposition
Commitment as one form of disposition in
carrying out policies JKN ready. Overall
236
the parties have agreed and are committed
to implement JKN as well as possible.
4. Readiness Bureaucratic Structure
Coordination of JKN program in General
Hospital Dr. FL. Tobing BPJS Sibolga
Sibolga to run properly. Hospitals as
health care providers are ready to provide
services and BPJS as the giver of the
budget prepared by claiming system.
ADVICE
5. Communication
Expected to hospitals and BPJS order to
improve socialization JKN with clear
information dissemination and provide
technical guidance JKN in order to
provide information and socialization
completely and correctly to all employees
and staff in the hospital.
6. Resources
a. Expected to hospitals in order to meet
the human resource needs by
proposing health workers and improve
the quality of health personnel in
accordance with the needs of patients
through training.
b. Recommended to the hospital to pay
more attention and increase more
facilities facilities and infrastructures
in accordance with the strategic plan
of the hospital.
7. Disposition
Expected to hospitals to be able to
maintain a good commitment to conduct
regular meetings, and carry out monitoring
and evaluation in order to improve JKN
services at the General Hospital Dr. FL.
Tobing Sibolga
8. Structure of Bureaucracy
Expected hospital with BPJS can maintain
and improve the coordination for the
smooth implementation of JKN in Sibolga
City.
Poster
237
238
ANXIETY LEVEL OF FAMILIES IN FACING SCHIZOPHRENIA
CLIENT BEHAVIOR AT THE POLYCLINIC OF NORTH SUMATRA
PROVINCE MENTAL HOSPITAL 2014
Johani Dewita Nasution, Endang Susilawati
Abstract
Background: Schizophrenia is a disease that affects the brain and causes thoughts, perceptions,
emotions, movement, and behavior strange and disturbed. In doing care clients with mental disorders,
it is necessary to support families because families occupying vital factor in the treatment of mental
patients at home. Objective: To determine the level of families anxiety in the face of the behavior of
schizophrenia client. Methodology: The study design was descriptive with cross sectional approach
and using the questionnaire. The number of samples of this study were 42 families that were taken by
using accidental sampling technique in psychiatric Hospital of North Sumatra Province in 2014.
Results: The results of this study indicate that the behavior is not regularly experience severe anxiety
as much as 61.5%, the catatonic behavior were found to have severe anxiety as much as 62.5%, and
paranoid behavior experience severe anxiety as much as 68.5%. Conclusions and Recommendations:
The results of this study showed respondents expressed experiencing severe levels of anxiety in the
face of schizophrenia client behavior. Therefore, it needs to be improved, especially on family
counseling of schizophrenia client in dealing with schizophrenic client's behavior so that the level of
anxiety experienced can be overcome or wane.
Keywords: Anxiety, Schizophrenia Behavior.
BACKGROUND
World Health Organization (WHO) defines
health as a state of complete physical, mental
and social and not merely the absence of
disease or infirmity. Mental health is a healthy
state of emotional, psychological and social
are visible from satisfying interpersonal
relationships, behavior and effective coping,
positive self-concept and emotional stability
(Videbeck, 2008).
There are two types of mental disorders which
can be found in the community, namely mild
mental disorder and severe mental disorder.
Mild mental disorder is a mental disorder
emotional examples. Severe mental disorder
one of which is schizophrenia. Most of the
patients were treated at a mental hospital is
patients with severe mental disorder of
schizophrenia.
Schizophrenia itself is a form of psychosis that
is often encountered everywhere. Marasmis
(2005) stated that Schizophrenia can also be
interpreted as a persistent and serious brain
disease resulting in psychotic behavior,
concrete thinking, and difficulty in
information
processing,
interpersonal
relationships, and solve problems (Stuart,
2007).
According to Videbeck (2008), defines
schizophrenia as a disease that affects the
brain and causes thoughts, perceptions,
emotions, movement, and behavior strange
and disturbed.
Schizophrenia is a disorder that occurs in brain
function (Nancy Anderkanson, 2008) that the
latest evidence about the attacks of
schizophrenia is a matter that involves a lot of
factors that include changes in the physical
structure of the brain, changes in the chemical
structure of the brain, and genetic factors (Iyus
Joseph , 2011).
Based on data from the APA (The American
Psychiatric Association), in the United States
there are 300 thousand patients with
schizophrenia who experience an acute
episode each year. The mortality rate of
patients with schizophrenia 8 times higher
than the death rate in the general
population.Patients with schizophrenia who
tried to commit suicide as much as 20-50%,
and 10% of them successfully (Iyus Joseph,
2011).
239
The prevalence of schizophrenia patients in
Indonesia is 11.6% or 17.4 million people
experiencing mental illness and usually occurs
around age 12 to 18 years had suffered from
schizophrenia. When Indonesia's population of
about 241 million people, it is estimated at
about 2.5 million people who suffer from
schizophrenia. And schizophrenia in the
general population are 11.6 when projected by
the Indonesian population is approximately
241 million people in 2012, there are 500
thousand to 2.5 million people who have
schizophrenia. Large numbers is a challenge
primarily for health ministries in addressing
this issue (Dien Emawati, 2009).
Approximately 0.46% of the total population
of Indonesia or the equivalent of 1.09315
million people at risk of severe mental
disorder. Results of Health Research
(Riskesdas) In 2007, there were more than one
million people in Indonesia are at risk of
developing severe mental disorders including
schizophrenia. Of about one million
inhabitants, only 38 260 people are served
with adequate care at the Mental Hospital
(RSJ), General Hospital (RSU), as well as
community health centers (Puskesmas). There
are still many Indonesian people who do not
fully understand about this disease, so patients
are not treated properly as treated in the health
care center.
In addition, based on data from the Ministry of
Health in 2013, there were still about seven
provinces in Indonesia which has no Mental
Hospital (RSJ) and four provinces still do not
have mental health professionals. Given the
complexity of mental health problems
including schizophrenia in Indonesia.
Range anxiety response can be described
starting from the individual responses to
anticipate anxiety, mild, moderate, severe,
panic, with a range of adaptive responses in
anticipation anxiety, mild and moderate
anxiety. Maladaptive response range contained
in the heavy anxiety and panic. Anxiety level
has different characteristics, the light level
anxiety increased alertness, sharpening the
senses, and the expansion of the visual field.
At moderate levels of anxiety, cognitive
already focused on stressors, the narrowing of
the field of perception but still able to carry
out something and take the desperation with
240
the help of others. At severe levels of anxiety,
attention totally focused on things even more
specific to the field of perception is very
narrow and is unable to think of anything else.
Similarly, the level of anxiety is very severe,
the individual loses control, rationality and
narrowing of individual perception, are not
able to do any activity, even though a lot of
referrals to others.
According to Friedman (1998) defines the
family as a social system. The family is a
small group of individuals who have a close
relationship with each other, interdependent
organized in one single unit in order to achieve
certain goals.
According padila (2011) The family is
composed of individuals who are united by
ties of blood marriage and adoption. Family
members often live together in one household
or if they separate, still considers as their
home. Family members interact and
communicate with each other in the family's
social role as husband and wife, father and
mother, son and daughter. The family uses the
same culture taken from society with its own
characteristics.
In doing care of clients with mental disorders,
it is necessary to support families because
families occupying vital factor in the treatment
of mental patients at home. This is because the
family is the closest support system for 24
hours together with the patient. Families will
determine whether patients will relapse or stay
healthy. Family consistent support will make
patients able to maintain an optimal treatment
program. In the presence of family members
who experience mental illness, it will affect
the system requirements on the family. This is
consistent with the results of a survey
conducted by Biegel et.al, 1995, quoted from
Stuart and Laraia, 2001, that of families who
have family members with schizophrenia are
at increased stress and anxiety the family, it is
marked by a different response to every
member of the family in readiness receiving
family members who experience mental illness
(Windyasih, 2008).
Based on a preliminary study of the families
who have family members affected by
schizophrenia in the Regional Mental Hospital
Clinic of North Sumatra Province 2014 said
that they were very anxious in the face of the
client because the client is exposed
schizophrenia client can not live independently
and do not want to work so troublesome
families and add the economy burden in the
family to pay for treatment of the client.
Based on the survey of researchers on 27
January 2014 at the North Sumatra Regional
Mental Hospital (RSJ) that the number of
patients with mental disorders outpatient in
2013 from January to December amounted to
15.205 people. Data in the last month which in
December amounted to 1,130 people. This
data was obtained from the Medical Record of
Mental Hospital of province of North Sumatra.
Based on the above background, researchers
are interested in studying how the anxiety
level of the family in the face of schizophrenia
client behavior in the Mental Hospital of North
Sumatra province 2014.
RESEARCH METHODS
This study used a descriptive method to design
"cross-sectional" is a method that can dig a
few variables in the same time to measure how
the anxiety level of the family in the face of
the client's behavior at the Polyclinic
schizophrenia of Mental Hospital of North
Sumatra Province 2014. The study was
conducted at the Polyclinic schizophrenia of
Mental Hospital of North Sumatra Province
2014 in January-May 2014. The population in
this study are families who have family
members with schizophrenia in outpatient at
Polyclinic schizophrenia of Mental Hospital of
North Sumatra Province 2014 as many as
1,130 people in December. Sampling was
done by accidental sampling is to take the case
or the respondent who happened to be there.
The sample size in this study was 42
respondents. The type of data in this study is
composed of primary and secondary data.
Primary data is data obtained directly from the
respondents
by
means
or
through
questionnaires. Secondary data is data
obtained from the Regional Mental Hospital in
North Sumatra Province on the number of
clients with schizophrenia in the Polyclinic.
Data analysis is the measurement of each
respondent's answer, then displayed in the
form of a frequency distribution table that
sought the percentage for each of the
respondents. Data analysis is to describe the
univariate analysis of the percentage of entire
research variables and presented in the form of
a frequency distribution table.
Research Result
The results showed the level of anxiety in the
face of the behavior of the client families
schizophrenia in the Mental Hospital Clinic of
North Sumatra province of Medan 2014 based
on client behavior schizophrenia are
disorganized behavior, catatonic and paranoid.
From the results of this research is that clients
schizophrenia disorganized behavior as much
as 3 respondents (7.1%) regularly and as many
as 39 respondents (92.9%) irregular. Catatonic
behavior as much as 10 respondents (23.8%)
did not catatonic and as many as 32
respondents (76.2%) catatonic. Paranoid
are not paranoid and as many as 35
respondents (83.3%) paranoid. Mild anxiety
levels by 5 respondents (11.9%), while as
many as 10 respondents (23.8%), weigh as
much as 26 respondents (61.9%) and panic as
much as one respondent (2.4%).
Distribution of research results based on the
level of anxiety of respondents schizophrenia
disorganized behavior in Mental Hospital
Clinic of North Sumatra province of Medan
2014 indicate that of the three respondents
(100%) orderly behavior as one of the
respondents (33.3%) were family concerns,
two respondents (66 , 6%), heavy anxiety and
no family with mild anxiety or panic. Of the
39 respondents (100%) disorganized behavior
as much as five respondents (12.8%) families
mild anxiety, 9 respondents (23%) were family
concerns, 24 respondents (61.5%) heavy
anxiety and only 1 respondent (2 , 56%)
categories panic anxiety.
level of catatonic anxiety of schizophrenia
respondents behavior indicates that out of 10
respondents (100%) catatonic behavior as one
of the respondents (10%) mild anxiety, 3
respondents (30%) were family concerns, 6
respondents (60) heavy anxiety and there was
no panic, while families of the 32 respondents
(100%) catatonic behavior as much as 4
respondents (12.5%) mild anxiety, 7
respondents (21.8%) were family concerns, 20
respondents (62.5%) heavy anxiety and only 1
respondent (3.12%) categories panic anxiety.
241
level of anxiety of schizophrenia respondents
with paranoid behavior indicates that of the
seven respondents (100%) are not paranoid
mild anxiety, 3 respondents (42.8%) were
family concerns, 2 respondents ( 28.57%)
heavy anxiety family and no family to panic,
while 35 respondents (100%) paranoid
mild anxiety families, seven respondents
(20%) were family concerns, 24 respondents (
68.5%) heavy anxiety and only one respondent
(2.8%) categories family of panic anxiety.
Discussion
Based on the research that has been done that
every respondent who has a family member
who suffered from schizophrenia have
different anxieties in the face of schizophrenia
clients ranging from mild anxiety, moderate,
severe, and panic. From the results obtained
from this study is the most severe anxiety. For
these conditions, the researchers sought a way
to provide education on the disease of
schizophrenia, positive attitudes of health
workers may also increase the good service so
that
families
get
information
about
schizophrenia in order to face the
schizophrenic client behavior.
The majority of respondents to the client's
behavior is irregular in the regular behavior of
a minority of schizophrenia and each
respondent experienced severe anxiety at
regular or irregular behavior and anxiety panic
disorganized behavior. Disorganized behavior
associated with traits like behavior chaotic,
incoherent speech, hallucinations and often
clear, flat affect, or inappropriate, disorganized
and delusions that often involve sexual themes
or religious. Social impairment is often found
in people with schizophrenia irregular. They
also showed ignorance and giddy mood,
strangulation and speak a no (Jeffrey S. Nevid,
et al 2005). According to the authors based on
research that has been done that the behavior
is not regularly found in the majority of clients
who are experiencing schizophrenia and in
need of support and control of the family
because of the irregular behavior of clients
often neglect their appearance and personal
hygiene and should not be separated from the
drug, and control of health personnel that the
illness recover quickly and do not recur.
242
The behavior of respondents with catatonic
schizophrenia at a client more than catatonic
behavior. Each respondent was experiencing
anxiety weight on whether or not catatonic
behavior and anxiety panic on catatonic
behavior. The main symptoms that
differentiate patients with schizophrenic
catatonic schizophrenia is a disorder other
motor behavior very clearly displayed by
sufferers (APA, 2000). According to the
authors catatonic behavior is a behavior that is
very dangerous for the family and people
around client schizophrenia because it
involves both extremes of motion that a time
could turn into a rowdy phase agitated or
injure another person.
The behavior of respondents with paranoid
schizophrenia clients with the highest number
compared paranoid behavior and each
respondent is experiencing severe anxiety and
paranoid behavior not be being paranoid
anxiety and panic anxiety paranoid behavior.
Paranoid schizophrenics have cognitive
functions and emotions that are relatively
stable, so they tend to be more "normal" when
compared to patients with other subtypes of
schizophrenia (Straus and Aloy, Accolla, and
Bootzin 1996). Thera are also evidence stated
that paranoid schizophrenics tend to have less
severe disruption in the functioning of the
work and functions for independent living
(APA, 2000). According to the authors
paranoid behavior in dire need of attention and
family support so that clients are not dissolved
in the hallucinations of schizophrenia clients.
And should not be separated from family
control, drug and medical personnel so that the
client illness recover quickly and do not recur.
Conclusion
From the results of research on the anxiety
level of the family in the face of the client's
behavior at the Polyclinic schizophrenia
Mental Hospital of North Sumatra province
with the number of respondents 42 people can
be concluded that the majority of families in
dealing with clients on the behavior of
disorganized schizophrenia experience severe
anxiety and panic anxiety minorities. More
families experiencing severe anxiety and are in
dealing with clients on the behavior of
catatonic schizophrenia. More families
experiencing severe anxiety and a little panic
in the face of a client on the behavior of
paranoid schizophrenia.
Suggestion
Suggested to health personnel so that the level
of anxiety experienced by the family in
dealing with family members who have
schizophrenia can be reduced , should increase
counseling on how to cope with anxiety in the
face of behavior clients of schizophrenia.
Expected to clients family in order to keep
control schizophrenia and routinely bring
clients for treatment and further enhance
knowledge
in
dealing
with
clients
schizophrenia. For further research in order to
carry out further research on other variables
that have not been examined in this study .
REFERENCES
Abdi Susanto.2013. 1 Juta Penduduk
Indonesia Berisiko Gangguan Jiwa
Berat-Kedaulatan
Rakyat
Online.(http://health.liputan6.com/read/6
78786/1-juta-lebih-penduduk-Indonesiaberisiko-alami-gangguan-jiwaDiakses 29
Januari)
Aloy, Lauren B, dkk. 1996. Abnormal
Psychology:
Current
Perspectives.
International Edition: McGraw-Hill inc.
Arikunto, S. 2010. Prosedur Penelitian Suatu
Pendekatan Praktik, Edisi Revisi VI,
Rineka Cipta: Jakarta.
Cancro, Robert & Lehman, Heinz E. 2000.
Schizophrenia: clinical features dalam
Kaplan
&sadock’s
comprehensive
textbook
of
Pshychiatry7thedition.
Benjamin J, Sadock’s, dkk. Philadelphia:
lippncott Williams &wilknis.
Ermawati. 2011. Asuhan Keperawatan Klien
Dengan Gangguan Jiwa. Jakarta: CV.
Trans info Media.
Friedman, 1998.Keperawatan Keluarga, Edisi
3. EGC: Jakarta.
Gawil W. Stuart. 2007. Buku Saku
Keperawatan Jiwa, Jakarta: EGC
Gunawan
Pamungkas.2011.Konsep
Kecemasan.
(http://teorikecemasan.blogspot.com/Diakses 2
februari 2014).
Hawari, Dadang. 2009. Pendekatan Holistik
Pada Gangguan Jiwa Skizofrenia.Jakarta:
FKUI.
Hawari, Dadang. 2013. Manajemen Stres,
Cemas dan Depresi, Edisi 2, Cetakan 4.
Jakarta: FKUI.
Jeffrey S. Nevid, dkk.2003. Psikologi
Abnormal. Jilid 2.Jakarta: EGC.
Nasir, Abdul & Abdul Muhid. 2011. DasarDasar
Keperawatan
Jiwa.
Jakarta:Salemba Medika.
Notoadmodjo, S. 2010. Metode Penelitian
Kesehatan. Jakarta: RinekaCipta.
Padila. 2012. Buku
Ajar Keperawatan
Keluarga. Yogyakarta :NuhaMedika.
Politeknik Kesehatan
Kemenkes Medan.
2012. Penyusunan KaryaTulis Ilmiah
Sayyid Siliwangi.2011. KTI Keperawatan
Jiwa
Skizofrenia
Residual
(http://sayyidsiliwangi.blogspot.com/diak
ses 2 Februari 2014)
Suliswati. 2005. Konsep Dasar Keperawatan
Kesehatan Jiwa. Jakarta : EGC.
Videbeck,
Sheila
L.2008.Buku
Ajar
Keperawatan Jiwa. Jakarta: EGC.
Yosep, Iyus. 2011. Keperawatan Jiwa. Jakarta:
Rafika Aditama.
243
MOTHER KNOWLEDGE DESCRIPTION ABOUT DIARRHEA
IN TODDLER
Ratni Siregar
Midwifery Study Program of Padangsidimpuan
Abstract
Diarrheal disease is still a public health problem in developing countries such as Indonesia, due to its
morbidity and mortality are still high. Therefore we need healthy behavior to prevent diarrhea.
Behavior is influenced by knowledge. Purpose of this study to describe mothers' knowledge of
diarrhea in toddler. Design of this research is descriptive with a population of 320 people and a large
sample was determined with a sample of at least 20% ie 64 people. The results showed that by the age
that mother with higher has better knowledge of diarrhea. Higher educated mother has better
knowledge of diarrhea. Based on Parity, the more often the mother giving birth and caring for babies,
the better knowledge of diarrhea.
Keywords: Mother, diarrhea, Toddler
BACKGROUND
Diarrheal disease is still a public health
problem in developing countries such as
Indonesia, due to its morbidity and mortality
are still high. Morbidity survey conducted by
Subdit diarrhea, the Ministry of Health from
2000 s / d in 2010, the tendency incidence
rose. In 2000, Diarrhea 301/1000 inhabitants,
in 2003 rose to 374/1000 population, 2006
rose to 423/1000 inhabitants and in 2010 to
411/1000 inhabitants. Extraordinary Events
(KLB) diarrhea is still often the case, the CFR
is still high. In 2008 outbreaks in the 69th
District of the number of cases of 8133 people,
239 deaths (CFR 2.94%).
In 2009 outbreaks in 24 Districts with the
number of cases 5,756 people, with 100 deaths
(CFR 1.74%), while in 2010 an outbreak of
diarrhea in 33 districts with the number of
4204 patients with 73 deaths (CFR 1.74%.)
(Indonesian Health Ministry, 2011)
One step in the achievement of the MDG's
(Goal to-4) is to reduce child mortality into 2/3
from 1990 to 2015. Based Household Health
Survey (SKRT), Mortality Study and the
Health Research from year to year, it is known
that diarrhea remains a major cause of infant
mortality in Indonesia. The main causes of
death from diarrhea is improper governance
both at home and in health facilities. To
decrease mortality due to diarrhea governance
need rapid and precise (Indonesian Health
Ministry, 2011).
244
Diarrhea is a condition where a person suffers
from diarrhea-diarrhea, watery stool, can be
mixed with blood and mucus sometimes
accompanied by vomiting. So that diarrhea can
cause fluid drained out of the body through
feces. If the diarrhea patients lose a lot of body
fluids then this can lead to death, especially in
toddler and children under five years of age
(Hasan, 2005).
Fairly high incidence of diarrhea in the city
Padangsidimpuan, the problem of diarrhea in
the city in 2012 Padangsidimpuan attack all
age groups for 2016 cases (13.55%). The age
group that is often attacked by diarrheal
diseases are children aged 5 years dibwah
many as 675 cases and school-age children
(elementary and secondary) as many as 409
cases (Padangsidimpuan City Health Office,
2012).
Based on a preliminary survey of researchers
in sustainable padangmatinggi village found of
10 mothers who have children who were
interviewed about the mothers of diarrhea only
four people who know about diarrhea.
Questions include understanding, causes,
prevention and treatment of diarrhea. The
village padangmatinggi sustainable toddlers
figure is also quite high. Or cognitive domain
knowledge is very important for the formation
of a person's actions or behavior. When
knowledge better then expected action or
behavior will be good too.
Therefore, researchers interested in studying
picture mothers' knowledge of diarrhea in
children under five in Sub Padangmatinggi
2015.
Purpose
To describe mothers knowledge of diarrhea in
toddler.
This study can serve as guidelines and
experience as well as a means of selfdevelopment is very valuable, to apply science
in midwifery services. Results of this study are
expected to be input or ideas - new ideas in
applying science in the practice of midwifery
services, especially on diarrhea in toddler.
