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"Penderita pneumonia yang dirawat di Rumah Sakit Cibabat Cimahi selama periode 2000-2003 sebanyak 1.559 orang, 120 orang diantaranya meninggal dunia CFR=7,71%, sedangkan di Rumah Sakit Hasan Sadikin Bandung selama periode yang sama telah merawat sebanyak 1.792 orang, 112 orang diantaranya meninggal dunia CFR=6,63%.Tingginya CFR penderita pneumonia di kedua rumah sakit tersebut menarik penulis untuk mengadakan penelitian, terutama pada balita yang cukup banyak penderitanya. Studi awal diketahui bahwa pada penderita pneumonia yang tidak meninggal di Rumah Sakit Cibabat terdapat sebanyak 36,5% memiliki gejala tambahan yang tidak lain sebagai penyakit penyerta pneumonia. Bagaimana dengan balita yang meninggal dunia?. Untuk itu penelitian yang penulis lakukan ini adalah untuk mengetahui pengaruh penyakit penyerta terhadap kematian balita akibat pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Hasan Sadikin Bandung. Desain penelitian yang digunakan pada penelitian ini adalah kasus kontrol, dengan jumlah sampel sebanyak 170 balita, yang terdiri 85 balita sebagai kasus dan 85 balita sebagai kontrol. Variabelvariabel yang diteliti adalah kematian balita penderita pneumonia sebagai variabel terikat, sedangkan sebagai variabel bebas adalah penyakit penyerta, sianosis, umur, jenis kelamin, status gizi, status imunisasi, status rujukan, kelas perawatan, dan lokasi tempat tinggal. Seluruh variabel yang diteliti bersumber dari data rekam medik di kedua rmah sakit tersebut sejak Januari 2000 sampai bulan Juni 2004.Hasil penelitian menunjukkan bahwa ada pengaruh penyakit penyerta terhadap kematian balita penderita pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Masan Sadikin Bandung. Balita penderita pneumonia disertai penyakit penyerta berisiko 3,38 kali dibandingkan dengan balita tanpa disertai penyakit penyerta. (p=0,00, OR=3,38, 95%CI=1,68--6,85). Ada pengaruh sianosis terhadap kematian balita akibat pneumonia, balita penderita pneumonia dengan gejala umum sianosis berisiko 7,42 kali meninggal dunia akibat dibandingkan balita tanpa gejala umum sianosis. (p=0,00, OR=7,42 95%CI=2,97-19,13).Melihat hasil penelitian diatas disarankan dalam menangani balita penderita pneumonia di Rumah Sakit agar lebih mewaspadai adanya penyakit penyerta dan gejala umum sianosis.Daftar Kepustakaan : 57 (1991-2004)

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South-East Asia Region World Health Organization (SEARO-WHO) reported that communicable diseases have caused 40% of 10.5 million of deaths among children under-five year olds in the world. In the 6 SEARO-countries, including Indonesia, it was estimated that about 9 of 10 deaths were caused by pneumonia, diarrhea, measles and malnutrition.

Based on an extrapolation of a result of Household Health Survey in 1992, the mortality rate of pneumonia among under-five children in Indonesia is about 6 per 1,000 under-five children. Therefore it is estimated that among under-five children, 150.000 deaths occur every year due to pneumonia. It means that pneumonia has significantly contributes on death among children, especially in the under-five group.

Cibabat Hospital in Cimahi has treated about 1,559 pneumonia cases during the period of 2000-2003, and among all those cases, 120 patient died (CFR=7.71%). Hasan Sadikin General Hospital in Bandung during the same period has managed 1,792 pneumonia cases with 112 deaths among the treated cases (CFR 6,63%).

There are several factors influencing pneumonia caused mortality, such as a) age (< 2 months), b) socio-economic status, c) malnutrition, d) low birth weight, e) low mother education, f) low health care coverage, g) high house density, h) inadequate immunization, i) contracting chronic diseases.

The objective of this study was to know the effect of underlying diseases on under-five child mortality due to pneumonia in Cibabat Hospital in Cimahi and in Hasan Sadikin General Hospital in Bandung.

The study results showed that there was an effect of underlying diseases on the under-five child mortality caused by pneumonia in both hospitals. An under-five pneumonia case with underlying disease(s) was 3.38 times more likely to cause death as compared to under-five pneumonia case without underlying disease(s). It was also found that cyanosis, as one of the common signs of emergency in pneumonia, also increased the risk of death. A pneumonia case with cyanosis was 7,42 times at risk to cause death than the case without cyanosis.

Based on our study, it is recommended that the medical staffs in the hospitals to be aware of the existing underlying diseases and to conduct integrated case management The medical staffs, as well as the mothers are also suggested to pay attention on the sign of cyanosis. This sign is actually not so difficult to be recognized, although it was frequently ignored. This common sign of cyanosis is important in pneumonia treatment in the field, using several case management approaches, including oxygenation.

The Ministry of Health and its relevant structures are also encouraged to establish the Integrated Management Program of the Under-five Child Sickness, especially related to pneumonia, by providing sufficient health) medical facilities (such as oxygen contractor) in the community health centers and the hospitals.