RESEARCH METHODS
This research is a kind of descriptive research
that aims to reveal the mother's knowledge on
diarrhea On toddlers. The data used are
primary data is data obtained directly from the
respondents. The population in this study are
all mothers who have children aged 0-5 years
in sub padangmatinggi sustainable as many as
320 people. The samples of at least 20% is the
number of samples in this study, so the sample
size is as much as 64 people. Samples obtained
by proportioned stratified random sampling.
After all the data collected with the total, the
researchers conduct data analysis in several
stages, starting with the editing, coding, entry,
and tabulating. Data analysis can be done by
looking at the percentage of the data collected
and presented in the table - the table of
frequency distribution
Table 1. Frequency Distribution of
Respondents by Knowledge
Knowledge
F
Percentage
(%)
Good
16
25
Enough
26
40,62
Less
22
34,38
Total
64
100
Based on the table 1 above it can be seen that
the majority of respondents knowledgeable
enough as many as 26 people (40.62%) and a
good knowledge of minority as many as 16
people (34.48%).
Respondents by Age.
Age
F
Percentage
(Tahun)
(%)
‹20 tahun
16
25
20 – 35 Tahun
20
31,25
›35 tahun
28
43,75
Jumlah
64
100
Based on the above table it can be seen that
the majority of respondents over the age of 35
years as many as 28 people (43.75%) and
minority aged <20 years as many as 16 people
(25%).
Table 3.
Distribution of Knowledge Respondents by
Age
No Age
.
Category
Good
F
%
Enough
F
%
6
37,50
9
45
1 ‹20
2 20 – 35 6
30
3 ›35
35,71 11
10
Less
F
%
10 62,50
5
25
39,29 7
25
Total
f
16
20
%
100
100
28
100
mothers with less than 20 years of age the
majority of less knowledgeable in the amount
of 62.50%. At the age of 20-35 years the
majority of knowledgeable enough in the
amount of 45%, and in the age over 35 years
the majority of knowledgeable enough in the
amount of 39.29%.
Table 4.
Distribution of Respondents by Education
Level
Education Level
Frequency
Percentage
(%)
Basic (SD, SMP)
High (SMA)
University
Total
21
26
17
64
32,81
40,63
26,56
100
Based on the above it can be seen that the
majority of high school educated many as 26
people (40.63%) and college educated
minorities as many as 17 people (26.56%).
245
Table 5.
About diarrhea by Education
No. Pendidikan
1
2
3
Dasar (SD,
SMP)
SMA
Kategori
Baik
Cukup
F
F
%
6
Perguruan
Tinggi
10
23,0
8
58,8
2
Total
Kurang
%
F
38,0 13
9
11 42,3 9
0
7
41,1
8
%
f
%
61,9 21 100
0
34,6 26 100
1
17 100
8
the majority of college education good mother
knowledge that is equal to 58.82%, while the
majority of mothers with primary education
less knowledge that is equal to 61.90%.
Parity
Table 6.
Distribution of Respondents by Parity
Primipara
Scundipara
Multipara
Grandemultipara
Total
Frequency
Percentage
(%)
14
16
19
15
64
21,88
25
29,69
23,43
100
Table 7.
About diarrhea Based on Parity
1.
2.
3.
4.
Good
Category
Enough
f %
F %
F
Primip 1 7,14
ara
Scund 1 6,25 6 37,50
ipara
Multip 5 26,3 1 52,63
ara
2 0
Grand 10 66,6 5 33,33
emulti
7
Total
Less
13
%
92,86
F
14
%
100
9
56,25
16
100
4
21,05
19
100
-
-
15
100
the more often a woman giving birth and
caring for a child, the better knowledge of the
mother would be.
DISCUSSION
Knowledge is the result of sensing out after a
commit to a particular object. Sensing occurs
246
According to the author the assumption that
the mother's knowledge on diarrhea is
influenced by several factors, such as age,
education and parity.
In the opinion of Arikunto, 2002 that will
influence the life of a person would do, in that
it can do a lot and work hard which middle age
will reach the point of peak of his career and
productivity.
In this study is not obtained from the research
gaps, where the higher the better a person's age
knowledge of diarrhea.
Based on Table 6 above it can be seen that the
majority of respondents berparitas multiparas
many as 19 people (29.69%), and a minority
of respondents berparitas primiparity many as
14 people (21.88%).
No. Parity
through human senses are senses of sight,
hearing, smell, taste and touch. Most of the
human knowledge acquired through education,
experience itself, the experience of others, the
media and the environment. Or cognitive
domain knowledge is very important for the
formation of one's actions. Knowledge
requires a physical boost in growing
confidence and encouragement behavioral
attitude every day so that it can be said that
knowledge is a stimulus to the actions of a
person (Notoadmodjo, 2003).
According to the author assuming the higher
the person's age the better the person's way of
thinking. Because a lot of experience in caring
for children during the life of the respondents
obtained. So that mothers will understand
more about the causes and prevention of the
diarrhea events. On the basic of the experience
that the mother's mother is expected to more
quickly find the incidence of diarrhea, how the
prevention of diarrhea that does not occur in
children under five.
Based on the level of education can be seen
that the higher the education level, the better a
person's knowledge. According to Hurlock
(2002), education is also one of the factors that
influence a person's perception because it can
make a person more receptive to new ideas
and new technologies.
The higher one's education is certainly more
extensive information received both formally
and informally, followed by training or
seminars have been followed. A person with
higher education tend to have more curiosity
over again so that the information obtained,
especially health information more widely
accepted than lower educated.
According Prawirohardjo, mothers who have
never given birth would have less knowledge
about diarrhea than those who had never been
pregnant gave birth because the experience
will add to the knowledge and information
gained from either the mother or the health
workers of the mass media and the print
media.
According to the assumptions of researchers,
there is no gap between the theory and the
results achieved, where the results showed that
the higher the mother's parity, the more the
mother's experience in knowing the causes and
treatment of diarrhea for children under five.
So the better knowledge of mothers about
diarrhea for children under five.
Conclusion
1. The majority of respondents knowledgeable
enough as many as 26 people (40.62%) and a
good knowledge of minority as many as 16
people (34.48%).
2. Based on the obtained results that the
mother's age to age less than 20 years the
majority of less knowledgeable in the amount
of 62.50%. At the age of 20-35 years the
majority of knowledgeable enough in the
amount of 45%, and in the age over 35 years
the majority of knowledgeable enough in the
amount of 39.29%.
3. The level of knowledge based education
result that the majority of college education
good mother knowledge that is equal to
58.82%, while the majority of mothers with
primary education less knowledge that is equal
to 61.90%.
4. The more often a woman gave birth to the
better knowledge of the mother would be.
Suggestion
Be able to increase or maintain their
knowledge and add knowledge about diarrhea
to follow health counseling about diarrhea in
the local health center or midwife clinic.
REFERENCES
Arikunto S, 2002, Prosedur Penelitian, Edisi
Revisi V, Penerbit: Rineka Cipta, Jakarta.
Hasan.R. Dkk, 2005, Ilmu kesehatan Anak,
Jakarta: Bagian Ilmu kesehatan Anak
Fakultas Kedokteran UI.
Kemenkes RI, 2011. Situasi Diare di
Indonesia. Buletin dan Jendela Data
Informasi Kesehatan.
Mochtar R, 2002, Sinopsis Obstetri Fisiologi
dan Patologi, EGC, Jakarta.
Nelson WE, 2005, Ilmu Kesehatan Anak,
Edisi 15, Vol. 1. EGC:Jakarta
Ngastiyah, 2005, Perawatan Anak Sakit,
Jakarta: Buku Kedokteran EGC
Notoadmodjo S, 2003, Ilmu Kesehatan
Masyarakat, Cetakan Kedua, Rineka
Cipta, Jakarta.
Prawirohardjo Sarwono, 2002, Buku Acuan
Nasional Pelayanan Kesehatan Maternal
dan Neonatal.
Ramali.A, 2006, Kamus Kedokteran, Jakarta:
Djambatan
247
THE DESCRIPTION OF KNOWLEDGE PREGNANT MOTHER TO
DEGREE GINGIVITIS IN PASAR MIRING VILLAGE OF DISTRICT
DELI SERDANG 2013
Asnita Simaremare, Sondang Siregar, Sri Junita Nainggolan, Reti Pratiwi
Department of Dental Nursing, Health Polytechnic Medan
ABSTRACT
Introduction : A pregnant mother in pregnancy period required knowledge for personal and health
care for the fetus. Especially knowledge in maintaining oral health, in this case the health of the gums.
Because approximately 50-75% of pregnant mother has an experience gingivitis. This is not only due
to the primary factors in the form of plaque and calculus but also because during pregnancy the
hormonal changes. The purpose of this study is to describe the level of knowledge of pregnant mother
on the degree of gingivitis in Pasar Miring Village District Deli Serdang.
Methods : This is a descriptive study with survey method, conducted in 3 months. Data collected in
the form of primary and secondary data. This study population were 32 the first trimester pregnant
mothers and samples taken from the entire population that was 32 maternal in 5 Posyandu. To
measure the level of knowledge about gingivitis pregnant mother by using a questionnaire and doing
examination to known the degree of gingivitis.
Result : From the data obtained the number of pregnant mother with good criteria knowledge level is
9 people (28.1%) and the number of pregnant mother who have gingivitis by 1 person (grade 1) and 8
(grade 2), 22 pregnant mothers (68.8%) had a moderate criteria knowledge level in which the number
of pregnant mothers with gingivitis as many as 6 person (degree 0), 7 person (1st degree), 7 person
(2nd degree) 2 person (3rd degree) and only 1 person (3.1%) with the bad level of knowledge with
gingivitis where there is 1 person (grade 2). It can be concluded from the results of this study, the
level of knowledge of pregnant mothers in the first trimester in Pasar Miring Village, including
criteria being the degree of gingivitis in the second most common. This results indicate that the
degree of gingivitis in pregnant mother is not only influenced by the level of knowledge but also due
to hormonal changes during pregnancy, especially in the first trimester. It is expected for pregnant
mother to always keep the gums healthy by brushing well and properly, to consume fruits and
vegetables that contain fiber and water, cleaning tartar, and check the state of your teeth and mouth to
the dental clinic in order to get action in accordance with the conditions of the pregnant mother.
Keywords: Knowledge Level, Degree Gingivitis
IINTRODUCTION
In the Republic Act no. 23/92 on health,
explaining that to achieve optimal health status
for the community. Organized efforts to
approach health maintenance of health
(promotion), disease prevention (preventive),
the healing of disease (curative), and
restoration of health (rehabilitative), which
conducted a comprehensive, integrated, and
sustainable (Mochtar,2008).
Oral and dental problems in Indonesia is a
public health problem. This is due to public
awareness of oral health maintenance is low.
In the pregnancy period usually devoted
attention to the pregnancy and the baby that
will be born. While attention to other body
parts almost forgotten, because it is not
associated with pregnancy. This opinion is
248
wrong, considering all the members of the
body are basically mutually supporting each
other, thus requiring particular attention.
The higher level of knowledge that one's life
will be more quality, the higher the growth and
well-being of the person. Including pregnant
mother
during
pregnancy
necessary
knowledge for personal and health care for the
fetus. Not only maintain pregnancy health
concerns also maintain oral health, especially
the health of the gums.
Because approximately 50-75% of pregnant
mother has an experience of gingivitis. This is
caused by the primary factors that plaque and
calculus as well as a secondary factor that
hormonal changes. Therefore, it needs a good
knowledge to reduce the negative impact of
gingivitis
during
pregnancy.
(www.pregnancy.org,2005).
According to Maulana (2006), maternal gum
disease or gingivitis is enlarged gums
pregnancy in pregnant mother due to hormonal
activity of the hormone estrogen and
progesterone. Hormone progesterone greater
influence on the process of inflammation.
Hormonal and vascular changes during
pregnancy may aggravate the inflammatory
response to bacteria, especially if the mother
has a medical and dental oral hygiene is poor.
THE AIMS OF STUDY
To describe the level of knowledge about
gingivitis pregnant mother against the degree
of gingivitis in Pasar Miring Village District of
Deli Serdang, 2013. Specifically of this
research to determine the level of knowledge
of pregnant mother about (the causes of
gingivitis during pregnancy, the prevent
gingivitis that occurs during pregnancy, the
average knowledge level of pregnant woman,
and determine the degree of gingivitis that
occurs in pregnant mother, and the last to
determine the knowledge level overview of
pregnant mother about the degree of gingivitis.
METHODS
This research is a descriptive study by using a
survey method to determine the level of
knowledge of mothers understood description
of gingivitis on the degree of gingivitis in
Pasar Miring Village District of Deli Serdang
2013.
The location of this research conducted in 5
Posyandu in Pasar Miring Village District Deli
Serdang 2013. Time research March to Mei
2013.
The population in this study were all pregnant
mothers in the first trimester in Pasar Miring
Village District of Deli Serdang, amounting to
32 people.
Sample of research partly or representative of
the population studied. In this case leads to the
idea Arikunto (2002), when the subject is less
than 100, it is better taken all of the
population. In this study the sampling carried
out on all pregnant women in the first
trimester in Pasar Miring Village District of
Deli Serdang which is the respondent
amounting to 32 people, total population.
The data collected in this study are secondary
and primary data. The collection of secondary
data, namely data obtained from the mother's
midwife clinic of the pregnant mother's womb.
Then the primary data collection is done by
giving questionnaires and examinations
degrees gingivitis pregnant mothers.
The data has been collected, processed
manually
with
the following steps:
1) The process of editing: Performed by
checking questionnaires that had been filled
with the purpose of data results.
2) The process of coding: By changing the
data already collected into the figures to
facilitate data processing.
3) Tabulating: The data that have been
collected are analyzed and presented in the
form of a frequency distribution table.
RESULTS AND DISCUSSION RESULT
From the research that has been done, then the
data obtained knowledge pregnant mothers
about the degree of gingivitis by giving
questionnaires and examinations gingivitis in
32 pregnant mothers in the first trimester in
Pasar Miring Village District of Deli Serdang
2013 are as follows:
knowledge level for pregnant mother about
the causes of gingivitis in Pasar Miring
Village District of Deli Serdang.
Knowledge
Number of Percentage
criteria
Maternity
Good
8
25
Median
23
71,9
Poor
1
3,1
TOTAL
32
100
Table 1 above shown that out of 32 pregnant
mothers are levels of knowledge about the
causes of gingivitis by criteria were as many
as 23 pregnant women (71.9), 8 pregnant
mothers (25%) have a good level of
knowledge of mothers and 1 pregnant mother
(3.1%) had a poor level of knowledge.
249
Table 2. Frequency Distribution Knowledge
Level for pregnant mother about the
Prevention of Gingivitis in Pasar Miring
Village Merbau District of Deli Serdang
Knowledge of Number of Percentage
Criteria
Maternity
Good
9
28
Median
22
68,9
Poor
1
3,1
TOTAL
32
100
From table 2 above shown that out of 32
pregnant mothers, there is a degree of
knowledge of pregnant mother on the
prevention of Gingivitis with median
knowledge level were as many as 22 pregnant
mothers (68.9%), 9 pregnant mothers (28%)
have a good knowledge level and one pregnant
mother (3.1%) had a poor level of knowledge.
Table 3. Average Level Knowledge
Pregnant Mother in Pasar Miring Village
District of Deli Serdang
Knowledge
Criteria
Level
Good % Medium % Poor
Maternity
The level of
knowledge of
pregnant
8
25
23
71,9
1
mothers about
the causes of
gingivitis
The level of
knowledge of
pregnant
mothers
9
28
22
68,75 1
about the
prevention of
gingivitis
Average
9
28,1 22
68,8 1
%
3,1
3,1
3,1
Based on the table 3 shown that the average
pregnant mother who has a good knowledge
level is 9 person (28.1%), 22 pregnant mothers
(68.8%) with a moderate level of knowledge
and one pregnant mother (7%) with the level
of poor knowledge.
Table 4. Frequency Distribution Degree of
Gingivitis for Pregnant Mother in Pasar
Miring Village District of Deli Serdang
Number of
Degree of
pregnant
%
Gingivitis
mother
Degree 0: Nothing
gingivitis
250
6
18,7
Degree 1: slight
inflammation, no
bleeding when
probing
Grade 2: moderate
inflammation,
slight bleeding on
probing
Grade 3: severe
inflammation,
spontaneous
bleeding on
probing
TOTAL
8
25
16
50
2
100
32
100
4. From the table above it can be seen that
there are 32 pregnant mothers who have been
examined found 6 pregnant mother (18.7%)
had gingivitis degrees 0, 8 pregnant mother
(25%) had gingivitis degree 1, 16 pregnant
mother (50%) gingivitis degree 2, and 2
pregnant mothers (6.3%) experienced grade 3
gingivitis.
Table 5. Overview Knowledge Level
Against Pregnant Mother About Gingivitis
Gingivitis Degrees in Pasar Miring Village
District of Deli Serdang.
Degree of
Knowledge
Gingivitis
Amount %
Level
0 1 2
3
Good
9
28,1 - 1 8
Medium
22
68,8 6 7 7
2
Poor
1
3,1 - - 1
TOTAL
32
32
6 8 16 2
From the data obtained in this study, it was
found the number of pregnant mother with
good knowledge of the criteria level is 9
person (28.1%) where the number of pregnant
mother who have gingivitis by 1 person (grade
1) and 8 (grade 2), 22 pregnant mothers
(68.8%) had a moderate level of knowledge in
which the number of pregnant mothers with
gingivitis as many as 6 people (degree 0), 7
person (grade 1), 7 (2nd degree), and 2 (grade
3), and 1 pregnant mother (3.1%) with the
level of knowledge with gingivitis bad only
one person (grade 2)
Discussion
Based on the data that has been obtained from
32 pregnant mother in the first trimester in
Pasar Miring Village Merbau District of Deli
Serdang in 2013 found that the level of
knowledge about the causes of gingivitis for
pregnant mothers with good criteria as much
as 8 pregnant mothers (25%), 23 pregnant
mothers (71, 9%) with moderate criteria and 1
pregnant mother (3.1%) had a poor level of
knowledge. While the results of a
questionnaire on the prevention of gingivitis
found 9 pregnant mothers (28%) have a good
level of knowledge, with the criteria being as
much as 22 pregnant mothers (68.9%), and
one pregnant women (3.1%) had a poor level
of knowledge.
The average level of knowledge of pregnant
mother who included both criteria are 9 person
(28.1%), 22 pregnant mothers (68.8%) with a
moderate level of knowledge and one pregnant
women (3.1%) with a poor level of
knowledge. This indicates that the level of
knowledge of pregnant mothers about
gingivitis in Pasar Miring Village, including
criteria for being. According the theory that
knowledge is influenced by education, media
and exposure information, (Notoatmodjo,
2003). Pregnant mothers in Pasar Miring
Village have an average education level high
school / equivalent and never get information
about gingivitis from television or newspaper
media.
From the results of gingivitis of 32 pregnant
mothers there are 6 pregnant women (18.7%)
had gingivitis degrees 0, 8 pregnant mothers
(25%) had gingivitis degree 1, 16 pregnant
mothers (50%) had gingivitis degree 2, and 2
pregnant mothers (6.3%) had gingivitis degree
3. Most of the pregnant mothers in the first
trimester in Pasar Miring Village gingivitis
degree 2 that occurs inflammation being in the
form of gingival redness, edema and slight
bleeding occurs when probing. It is due to
hormones
pregnancy,
estrogen
and
progesterone, the risk of inflammation or
gingivitis be larger. Gingivitis gravidarum
medical terms, pregnancy gravidarum, or
hyperplasia gravidarum.
(www.pregnancy.org).
From the data obtained in this study, it was
found the number of pregnant mothers with
good knowledge of the criteria level is 9
people (28.1%) where the number of pregnant
mother who have gingivitis by 1 person (grade
1) and 8 (grade 2), 22 pregnant mothers
(68.8%) had a moderate level of knowledge in
which the number of pregnant women with
gingivitis as many as 6 people (degree 0), 7
person (grade 1), 7 (2nd degree), and 2 (grade
3), and 1 pregnant mother (3.1%) with the
level of knowledge with gingivitis bad where
there is one person (grade 2). It can be
concluded from the results of this study, the
level of knowledge of pregnant mother in the
first trimester in Pasar Miring Village,
including criteria being the degree of gingivitis
2 is the most common form of gingival
inflammation was on a reddish color, there is a
slight edema and bleeding on probing.
In other words gingivitis is not only influenced
by aspects of knowledge, but there are many
other factors that also affect the occurrence of
gingivitis. So although the level of knowledge
of pregnant mothers including criteria were
however most pregnant mother experience
gingivitis first trimester of 2nd degree.
Cause of gingivitis during pregnancy is a
primary factor in the form of local irritation
from plaque and tartar because during
pregnancy there is a change in the
maintenance of oral hygiene that may be
caused by feelings of nausea, vomiting, feeling
of fear when brushing your teeth due to gum
bleeding arise or the mother is too tired with
her pregnancy so she lazily brushing teeth.
This situation by itself would add to the
buildup of plaque that aggravate the situation
gums of pregnant mother. In addition the
secondary factors such as an increase in the
concentration of hormones, causing dilation of
blood vessels resulting in increased blood flow
to the gums become more red, swollen and
bleed easily. The act of gingivitis treatment in
pregnant mother is to eliminate all kinds of
local irritation that plaque and tartar by
brushing teeth properly and clean the tartar.
Pregnant mothers should also check the state
of your teeth and mouth to dental clinics so
that appropriate countermeasures can be given
to pregnant mother as well as consume fruits
that contain vitamin C and vegetables contain
water and fiber (Maulana, 2006).
CONCLUSION
From the research that has been done shown of
a knowledge level against pregnant mother
about Gingivitis degrees in Pasar Miring
Village Merbau District of Deli Serdang in
251
2013 with a sample of 32 pregnant mother in
first trimester, it can be concluded as follows:
1. The level of knowledge of pregnant women
about the causes of gingivitis in Pasar
Miring Village District of Deli Serdang in
2013 were most numerous in the category
of being as many as 23 person (71.9%).
2. The level of knowledge of pregnant mother
on the prevention of gingivitis in Pasar
Miring Village District of Deli Serdang in
2013, the most numerous category where
that 22 person (68.75%).
3. The average level of knowledge of
pregnant mother in Pasar Miring Village
District of Deli Serdang District in 2013
including the criteria being that 22 pregnant
mothers (68.8%).
4. The degree of gingivitis of 32 pregnant
women in Pasar Miring Village District of
Deli Serdang In 2011, the most widely
experienced by pregnant mother is the
degree of gingivitis 2 of the 16 pregnant
mother (50%).
5. The level of knowledge about gingivitis
pregnant mother on the degree of gingivitis
is a good criterion of knowledge level is 9
people (28.1%) where the number of
pregnant mother who have gingivitis by 1
person (grade 1) and 8 (grade 2), 22
mothers pregnant (68.8%) had a moderate
level of knowledge in which the number of
pregnant mother with gingivitis as many as
6 people (degree 0), 7 person (grade 1), 7
(2nd degree), 2 (grade 3), and 1 pregnant
mother (3.1%) with the level of knowledge
with gingivitis bad where there is one
person (grade 2).
SUGGESTION
1. It is expected that the cadre's or midwife
can provide counseling to pregnant mothers
in every implementation Posyandu. To
increase knowledge and awareness of
pregnant mothers in the village sloping
252
market in terms of maintaining oral health,
especially the health of the gums.
2. It is expected that the cadre's or midwife
attention to the state of the gums of
pregnant mother, especially in the first
trimester so as to reduce the negative
impact of gingivitis that occurs during
pregnancy.
3. It is expected for pregnant mother to
always keep the gums healthy by brushing
well and properly, to consume fruits and
vegetables that contain fiber and water,
cleaning tartar, and check the state of your
teeth and mouth to the dental clinic in order
to get action in accordance with the
conditions of the pregnant mother.
REFERENCES
Arikunto, S., 2002, Procedure Research,
Rineka Cipta, Jakarta
Houwink, B., et al, 1993, Preventive Dentistry,
Gadjah Mada University Press,
Yogyakarta
Ircham, M., 1994, Taking Care of Dental
Health and Mouth, Liberty, Jakarta
Machfoedz, I., 2008, The Research
Methodology
(Qualitative
and
Quantitative), Fitramaya, Yogyakarta
Maulana, M., 2006, The Intelligent Facing
Pregnancy and Baby Sitting, AR-Ruzz
Media, Yogyakarta
Mochtar, M., et al, 2008, Science Teeth and
Mouth Disease, Yoga Ink, Medan
Notoatmodjo, S., 2005, The Health Research
Methodology, Jakarta
Nurfarida 2009, Scientific Paper, Polytechnic
Ministry of Health, Medan
Panjaitan, M., 1995, Preventive Dentistry,
University of North Sumatera Press,
Medan
Pintauli, S., 2008, Improve of Dental Health
and
Mouth,University
of
North
Sumatera Press, Medan
KNOWLEDGE ABOUT FLUOR ALBUS HAZARDS TO PREGNANT
WOMEN AT SUNDARI GENERAL HOSPITAL 2012
Yusrawati Hasibuan
Midwifery Departement of Poltekkes Kemenkes Medan
Abstract
One of the most important organs and sensitive area that require special care is reproductive. In
Indonesia, women who experience vaginal discharge, more than 75%. Fluor Albus closely related to
humid weather conditions that facilitate development of fungal infection. Fluor Albus occurs almost
in all ages, including during pregnancy, which can result in a high risk, premature rupture of
membranes, so that premature birth or babies born with low birth weight. This study is cross
sectionale, The population of all pregnant women who come to the Sundari General Hospital of
Medan in April 2012 as many as 67 people with accidental sampling. Results of research knowledge
pregnant women about the dangers of vaginal discharge during pregnancy majority less (70.1%).
Based education is basic education 52.2%. Sources of information about flour albus 13.4% obtained
from the family environment and 56.7% of the mass media. Primigravidae 34,4% and 11.9% of
grandemultipara. Obtained relationship between knowledge about the dangers of fluor albus with
resources and pregnancy.
Keywords
: Knowledge, Pregnancy, Flour Albus
BACKGROUND
One of the most important organs and
sensitive and require special care is
reproductive. Knowledge and good care is a
decisive factor in maintaining reproductive
health, if not kept clean will cause infection.
One of the signs and symptoms of infectious
diseases of the female reproductive organ is
the occurrence of fluor albus. Fluor albus is
one problem that has long been an issue for
women . In the case of the reproductive
physiological, many women complain of
vaginal discharge and felt very uncomfortable,
itchy, smelly, sometimes even sore. Results of
the study of female reproductive organs , it
turns fluor albus related to daily habits ,
namely a lack of self-awareness of organ
intimate hygiene ( Manuaba , 2008) .
Fluor albus disease affects about 50% of the
female population and about almost at all ages.
In Indonesia, over 75% had experienced
vaginal discharge. It is closely related to
humid weather conditions that facilitate
development of fungal infection such as that of
the fluor albus disease (Korekjos, 2011).
Pregnant women also often experience vaginal
discharge during pregnancy (Elmanan, 2011).
According Dwina (2008), a woman more
susceptible to vaginal discharge during
pregnancy, during pregnancy because of
hormonal changes that one consequence is an
increase in the amount of fluid production and
a decrease in vaginal acidity. All of this
contributes to an increased risk of vaginal
discharge, especially those caused by fungal
infections.
Discharge can be normal (physiological) and
abnormal (pathological). Under normal
circumstances, the discharge tends to clear or
slightly yellow and viscous like mucus and is
not accompanied by the smell or itching.
However, if the discharge is accompanied
odor, itching, pain when urinating or color is
greenish or mixed with blood, then this can be
considered abnormal (Ellya, 2010).
Fluor albus in pregnant women can lead to a
high risk in the early amniotic, so that
premature birth or babies born with low birth
weight. The most common cause of abnormal
253
vaginal discharge is infection. Three factors
that affect their own bodies, environmental
and viruses or germs. Figures overall
prevalence of vaginal discharge is not known
for certain, largely because the condition is
often diagnosed and treated solely by the
patient (Yuxie, 2008).
Qomariah (2002) explained that the
Reproductive Tract Infection (RTI) is a global
health problem whose effects are infertility,
ectopic pregnancy, miscarriage, premature
rupture of membranes, increased risk of
contracting HIV and even death. It is shown
that the vaginitis is the most common
gynecological problems occur in primary
health care and 90% are caused by bacterial
vaginosis, candidiasis and trichomoniasis.
Data Cipto Mangunkusumo hospital, from 71
cases of flour albus, with complaints of itching
amounted to 86.1%, with 87.5% of complaints
burning, and fluor albus 81.1% (Medical,
2008).
RESEARCH METHODS
This study is cross sectionale . The population
of all pregnant women who come to the
Sundari General Hospital of Medan in April
2012, the average pregnant women who visit
each month 200 people , sample as many as 67
people. Sampling with accidentally. The X2
test analysis used to determine the relationship
of the characters of pregnant women with
vaginal discharge.
254
RESULTS
1. Knowledge
Chart 1
Distribution of Respondent
Knowlegde About FlourAlbus at
Sundari Hospital of Medan 2012
Based on chart.1 by 47 ( 70.1 % ) pregnant
women have lack knowledge about the
dangers of flour albus.
Chart 2
Respondent Sources of Information at Sundari
General Hospital of Medan in 2012
Based chart.2 as much as 9 ( 13.4 % ) pregnant
women gain knowledge about the dangers of
flour albus from families and 56.7 % of the
mass media .
3. Education Distribution
Chart 3
Distribution of Respondent Education at
Sundari General Hospital in 2012
Based chart.3 of 35 ( 52.2 % )pregnant women
have a basic education.
4. Pregnancy
Chart 4
Distribution of Respondent According to
Pregnancy at Sundari General Hospital in
2012
Based on chart 4, majority respondents were
grandemultigravida as many as 11,8% and
primigravida as many as 34,3%.
DISCUSSION
1. Knowledge
Based on the chart 1 the majority of pregnant
women knowledge about flour albus were less
(70.1%). Knowledge is the result of the idea,
and this occurred after people perform sensing
on a particular object. Sensing occurs through
the five senses, the senses of sight, hearing,
smell, taste and touch. Most of the human
knowledge acquired through the eyes and ears.
According to Nursalam (2007) generally a
good knowledgeable person will behave
properly in accordance with what he knows
and knows what benefits derived from such
behavior, whereas less knowledgeable person
will behave less well because they do not
know about the objectives, benefits in personal
care or hygiene vagina. Clean the vagina does
not need to use excessive vaginal cleaning use
ordinary soap is enough to avoid kejadinya
whitish (Murtiastutik, 2009). Discharge
prevention by avoiding the use underwear that
is too tight, the use of underwear made from
nylon or polyester (cotton) and do not use
excessive vaginal cleaning wash the genital
area from front to back instead of vice versa in
order not to infect bacteria from the anus to the
vagina.
The source of information is everything that
mediates who provide information, stimulate
the mind and ability. By getting information
about health, one can determine and change
behavior to get a healthy lifestyle. After
getting this information, so that the person will
behave according to their knowledge. In the
second chart, as many as nine (13.4%).
pregnant women gain knowledge about the
dangers of flour albus of families and 56.7%
of the mass media. When traced more
pregnant women are a source of information
about the whiteness comes from a family.
Morepregnant women to get information about
health or danger of discharge from many
sources, then the mother can change her
behavior in accordance with the knowledge or
information he got. So that the mother can
prevent complications during pregnancy and
mothers can live healthily.
3.Education
Based chart.3 of 67 respondents as many as 35
(52.2%) have basic education (primary school,
secondary school). According to Notoadmojo
(2003), education has the most important role
in determining the quality of the human being.
Education is essentially an event of delivering
a message to the community, group or
individuals in obtaining better knowledge. So
the higher one's education is the easier of the
person receiving the information. With higher
education, the person will tend to be easy to
get the information. The more information the
more knowledge in the can, and is more
exposed compared with lower educated.
The results are consistent with Mc Carthay and
Maine (1992) in Lubis (2012) says that women
with higher education tend to be more
255
attention to the health of himself and his
family.
4. Pregnancy
Based on the chart 4. grandemultigravida
obtained as much as 11.8% and 34.3% were
primigravidae. Primigravidas is generally less
knowledge about
flour
albus while
grandemultigravida were the majority have a
good knowledge of flour albusand no less
knowledgeable because they already have
experience in previous pregnancies, so that
they are more aware of the dangers of vaginal
discharge during pregnancy and to prevent the
risk of complications to baby.Respondent with
less knowledgeable majority occur because of
the lack of experience possessed by
respondents that have not been used to the
things that will affect pregnancy, besides that
the majority of respondents also have a basic
education so that mindset and undeveloped
knowlwedge to accept the information
obtained, this research also obtained better
than primigravidae and multigravida.
CONCLUSION
From the research that has been done can be
concluded that the majority of respondents are
knowledgeable about as much as 70.1%.
Respondents who obtained the majority of
resources from less knowledgeable family.
Education respondents in basic education as
much as 52.2%. Primigravidas majority of
respondents are less knowledgeable and
grandemultigravida majority of the good
knowledge of flour albus. The higher the
education, the better knowledge. Respondents
multigravida have better knowledge than
primigravidae. So the more often pregnant
women, then the better knowledge will
received by mother about the dangers of
vaginal discharge during pregnancy.
SUGGESTION
For pregnant women are expected to be able to
increase their knowledge about the dangers of
vaginal discharge during pregnancy, to prevent
complications for both mother and baby.
Increased knowledge can be done through the
256
mass media and attending health education
either given health care workers and other
informants.
For health workers are expected to be able to
improve services through health promotion
and dissemination to all pregnant women and
families about the dangers of vaginal
discharge during pregnancy, because of the
results very little fluorine albus respondent
gets knowledge of health care workers.
REFERENCES
Andira.,S.2010. Kesehatan
Reprodiksi.Yogyakarta. EGC
Arikunto,Suharsimi.
2003. Prosedur
Penelitian. Jakarta: Rhineka Cipta
Elmanan.2011. Miss V. Yogyakarta: Buku
Biru
Ellya eva,dkk. 2010. Kesehatan Reproduksi
Wanita. Jakarta: TIM
Hidayat. 2010.Metode Penelitian Kebidanan
dan Teknik Analisis Data. Jakarta:
Salemba Medika
Kasdu.2005. Solusi
Problem
wanita Dewasa. Jakarta: Puspa Sehat
Kenneth,Levene J. 2009. Obstetri williams.
Jakarta: EGC
Nursalam. 2003,Konsep & Penerapan
Metodologi
Penelitian
Ilmu
Keperawatan. Jakarta:
Salemba
Medika
Notoatmodjo,S.2007. Promosi Kesehatan dan
Ilmu Perilaku. Jakarta: Rhineka Cipta
________,S.2007. Pendidikan dan Perilaku
Kesehatan. Jakarta: Rhineka Cipta
Manuaba.2008. Memahami
Kesehatan
Reproduksi Wanita. Jakarta: Arcan
________.2008.Gawat-Darurat-ObstetriGinekologi&Obstetriginekologi
Sosial untuk Profesi Bidan. Jakarta.
EGC
________.2009. Memahami
Kesehatan
Reproduksi Wanita. Jakarta: Arcan
________.2010. Ilmu Kebidanan, Penyakit
kandungan, dan KB. Jakarta: EGC
Pujiningsih.2010. Permasalahan Kehamilan
yang Sering Terjadi. Yogyakarta: Oryza
KNOWLEDGE AND ATTITUDES RELATIONSHIP
OF DIABETICS PATIENTS AGAINST DIABETIC ULCERS INCIDENT
AT MEDAN PETISAH COMMUNITY HEALTH CENTER
(PUSKESMAS)WORK AREAS 2013
1
1
Dina Yusdiana Dalimunthe
Abstract
Background: Diabetes mellitus is a state of chronic hyperglycemia accompanied by metabolic
disorders due to hormonal disturbances, which cause a variety of chronic complications in the eyes,
kidneys, nerves and blood vessels and accompanied by lesions in the basal membrane in the
examination with an electron microscope.
Objective: To determine the relationship of knowledge and attitude of Patients with diabetes on the
incidence of diabetic ulcers in the working area of Petisah health centers in 2013.
Methodology: This study uses correlation analytic design with cross sectional approach. Total sample
is 35 person taken by using accidental sampling technique in Medan Petisah community health center.
Results: The results showed that 16 person (46%) both knowledgeable and 8 (23%) knowledgeable
enough. Having a positive attitude as much as 22 person (63%) while the negative attitude as many as
13 person (37%). The majority of respondents that do not suffer from diabetic ulcers were 19 person
(54%) with positive insidence, while a minority of respondents who did not suffer from diabetic
ulcers 2 (6%) to be negative on the incidence of diabetic ulcers. There is a significant relationship
between knowledge and attitudes on the incidence of ulcers of diabetic patients in Medan Petisah
community health center in 2013 with p value <0.05.
Conclusions and Recommendations: Because there is a significant relationship between knowledge
and attitudes on the incidence of ulcers of diabetic patients, it is expected that person with diabetes
mellitus are more favorable to what was already known that health problems such as diabetic ulcers it
happened increasingly unavoidable.
Keywords: Knowledge, attitudes, diabetes mellitus, diabetic ulcers
BACKGROUND
Long term plan of development in the health
sector is the implementation of quality health
care, equitable, human and able to realize a
strong, healthy, intelligent, and productive. For
the health development of human resources
directed to improving the welfare of families
and communities, and heighten public
awareness of the importance of life. To realize
optimal public awareness organized health
efforts with thorough approach to health care,
one of them with the knowledge of diabetes
mellitus (Health Ministry, 2008).
Diabetes become a serious illness and received
attention in the community. This is because
diabetes can lead to complications that attacks
the entire body. Diabetes Mellitus case today
continues to rise with increasing levels of
affluence, changing lifestyle and diet, as well
as age (Badawi, 2009).
Everyone can suffer from Diabetes Mellitus
both young and old. High levels of blood
glucose continuously or prolonged exposure
may cause complications of diabetes.
Based on research of Murray (2000), every 19
minutes there is one person who is blind and
one person in the world amputated due to
complications of Diabetes Mellitus. Various
complications can occur if the management of
Diabetes Mellitus is not optimal (Maulana,
2009).
According to World Health Organization
(WHO) data (2007) the number of patients
with Diabetes Mellitus in the world reached
246 million person, which is about 40% of the
total world population. The first of the highest
order, namely India (37.77 million), China
(20.8 million), followed by the United States
(17.7 million) and which ranks fourth, namely
Indonesia (17 million) peoples with diabetes
mellitus. In 2000, there were approximately
257
5.6 million of Indonesian peoples who suffer
from diabetes mellitus. However, in 2006 this
number increased sharply to 14 million
peoples and a continuous increase in number
from year to year, and in 2007 reached 17
million (Pearson, 2008).
Diabetes is one of the most expensive disease
to treat because it requires long-term care, not
only to regulate blood sugar levels, but is also
associated with serious medical complications.
Many person in these countries can not afford
to buy the drugs they need to control their
diabetes. Similarly, countries with little public
health budgets. They must find cost-effective
ways to prevent the disease at an early stage or
treat complications in a way that is more
effective as exercising and eating healthy
foods regularly. If not, it will be at risk of
diabetes. That is how they control diabetes
(Carol, 2011).
Research results related diabetes mellitus has
been done by Barry J. Goldstein in various
countries such as Asia, Latin America and the
Middle East, recorded 21% of patients with
this disease did not control routine to their
specialist physician. More than half (58%) of
the physicians surveyed believe that patients
do not always tell them about the progression
of the disease so that the doctors can not help
with the maximum. In Asia, Latin America
and the Middle East nearly three-quarters of
patients (74%) surveyed said that will be very
useful when there is good communication
between health workers with diabetes mellitus
patients. This shows the lack of public
knowledge due to a lack of communication
between health workers and patients with
diabetes mellitus or otherwise. (Harold, 2012).
According Sidartawan (2008), the increasing
prevalence of diabetes mellitus in several
developing countries lately still highlighted.
Increasing per capita income and changes in
lifestyle, especially in big cities caused an
increase in the prevalence of degenerative
diseases, such as diabetes called diabetes,
coronary heart disease (CHD), hypertension,
and others. Diabetes has also been included in
the list of "Asian disease". In 2003 alone an
estimated 89 million person in Asia suffer
from diabetes. Recorded 4 of 5 countries in the
world with the largest number of diabetics in
Asia, namely: India (32.7 million person),
China (22.6 million person), Pakistan (8.8
258
million person), and Japan (7.1 patients ).
While the number of patients with diabetes
mellitus is found in Southeast Asia: Singapore
10.4%, Thailand 11.9% 8% Malaysia and
Indonesia 5.7%.
Of Indonesia's population, diabetes mellitus is
approximately 17 million person (2006) in
which only 50% were aware of diabetes and
among them only 30% who came for treatment
regularly and about 15% among patients with
diabetes mellitus gangrene will experience
during life. Person with diabetes mellitus need
to give more attention to the health of the feet
because diabetes can cause complications
known as diabetic foot (diabetic foot).
Diabetic foot is one of the complications of
diabetes are still unnoticed. Whereas the
consequences of the diabetic foot is already
deteriorated can cause gangrene and lead to
amputation (Nabyl, 2009).
Based on preliminary surveys that have been
conducted by researchers on February 26,
2013 in Medan Petisah community health
center (Puskesmas) , the number of patients
with Diabetes Mellitus were 414 patients
recorded in 2010. Subsequently , in 2011
recorded 451 person and in 2012 there were
475 patients . In other words , person with
diabetes mellitus is increasing from year to
year and became one of the 10 top health
problems in the health center.
Therefore, researchers interested in conducting
research on knowledge and attitudes
relationship of diabetics patients against
diabetic ulcers incident at Medan Petisah
community health center (puskesmas) work
areas in 2013.
RESEARCH METHODS
The type of this research is the correlation
analytic method that studies find a relationship
between the dependent variable and
independent variables. The study design was
cross-sectional approach where data each
variable measured in the same time.
(Nursalam, 2010). This study was conducted
in Medan Petisah Community Health Center
(Puskesmas) .This study began in April 2013
till June 2013. As for the population in this
study were all patients with diabetes mellitus
in Medan Petisah Community Health Center
(Puskesmas) as many as 475 patients in 2012,
with an average of 39 person per month. The
sample size in this study was 35 respondents.
With a sampling technique is done by
Accidental Sampling by coincidence anyone
who met the appropriate requirements and
desired data. The type of data in this study
consisted of primary data and secondary data.
Primary data is data obtained directly from
respondents
through
questionnaires.
Secondary data is data obtained from Medan
Petisah
Community
Health
Center
(Puskesmas) about the data amount with
diabetes who come to the clinic for treatment.
Data processing techniques through: 1)
Editing, Before the data obtained by checking
the data to check the questionnaires that have
been entered, clarify, see the completeness,
accuracy in testing the questionnaire; 2)
Coding, Editing Once done, followed by
encoding the data to facilitate the entry of data
by computerized methods; 3) Cleaning the
data, carried out when there is an error in
entering the data; and 4) Tabulating, to
simplify data analysis, data processing and
retrieval of data conclusions incorporated into
a frequency distribution table.
Data were analyzed with:
a. Univariate analysis
This analysis is used to determine descriptive
overview of each variable. Data collected and
analyzed descriptively by looking at the
percentage of the collected data and generate
the proportion of each of the variables being
measured and presented in the form of a
frequency distribution table.
b. Bivariate analysis
This analysis was conducted to look at the
significance level of the relationship between
independent variables and the dependent
variable. Statistical tests were used to analyze
the relationship between any independent
variables (knowledge and attitude) with
dependent variables (incidence of diabetic
ulcers) in this study is the chi-square test for
scale independent variables and the dependent
variable is categorical scale. Confidence level
used is 95% with a significance level of =
0.05.
The provisions of meaningful relationship if ρ
values <0.05. Ha received means that there is a
significant correlation between the two
variables studied and the relationship is said to
be significant if ρ value> 0.05. Ha rejected.
Research Result
From the results of a study of 35 respondents
based on the respondents' knowledge on the
incidence of diabetic ulcers in Medan Petisah
Community Health Center in 2013, majority of
16 person (46%) good knowledge of 8 person,
while a minority (23%) knowledgeable
enough. Attitudes of respondents to the
incidence of diabetic ulcers at Medan Petisah
Community Health Center in 2013 and the
majority of respondents have a positive
attitude as much as 22 person (63%), while
respondents with a negative attitude as many
as 13 person (37%). The incidence of diabetic
ulcers majority of respondents did not suffer as
much as 21 person (60%), while a minority
suffer from as many as 14 person (40%).