References: 57 (1991 - 2004)"

"Dewasa ini sekitar 45% kematian bayi terjadi pada bayi berumur kurang dari satu bulan, dan 20% kematian bayi tersebut disebabkan oleh Berat Badan Lahir Rendah (BBLR) (Depkes, 1996). Dilihat dari segi kesehatan masyarakat BBLR turut berperan di dalam menentukan sukses tidaknya pembentukan generasi mendatang (Population Report, 1998), karena BBLR dapat mengakibatkan tumbuh kembang bayi dan anak terhambat, serta menimbulkan gangguan kesehatan pada bayi yang dilahirkan. Banyak upaya yang dilakukan untuk mengurangi risiko BBLR, antara lain dengan meningkatkan pelayanan antenatal care (ANC).Tujuan penelitian ini adalah untuk mengetahui gambaran terjadinya BBLR yang berhubungan dengan frekuensi ANC, pemberian vaksinasi tetanus toxoid, pemberian tablet besi, tinggi fundus uteri, berat badan ibu, tinggi badan ibu, tekanan darah ibu, umur ibu, pendidikan ibu, lingkar lengan atas ibu, kadar Hb ibu, paritas, jarak kehamilan, dan jenis kelamin bayi.Penelitian ini merupakan studi observasional dari data sekunder laporan data maternal perinatal dasar RSUP dr. Hasan Sadikin Bandung tahun 2000. Rancangan penelitian yang digunakan adalah cross sectional dengan sampel penelitian sebanyak 863 ibu yang melahirkan tunggal dan cukup umur selama tahun 2000. Analisis yang digunakan adalah univariat, bivariat dengan uji chi square dan multi variat dengan uji regresi logistik.Hasil penelitian ini menunjukkan bahwa kejadian BBLR dari 863 kelahiran tunggal dan cukup umur adalah sebanyak 53 kelahiran (6,1%), sedangkan kejadian BBLR dan total populasi yaitu dari 2684 kelahiran, termasuk tunggal, kembar prematur dan cukup umur, sebanyak 462 kelahiran (17,2%). Hasil penelitian univariat menunjukkan bahwa yang frekuensi ANCnya tidak adekuat sebesar 14,63%, tinggi fundus uteri yang tidak normal adalah sebesar 34,62%, tinggi badan kurang dari 145 cm sebesar 14,75%, tekanan darah tidak normal sebesar 12, 42%, paritas > 4 sebesar 8,9%. Hasil analisis statistik menunjukkan bahwa ada hubungan yang bermakna antara variabel tersebut dengan kejadian BBLR (p < 0,05), sedangkan variabeI vaksinasi tetanus toxoid, berat badan ibu, umur ibu, pendidikan ibu, LLA ibu, kadar Hb ibu, jarak kehamilan, dan jenis kelamin bayi tidak mempunyai hubungan yang bermakna.Variabel tablet tablet besi tidak dapat dianalisis karena datanya kurang bervariasi. Dari model regresi logistik diketahui ternyata variabel yang paling besar peranannya terhadap kejadian BBLR adalah frekuensi ANC, tinggi fundus uteri, dan tekanan darah ibu, sedangkan yang paling kuat hubungannya dengan kejadian BBLR adalah tinggi fundus uteri, dengan OR 15,46 ( CI 95 % ).Disarankan agar rumah sakit melakukan pemantauan yang ketat terhadap ibu yang terdeteksi mempunyai risiko BBLR, dan menyiapkan ruangan bersalin khusus dengan sarana yang lengkap untuk persalinan BBLR Untuk petugas lapangan atau penyuluh kesehatan, agar dapat menyebarluaskan informasi mengenai tanda-tanda yang menunjukkan BBLR, serta memberikan informasi mengenai penanganan kejadian BBLR Bagi praktisi kesehatan terutama bidan praktek swasta, agar dapat melakukan deteksi dini kejadian BBLR.

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Nowadays about 45% infant mortality occurs to infant in the age less than 1 month, and 20% as stated above caused by low birth weight (LBW) (Depkes, 1996). From the view of public health, LBW has its role to determine the successful future generation formation (Population Report, 1998), because LBW can cause retardation to child growth, also can cause health birth infant problem. There are efforts had been done to reduce LBW risk, such as increase antenatal care (ANC).

This research aim is to know the description LBW occurred which related to the frequency of ANC, tetanus toxoid vaccination, iron tablet distribution, fundus uteri height, mother's weight, mother's height, mother's blood pressure, mother's age, mother's education, mother's upper arm circumference, mother's Hemoglobin level, parity, interval of pregnancy, and infant gender.

This research is observational study by secondary data analyzed. Secondary data is taken from the audit maternal prenatal dr. Hasan Sadikin General Hospital Bandung in year 2000. The design used in this study is cross sectional with 863 mothers who deliver single baby and mature during year 2000. The analysis of this research is using univariate, bivariate with chi square test and multivariate with logistic regression test.

The research showed that from 863 single and mature births, 53 infants are LBW (6,1%), while L13W from total of population from 2684 births, including single, preterm twin and mature, are 462 births (17,2%). The result of univariate test showed that the inadequate ANC are 14,63%, abnormal fundus uteri height are 34,62%, less than 145 cm height are 14,75%, abnormal blood pressure are 12,42%, parity > 4 are 8,9%. The result of statistics analysis showed that there is meaningful relationship between stated variables with LBW (p< 0,005), while tetanus toxoid vaccination, mother's weight, mother's age, mother's education, mother's upper arm circumference, mother's hemoglobin content, spacing of pregnancy, and infant gender, are not related to LBW and the ferrum distribution cannot analyzed because the data is not representatives to analyzed. From the logistic regression is known that the determinant factor to LBW is ANC frequency, fundus uteri height, and mother's blood pressure.

It is suggested that hospital carry out the tight supervision to LBW detected mother, and preparing special delivery room with fully equipped for LBW delivery. Health worker is hoped to spread out the information about the LBW symptom, also spread out the information about taking care of LBW. For the private health practitioners especially private midwife, it is necessary to detect LBW early, and refer immediately if there is no ability to deliver LBW infant."