2. Analysis Bivariat
From the results of research conducted on 35
respondents obtained knowledge of the
distribution of the results of the relationship of
diabetes mellitus on the incidence of Diabetic
Ulcers in Medan Petisah Community Health
Center, as in Table 1 below:
Table 1.
Distribution of Respondents Frequency
According To Diabetic Mellitus Patients
Knowledge to Diabetic Ulcers Incident At
Medan Petisah Community Health Center
2013
Ulkus Diabetikum
Incident
Knowled
No
Do not
ge
Suffers
Suffer
F
% F
%
1 Good
2
6
14 40
2 Enough 3
8
5
14
3 Less
9
26 2
6
Total
14 40 21 60
Total ρvalue
F
16
8
11
35
%
46
23
0,001
31
100
From Table 1 above, Distribution of
Respondents Frequency According To
Diabetic Mellitus Patients Knowledge to
Diabetic Ulcers Incident At Medan Petisah
Community Health Center 2013, can be seen
that of the 16 respondents knowledgeable
good majority of a total of 14 person (40 %)
and do not suffer incidence of diabetic ulcers,
followed of 11 respondents knowledgeable
less , the majority were 9 person (26 %) suffer
from diabetic ulcer incidence and from 8
259
respondents knowledgeable enough majority
as much as five person (14 %) do not suffer
the incidence of diabetic ulcers .
While the distribution of the attitude of person
with diabetes mellitus relation to the incident
Diabetic Ulcers in Medan Petisah Community
Health Center can be seen in table 2 below :
Table 2.
Distribution of Respondents Frequency
According To Diabetic Mellitus Patients
Attitudes to Diabetic Ulcers Incident At
Medan Petisah Community Health Center
2013
Ulkus Diabetikum
Incident
ρTotal
No Attitude
valu
Do not
Suffer
e
suffer
F
% F % F %
1 Positive 3
9% 19 54% 22 63%
2 Negative 11 31 2
6% 13 37%
0,000
%
Total
14 40 21 60 35 100
From Table 2 that explained the distribution
of respondents frequency according to diabetic
mellitus patients attitudes to diabetic ulcers
incident at Medan Petisah Community Health
Center 2013 can be seen that the positive
attitude of the majority of the 22 respondents
were 19 person (54%) do not suffer the
incidence of diabetic ulcers and of 13
respondents majority being negative as many
as 11 person (31%) do not suffer incidence of
diabetic ulcers.
Discussion
Based on the analysis Chi Square (Person Chi
Square) knowledge and attitude of person with
diabetic ulcers on the incidence of diabetic
ulcers, acquired respectively p-value <0.05
with a confidence level of 95%. This shows
that there is a statistically significant
relationship between knowledge and attitudes
on the incidence of ulcers of diabetic patients
in Medan Petisah Community Health Center in
2013.
Results of a study of patients with diabetes
mellitus knowledge in accordance with the
theory of Henry and Goddess (2012) that
knowledge is the result out and this happened
after person hold to a particular object sensing
happens through the human senses of sight,
hearing, smell, taste and touch with their own
260
.With the basic knowledge proves that
respondents who have a good knowledge not
suffer from diabetic ulcers in patients with
diabetes mellitus. While the attitude is a
reaction or response of someone who is still
closed to a stimulus or object. Stimulus
received related to the knowledge of person
with diabetes mellitus on the incidence of
diabetic ulcers will determine the patient in
addressing this.
This study is in line with the theory of
Notoadmodjo (2007), states that knowledge is
strongly influenced by education as in patients
with diabetes mellitus. If the knowledge of
patient well then there is no diabetic ulcers as
many as 14 person (40%). It must be
emphasized also that does not mean someone
who is less educated lower the absolute
knowledge. It is given that the increase is not
absolute knowledge gained from formal
education, but also obtained through nonformal education such as print media,
electronic, health education that will increase
someone knowledge. As in this study, there
were 2 person (6%) were suffering from
Diabetic ulcers. Notoatmodjo (1997), quoted
by Wawan and Goddess (2010) also expressed
the attitude is a reaction or response of
someone who is still closed to a stimulus or
object. Stimulus received related to the
knowledge of person with diabetes mellitus on
the incidence of diabetic ulcers will determine
the patient in addressing this.
Researchers assumptions about knowledge:
the knowledge of someone can be influenced
by several factors: education, interests,
experience,
age,
and
environmental
information. Education greatly affects a person
to have a good knowledge. The more
education obtained from both formal and nonformal education to be better knowledge.
Researchers assumptions about attitudes can
be formulated that attitudes towards certain
things is influenced by several factors:
personal experience, the influence of others
that are considered important, the influence of
culture, media and emotional factors. Greatly
affect someone experience to have the positive
attitude towards the events that happened. The
more experience in diabetic mellitus gained,
the more able he is to be positive about the
incidence of diabetic ulcers.
Conclusion
1. Based on the analysis and discussion of the
results of research that variable knowledge on
the incidence of diabetic ulcers have p value =
0.001 (p <0.05) with a confidence level of
95% have a relationship with the incidence of
diabetic ulcers. This is shown by the majority
of respondents who do not suffer from diabetic
ulcers as many as 14 person are
knowledgeable both on the incidence of
diabetic ulcers, while a minority of
respondents who did not suffer from diabetic
ulcers are less knowledgeable on the incidence
of diabetic ulcers and knowledgeable both on
the incidence of diabetic ulcers but suffer from
diabetic ulcers are as many as 2 person (6%).
2. Based on the analysis and discussion of the
results of research that variable attitudes
toward the incidence of diabetic ulcers have p
value = 0.000 (p <0.05) with a confidence
level of 95% have a relationship with the
incidence of diabetic ulcers. This is shown by
the majority of respondents who do not suffer
from diabetic ulcers as many as 19 person
(54%) were positive on the incidence of
diabetic ulcers, while a minority of
respondents who did not suffer as much as 2
diabetic ulcers (6%) were the negative attitude
towards the incidence of diabetic ulcers.
Suggestion
Recommended for all patients with diabetes
mellitus in Medan Petisah Community Health
Center continue to improve knowledge either
through direct or indirect experience, both
formal and informal education that the
incidence of health problems such as diabetic
ulcers increasingly unavoidable and diabetes
mellitus in order to be positive about what
already known by person with diabetes so that
health problems such as diabetic ulcers it
happened increasingly unavoidable. As for
Medan Petisah Community Health Center in
order to further improve programs that can
encourage everyone with diabetes mellitus to
improve knowledge and more positive
attitudes towards the incident that it can be
minimized further.
REFERENCES
Arikunto,S.,2006. Prosedur Penelitian Suatu
Pendekatan Praktik. Edisi Revisi VI.
Jakarta: Rineka Cipta
Badawi, 2009.Melawan dan Mencegah
Diabetes. Yogyakarta: Araska Printika
Russel,2011.Bebasdari 6 Penyakit Paling
Mematikan.Yogyakarta
:
Media
Pressindo
Maulana,2009.
Bersahabat
dengan
Diabetes.Jakarta: Penebar Plus
Notoadmodjo,S., 2007.Metode Penelitian
Kesehatan. Jakarta: Rineka Cipta
PoliteknikKesehatan,2006.Panduan
Penyusunan KTI.Medan
Sidartawan.2008.Hidup
Secara
Mandiri
dengan Diabetes Melitus, Kencing
Manis, Sakit Gula. Jakarta: Balai
Penerbit
Fakultas
Kedokteran
Nabyl.2009.Cara Mudah Mencegah dan
Mengobati
Diabetes
Melitus.Yogyakarta: Genius Printika
Prasedjo, 2005.Melawan dan Mencegah
Diabetes.Media Pressindo.Yogyakarta
Vitahealth, 2006. Diabetes.PT Gramedia
Pustaka Utama. Jakarta.
Wawan,
A.
danDewi,
M.,2011.
TeoridanPengukuranPengetahuanSikapd
anPerilakuManusia.Jakarta
:NuhaMedika.
http://www.newsmedical.net/news/20110915/10632/In
donesian.aspx
http://diabetesmelitus.org/perawatan-kakidiabetes/#ixzz2NrRa7hXF
261
STUDY ANTIMICROBIAL ACTIVITY OF ETHANOL EXTRACT
CURRY LEAVES (MURRAYA KOENINGII L. SPRENG) AGAINST
STAPHYLOCOCCUS AUREUS AND ESCHERICHIA COLI
Panal Sitorus 1, Djamidin Manurung 2, Ernawaty2
1.Departement of Pharmaceutical Biology, Faculty of Pharmacy, Sumatera Utara University
2. Polytechnic Health Ministry of Medan
Corresponding Outhor Email: [email protected]
ABSTRACT
Curry (Murraya koeningii L. Spreng) is included in Rutaceae family. Curry leaves are used in
herbal medicine and effective antimicrobial agent empirically. The porpose of this study are to
extract Murraya koeningii L. Spreng leaves with ethanol, Karacterization, phytochemical screning of
simplex and ethanol extract and study its antimicrobial activity of curry leaves extracts, against
Staphylococcus aureus and Escherichia coli. Extraction with maceration was carried out by using
ethanol 96% at simplex, phytochemical screening and study antibacterial activity curry leaves extracts
at Staphylococcus aureus and Escherichia coli conducted as invitro agar diffusion method by using
paper disk. The result of simplex and ethanol extract characterization obtained water value 4.63%;
10.50% respectively, water soluble extract value 28.42%; 55.53% respectively, the ethanol soluble
extract value 14.83; 6.,21% respectively, the total ash value 8.84%; 4.52% respectively and the acid
insoluble ash value 1.13 %; 0.85%. The result of phytochemical screening of simplex and extract
showed the presence of flavonoids, glycosides, tannins and saponins. The results of study
antimicrobial activity of ethanol extract of curry leaves can inhibit the growth of Staphylococcus
aureus at concentration of 500 mg/ml, with an effective diameter inhibition zone of 15.03 mm and
Escherichia coli at a concentration of 300 mg/ml, with effective diameter inhibition zone of 14.16
mm.
Keywords: Murraya koeningii L. Spreng , Antimicrobial, Staphylococcus aureus, Escherichia coli
Introduction
Plants have an important as medicine. The use
of plants as traditional medicine is still used by
the people in Indonesia, and traditionally used
to treat various types of diseases and effective
empirically. The herbs / plants had much
success treating some diseases can not be
treated with conventional drugs (chemistry) .
Natural inggredients of traditional medicinal
plants Indonesia is still a lot that has not been
studied, one of which is a plant greeting
Koja/curry
(Murraya koeningii L.
Spreng) ,3,6,19,24.
Plants regards Koja (Murraya koeningii L.
Spreng) included in the class family Rutaceae,
this plant comes from the region of India and
Sri Lanka. Koja/curry high regards plants have
0.8 to 4 meters and a diameter of 15-40 cm,
the leaves form a double compound, pinnate
shaped, small, pointed tip, dark green and
shiny. The flowers are white and small fruit is
green when young and purple after being
cooked, 3, 4,5
262
Koja/curry leaves numerous in Aceh province
which is called "leaf temurui". Koja/curry
leaves used extensively by the community as
flavorings cuisine and has a versatile role in
traditional medicine. The bark and roots are
used to treat venomous animal bites. Leaves to
cure dysentery, insect bites, drug injury,
diarrhea and vomiting.. The leaves and roots
are also used traditionally as, anthelmintic,
analgesic, curing hemorrhoids, inflammation,
itching and can reduce hair loss, 3,7,11,13,16.
Efficacy of curry leaves in the health field has
been widely studied, including anticancer and
anti-inflammatory
effects,
antioxidants
antidiabetic and antibacterial,11, 13,16,18,19,.
Several researcher had tested the antibacterial
essential oil of curry/Koja leaves using the
bacterium Escherichia coli, Staphylococcus
aureus and Salmonella typhi, the results
showed where the essential oil of curry leaves
have inhibitory effect on the species of
bacterial, 22.
Koja/curry
leaves
contain
secondary
metabolites such as tannins, flavonoids and
essential oils,1,12,23.
Based on the analysis it can be concluded that
ethanol extract of curry leaves exhibited the
antibacterial activity against Escherichia coli
and Staphylococcus aureus. 13,20.22,24
Material And Methods
This study is done by experimental
methods.This study involves collecting
materials, characterization, phytochemical
screening of simplex ,extraction and test
antimicrobial activity of the extract curry
leaves against Staphylococcus aureus and
Escherichia coli. Determination of the
antimicrobial activity of extracts of curry
leaves performed with agar diffusion method.
The principle of this study is to use a solid
medium and then the paper disc diameter
inhibitory ( clear zone ) bacteria were
measured with calipers, 9,14.
Material
The materials used in this study were curry
leaves (Murraya koeningii L. Spreng). distilled
water, Nutrient Agar(Difco). The chemical
used unless otherwise stated are pro-analysis
grade, i.e: ethanol, n-hexane, mercury (II)
chloride,
iodine
sodium
hydroxide,
bismuth(III) nitrate, iron (III) chloride,
potassium
iodide,
benzene,α-naphthol,
concentrated
nitric
acid,
concentrated
hydrochloric acid, sulfuric acid concentrated,
lead ( II ) acetate, acetic acid anhydride,
isopropanol, Sodium chloride, chloroform,
methanol, Amil alkohol magnesium powders
and The microbias were used bacteria
Staphylococcus aureus ATCC 25923 and
Escherichia coli ATCC 25 922 .
Sampling
The collection of materials was done
purposively without comparing with the same
plants from the other regions. The samples
used are curry leaves(Murraya koeningii
L.Spreng), taken from Jl. Sempurna kec.
Medan Baru, North Sumatera.
Identification of Samples
Identification of Curry/Koja (Murraya
koeningii L.Spreng) leaves was performed in
Bogoriense
Herbarium,
LIPI,
Jakarta,
Indonesia.
Extraction
Extraction was conducted with ethanol by
using maceration method. 300 g simplex
powder was macerated with 2250 ml of
ethanol in a container and let stand at room
temperature for 5 days protected from light.
Maserat was separated with residues. Residues
washed with 750 ml of ethanol. All off
maserat combined and evaporated by rotary
evaporator at 40 ° C to obtain the extract
ethanol , then dried with freeze dryer at - 400C
for ± 24 hours and obtain ethanol extract,7,8,11.
Characterization of Simplex
Characterization of simplex are to inspection
simplex characteristics and study of groups of
chemical compounds of ethanol extract curry
leaves.4,5.
Test Antimicrobial Activity of Extract
The test solution of ethanol extract of curry
leaves with various concentrations and test the
antimicrobial activity of the extract against
Staphylococcus aureus and Escherichia coli.
Determination of the antimicrobial activity of
extracts of leaves curry performed with agar
diffusion method. The principle of this study is
to use a solid medium and then the paper disc
diameter inhibitory (clear zone) bacteria were
measured with calipers,9,10,15,1720,21..
Test Solution Extrac Curry leaves With
Various Concentrations
The ethanol extract weighed 5 g dissolved in
dimethyl sulfoxide (DMSO) to 10 ml of the
extract concentration is 500 mg / ml, then
made further dilution to obtain the extract with
a concentration of 400 mg / ml; 300 mg / ml;
200 mg / ml; 100 mg / ml; 75 mg / ml and 50
mg / ml. Then put the paper into the extract
discs with various concentrations, let for 30
minutes, 1,2,9,10.
1.Bakteri Staphylococcus aureus
Inoculum (0.1 ml) put into a sterile petridish,
then pour the media Nutrient order of 20 ml
with a temperature of (45-50) 0C.
Further cup rocked on the surface of the table,
sothat the media and the bacterial suspension
well blended .
After that, implanted paper disk, soaked
ethanol extract of curry leaves with various
concentrations. Then incubated at 25°C for 48
hours. Furthermore, the diameter of inhibition
263
zone surrounding paper disk was measured
with calipers, 4,5.
2.Bakteri Escherichia coli
Inoculums(0.1 ml) put into a sterile petridish,
then pour the media Nutrient order of 20 ml
with a temperature of (45-50)0C.Further cup
rocked on the surface of the table , sothat the
media and the bacterial suspension well
blended . After that, implanted paper disk.
soaked ethanol extract of curry leaves with
various concentrations. Then incubated at 25
°C for 48 hours. Furthermore, the diameter of
inhibition zone surrounding paper disk was
measured with calipers, 4,5
Characterization Simplex
The result of simplex and extract
characterization shown in Table 1. Below, 4,5.
Table1. Caracterization of Simplex and
Extract
No Parameter
Result
Simplex
Extrac
(%)
t(%)
1
water value
4.63
10.50
2
water soluble
28.42
55.53
extract
3
ethanol
14.83
65.21
soluble extract
4
total ash value
8.84
4.52
5
acid insoluble
1.13
0.85
ash value
Phytochemical screening
The result of phytochemical screening of
simplex and extract ethanol curry leaves
showed the presence of
flavonoids,
glycosides, tannins and saponins was shown in
Table 2. Below,12
Table 2 Chemical compounds of curry
leaves
No
Parameter
Result
Simplex
Extract
1
Alkaloids
2
Flavonoids
+
+
3
Saponins
+
+
4
Tanins
+
+
5
Glikosids
+
+
6
Steroid/
+
+
Triterpenoid
Test Antimicrobial Activity
264
The results of test antibacterial activity of
ethanol extract of curry leaves against
Staphylococcus aureus and Escherichia coli
was shown in Table 3. Below
Table 3. Antimicrobial Activity of
Ethanol Extract
NO
ConcentraRegional diameter
Bacterial Growth
tion
Inhibition (mm)*
extract
S.a
E.a
Etanol
mg/ml
1
500
15,03
17,66
2
400
13,53
15,90
3
300
12,26
14,16
4
200
11,10
13,16
5
100
10,40
11,73
6
75
9,40
11,03
7
50
8,26
9,50
8
Blank
Specification:
( * ) = Average measurement 3x ,
( - ) = No results
The test results showed that the antimicrobiial
activity of the ethanol extract of curry leaves
can inhibit the growth of bacterium
Staphylococcus aureus at concentration of
500 mg / ml with an effective diameter of
inhibition area of 15.03 mm and the bacterium
Escherichia coli at a concentration of 300 mg /
ml with a diameter of inhibition area of 14 , 16
mm. The minimum inhibitory concentration of
ethanol extract can inhibit the growth of
Staphylococcus aureus at concentrations of 50
mg / ml with inhibition area diameter of 8.26
mm and Escherichia coli at a concentration of
50 mg / ml with the diameter of Inhibition
zone of 9.50 mm The antimicrobial activity of
a substance to inhibit the growth of
microorganisms depend on the extract
concentration, l0,15,17,21.
Conclusions and suggestions
Conclusion
From the analysis of the data above it is
concluded that:
1. Characteristics powder simplex and ethanol
extract curry leaves respectively obtained
water value 4.63%; 10.50%, water soluble
extract value 28.42%; 55.53%, the ethanol
soluble extract value 14.83; 6.,21%, the
total ash value 8.84%; 4.52% and the acid
insoluble ash value 1.13 %; 0.85%.
2.Phytochemical screening of simplex powder
and ethanol extract of curry leaves showed
that the chemical compounds of flavonoids,
steroid /triterpenoids, tannins, saponins,
and glycosides.
3.The antimicrobial activity of ethanol extract
of curry leaves against Staphylococcus
aureus and Escherichia coli effectively
showed that the antimicrobial activity can
inhibit the growth of Staphylococcus
aureus at a concentration of 500 mg / ml
with an effective diameter of inhibition
zone of 15.03 mm and Escherichia coli at a
concentration of 300 mg / ml with an
effective diameter of the inhibition zone of
14.16 mm.
Suggestions
It is suggested to further research to study
ethanol extrac of curry leaves against molds.
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24.World Health Organization. (2011). Quality
Control Methods For Herbal Material.
Switzherland: WHO. Hal. 29-38.
THE EFFECT OF FAMILY PSYCHOEDUCATION THERAPY
TOWARD THE PARENT’S ABILITY TO THE MENTAL
RETARDATION CHILD INDEPENDENCY IN SLBN-1
PALANGKA RAYA
Syam’ani*
Nursing Major, Polytechnic Health Ministry of Palangka Raya, G. Obos Street No. 30, 73111, Palangka Raya
e-mail: [email protected]
Abstract .
The problem of mental retardation associated with all portions, especially the family/parents. Family
environment influential directly in educating a child because at the time of birth and for the next
period, children and families requiring assistance another person to carry out his life. Families of
children with mental retardation often have more complex problems in the formation of personality,
behavior and meeting the needs of children. The aims is to determine the effect of family
psychoeducation therapy on the parent’s ability in a mental retardation child's independence. This
research use “one group-pretest-postest design”. The samples in this study were 32 respondents who
are parents of children with mental retardation and school in SLBN 1 Palangka Raya. The results of
this study indicate that the family’s ability in the mental retardation child's independence after family
psychoeducation therapy increased significantly by 1.61 with p value = 0.000 (α 0.05). It can be
concluded that there is a significant change in the average ability of the family in the mental
retardation child's independence before and after family psychoeducation therapy. The research
recommends family psychoeducation therapy as one of the independent nursing intervention for
families who have mental retardation child to increase the child's independence
Keywords: family psychoeducation therapy, parent’s ability, mental retardation child
Refferences: 19 (1995 – 2010)
INTRODUCTION
Nursing as health system integrity in
Indonesia take an important role to cover
mental health problem. Mental health nursing
will be give an optimal contribution if nurse
using problem solving method in nursing
process on their care to client, including their
care to mentally rearded child.
Mental retardation is a condition of
mental development that stalled or incomplete,
which is mainly characterized by the presence
of skills impairment during development
period, so give effect on all levels of
intelligence, ie cognitive ability, language,
motoric, and sociality (Lumbantobing, 2001).
Mentally retarded child is not capable of
learning and adapting because of low
intelligence, usually an IQ below 70. They
also have behavioral disorders of social
adaptation where children have difficulty
adjusting to the surrounding community,
childish behavior is not in accordance with the
age (Soetjiningsih, 1995).
The incidence of the mentally retarded is
quite a lot, especially in developing countries
and causing of anxiety or dilemma of families,
communities and countries. In Indonesia, the
incidence of mental retardation was reported
quite high. From the results of the Household
Health Survey conducted Agency for Health
Research and Development Department of
Health show the prevalence of mental
retardation is five per 1000 population (Atika,
2003). Research in various countries found
that the prevalence of moderate and severe
mental retardation in the age group 15-19
years is approximately 3.0 to 4.0 per 1000.
Few studies have also found that people with
mental retardation who suffer from psychiatric
disorders
and
behavioral
disturbances
frequency high enough. There is also a few
families in Indonesia who do not understand
how to care the children with mental
retardation optimally because they think that
they do not have hope in the future
(Muchayaroh, 2002).
The actual prevalence rate of mental
retardation in children is higher than the
reported figures, as most surveys report only
severe cases only. Research in various
countries found that people with mental
retardation who suffer from psychiatric
267
disorders and behavioral disorders is quite
high frequency. In the survey conducted by
Rutter, et al found that nearly a third of them
felt
"disturbing"
by
his
parents
(Lumbantobing, 2001).
Issue of mental retardation is associated
with all sides, especially the family / parents.
Family environment directly influential in
educating a child because at birth and for the
next period that is long enough for children
that need help from family and others to carry
out his life. Families of children with mental
retardation often have
a more complex
problem in the formation of personality,
behavior and meeting the children need.
Families who have children with disabilities
tend to provide an overload protection on their
children so that children have a limited
opportunity to gain experience in accordance
with the level of development.
The increasing age of the child RM then
the parents have to make adjustments,
especially in fulfilling child needed daily so
that later they do not have a prolonged
dependency and cause problems that are not
fun, so it takes particular care to parents by
helping independence of children with mental
retardation, One treatment that can be given to
parents is through family psychoeducation
therapy.
Family psychoeducation therapy is one of
the elements of family mental health care
programs by providing information and
education through communication t both
therapeutic and educational approaches and
pragmatic (Stuart & Laraia, 2005). Family
psychoeducation given in 5 sessions consist of
session I: identification of the problem, session
II: how to care for family members who are
experiencing problems, session III: stress
management, session IV: load management
and session V: community empowerment.
Research on family psychoeducation therapy
have been carried out. This therapy showed an
increase in outcomes in clients with
schizophrenia and other severe mental
disorders (Anderson, 1983 in Levine, 2002).
Results of another study conducted by Mc.
Farlane (1995), shows the same thing, where
family psychoeducation therapy proven
effective in lowering the relapse of patients
with schizophrenia.
Based on the exposure, researchers are
interested in studying about family
psychoeducation therapeutic effect on the
268
ability of parents to mental retardation child's
independence in SLBN 1 Palangkaraya.
Methods
The design of this research study: "onegroup pre-test-post-test design" are defined
according to Prasetyo & Jannah (2005),
namely: an experimental group measured the
dependent variable (pre-test), and then given
stimulus, and remeasured dependent variable,
without a comparison group. Sampling by
using total sampling, which all parents who
have mental retardation child, totaling 32
respondents, who attended the SLBN-1
Palangkaraya and met the inclusion criteria.
Samples that have met the inclusion criteria
measurements were taken prior to the
characteristic ability of parents in a child's
independence
mental
retardation
as
observation first stage (pre-test). The
observations contained in the data collection
sheets that have been available. Furthermore,
parents are given family psychoeducation
therapy, and then observed their behavior as a
response to observations of the second phase
(post-test). The observations contained in the
data collection sheets, as is done in the first
phase. Then analyzed to determine the change
in the ability of parents in a child's
independence mental retardation before and
after the intervention.
Population and Sample
In this study population is the parents
who have children with mental retardation
who attend school at the State Special Schools
1 (SLBN-1) Palangkaraya. Sampling by using
total sampling, which all parents who have
children with mental retardation, totaling 32
respondents who attended the SLBN-1
Palangkaraya and met the inclusion criteria.
Methods
This study using questionnaire with some
closed questions to identify the ability of
parents in a mental retardation (MR) child's
independence before and after therapy family
psychoeducation.
The data was collected by distributing a
questionnaire containing a list of questions
filled out by respondents.
Pre-test done 1 day prior to treatment. Pre
test was conducted on the family in this case is
the 32 parents who have children in school in
the RM and SLBN 1 Palangkaraya. At this
stage the researchers assessed the ability of
parents in a MR child's independence, to
determine the initial capability prior to
intervention of family psychoeducation
therapy. After the pre-test, each respondent is
then given family psychoeducation therapy as
many as five sessions.
Post-test conducted on day 14 after the
family psychoeducation therapy ended. At this
stage the researchers assessed the ability of the
family in the MR child's independence.
Data Analysis
Data analysis techniques using pre-test
requirements analysis and test the effect. To
test that is pre-requisite analysis using
normality test where normality test data in this
study using a non-parametric statistics on the
value of Kolmogorov-Smirnov. According
Priyanto (2010) suggested that the data are
expressed in normal distribution if the
significance is greater than 0.05. In this study,
the significance value was 0.32 so it can be
concluded that the data were normally
distributed.
Meanwhile,
to
perform
calculations using the formula test the effect of
pre-test and post test one group design is a
statistical test by using test dependent sample
t-test (Paired t-test).
Results
Parent’s Ability in MR child’s
independence
The ability of parents in a MR child's
independence
before
the
family
psychoeducation therapy can be seen in the
table below:
Table 1
Parent’s Ability Before Psychoeducation
therapy (n = 32)
Characteristic N Mean SD Minimal Maksimal
Parent’s
32 74,75 9,608 41 – 88
ability before
intervention
The results showed that total of 32 parents
who have children with RM shows the average
ability in the child's independence before
family psychoeducation therapy is 74.75. With
a standard predetermined value, the
researchers concluded that the average ability
of the family in a child's independence prior to
therapeutic
intervention
RM
family
psychoeducation is at a level good enough.
After the intervention of family
psychoeducation therapy, the ability of the
family in the MR child's independence can be
seen in the following table:
Table 2
Parent’s Ability After Psychoeducation
Therapy (n = 32)
Characteristic n Mean SD MinimalMaksimal
Parent’s
32 80,66 11,218 53 - 97
ability after
intervention
Table 3.
Analysis of Changes in Parent’s Ability
Before and After Psychoeducation Therapy (n
= 32)
Variable
Parent’s
ability
a. Before
b. After
Mean SD
SE
t
p value
74,75 9,608 1,699 0,000
80,66 11,218 1,983 4,69
4
difference5,91 1,61
Discuss
After the intervention of psychoeducation
therapy there is improvement in the ability of
the MR child's independence become 80.66.
With a standard predetermined value, the
researchers concluded that the average ability
of the family in the child's independence after
give intervention RM family psychoeducation
therapy is increased to good.
It’s mean that in line with that proposed by
Carson (2000) that psychoeducation is a tool
that is increasingly popular family therapy as a
strategy to reduce the risk factors associated
with the development of behavioral symptoms.
So in principle, psychoeducation can help
family members to increase knowledge about
the disease through the provision of
information and education to support treatment
and rehabilitation of patients as well as
increased support for the family members
themselves
Effect of Psychoeducation Therapy towards
Parent’s
Ability
to
MR
Child’s
Independence
Family psychoeducation therapy is one
elements of family mental health care
programs by providing information and
269
education through therapeutic communication.
Psychoeducation program is an approach both
educational and pragmatic (Stuart & Laraia,
2005). In this study, given intervention in the
form of family psychoeducation therapy to the
32 respondents who have children with
moderate mental retardation, with the aim of
providing a deeper understanding to the
families of children with mental retardation
and how to care.
Statistical test results in this study by
using dependent test sample t-test (Paired ttest) demonstrated that the parent’s ability
after the family psychoeducation therapy
increased significantly by 1.61 with a p value
= 0.000
(α 0.05). It can be concluded that
the α 5% no significant change in the average
ability of the family in the child's
independence RM before and after therapeutic
intervention in the form of family
psychoeducation (p value 0,000 <α 0.005).
Mohr (2006) divides the role of families
who have children with mental retardation into
5 (five), portions: 1). to respond to every need
of the family members especially need
stimulation of growth and development in
children with intellectual challenges, 2). help
any psychosocial problems in the family active
and as a result or care for children with
intellectual challenges, 3). division of tasks
associated with the equitable distribution of
the stimulation of growth and development of
children with intellectual challenges, 4).
encourage interaction within and outside the
family, as well as 5). improving the quality of
health in each family member. This is one of
them can be met through family
psychoeducation therapy.
The inability of the family to manage
stress occurs because of a conflict between: a
strong desire to have a healthy child, and
simultaneously (together) occurs fear and
anxiety when what it does will lead to a
mistake for their children. This can affect the
ability of families in child care so that it will
interfere / impede child development RM.
Through family psychoeducation therapy, the
expected family as a system that can provide
support in the establishment of sustainable
health care in helping the mentally retarded
child's independence, not only provide
physical treatment but also psychological and
social care. Research has been done by
Nurbani
(2009)
states
that
family
psychoeducation can help decrease anxiety
270
and burden of the family in caring for family
members who have suffered a stroke. Based
on the explanation given then the family
psychoeducation can be a form of therapy for
families with MR children in order to cope
with anxiety and burden of caring for MR
children which in turn can enhance the ability
of families in the child's independence RM.
Family as the smallest unit closest to the
MR child, should be able to act as caregiver
for MR children. That is what the family is
very large role in helping the MR child
independence. Form of management of the
child's family RM, reinforces the concept that
intervention is needed not only on for the
child, but also the family as a system requires
intervention. This is evidenced by research
conducted by Miltiades and Pruchno (2001) in
Maes, Broekman, Lecturer & Nauts, 2003)
which confirms that the intervention should be
given not only focus on children RM as an
individual, but also involves directly to the
needs of the family. Therefore, nursing
interventions that focus on the MR child's
family not only restore their state, but also to
develop and enhance the ability of families to
cope with the load and family health problems,
particularly the psychosocial problems that
may arise as a result of caring for mental
retardation children.
Conclusions
Total of 32 parents who have children
with MR shows the average ability in the
child's
independence
before
family
psychoeducation therapy was 74.75 (at the
level of Pretty Good). The results showed that,
out of a total of 32 parents who have children
with MR shows the average ability in the
child's independence after a given family
psychoeducation therapy was 80.66 (at the
level of Good). Results of statistical analyze
by using test dependent sample t-test (Paired ttest) demonstrated that the ability of the family
in the MR child's independence after the
family psychoeducation therapy increased
significantly by 1.61 with a p value = 0.000 (α
0.05), then it can be concluded that there is a
significant change in the average ability of the
family in the MR child's independence before
and after therapeutic intervention in the form
of family psychoeducation therapy (p value
0,000 <α 0.005)
Refferences
1. Carson, V. B. (2000). Mental Health
Nursing: The Nurse-Patient Journey. (2th
edition). Philadelphia: W.B. Saunders
Company.
2. Friedman, (2010). Family nursing theory
and practice. (Edisi 5). Jakarta: EGC.
3. Keliat, Budi Anna. (1995). Participation
of Families In Care Mental Disorders
Jakarta : EGC
4. Lumbantobing, S. M. (2001). Children
With Mental Retarded. Jakarta : FKUI
5. Maes, Broekman, Dosen & Nauts. (2003).
Caregiving burden of families looking
after persons with intellectual disability
and behavioural or psychiatric problems.
Journal
of
Intellectual
Disability
Research, volume 47, part 6, p 447-455
6. McIntyre, Blacher & Baker. (2002).
Behaviour/mental health problems in
young adults with intellectual disability:
The impact on families. Journal of
Intellectual Disability Research, volume
46 part 3, 239-249
7. Mohr.W.K. (2006). Psychiatric mental
health nursing (6th ed). Philadelpia:
Lippincott Williams dan Wilkins.
8. Muchayaroh, Luluk. (2002). Children
With Mental Retarded Perception
Families Against Children With Mental
Retardation in Poli YPAC Physiotherapy
Branch Malang. Undergraduate Thesis.
http://digilib.itb.ac.id. Copyright Â©
2002
by
UPT.
Perpustakaan
Muhammadiyah University of Malang.
Gived at April 2012.
9. Notoatmojo, Soekidjo. (2002). Health
Research Methodology.Jakarta : PT.
Rineka Cipta.
10. Nurbani.
(2009).
psychoeducation:
Anxiety and Family Expense (caregiver)
in Caring for Stroke Patients in RSUP dr.
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Cipto Mangunkusumo. Tesis. FIK-UI:
Jakarta.
Nursalam.
(2003).
Concept
and
Implemen-tation Methodology of Nursing
Research: Guidelines for Thesis, Thesis
and Nursing Research Instruments.
Jakarta : Salemba Medika
Pearce, John. (2000). Overcome Anxiety
and Fear Child: Helping Children Ways
Against Fear and Developing Confidence.
translation: Liliana Wijaya. Jakarta :
Penerbit Arcan
Rasmun. (2001). Psychiatric mental
health nursing integrated with the family:
Concepts, theories, nursing care and
interaction process analysis (API).
Jakarta: CV Sagung Seto
Resch, Mireles, Benz, Grenwelge,
Peterson & Zhang. (2010, Maret). Giving
parents a voice: A qualitative study of the
challenges experienced by parents of
children with disabilities. American
Psychological Association Journals. Vol.
55, No. 2, 139–150
Soetjiningsih. (1995). Tumbuh Kembang
Anak. Jakarta : EGC.
Stuart, G. W. & Laraia, M.T. (2005).
Principles and Practice of Psychiatric
Nursing. (7th edition). St. Louis: Mosby.
Utami, Yuniara R. (2009). Adjustment
and Parenting Parents of Child Mental
Retardation. Surakarta: Faculty of
Psychology,
University
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Muhammadiyah.
Varcarolis, Elizabeth M., et al. (2006).
Foundation of Psychiatric Mental Health
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edition). Sounders Elsevier: St. Louis
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271
EVALUATION OF ANTIBIOTIC DOSE APPROPRIATENESS IN
PATIENTS WITH CHRONIC RENAL FAILURE IN HAJI ADAM
MALIK HOSPITAL MEDAN ON PERIOD JANUARY – JUNE 2014
Maya Natalina, Aminah Dalimunthe*, Khairunnisa, Imam Bagus Sumantri
Faculty of Pharmacy, University of Sumatera Utara, Medan.
ABSTRACT
Antibiotic is a substance produced by microbes that can inhibit or eradicate other microbes. In
patients with chronic renal failure, the adjustment dose of antibiotic based on creatinine clearance. As
some antibiotics are mainly excreted through renal, therefore it is necesarry to adjust the dose. One
important indicator to reach therapy is the accuracy in giving dose to inhibit the progression of renal
disease and to maintain the patient’s life quality. The aim of this study was to evaluation of antibiotic
dose appropriateness in patients with chronic renal failure in Haji Adam Malik Hospital Medan on
period January – June 2014. The method of dose adjustment in patients with renal failure is based on
the drug clearance by Cockcroft-Gault equation. There are 82 medical records of patients with chronic
renal failure which fits the inclusion criteria and used as a sample. The result showed that the majority
of patients with chronic renal failure was at 39 – 48 years old (30,5%) and female (51.2%). Based on
the stage, the majority of patients with chronic renal failure was stage 5 (72%), followed by stage 4
(18.3%), stage 3 (8.5%) and stage 2 (1.2%). The most widely antibiotic which used by patients with
chronic renal failure was ceftriaxone (59.7%). The dose appropriateness of antibiotic was 93%. There
was no difference of dose in patients with chronic renal failure in Haji Adam Malik Hospital Medan
on period January – June 2014 based on characteristics of age, sex and stage chronic renal failure.
It can be concluded that the dose of antibiotic use in patients with chronic renal failure on
period Januay – June 2014 was appropriated, in accordance with standard treatment recommended by
Haji Adam Malik Hospital Medan.
Key words: Dose appropriateness, antibiotic, chronic renal failure
BACKGROUND
Chronic kidney disease is a pathophysiological
process with diverse etiologies, can result in a
progressive decline in renal function, and
generally end up with kidney failure requiring
renal replacement therapy which remains, in
the form of dialysis or kidney transplantation
(Suwitra, 2006). Chronic renal failure (CRF) is
one disease that is not contagious and is a state
of impaired renal function which is a chronic,
progressive and irreversible underway (can not
be returned to its original state) (Romauli,
2009).
Criteria for chronic renal disease is kidney
damage (renal damage) that occurred more
than three months, in the form of structural or
functional abnormalities, with or without a
decrease in glomerular filtration rate (GFR).
Manifestations is pathology and there are signs
of renal disorders including abnormalities in
the composition of blood or urine or
abnormalities in imaging tests (imaging tests)
272
and glomerular filtration rate (GFR) of less
than 60 ml / min / 1,73 m2 for 3 months, with
or without damage Renal (Suwitra, 2006).
According to Aslam (2003), the signs and
symptoms of disease with chronic renal failure
(CRF) include nocturia, edema, anemia (ironresistant,
normochromic,
normocytic),
electrolyte disturbances, hypertension, bone
disease (renal osteodystrophy), neurological
changes ( lethargia example, mental disorder),
impaired muscle function (eg, muscle cramps,
sore feet) and uraemia (eg, decreased appetite,
nausea, vomiting, pruritus). Uraemia (urea in
the blood), which illustrates the high levels of
blood urea, is often used as another word for
renal failure (acute and chronic).
Now, the prevalence of chronic renal failure
(CRF) is increasing every year in developing
countries. According to the research results
Hallan, et al., 2006 states that the prevalence
of chronic kidney disorders in the general
population of Europe is equal to 10.2%, and
the prevalence of the United States in the
amount of 11.5%. Based on data from the
United State Renal Data System (USRDS) in
2013 estimated that more than 20 million (or
more than 10%) of adults in the United States
have chronic kidney disease per year. Cases of
kidney disease in the world per year increased
by more than 50%. Based on the survey results
of
Perhimpunan
Nefrologi
Indonesia
(PERNEFRI) showed 12.5% (approximately
25 million people) of the population in
Indonesia
decreased
kidney
function
(PERNEFRI, 2009). In recent years, patients
with kidney failure in Indonesia is relatively
high, reaching 300,000 people but not all
patients can be treated by the medical staff, the
new estimated 25,000 patients who can be
treated, meaning that there are more than 80
percent of patients who have not received
treatment (Susalit, 2012).
Antibiotics are a group of drugs most
commonly used today. Excessive use of
antibiotics and is not appropriate in some
cases, cause problems antimicrobial resistance.
The use of more than one antibiotic for
treatment of infection is still a controversial
issue today (Aslam, 2003). Antibiotics are
substances produced by microbes that may
inhibit or eradicate microbes other types.
Drugs used to kill microbes, cause infection in
humans, must have selective toxicity
properties as high as possible. This means that
the drug must be very toxic to microbes, but
relatively non-toxic to its hospes (Abidin,
2010).
On impaired renal function, a dose of
antibiotics adapted to creatinine clearance
(creatinine clearance). Dose of medication is
very important for a drug with toxictherapeutic ratio is narrow, or who are
suffering from kidney disease. In general with
creatinine clearance 40-60 ml / min
maintenance dose reduced by 50%. When the
creatinine clearance 10-40 ml / min, other than
maintenance dose reduced by 50% should also
extend the provision doubling the distance and
try to avoid drugs that are nephrotoxic. List of
antibiotics with the main elimination through
the kidneys and require dose adjustment
among others: the majority of ß-lactams,
aminoglycosides, TMP - SMX, monobactam,
ciprofloxacin,
levofloxacin,
gatifloxacin,
gemifloxacin, vancomycin, nitrofurantoin,
Phosphomycin, tetracycline, daptomycin,
carbapenem, polymyxin B , colistin, and
flucytosine (Ministry of Health, 2011).
In some studies related to the adjustment of
drug doses in patients with chronic renal
failure, there are several methods to estimate
the exact dosage regime for patients with renal
impairment. Dose adjustments in patients with
renal impairment is based on the patient drug
clearance. Two common approaches to
pharmacokinetics dose adjustments include
methods based on drug clearance and methods
based on the elimination half-life (Hassan, et
al., 2009).
Application of pharmacokinetics aims to
improve the effectiveness of therapy or
lowering the side effects and toxicity in
patients. Dose adjustments in the form of a
decrease in the total maintenance dose is often
needed. Changes in dose are often encountered
is lowering the dose of the drug or drug
delivery interval prolongation, or a
combination of both (Shargel and Yu, 1999).
According to Aslam (2003), to select and
determine the drug dosage required knowledge
of the physiological changes that occur in the
elderly, (such as decreased renal function, with
the consequent decrease in drug clearance) and
the frequency of drug side effects is higher.
Therefore, some antibiotics excreted primarily
through the kidneys, a dose adjustment is
necessary and monitoring of drug levels in
serum against certain medications in the
elderly. In general, the class of beta-lactam
antibiotics have side effects that most rare and
lightest.
Based on this background, it is necessary to
study to look at the suitability dose of
antibiotic use in patients with chronic renal
failure are implemented in Haji Adam Malik
Hospital.
METHOD
This research was conducted at the General
Hospital Haji Adam Malik Medan is located at
Jalan Bunga Lau number 17 in November
2014. As for the method, stage, flowcharts,
operational definitions, data analysis, and the
workings of this study. This study is non
experimental and descriptive method design
(design)
cross-sectional
study
with
273
retrospective approach. The study was
conducted in Haji Adam Malik Hospital with
retrieval and data collection conducted in
November 2014 with data collection for six
months of observation, ie from January 2014 June 2014.
amounted to (30.5%) and the lowest age group
were in the age group 19-28 years amounted to
(3.7%). These results indicate that age group
are more likely to suffer CRF at the age group
he was around thirteen years younger that are
in the age group 39-48 years.
Population and Sample
The population in this study were all patients
with chronic kidney disease who received
antibiotic therapy in Haji Adam Malik
Hospital in the period January 2014 - June
2014.
Characteristics Stadium
Descriptions regarding patient demographics
were also conducted to determine disease
stage chronic renal failure suffered by the
patient. Distribution characteristics of CRF
stage suffered by the patient can be seen in the
table below.
Data Analysis
Data were collected from medical records
checked and processed using the program
Statistical Product and Service Solutions
(SPSS) version 18.0, then presented in tabular
form.
This research has been conducted in Haji
Adam Malik Hospital in November 2014. The
data is taken from the medical records of
patients hospitalized with a diagnosis of
chronic kidney disease in the period January
2014 - June 2014. Based on the results of the
research, found chronic renal failure patients is
about 132 people and 82 patients from medical
records of patients who met the inclusion
criteria data to be used as research subjects.
Based on the characteristics of the age of the
subjects of this study, the age range of patients
according to the table below.
Table 1 Frequency Distribution Age Chronic
Renal Failure Patients In Hospital
Haji Adam Malik period January
2014 - June 2014.
Frequency
Age (years
Percentage
(Patients
old)
(%)
Number)
19 – 28
3
3,7
29 – 38
12
14,6
39 – 48
25
30,5
49 – 58
22
26,8
59 – 68
13
15,9
≥ 69
7
8,5
Total
82
100
In the above table shows that the age
distribution in the age group 39-48 years
274
Distribution Characteristics Stage
Chronic Renal Failure Patients In
Hospital Haji Adam Malik period
January 2014 - June 2014.
LFG
Stadiu
Frequen Percenta
(ml/min/1,73
m
cy
ge (%)
2
m)
I
>90
II
60 – 89
1
1,2
III
30 – 59
7
8,5
IV
15 – 29
15
18,3
V
<15
59
72
Total
82
100
Table 3
Based on the results obtained from the
characteristic table stage CRF suffered by
patients in the period January 2014 - June
2014 showed that of 82 patients with CRF
were using antibiotics, the majority were in
stage 5 (72%). The small number of patients
hospitalized in conditions of CRF stage 2 and
the absence of CRF patients in stage 1 because
the condition at an early stage the patient has
not felt the complaint (asymptomatic) and the
state of the glomerular filtration rate (GFR)
was normal or even increased (Suwitra, 2006)
, According Sjamsiah (2005), this is because in
general
the
symptoms
or
clinical
manifestations of the disease is the appearance
of chronic renal failure is the sudden or
gradual, even some that do not cause obvious
symptoms early so that the decline in renal
function are often not perceived even ignored
by patients and only detected after his kidney
condition worsened and the more severe
clinical manifestations are usually on the
condition of late-stage (stage 5).
Use of Antibiotics
Based on the results of the study, of 129
antibiotic use in patients with CRF in Haji
Adam Malik Hospital Medan period January
2014 - June 2014, the most widely used
antibiotic was ceftriaxone (59.7%), followed
by ciprofloxacin (29.5%), meropenem (5.4%),
and metronidazole (3.9%). Data details can be
found in Table 3.4 below.
Tabel 4
Distribution Use of Antibiotics in
Patients with Chronic Renal
Failure In Haji Adam Malik
Hospital period January 2014 June 2014.
No
Anibiotic
Frequency
1
2
3
4
5
6
Cefotaxime
Ceftazidime
Ceftriaxone
Ciprofloxacin
Meropenem
Metronidazole
Total
1
1
77
38
7
5
129
Percentag P
e (%) value
0,8
0,8
59,7
29,5 0,000
5,4
3,9
100
Appropriate Dose Antibiotic in Patients with
CRF Results dispensing appropriate of
antibiotic dosage in patients with CRF can be
seen in Table below.
Table 5
appropriate Dose of Antibiotic
in Patients with Chronic Renal
Failure in Haji Adam Malik
Hospital Medan period January
2014 - June 2014.
\appropriate Dose of Antibiotic
Frequeny
Appropriate
Not appropriate
Total
120
9
129
Percentage
(%)
93
7
100
In this study showed dose conformity
percentage of antibiotic use that from 129 the
amount of antibiotics used in patients with
CRF in Haji Adam Malik Hospital Medan
period January 2014 - June 2014, acquired 120
number of antibiotics (93%) that their use
complies with the standards on the treatment
recommendations CRF patients, while 9
number of other antibiotics (7%) its use does
not comply with the recommended standards.
Results of the dose dispensing appropriate of
antibiotic use in patients with CRF based on
the characteristics of age, sex, and stage of
CRF can be seen in the table below.
Table 6
Appropriate
Dispensing
Antibiotic Dose in Patients with
Chronic Renal Failure in Haji
Adam Malik Hospital Medan
period January 2014 - June 2014
Based on Characteristics of Age,
Gender, And Stadium CRF.
Appropriate Dosage
Appropriate
Not Appropriate
Characteristic
(Number of
(Number of
Patients)
Patients)
19 – 28
3
0
29 – 38
11
1
Group
39 – 48
24
1
Age (Year
49 – 58
19
3
s Old)
59 – 68
11
2
69 – 79
6
1
Female
36
6
Sex
Male
38
2
II
1
0
III
7
0
Stadium
IV
15
0
V
51
8
P
Value
0,806
0,157
0,327
Based on the research that has been written in
the table above can be seen that the
characteristics of age, almost every age group
there is a dose of antibiotics is not appropriate
where the largest number were in the age
group 49-58 years (3 people), then in the age
group 59 - 68 years (2), at any other age group
only one person, and only in the age group 1928 years who did not have dosing of
antibiotics are not appropriate.
On the characteristics of gender shows that
female gender who have suffered the greatest
number of nonconformities dose antibiotic use
as many as six people. Then on the
characteristics of the patient's CRF stage, it
can be seen that only on stage 5, which has a
discrepancy dose antibiotic use as many as 8
people. Stage 5 is the stage with the state of
renal function has worsened and the patient
began to experience symptoms severe enough
because the kidneys are no longer able to
maintain fluid and electrolyte homeostasis in
the body, and therefore are expected to pay
more attention to the dosing of antibiotics and
also drug- Other medicines will be given so as
not to worsen the patient's condition.
In Table 6 shows that there are 8 people CRF
patients who experienced a number of
mismatches dose of antibiotic use in
accordance with the recommended dose, while
in table 3.5, there are 9 number of antibiotics
whose use is not in accordance with the
recommended dose. The difference is because
275
there is a discrepancy figures panggunaan
doses of antibiotics for 2 number of antibiotics
that are given to a patient. In the seven other
patients who had mismatches dose, each
patient experienced a dose discrepancy
antibiotic use antibiotics only for one number
so that when added together it will remain
there nine the number of antibiotics whose use
is not in accordance with the recommended
dose.
CONCLUSIONS
The percentage of the most widely used
antibiotics in patients with chronic renal
failure is ceftriaxone (59.7%), followed by
ciprofloxacin (29.5%) and meropenem (5.4%).
Analysis of the data showed that there are
significant differences in the types of
antibiotics that are used in patients with
chronic renal failure in Haji Adam Malik
Hospital Medan period January 2014 - June
2014. The level of dose conformity in the use
of antibiotics are used in patients with chronic
renal failure in Haji Adam Malik Hospital
Medan the period January 2014 - June 2014
has been good, a total of 120 the number of
antibiotics (93%) dose use has been in
accordance with the recommended standard
treatment guidelines based on the analysis of
data and there is no difference suitability dose
use of antibiotics in patients with chronic renal
failure in Haji Adam Malik Hospital Medan
the period January 2014 - June 2014 based on
the characteristics of age, sex and stage of
chronic renal failure.
BIBLIOGRAPHY
Abidin, Z. (2010). Antibiotik. Diambil dari
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Kelompok Gramedia. Halaman 137139, 328.
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Neil, R.P., Solfrid, R., Hans, A.H.,
Stian, L., dan Jostein H. (2006).
International comparison of the
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Ghazali R. (2009). Drug use and
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Penggunaan
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Alwi, I., Marcellus, S.K., Setiati, S.
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Chronic Kidney Disease in the United
States. Bethesda: National Institutes of
Health, National Institute of Diabetes
and Digestive and Kidney Disease.
1(16): 1 – 148
WOMAN’S KNOWLEDGE AND ATTITUDES ABOUT
PARTICIPATION IN THE INVESTIGATION IVA TEST (VISUAL
INSPECTION OF ACETIC ACID) IN DUSUN IV DESA TENGAH
PANCUR BATU SUB-DISTRICT DELI SERDANG 2014
Suswati, Dewi Meliasari
Department of Midwifwery, Polytechnic of Health, Medan
ABSTRACT
Low coverage of early detection or screening is one of the reasons why increasing the
incidence rate of cervical cancer reach out 1.4 million women in the world, this study aimed to know
the woman’s participation in investigation IVA test (Visual Inspection of Acetic Acid) in Dusun IV
Desa Tengah Pancur Batu sub-district Deli Serdang regency 2014.
This study used descriptive method. Population was all of women that had married who
become subject investigation IVA test (Visual Inspection of Acetic Acid) in Dusun IV, sample were
taken as many as 57 people. Sampling technique was used total sampling. This study conducted from
March until July 2014.
The result of study showed from 57 respondent, the majority of respondents didn’t want to
participate in investigation IVA test (Visual Inspection of Acetic Acid) were 35 people (61.40%),
majority of the less knowledgeable were 25 people (43.90%), the majority that have supportive stance
were 37 people (65.00%), well knowledgeable with the supportive stance were 18 people (48.64%),
and well knowledgeable women’s majority with supportive stance about participation in investigation
IVA test were 18 people (48.64%).
Respondent’s knowledge and attitudes about participation in investigation IVA test (Visual
Inspection of Acetic Acid) were less knowledgeable and supportive stance. Hopefully, for midwives
and health workers more increase information about health. So, hopefully women can be more
participation in investigation IVA test (Visual Inspection of Acetic Acid).
Keywords : Woman’knowledge, attitudes, IVA Test
INTRODUCTION
Cervical Cancer is important health
issues for women around the world. Cervical
cancer is a malignancy that occurs in the
cervix caused by Human Papilloma Virus
(HPV). HPV is transmitted through sexual
contact and its infection occurred in 75% of
women who had been sexually. This cancer
has invaded more than 1.4 million women
worldwide (Depkes, 2009).
According to International Agency for
Research on Cancer (IARC) in Depkes (2008),
cervical cancer took second place of all
cancers in women with the incidence rate of
9.7% and 9.3% the number of deaths from all
cancers for women in the world. According to
World Health Organization (WHO) predicted
that more than 500.000 new cases of cervical
cancer were found in the world and 90% of all
cases are in the developing countries. if it is
not followed up with immediately, deaths due
to cervical cancer in Indonesia is expected to
increase almost 25% in the next ten years is 16
per 100.000 women (Astana, 2009).
Based on the evaluation of cervical
cancer management at H. Adam Malik
hospital and Pirngadi hospital during the last 5
years cervical cancer. Data analysis included
age, parity, clinical stage, histopathology type,
method of treatment. With the results during
this period obtained a number of 303 patients
with cervical cancer. The largest age group is
40-49 years is 151 cases (49.83%), Lili.
(2010).
In Indonesia screening programs
(early detection) has not been a priority in the
government program. Many cases of cervical
cancer were not detected by health workers
caused by the lack of awareness and
participation of women in the early detection
of cervical cancer, so this has resulted in
women belatedly realized their cervical cancer
(Diananda, 2009).
Besides Pap Smears, early detection
can be done by IVA (Visual Inspection of
Acetic Acid) that inspection with acetic acid
4%. In Indonesia itself, a factor of late
diagnosis and the expensive medicines and
277
care costs are a major obstacle treatment
cervical cancer (Setiawan, 2010).
The results of tests IVA (Visual
Inspection of Acetic Acid) in health centers
Pancur Batu Deli Serdang. From 235 people as
a target IVA programs that is in the Desa
Tengah only 63 people or (18.80%) who want
to come and doing the IVA test (Visual
Inspection of Acetic Acid).
RESEARCH METHODS
The research is Descriptive research in
which the data taken is the primary data. Data
obtained from the questionnaire assessment
that aimed to know women's participation in
the development of inspection IVA test
(Visual Inspection of Acetic Acid) in Dusun
IV Desa Tengah Pancur Batu sub-district Deli
Serdang regency 2014 (Notoatmodjo, 2010.a).
Populations in this study were all women,
including inspection targets IVA (Visual
Inspection of Acetic Acid) in Dusun IV in
2014 which amounts to 57 people. The
numbers of samples in the study were 57
people using total sampling technique that was
the entire population of 57 people who
sampled the study (Suliystyaningsih, 2011).
This research was done in Dusun IV
Desa Tengah Pancur Batu sub-district Deli
Serdang regency 2014 because there are still
many women who did not want to do
inspection IVA test (Visual Inspection of
Acetic Acid) by reason of shame and did not
know about the IVA test (Visual Inspection of
Acetic Acid). The research was done from
June – August 2014
Data have been collected, the
processed manually with the following steps
(Notoatmodjo 2010.a) :
a. Editing Process
Checking list of questions that have
been submitted to the respondents, when did
inspection completeness of questionnaire
answers still found respondents who did not
answer all the questions fully so that
researchers did confirm to respondent to fill in
all questionnaires fully.
b. Coding Process
The author clarified existing answers
by giving a code-shaped figure. Namely
1,2,3......to 57 in which names and respondents
answer replaced in numbers.
c. Scoring Process
Calculating or scoring on the
respondents answer. Value was given
depending on the number of question and
278
appropriate
with
the
predetermined
measurement aspect.
Measurement of knowledge conducted
based on the total value of respondents answer
from all the questions that given with the total
questions as many as 20 in the form of
multiple-choice questions
a. If it is true gets the score 5
b. If it is wrong gets the score 0.
Measurements conducted on the
attitudes based on the total value of the
respondents' answers from all the questions
that given with the total questions as many as
20 questions. For the supporting question
a. Totally Agree: TA (Score 4)
b. Agree: A (Score 3)
c. Disagree: DS (Score 2)
d. Totally Disagree: TDS (Score 1)
For the question did not support the category
a. Totally Agree: TA (Score 1)
b. Agree: A (Score 2)
c. Disagree: DS (Score 3)
d. Totally Disagree: TDS (Score 4)
Data analysis conducted by using
Descriptive Analysis by looking at the
percentage of data that has been collected and
presented in the form of a frequency
distribution tables and an explanation, about
everything related to the woman's participation
in the investigation IVA test (Visual
Inspection of Acetic Acid) in Dusun IV Desa
Tengah Pancur Batu sub-district Deli Serdang
2014.
RESULT AND DISCUSSION
RESULTS
The results of this study based on the primary
data had been conducted for respondent’s
participation obtained as follows :
Table 1
Distribution of respondent's participation
Inspection of Acetic Acid) Dusun IV Desa
Tengah Pancur Batu sub-district Deli
Serdang 2014
No Respondent’s
Sum
participation in
F
%
investigation IVA
test
1
Want
22
38.60%
2
Do not want
35
61.40%
Total
57
100%
Based on the table 1 above can be
seen that the participation of respondents are
willing to participate in the investigation IVA
test (Visual Inspection of Acetic Acid) in Desa
Tengah Pancur Batu sub-district were 22
people (38.40%) and the respondents who
would not participate in the investigation IVA
test (Visual Inspection of Acetic Acid) in Desa
Tengah Pancur Batu sub-district were 35
people (61.40%).
Table 2
Distribution of respondent's knowledge
about participation in the investigation IVA
test (Visual Inspection of Acetic Acid) in
Dusun IV Desa Tengah Pancur Batu subdistrict Deli Serdang 2014
No Knowledge
Sum
F
%
1.
Good
15
26.30%
2.
Enough
17
29.80%
3.
Less
25
43.90%
Total
57
100
Based on the table 4.1.2 above can be
seen that the majority of respondents
knowledge in the investigation IVA test
(Visual Inspection of Acetic Acid) in Desa
Tengah Pancur Batu sub-district less
knowledge as many as 25 people (43.00%)
and good knowledge of minority as many as
15 people (26.30%).
Table 3
Distribution of respondent's participation
Inspection of Acetic Acid) based on Attitude
in Dusun IV Desa Tengah Pancur Batu subdistrict Deli Serdang 2014
No
Attitude
F
%
1
Support
37
65.00%
2
Not Support
20
35.00%
Total
57
100
Based on table 3 above can be seen
that from 57 respondents majority were
supportive as many as 37 people (65.00%),
and the minority did not support as many as 20
people (35.00%).
Table 4.
Distribution of respondent's knowledge
about participation in the investigation IVA
test in Dusun IV Desa Tengah Pancur Batu
sub-district Deli Serdang 2014
(Visual Inspection of Acetic Acid)
No Attitude
Knowledge
Good
F %
1 Support
18 48.6
4
2 Not Support 2 10
Enough
F %
14 37.8
5
4 20
Sum
Less
F % F
5 13.5 37
1
12 70 20
%
100
100
Based on table 4 above can be seen
that the majority of good knowledgeable
respondent with the supportive stance were 18
people (48.64%), and the minority of enough
knowledgeable with not supportive stance
were 2 people (10%).
DISCUSSION
From the results, it can be known
about the respondent's participation in the
investigation IVA test (Visual Inspection of
Acetic Acid) in Dusun IV Desa Tengah Pancur
Batu sub-district Deli Serdang regency 2014
based on knowledge and attitude.
Based on the result of research, can be
known that respondents majority with less
knowledgeable were 25 people (43.90%),
enough knowledgeable were 17 people
(29.80%), good knowledgeable were 15
people (26.30%).
Basically, knowledge consists of all
facts and theories that enable someone for
resolve their problems. The knowledge
obtained either from direct experience or
through the others experience. If the person's
level of knowledge higher in daily life it
would be good because it is based on science.
According to the assumption of the
author, the results of this study are consistent
with the statement Notoatmodjo. From the
results showed that woman who did not want
to do inspection IVA test (Visual Inspection of
Acetic Acid) are less knowledgeable, where
knowledge affects the woman's participation in
the investigation IVA test (Visual Inspection
of Acetic Acid).
The results obtained by researchers
accordance with the results of the study from
Melva (2009), stated that the knowledge is
good, then the woman will be aware to check
the IVA test because it is important to health.
279
Based on the result of research, can be
known that from 57 respondents’ respondents’
majority
have
supportive
stance
in
Acetic Acid) were 37 people (65.00%) and not
supportive stance were 20 people (35.00%).
According to Notoatmodjo (2010),
after someone knows the stimulus or the next
object processes then assess or act towards an
object or object stimulus. Then conduct an
assessment or opinion which known to be
practiced or implemented in daily life.
According to the assumption of the
author, the results of this study are consistent
with the statement Notoatmodjo, because the
results showed that woman who did not want
to do inspection IVA test (Visual Inspection of
Acetic Acid) have not supportive stance which
the attitude affects someone to participate in
Acetic Acid).
The result of this study is consistent
with Masrina (2008) stated that respondents
have good attitude because respondents have
knowledge, balance in belief, it is also
consistent with theory of Walgito, that not
supportive attitude appear because the
unpleasant feelings caused by the lack of
resources IVA test either benefit or how it
works. But there is also woman with good
knowledge but still not support; this case
happened because she has not confidence to do
in daily life.
Based on the result of research, from
37 respondents respondent’s majority have
good knowledge with supportive stance in
investigation IVA test were 18 people
(48.64%), enough knowledge were 14 people
(37.85%) with supportive stance, and minority
less knowledge with not supportive stance
were 5 people (13.51%). From 20 respondents
majority less knowledge with not supportive
stance in investigation were 12 people (70%),
enough knowledge with not supportive stance
were 4 people (20%), and minority good
knowledge with not supportive stance were 2
people (10%).
According to Notoatmodjo (2010)
after someone knows the stimulus or the next
object processes then assess or act towards an
object or object stimulus. Then conduct an
assessment or opinion which known to be
practiced or implemented in daily life.
The results of this study are consistent
with the theory of Notoatmodjo (2010),
280
because from the result of research found that
respondents that have good knowledge with
supportive stance in investigation in IVA test.
While woman didn’t want to check in IVA test
have less knowledge with not supportive
stance. This research is consistent with the
result of research from Evidasanti (2010) said
that knowledge and attitude will affect
woman’s perception in doing check in IVA
test.
CONCLUSION
From the result of research and
discussion “Woman’s Knowledge and
Attitudes about Participation in the
Investigation IVA Test (Visual Inspection of
Acetic Acid) in Dusun IV Desa Tengah Pancur
Batu sub-district Deli Serdang regency 2014”
can be conclude that :
1. Woman’s less knowledge were 25
people (43.90%), compared with good
knowledge were 15 people ( 26.30%).
It can be happened because less
knowledge will affect the woman’s
participation in doing IVA test (Visual
Inspection of Acetic Acid).
2. Not supportive stance were 20 people
(35%). It can be happened because
woman’s knowledge still low about
investigation IVA test, so it affected
woman’s participation in doing IVA
test.
3. Woman didn’t want to check in IVA
test have less knowledge with not
supportive stance were 12 people
(70%). It can be happened because
woman’s knowledge and attitude
affect in doing IVA test.
REFERENCES
Arifin, Zainal. 2010. Learning Evaluation.
Rosda karya, Bandung.
Astana, Mahesa. 2009. Friends with
Cancer. Araska. Yogyakarta.
Depkes. 2008. Depkes RI Profile, Cervical
cancer.
Diananda, Rama. 2009. Know the Ins and
Outs of Cancer. Kata hati. Jogjakarta.
Dunleavey, Ruth. 2009. Cervical cancer, a
guide for Nurse. 2009. Willey –
Black Well. Sidney Australia.
Emilia. 2010. Women's Reproductive
Health. Araska. Yogyakarta.
Fariz, Aziz. dkk. 2008. Gynecologic
Oncology. Bina pustaka Sarwono
Prawiroharjo. Jakarta.
Indrapraja. Cervical Cancer and
Prevention. Dalam Nugroho, Taufan.
2010. Jakarta. Pustaka Pelajar.
Lili. Garliah. 2009. Cervical Cancer
Research Report. Medan Indonesia.
FK.USU.
Marmi, dkk. 2011. Pathological Midwifery
Care. Yogyakarta. Pustaka Pelajar.
Nazir, Moh. 2009. Research Method.
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281
THE EFFECTS OF PEPINO (Solanum muricatum) EXTRACT TO THE
DECREASE OF GLUCOSE CONTENT IN BLOOD OF WHITE RATS
Ratus novergicus)
Riris Opposunggu, Bernike Doloksaribu, Oslida Martony
Department of Nutrition Health Polytechnic of Kemenkes Medan
ABSTRACT
The developing countries face the health problem. One of them is degenerative disease. The
prevalence of diabetes mellitus in the world is increase drastically in the last decade and it estimate
this number is increase in the future In Indonesia, it increase from 2.5 million in 1994 to be five
million in 2010. Manganese mineral in pepino has function as anti diabetic, in addition to the content
of –sitosterol and stigma sterol as active compound as anti hyperglycemia on pepino extract.
This research aims to study the influence of pepino extract to the decrease of glucose content in blood
of white rats. The population in this research is white rats (Rattus norvegicus) and sample in this
research is 16 white rats. This research is experimental study. The collected data was primary data by
take the data of experiment result, i.e. data of measurement of beginning blood glucose content and
end blood glucose content of the white rats using digital glucose test.
Based on the results of statistical test using Anova test, the value of p (0.000) < α (0.05), it means that
there is an influence of pepino extract to the decrease of blood glucose content on white rats. The
result of analysis by Duncan test, the application of pepino extract will decrease the blood glucose
contant for 67.5 mg/dl.
The application of pepino extract for 1 ml/day during 2 weeks will decrease the blood glucose content
for 67.5 mg/dl
Keywords : Blood glucose contant, Pepino
INTRODUCTION
A. Background
The developing countries face the health
problems and one of them is degenerative
disease. The national health survey indicates
that the increasing of prevalence of diabetes
mellitus for 8.3% of the population in 1996. In
2003, 194 million of people in the world
whose the age 20 – 79 years old are diagnosed
with diabetes mellitus disease. In 2025 it
estimates the number to be 72% of 333 million
people in the world. (Matsura, 2005)
The data of World Health Organization
(WHO) indicated that the number of patient
with diabetes mellitus in Indonesia is in the
fourth position after India, China, USA for 17
million people (8.6%). Even 7.5% of
population in Java and Bali have diabetes
mellitus (Alidjaja, 2003).
WHO estimates, the global prevalence of
Diabetes Mellitus type 2 will increase from
171 people in 2000 to be 366 millin in 2030.
Indonesia is in the fourth big nation with the
diabetes mellitus in the world.
Pepino (Solanum Muricatum) as member of
family Solanaceae (eggplant) contains gum,
B-cytosterol and Stigmasterol and the lower
282
glychemic index. The content of Manganese in
pepino has a function as co-factor of any
enzymes that help a process to regulate the
insulin because its glychemical index is lower
that delay the increasing of blood glucose
content and to maintain the normal glucose
content, B-cysterol and Stigmasterol tht
increase the production of insulin (HGakimah,
2010).
Problem Formulation
What the influence of application of pepino
(Solanum Muricatum) extract to the decrease
of blood glucose content of white rats (Rattus
Novbergicus).
B. The Objective of this Research
1. General Objective
To study the influence of the application of
pepino (Solanum Muricatu) extract to the
decrease of blood glucose content of white rats
(Rattus Novergicus).
2. Specific Objective
a. To study the beginning blood glucose
content of white rats (Before the
application of glucose 1 ml/day during 1
week).
b. To study the end blood glucose content of
white rats (After the application of pepino
extract 0.5 ml, 0.75 ml, 0.1 ml during 2
week).
c. To analyze the influence of the application
of pepino extract to the decrease of blood
glucose content of white rats.
C. Purposes of Research
As information to the patient of diabetes
mellitus about the influence of the application
of pepino extract to the decrease of blood
glucose content.
METHOD OF RESEARCH
A. Location and Time of Research
This research was conducted at chemical
laboratory of Nutrition Department of
Politekkes Kemenkes Medan since June up to
August 2014.
B. Type and Design of Research
This research is poor experimental study using
randomization.
The choosing of research object for groups and
application of treatment is using RAL method
with Posttest Only Design Group.
C. Population and Sample
Population in this research : white rats in
species of Rattus Novergicus Strain Wister
that consist of 16 white rats, the number of
sample is 3 for each repetition and 4 treatment
(X0, X1, X2, X3) and 4 reserves so it needs
16 white ratas.
1. White rats (Rasttus novergicus) is
experiment animals in white color and
body weight is 250 gr, age 2 months
2. Blood glucose content is the measurement
of blood glucose content of white rats
before the application of glucose 50% for
1 ml/day.
3. The end blood glucose content is the
measurement of blood glucose content of
white rats after the application of pepino
extract in dosage 0.5 ml, 0.75 ml and 1 ml
during 2 weeks.
4. Glucose 50% is 50 gr glucose crystal
dissolved into 100 ml aquadest
D. Procedure of Research
The procedure of research are :
1. Preparation
a. Cage preparation
b. Choosing the experiment animal (male
white rats)
c. Numbering of white rats
d. Preparation of glucose solution 50%
2. Experiment phase
With four groups (X0, X1, X2 and X3),
the experiment procedure are as follows :
Step 1 : Adaptation during two days
Step 2 : In the third day, the glucose 50%
was applied in dosage 1 ml/day
Step 3 : In the eleventh day, to apply the
pepino extract in dosage 0.5 ml/day, 0.75
ml/day and 1 ml/day during fourteen days
in group X1, X2, X3 while group X0 did
not get the pepino extract and only as
control. On the 26th day, the blood was
took and to measure the blood glucose
content on group X0, X1, X2 and X3.
Type and Method of Data collecting
The type of data is primary data
Data processing and analysis
The applied statistical test is One Way Anova
Test (p = 0.05) to test the comparison of
average of blood glucose content on white
rats in each groups. If in One Way Anova test
there is different average, so it need the
advanced analysis (Post Hoc Test Tukey ) (p =
0.05) to determine group with the different of
average of blood glucose content on whire rat.
The blood glucose content of white rats
Table of analysis of blood glucose content of
white rats
No
Treatment
Group
N
KGD White
rats (mg/dl)
Mean ± SD
1
Control (X0)
4
141.50 ± 3.10a
2
Treatment (X1) 4
130.00 ± 3.55a
3
Treatment (X2) 4
116.50 ± 8.58b
4
Treatment (X3) 4
95,50 ± 6.55c
Note *) the different notation indicates the
significant difference )p < 0.05)
The average of blood glucose content on group
X3 has a lower content (95.50 ± 6.55) it means
that the application of pepino extract in dosage
1 ml/day decrease more the blood glucose
content, while the higher one is in group X0
(141.50 ± 3.10)
The result of analysis by One Way Anova
indicates that there is decrease of glucose
content significantly (p<0.05) on the treatment
group of X1 (130.00 ± 3.55) if compared toi
283
KDG Tikus Putih
(mg/dl)
treatment X0 (141.50 ± 3.10), treatment group
of X2 (116.50 ± 8.58) and treatment group of
X3 (95.50 ±6.55). based on the results indicate
that the higher of dosage of pepino extract, the
higher of decrease of blood glucose content on
white rats. This proves that decrease of blood
glucose content in dosage 1 ml give a
maximum result in decr5ease blood glucose
content.
Depiction of comparison of the average of
blood glucose content of any groups before
analysis by One Way Anova is as follows :
200 141.5
130
116.5
95.5
100
0
X0
X1
X2
X0 X1 X2 X3
Perlakuan
X3
Figure : The Average of Blood glucose content
of white rats.
Based on the figure, it indicates that there is
change of blood glucose content that different
in group X0, X1, X2 and X3. The application
of pepino extract in the various dosages, i.e.
0.5 ml, 0.75 ml and 1 ml will decrease the
blood glucose content of white rats. The
decrease of blood glucose content of white rats
is caused by the compound of β-cytosterol and
stigmasterol as active compound that give an
effect of anti hyperglycemic β-cysterol and
st5igmasterol on pepino extract as unsaturated
fitosterol. Β-cytosterol and stigmasterol is a
combination and compound of fitosterol that
provide a good synergic effect than the single
compound (Hakimah, 2010)
Based on results of Homogeneous test, p value
= 0.087 (p value > 0.05) indicates that the
variance of sample groups is same or
homogenous. Based on results of Anova Test,
p value = 0.000 (p value < 0.05) and indicates
that the average of blood glucose content on
treatment group is not identicfal or there is
difference of average of decrease of blood
glucose content on white rats by the
application of pepino extract with the various
dosages. Based on result of Anova Test value
< 0.05 is not identical or there is difference of
average, the test is continued by see the p
value of the Multiple Comparison table. And p
value on Multiple Comparison table, p value =
284
0.000 (p value < 0.05), this result indicates the
average of blood glucose content on each
treatment is not same.
Conclusion
The application of pepino extract for 1 ml will
decrease blood glucose content of white rat for
67.14 mg/dl while the application of pepino
extract for 0.5 ml will decrease the blood
glucose content of white rats for 27.7 mg/dl.
Suggestion
It is sugg4ested to the patient with the higher
blood glucose content to decrease the glucose
content by consume pepino.
Bibliography
Almatsier, Sunita. 2004. Prinsip Dasar Ilmu
Gizi. Gramedia Pustaka Utama.
Jakarta
Alidjaja, Juniarta, 2003. PerananFunction
Food Dalam Upaya pencegahan
dan
Pengobatan
Beberapa
Penyakit.
Jurnal
Pertemuan
Ilmiah Nasional (PIN) AsDI ke
III. Yogyakarta
Candra
,
Budiman,2007,
Metodologi
Penelitian Kesehatan, Jakarta.
Indra R. M. 1999, Penelitian Eksperimental
dalam Buku Ajar Metodologi
Penelitian,
Malang,
FK
Universitas Brawijaya.
Ide, Pangkalan. 2010. Health Secret of
Pepino. Mencicipi Pepino si Buah
Ajaib,
Pendatang
Baru
Asal
Pegunungan Andes sebagai Obat
Dewa. Jakarta : PT. Gramedia Pustaka
Utama.
Handayani,
Diah.
2007.
Peranan
Micronutrient Pada Diet Diabetes
Mellitus. Seminar 2nd Malang
Nutrition UpDate- Santika Hotel 3-4
Nopember 2007
Hakimah Ainun indi. 2010. 81 Macam Buah
Berkhasiat Istimewa. Syura Media
Utama. Jawa Tengah.
Matsura. 2005. Core Competencies In
Diabetes Care. Jurnal, NCD Malaysia
2005, Volume 4, No 2.
Enrico Marentek. 2006 Retensi Insulin Pada
Diabetes melitus Type 2. Jurnal,
Makasar
Nurjanah Nunung, 2006. Taklukkan Diabetes
Dengan Terapi Jus. Puspa Swara.
Jakarta
SATISFACTION LEVEL OF OUTPATIENT TO THE PHARMACY
INSTALLATION SERVICE AT RS KUSTA PULAU SICANANG
BELAWAN
Sitanggang, Rosmayani Silitonga, Cory Karlina Purba
[email protected]
Abstract
Leprosy is chronic transmitted infection disease caused by Mycrobacterium lepra. These bacteria
attract the skin and periphery nerves on human being. This research aims to study the satisfaction
level of the outpatient to the pharmacy installation service with sample of 64 respondents of outpatient
who stay at lodging of RS Kusta P. Sicanang, Belawan who have be cared. In order to get the data of
results, each respondent fill the questionnaire based on the received service.
The satisfaction level of outpatient on 5 studied dimension, such as : (1) the respond of officer is
satisfactory 75.52%, (2) Reliability of officer is quite satisfactory 71.06%. (3) Guarantee for the
availability of medicines is quite satisfactory 68.39%. (4) the empathy of officer is quire satisfactory
68.59% and (5) physical condition of hospital is quite satisfactory 61.81%. the performance of officer
or staff of Pharmacy Installation is based on the expectation of the patient so the client is satisfied and
quite satisfied to the service of hospital.
Keywords : Service of Pharmacy Installation officer, satisfaction level of the outpatient,
Rumah sakit Kusta P. Sicanang.
Introduction
Hospital is a place to do the health care by :
The increasing of health level Disease
preventive Treatment
Halth recovery harmoniously, integrally and
continuously in Puskesmas (Health Center),
Hospital type E, type D, type C, type B and
type A.
Method of Research
This research applies descriptive method, i.e. a
depiction of the satisfaction level of outpatient
to the service of pharmacy installation to the
outpatient who stay at lodging of hospital.
The collected data of this research are : (1)
Primary data, i.e. data collected from the
patient directly through direct interview and
questionnaire. (2) secondary data is data of
patient from hospital, (3) the data was
collected in 2 weeks.
The sample was took by purposive sampling
method with criteria is patient who stay in
lodging around the hospital.
The Data Analysis
The characteristic of respondent based on
gender and age
NoRespondent Number (person)Percentage (%)
1 Gender
Male
32
50
Female
32
50
2 Age range
15-25 (years) 12
19.75
25 – 35 (years)
35 – 50 (years)11
17.19
> 50 (years)
30
46.87
11
17.19
Characteristic and type of service
Charact
Type of service
No. of
eristic
SM M CM
No
Questi
of
(5) (4) (3)
onnaire
service
1 Respons 3
27
103 55
e
2 Reliabili 5
39
131 123
ty
3 Quarant 8
23
202 220
ine
4 Empath 4
21
103 100
y
5 Physical 5
3
103 145
KM SKM
Total Percent
(2) (1)
6
1
725
75.52
22
5
1137 71.06
65
2
1715 71.06
29
3
878
68.59
58
11
989
61.81
285
SM
M
CM
KM
= Very satisfactory
= Satisfactory
= quiet satisfactory
= not satisfactory
Conclusions
The satisfaction level of outpatient on 5
studied dimension, such as : (1) the respond of
officer is satisfactory 75.52%, (2) Reliability
of officer is quite satisfactory 71.06%. (3)
Guarantee for the availability of medicines is
quite satisfactory 68.39%. (4) the empathy of
officer is quire satisfactory 68.59% and (5)
physical condition of hospital is quite
satisfactory 61.81%. the performance of
officer or staff of Pharmacy Installation is
based on the expectation of the patient so the
client is satisfied and quite satisfied to the
service of hospital.
References
Ahaditomo ( 2003, 1995) Pelayanan yang
berhubungan dengan penggunaan obat,
Jakarta.
Azwar (1996) Pelayanan Kesehatan Bermutu,
Jakarta.
Charles, J.P dan Amalia.2003, Farmasi Rumah
Sakit, Teori dan Penerapan, EGC: Jakarta.
Ditjen PP-Pl (2007). Buku Pedoman
Pemberantasan Penyakit Kusta
286
Dermawan (2008), Pusat Latihan Kerja
Nasional. RS. Kusta P. Sicanang.
Makasar.
Kotler, Philip dan Amstrong, G.1997, Dasardaras Pemasaran, Jakarta: Prenhalindo.
Kotler, Philip dan Kevin Lane Keller, 2008,
Manajemen
Pemasaran
(Marketing
Management, Thirtennth Edition) :
Jakartta.
Naafs dan Wheate (1978). Interval waktu
antara awal anti lepra Pengobatan dan
perkembangan reaksi pada pasien Lepra,
Jakarta.
Parasuman, dkk (1998). Skala Servqual; yang
terbagi atas lima dimensi, Yogyakarta.
Supranto, (1997). Kual;itas Pelayanan
Penyedia Jasa, Jakarta.
Tjiptono
dan
Fandy.
2008,
Sevice
Management
Mewujudkan
Layanan
Prima, Jogjakarta
Watson dan Jean M (1996). Tindakan penting
untuk mengurangi resiko cacat pada
penderita kusta, Jakarta.
Wexley dan Yukl (1997), Kepuasan
Konsumen, Jakarta.
http://bhogey.com/2009/11/fungsi-tugas-dantipe-tipe-rumah-sakit.html
9/21823/4/Chafter%20ii/pdf
OVERVIEW OF KNOWLEDGE AND PUBLIC ATTITUDE TOWARD
THE USE OF MEDICINE WITHOUT PRESCRIPTION IN YASMIN
PHARMACY AT JALAN PINANG BARIS MEDAN
Zulfa Ismaniar Fauzi
[email protected]
ABSTRACT
Healthy is a health condition, either physics, psychic, spiritual or social that enable anyone for
productive life either socially or economically. One of efforts to increase the health level of society is
a pharmacy related work and one of pharmacy service by pharmacy is self medication or the using of
medicine without prescription.
This research is a descriptive study. The method of data collecting is a survey by distribute
the questionnaire to the respondent. The population in this research is 1623 and the number of sample
is 94 respondent.
The results of research indicates that all of respondent, 83% know the definition of self
medication, know the type of medicine use in self medication (82.6%), 83.0% of respondent know
that the antibiotic must be used up in the determined period and 73.4% know that did not all of
diarrhea treated by antibiotic. The attitude of respondent to the using of medicine without prescription
is profitable to he people (45.7%), is hazardous for health without direction of using (55.3%), is
cheaper than medicine with prescription (51.1%) and must known based on clear direction (48.9%)
Based on this research it concluded that the people has a good knowledge for 53 respondent
(56.4%). The people who has a good attitude is 51 persons (54.3%).
Keywords
: Knowledge, Attitude of user of medicine without prescription
INTRODUCTION
According to the Act No. 36 of 2009,
healthy is a health condition, either physics,
psychic, spiritual or social that enable anyone
for productive life either socially or
economically. The health development as one
of efforts of the national development in order
to achieve the awareness, willingness and
capability for health life for each people in
order to realize the society health level
optimally. The implementation of health
activities by maintenance approach, health
service, health promotion, diseases prevention,
disease treatment (curative) and rehabilitation.
One of efforts for the increasing of health level
of society is through pharmacy related work,
and the place of the pharmacy activity is
pharmacy.
Self medication can be performed for
the mild, general and non active diseases
(Wulandari, 2010). The using of medicine in
self medication is one of health attitude. The
type of medicine used by people in self
medication is free drugs, limited free drugs
and Pharmacy Compulsory drug. Factors
influence the increasing of self medication is
the development of innovative pharmacy
technology, type and brand that known by
society, the change of regulation about the
medicine or pharmacy, the awareness of
society on the importance of health , the
influence of information or advertisement, the
easiness to get the medicine and the high price
of health condition.
METHOD OF RESEARCH
This research describe an overview of
knowledge and public attitude toward the
using of medicine without prescription in
Yasmin Phrmacy Jalan Pinang Baris Medan.
The data was processed using descriptive
method with survey research model in cross
sectional study, i.e. a research to study the
correlation dynamic between the risk factors
with effect and approach method, observation
or data collecting, simultaneously. (Sugiyono,
2010).
SAMPLING
The sample of this research is took by
purposive sampling based on certain
consideration determined by researcher, based
on known characteristic (Notoatmodjo, S.
2010). The criteria of sample is a consumer
who buy the medicine without prescription.
287
RESULT
Category of Knowledge of Respondent to
the Using of Medicine without prescription
at Yasmin Pharmacy Jalan Pinang Baris
Medan.
No Category of Frequency Percentage
Knowledge
1
Good
53
56.4
2
Good
16
17.0
enough
3
Poor
24
25.5
4
Bad
1
1.1
Total
94
100.0
Category of Attitude of Respondent to the
Using of Medicine without prescription at
Yasmin Pharmacy Jalan Pinang Baris
Medan.
No Category
Frequency Percentage
of Attitude
1
Good
51
54.3
2
Enough
34
36.2
3
Poor
9
9.6
4
Bad
0
0.0
CONCLUSION
Generally people already have a good
knowledge. This is indicated by the majority
of respondents drug users without prescription
in pharmacies Yasmin Jalan Pinang Baris
Medan. This research concludes that the
people has a good knowledge for 53
respondent (56.4%) and the respondent who
have a good attitude is 51 respondent (54.3%)
REFERENCE
Anief, Moh.1997. Ilmu Meracik Obat. Gajah
Mada University Press. Yogyakarta.
Anonim.2012. Penggolongan Obat Menurut
Permenkes.
288
http://Apotekonlines.blogspot.com/2012/1
2/Penggolongan-obat-menurut
permenkes.html
Anonim. 2013. Hal Yang Harus
Diperhatikan Saat Melakukan
Swamedikasi.
http://pharmaselfcare.wordpress.com/201
3/04/30/swamedikasi-an
introduction.html
Aspuah, S.2013. Kumpulan Kuesioner dan
instrument Penelitian Kesehatan. PT.
Nuha Medika. Yogyakarta
Bogadenta, A. 2013. Manajemen Pengelolaan
Apotek. Ed.II. D-Medika. Yogyakarta.
Kartika, U.S.M.2010. Pola Penggunaan Obat
Dalam Upaya Pasien Melakukan
Pengobatan Sendiri Di Beberapa Apotek.
Skripsi. Fakultas Farmasi. Universitas
Sumatera Utara. Medan.
Manan, El. 2014. Buku Pintar Swamedikasi.
Ed.I. Saufa. Yogyakarta.
Nazir, Moh. 2011. Metode penelitian. Graha
Indonesia. Jakarta.
Notoatmodjo, S. 2002. Metode Penelitian
Kesehatan. Rineka Cipta. Jakarta.
Notoatmodjo, S. 2010. Promosi
Kesehatan, Teori dan Aplikasi. PT.
Rineka Cipta. Jakarta.
Sugiyono.
2010.
Metode
Penelitian
Kuantitatif, Kualitatif dan R&D. Ed.X.
PT. Alfabeta. Bandung.
Syamsuni, A.H.2006.Ilmu Resep. Penerbit
Buku Kedokteran. EGC. Jakarta.
Tjay, T.H. dan Kirana R. 2007. Obat-Obat
Penting. Ed. V. PT. Elex Media
Komputindo. Jakarta.
Wulandari,
N
.2010.
Swamedikasi.
http://nikenwulandari.blogspot.com/2010/01/swamedi
kasi.html.
FACTORS CAUSE NEONATAL ASPHYXIA OCCURRENCE
OF NEONATAL ASPHYXIA IN THE PERINATOLOGY
OF DR.PIRNGADI GENERAL HOSPITAL MEDAN 2014
Tiurlan Mariasima Doloksaribu, Risma Dumiri Manurung
Department of Nursing, Poltekkes Medan
Abstract
Neonatal asphyxia is a condition in which a baby can not breathe spontaneously and regularly soon
after birth so can cause infant growth is not optimal due to lack of oxygen from the mother to the fetus
that can cause the baby hypoxia. The occurrence of asphyxia due to several factors such as maternal
age, gestational age, parity, birth weight, type of delivery and prolonged labor.
This is a descriptive study that aims to describe the causes of neonatal asphyxia in newborns in
Perinatology space Hospital Dr. Pirngadi MedanTahun 2014. This study was a survey, and the
population in this study were all women who give birth to babies with neonatal asphyxia, amounting
to 90 people.
The result showed that majority of respondents (80%) age <20 years, 41.3% of respondents preterm
gestational age (28-36 weeks), 47.4% of respondents grandemultipara (number of children> 5), 51.1%
of respondents having a baby with normal birth weight, 57.1% of respondents do not normal
childbirth and 59.3% of respondents who gave birth to a baby with neonatal asphyxia experienced
prolonged labor.
Mother suggested to give more attention to health both before and after childbirth and health workers
also to improve their knowledge and skills in performing the management of asphyxia by means
ranging from aspects promotive, curative, rehabilitative so that mortality and morbidity in infants
decreased.
Keywords
: Causes, asphyxia Neonatorum
Bibliography : 25 readings (2005-2013)
BACKGROUND
Neonatal asphyxia is a form of emergency
newborn respiratory depression that continues
to cause various complications and is a cause
of mortality and morbidity in infants
(Maryunani A, 2009).
WHO data (2005) mentions approximately
23% of neonatal deaths are caused by asphyxia
with the proportion of stillbirths is greater
(Sari et al, 2011).
In 2011, Indonesia is the fifth highest IMR for
ASEAN countries is 35 per 1,000, Myanmar
48 per 1000, Laos and Timor Leste and
Cambodia 46 per 1000 36 per 1000 with 32%
of cases of prematurity, asphyxia 30%,
infections (22%), congenital anomalies (7%),
and others 9% (Herianto et al, 2012).
Various factors causing neonatal asphyxia
including preterm labor, prolonged labor,
preeclampsia and eclampsia, delivery by
actions, infant factors and other factors
(JNPK-KR, 2007).
Asphyxia if it lasts too long can cause brain
bleeding, brain damage and possible
developmental delays and lead to lifelong
disabilities such as blindness, deafness, brain
defects and death, therefore it is necessary
interventions and appropriate action to
minimize the occurrence of infant deaths
(MOH, 2008).
Tahir study (2012) showed that the factor
delivery (prolonged labor, type of delivery,
and premature rupture of membranes) at risk
of having a baby with neonatal asphyxia
percentage of mothers who experienced
prolonged labor amounted to 20.3% (OR =
3.417; 95%) and those who do labor act of
57.7% (OR = 4.444; 95%) and women who
experienced premature rupture of 37.9% (OR
= 2.471; 95%) had statistically proven
meaningful relationship. While research
Herianto, et al (2012) showed that the
proportion of women aged <20 years and> 35
years of 46.7%, based on parity mothers with
parity nullipara and grandmultipara by 66.7%
289
and by birth weight is known that infants with
low birth weight by 33.3%.
Data Medical Record Hospital Dr Pirngadi
Medan the number of babies suffering from
neonatal asphyxia in 2011 as many as 41
people, in 2012 as many as 23 people and in
2013 as many as 26 people.
RESEARCH METHODS
Type a descriptive study with survey research
design is a method that describes the
relationship between the various variables
studied, from objects that have a unit or
individual that is quite a lot. Location
perinatology research conducted in space
Hospital Dr. Pirngadi Medan, which was
conducted in December 2013 - June 2014. The
population is all women who give birth to
babies with neonatal asphyxia in a room
Perinatology Hospital Dr. Pirngadi field with
the total population is 90 people baby.
Sampling using the total population taken by
collecting status / medical record from 2011
respondents as many as 41 people, in 2012 as
many as 23 0rang and by 2013 as many as 26
people so the total number of samples as many
as 90 people. Data analysis Descriptive see the
proportion of variable maternal age, maternal
gestational age, parity, body weight infants,
the type of delivery and prolonged labor
RESEARCH RESULT
An overview of research results factor in the
neonatal asphyxia in newborns in hospitals
perinatology space Dr.Pirngadi field include
maternal age, maternal gestational age, parity,
infant birth weight, type of labor, prolonged
labor and neonatal asphyxia classification.
decline, and at age <20 years of reproductive
organs of a woman also has not functioned
perfectly so that the risk of having a baby with
asphyxia.
At the age of 20-35 years of age known as safe
for pregnant and do labor. However, from the
research can be seen that at this age there is
42.9% of mothers give birth to babies with
severe asphyxia, it is because in this age of
mothers giving birth many abnormally
(sectio). In addition to the 20-35 year-old
women who can give birth to a baby because
of the possibility of maternal neonatal
asphyxia is accompanied with other diseases
that are being experienced as premature
rupture of membranes, solutio placenta, and
placenta previa.
In line Herianto study (2012), that the
proportion of mothers aged 20-35 years gave
birth neonatal asphyxia by 53.3%, at age <20
years and> 35 years of 46.7%. Herianto
research results mentioned that the aging will
be followed by changes in the development of
organs in the pelvic cavity and this situation
will affect the life of the fetus in the womb.
Tahir research results (2012) showed that the
proportion of mothers who gave birth at most
neonatal asphyxia at the age of 25-28 years
that is equal to 24.2%. Therefore, the age
factor to be considered in a marriage that
neonatal asphyxia at birth does not occur.
DISCUSSION
1.Mother age
Age is one component of reproductive status,
Hanifa (2005) suggested that in the group of
20-35-year-old mother's maternal mortality
rate is lower than that seen in women aged less
than 20 years, and compared with a group of
mothers aged 35 years or more.
2.Gestation
Pregnancy postdates (posterm) has a close
relationship with perinatal morbidity and
mortality, babies born to mothers over 42
weeks due to a decrease in the hormone
progesterone stimulate the birth process and
increases uterine sensitivity to oxytocin. The
result showed that 100% of infants
experiencing severe asphyxia due to the aging
of the placenta resulting in reduced supply of
food and oxygen from the mother to the fetus,
besides pregnancy that is too long can lead to
oligohydramnios.
From the research that has been done can be
seen that the majority of mothers were aged
<20 years gave birth asphyxia 80% by weight
and maternal age> 35 years also gave birth
asphyxia 50% by weight. According to this
theory is because in the age> 35 years of a
woman's reproductive function began to
Based on the results of the study showed that
women with gestational age between 28-36
weeks (preterm) gave birth asphyxia as many
as 46 people with severe asphyxia 41.3%. It's
caused by babies born preterm organ - not yet
mature organs such as the liver, respiratory
system, kidneys, gastrointestinal (digestive
290
system), and thermoregulatory. This causes the
respiratory system, especially the baby's lungs
are not yet working optimally, the surfactant is
still less so that there is the possibility of the
development of lung disorders, respiratory
muscles are weak, so the baby's cry sounded
weak and whimpering infant may suffer as a
result of asphyxia (Maryunani A, 2013).
Hartatik research results (2013) says that
infants with neonatal asphyxia majority of
preterm gestational age by 28 people (70%)
gave birth asphyxia risk 2.9 times. In line
Wahyuningsih research, E (2011) says that the
pregnancy term, the potential occurrence of
respiratory depression newborn asphyxia
continues to be decreased by 87% at 28-40
weeks gestation
Mansjoer (2005), stating that neonatal
asphyxia usually occurs in babies born to
mothers with preterm birth or through time.
3.Parity
Manuaba (2004) suggested that high parity
enable the occurrence of complications of
pregnancy and childbirth that can cause
disruption of transport oxygen from the
mother to the fetus which would cause
asphyxia.
Based on the survey results revealed that
mothers who give birth to children more than
5 (grandmultipara) gave birth to a baby with
asphyxia was as much as 100%, and
primiparous mothers who gave birth to
children with severe asphyxia as many as 18
people (47.4%).
Wahyuningsih research results, E (2011) as
many as 16 people (53.3%) of respondents
parity primiparity asphyxiated due to the
content of the muscles are still stiff and not
perfect so the ability of low conception this
causes frequent occurrence of complications
such as his disorder hypotonic so that blood
flow to the uterus is reduced resulting in
decreased oxygen to the placenta.
4.Baby Weight
Table 4. known that babies born with normal
weight did not experience severe asphyxia
41.9%. Maryunani, A (2009) suggested that
infants with low birth weight or <2500 grams
growth is normally recorded have difficulty
breathing immediately after birth because of
the number of functioning alveoli is still small,
and the surfactant is less so easy alveoli
collapse during the expiratory lead to
respiratory distress such as respiratory distress
and neonatal asphyxia.
Results of this study also found that 51.1% of
infants with normal weight suffered severe
asphyxia due to other factors such as occurred
nuchal cord, childbirth complications and
others. Herianto (2012) suggests that there is a
significant relationship between low birth
weight with neonatal asphyxia, OR 3.5 times
the risk of having a baby with neonatal
asphyxia.
5.Delivery type
Many indications that resulted in a mother
should do is not normal delivery as the
location of the abnormality of the fetus,
prolonged labor, placenta previa preeklampsi
and eclampsia etc. (Purwaningsih W, 2010).
Based on the research as much as 57.1% of
babies were born with severe asphyxia on
respondents who gave birth to the action
section. Bobak et al (2005) states that babies
born via sectio Caesaria more often with
respiratory infections or neonatal asphyxia
because the baby whose birth too fast can not
experience the adaptation or transition
between the world inside the womb and
outside the womb. Consistent research Tahir
(2012), women with abnormal labor 57.7%
risk of having a baby with 4.44 times
asphyxia.
6. Parity
Babies are too long in the birth canal is bad as
fetal heart rate fast / irregular, there is
meconium in the amniotic fluid that can lead
to infant hypoxic even asphyxia. The severity
of injury increases with the length of labor that
risk rises rapidly after more than 24 hours in
primi and more than 8 hours on a multi
(Oxorn, 2010).
These results indicate the respondents who
experienced prolonged labor gave birth to
babies with severe asphyxia by 59.3%. Oxorn,
(2010) states that the duration of labor, the
higher morbidity and mortality of fetal
asphyxia and becoming more frequent,
consistent with research Tahir (2012), suggests
that women who experienced prolonged labor
291
due to his inadequate 3.41 times the risk of
having a baby neonatal asphyxia. Really need
to pay attention during childbirth pelvic
abnormalities,
premature
rupture
of
membranes, his disorders, obstructed labor
leaders to avoid prolonged labor.
CONCLUSION
1.Majority respondents (80%) gave birth to
infants with asphyxia Neonatorum age <20
years.
2.Majority (41.3%) of respondents preterm
gestational age (28-36 weeks) gave birth
asphyxia.
3.Majority
respondents
(47.4%)
grandemultipara (number of children> 5) gave
birth to a baby with neonatal asphyxia.
4.Baby with normal birth weight neonatal
asphyxiated by (51.1%)
5.Respondent with abnormal childbirth
(57.1%) gave birth to a baby with neonatal
asphyxia.
6.Respondent who gave birth to a baby with
neonatal asphyxia experienced prolonged
labor (59.3%).
ADVICE
1.To health workers, especially in the field
Dr.Pirngadi perinatology hospitals to provide
health education for pregnant women as well
as for personnel attending births for more
attention to the course of the delivery process
and must always be alert to the conditions of
labor complications that can reduce the
incidence of neonatal asphyxia.
2. For the mother should follow the family
planning program, to plan a pregnancy, pay
attention to nutrition during pregnancy,
antenatal
Another
3.Researchers advised to examine other factors
causing the occurrence of neonatal asphyxia
and how the relationship between the factors
studied the incidence of neonatal asphyxia.
DAFTAR PUSTAKA
Alimul, A. 2007. Riset Keperawatan dan
Tehnik Penulisan Ilmiah. Salemba :
Mudika
Bobak, dkk. 2005. Buku Ajar Keperawatan
Maternitas Edisi 4. EGC : Jakarta
Depkes RI. 2008. Profil Kesehatan Provinsi
Jawa
Tengah
2008.
www.dinkesjatengprov.go.id.
[diakses
tanggal 17 februari 2011]
292
Hanifa. 2011. Hubungan berat badan lahir
dengan kejadian asfiksia pada bayi baru
lahir di RSUD Prof.Marjono Soekarjo.
FK Universitas jenderal soedirman.
Purwokerto
Hartatik. 2013. Pengaruh umur kehamilan
pada bayi baru lahir dengan kejadian
asfiksia di RSUD Dr.Moewardi. Stikessu
Aisyiyah Surakarta
Herianto dkk. 2012. Faktor-faktor Yang
mempengaruhi
Terjadinya
Asfiksia
Neonatorum di RS Umum ST Elisabet
Medan. http://www.geogle.com.
JNPK-KR,
2007.
Pelatihan
Asuhan
Persalinan Normal Asuhan Esencial
Persalinan. Revisi, 2007 : Jakarta.
Kristiyana SW. 2010. Asuhan Keperawatan
Neonatus dan Anak. Muhamedika :
Jakarta.
Maeleeny.
2011.
Gambaran
asfiksia
neonatorum pada bayi baru lahir di RS
umum haji adam malik medan. FK USU
Medan
Mochtar, R. 2012. Sinopsis Obstetri. EGC :
Jakarta.
Mansyoer. 2005. Kapita selekta kedokteran.
Media Aesculapius : Jakarta
Manuaba. 2004. Ilmu kebidanan penyakit
kandungan dan keluarga berencana
untuk pendidikan bidan. EGC : Jakarta
Maryunani
A,
Eka.
2013.
Asuhan
Kegawatdaruratan
Maternal
dan
Neonatal. TIM: Jakarta
Maryunani A, Nurhayati. 2009. Asuhan
Kegawatdaruratan dan Penyulit Pada
Neonatus. TIM : Jakarta
Notoadmodjo, soekidjo. 2007. Metodologi
Penelitian Kesehatan. Rineka cipta :
jakarta.
Oxorn, dkk. 2010. Ilmu Kebidanan: Patologi
dan Fisiologi Persalinan. C.V Andi
Offset : Yogyakarta.
Purwaningsih W. 2010. Asuhan Keperawatan
Maternitas. Muhamedika : Yogyakarta.
Rukiyah A, Lia. 2010. Asuhan Neonatus Bayi
dan Anak Balita. TIM : Jakarta.
Saifuddin, AB. 2006. Buku Panduan Praktis
Pelayanan Kesehatan Maternal dan
Neonatal. Yayasan Bina Pustaka Sarwono
Prawirohardjo : Jakarta.
Sari
dkk.
2011.
Pencegahan
dan
Penatalaksanaan Asfiksia Neonatorum.
Health Technology Assessment Indonesia
Departemen
Kesehatan
Republik
Indonesia.
Sudarti, A. 2013. Asuhan neonatus resiko
tinggi
dan
kegawatdaruratan.
Muhamedika : Jakarta.
Tahir dkk. 2012. Resiko Faktor Persalinan
Dengan Kejadian Asfiksia Neonatorum.
Skripsi. FKM Universitas Hasanuddin
Makassar.
Wahyuningsih, E., Saifuddin. 2011. Hubungan
paritas dengan kejadian asfiksia di
Rumah Sakit Islam Surakarta.
Wiknjosastro. 2005. Ilmu kebidanan. Yayasan
Bina Pustaka. Jakarta
293
COMPARISON OF LEVELS LEPTIN
IN VISCERAL AND NON VISCERAL OBESITY
Yulina Dwi Hastuty
Department of Midwifery , Poltekkes Kemenkes Medan
Abstract
This study aims to determine the ratio between the levels of leptin, visceral and non-visceral obesity.
To achieve the goal, examination and laboratory studies include measurement of height, weight, waist
and pelvis as well as the levels of leptin. The study population was all persons suspected of obesity
obtained by accidental sampling. Analysis of the results using SPSS with significance level of p
<0.05. The results showed that the percentage of obesity is more prevalent in women than in men and
obese highest age group was found in the age group 31-40 years. Leptin levels did not differ between
visceral obesity with non-visceral obesity (p> 0.05) and leptin levels were higher in women than men
(p <0.05).
Key words: leptin, visceral obesity, non-visceral obesity
Introduction
Obesity is a global problem in
developed countries and developing countries.
The prevalence of obesity is increasing in
recent years and has led to serious health
problems. Globally, at least 2.8 million deaths
each year linked to weight gain and obesity
which 300,000 occur in the United States and
350,000 in Southeast Asia (Rahmouni et al,
2005: WHO / SEARO, 2011). Based on data
from the Noncommunicable Disease in SouthEast Asia Region in 2008 the prevalence of
individuals with a BMI ≥ 25 kg / m2 increased
from 2.7% to 8.9% in Bangladesh, 1.6% to
10% in Nepal and 11% to 15% in India, while
in Indonesia percentage reached 16% in men
and 25% in women (WHO / SEARO, 2011).
For the North Sumatra region data obtained
from the Regional Health Research (Riskesda)
in 2007 showed the percentage reached 11.9%
overweight and 13.5% obese. In 2010 the
percentage of overweight in males 10.9% and
12.8% in women, while the percentage of
obese 9.4% in males and 17.4% in women
(Riskesda, 2010)
Increasing the number of individuals
with obesity is bad for health, considering
obesity is a chronic disease that is polygenic or
monogenic which may result in some
circumstances or pathological dysfunction
(Klein & Romijn, 2008). Some things that can
influence obesity, including genetic factors,
food intake, neuroendocrine mechanisms,
social, cultural and lifestyle (Librantoro,
2007). In Indonesia, lifestyle changes that lead
to Westernization causes changes in diet refers
294
to a diet high in calories, fat and cholesterol
that have an impact on the increased risk of
obesity (DirKes, 2009).
Obesity is defined as a condition there
is an excessive accumulation of body fat,
According to the standard body mass index
(BMI), BMI> 25 kg / m2 categorized as obese
(Asia-Pacific, 2000). Normally the excess fat
will be stored layer of subcutaneous, but due
to malfunctioning or damage the layer of
accumulated visceral fat (Ibrahim, 2009). Fat
distribution in different places have
implications for morbidity (Flier, 2006;
Ibrahim, 2009). Abdominal and intraabdominal fat has greater significance than the
fat that is distributed in the lower extremities
or the whole body (Flier, 2006). Obesity is
also a factor presdiposisi occurrence of
hypertension,
dyslipidemia,
diabetes,
cardiovascular disease, renal failure and
inflammatory responses (Bravo, 2006).
Prospective studies using anthropometric
measurements found that visceral obesity is
closely linked with hypertension, diabetes and
cardiovascular disease (Tchernof, 2007).
Obesity can be divided into abdominal
or visceral obesity and obesity periper or nonvisceral (Wajchenberg, 2000; Klein & Romijn,
2008), which distinguishes them is that
visceral fat had the glucocorticoid receptor and
androgen more, metabolism is more active,
more sensitive to lipolysis and more resistant
to insulin. Visceral adipose tissue (VAT) has a
greater capacity to produce Free Fatty Acid
(FFA), increases glucose and more sensitive to
adrenergic stimulation (Ibrahim, 2009).
Today has been much studied matters related
to obesity, including the causes of obesity and
the resulting risks. Leptin is a hormone that is
considered to play a role in causing obesity.
Leptin was first discovered in 1994 on obese
mice (gen ob / ob), is a 16 kDa peptide
produced largely by adipose tissue that acts as
a major regulator in the regulation of energy
balance and body weight (Friedman, 1998).
The main function of leptin is to
provide a signal of energy stores in the body to
the central nervous system so that the brain
can make adjustments required to balance
energy intake and expenditure (Friedman &
Halaas, 1998; Enriori, 2006). Leptin levels
decreased within 12 hours after starvation or
during fasting and increased after several days
of consuming a lot of food (Klein & Romijn,
2008). As a control of the energy balance in
humans, leptin is an anti-obesity hormone that
is based on the hypothesis that high leptin
levels will prevent the occurrence of obesity
(Bravo et al, 2006). Unfortunately this does
not happen, most obese individuals have
higher levels of leptin, but does not stimulate
the expected loss of fat mass (Myers, 2008;
Oswal, 2010).
Some researchers have found that
higher leptin levels in obese people compared
to people with normal weight (Considine,
1996). Leptin levels are also found to be
higher in women with hypertension compared
to non-hypertensive and leptin levels were
higher in pre-menopausal women compared to
postmenopausal (Khokhar, Et al, 2010). Leptin
suppress gene expression acetil Karboxylase
CoA, fatty acid synthesis and lipid synthesis,
biochemical reactions that contribute to the
accumulation of lipids (Fruhbeck, 2001:
William, 2002: Turner, 2006) Although there
has been much research on leptin, but until
now has not been widely studied how the
comparison levels leptin between visceral and
non-visceral obesity.
METHOD
1. Equipment and Materials
Tools used: meter, microtaise, 96-Wells
Microplate
with
anti-human
leptin,
Micropipettes, Multichannel pipettes, pipette
and tips, Elisa test kits, syringes 5 cc,
centrifuge, incubator, test tubes, silicon tubes
containing
EDTA,
tissue,
handscoon,
measuring cup 100 ml, software for data
analysis ELISA.
Materials used: plasma samples, wash
buffer concentrate, standard (recombinant
human leptin), Sodium Azide 0:09%,
deionized water (distilled water), buffer
concentrations, leptin detection antibody
(Biotinylated anti-human leptin), HRPStreptavidin
concentrate,
Tetramethylbenzidine
(TBM)
one-step
substrate reagents, Stop Solution (sulfuric
acid).
2. Working procedures
a. Data collection
Study subjects who meet the criteria for
obesity, requested willingness to follow the
research, and then made a personal anamnesis,
previous medical history and physical
examination. All subjects who entered the
inclusion criteria are required to complete a
research agreement. The whole subject of
further sampled measured BB, TB, pelvic and
waist circumference were then categorized
into or non-visceral visceral obesity.
b. Measurements Weight (BB) and Height
(TB)
Weighing performed by the weighing stand
(platform beam balance scale) which has been
calibrated prior to the accuracy of 100 grams.
Measurements carried out by way of a subject
standing upright on the scales and then figure
appointed needle (scale) scales read as a result
(in kg).
Height measurement is done by using a
measuring instrument upright (microtaise) up
to 0.1 cm accuracy. Measurements were made
with upright, face facing straight ahead
without wearing footwear, the result is read in
cm.
c. Waist Circumference Measurements (LP)
and Pelvic Ring (LPA)
Waist circumference was measured in an
upright position and quiet. Shirt or
obstructions removed measurement. Place the
tape measure on the top edge Crista illiaca
dextra. Measuring tape looped around the
abdominal wall as high as Crista illiaca. Make
sure the measuring tape is not too tight leather
pressing and parallel to the floor.
Measurements were made at the end of a
normal expiration. Read waist circumference
in centimeters. Circumference measurements
of the pelvis (LPA) was performed using a
measuring tape in a standing position and
breathe as usual. Measured by circling the
pelvis at the point of m

challenges, strategy and health treatment approach to nutrition and

Transcription

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