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Abstrak :
Masalah kematian maternal dan noenatal masih merupakan masalah pokok yang dihadapi oleh bangsa Indonesia, dimana AKI di Indonesia tahun 2005 sebesar 262 per seratus ribu kelahiran hidup. Salah satu penyebab kematian tersebut akibat masih rendahnya cakupan persalinan oleh tenaga kesehatan dan masih tingginya persalinan ditolong oleh tenaga non kesehatan (dukun bayi). Proporsi angka cakupan persalinan oleh tenaga kesehatan di Kabupaten Garut tahun 2006 adalah 67,4% sementara sisanya oleh dukun bayi. Pencapaian tersebut tidak sejalan dengan pencapain hasil cakupan K4 pada tahun yang sama sebesar 85,4%, hal ini menunjukkan adanya kesenjangan antara kedua hasil cakupan tersebut. Idealnya, kenaikan cakupan K4 diikuti pula oleh kenaikan cakupan persalinan. Kesenjangan tersebut telah mengindikasikan telah terjadinya unmet need persalinan, yaitu ketidaksesuaian antara keinginan dengan kenyataan mengenai tenaga penolong persalinan. Tujuan penelitian ini adalah untuk mengetahui determinan unmet need persalinan di Kabupaten Garut tahun 2007. Penelitian menggunakan data sekunder dari hasil survei data dasar pengembangan model pelayanan kesehatan neonetal esensial di Kabupaten Garut tahun 2007 oleh Pusat Penelitian Kesehatan (PPK-UI) dan Pusat Kajian Promosi Kesehatan FKM-UI. Metode penelitian adalah Cross Sectional, dengan populasi adalah ibu-ibu yang mempunyai bayi 0-11 bulan yang tinggal menetap di 10 Kecamatan di Kabupaten Garut. Sampel yang berjumlah 246 orang, diambil menggunakan metode cluster probability proportionate size. Hasil penelitian menunjukkan dari 246 responden yang mempunyai keinginan untuk melahirkan oleh tenaga kesehatan 21,1% terjadi unmet need persalinan dan 78,9% sesuai dengan keinginannya (met need). Paritas merupakan faktor yang berhubungan dengan unmet need persalinan (p = 0,049), dimana iu yang mempunyai paritas tinggi berpeluang 2 kali untuk unmet need persalinan dibandingkan dengan ibu yang mempunyai paritas rendah setelah dikontrol oleh faktor pendidikan ibu, status ANC dan status ekonomi (OR = 2, 95% CI = 1,0 ? 3,8). Berdasarkan hal di atas, disarankan untuk lebih meningkatkan kegiatan KIE pada saat pemeriksaan kehamilan (ANC) sehigga pengetahuan ibu hamil tentang kehamilan, persalinan dan KB dapat lebih meningkat, disamping meningkatkan kegiatan penyuluhan kesehatan secara berkesinambungan kepada masyarakat, terutama tentang tanda bahaya kehamilan dan persalinan. ......The problem of neonatal and maternal deaths.is still the main problem faced by indonesian people, where the maternal death rate in Indonesia, in the year of 2005 was 262 per one hundred thousand of living birth.one of the mentioned death causes was that the child-birth coverage carried out by medical workers was still low and child- birth performed by non medical workers was still high. The percentage of child-brith coverage rate by medical workers in Garut regency in 2006 was 67,4 % meanwhile the rest was performed by conventional midwives. The mentioned achievement was not in accordance with that of the result of K4 coverage in the same year as much as 85,4 %, this case showed the presence of discrepancy between both mentioned coverage results.ideally, the raise of K4 coverage should have been followed by the raise of child-birth coverage as well. This discrepancy had indicated that unmet need child-birth had occured, that is the unconformity between desire and fact concerning medical workers for child- birth. The objectives of this research is to recognize the determinant of unmet need of child- birth in Garut regency in 2007.The kind of the research used secondary data from the result of base data survey for the development of essential neonatal health service model in Garut regency in the year of 2007 performed by Health Research Centre ( PPK-UI ) and Health Promotion Study Centre of FKM-UI.the method of the research is Cross Sectional . Population consists of the women having 0-11 month babies who settle in ten sub-districts with sample selection follows the method of 30 cluster, cluster is the rural-district with dursion criteria based on the number of population (probability proportionate size). by using c-survey, it is obtained 30 rural- districts, later 16 women are selected at random from every rural-district so that it fulfills the sample of 640 people. The number of respondents who fulfill criteria of unmet need child-birth is 246 people. The result of the research shows that from 246 respondents who have desire to give birth to by medical workers, 21.1% is unmed need child-birth and 78,9% is in accordance with their desire (met need) that is medical workers as the helper of child-birth. The result of statistics test shows significantcorrelation between parity and unmet need child-birth (p=0.049). In the meantime, the result of valid final modeling is model without interaction, later the most dominant factor as the determinant of unmet need child-birth is parity with the value of odds ratio as much as 2.0 respectively after being controlled by the factors of mothers education, ANC status and economics status (OR = 2, 95% CI = 1,0 ? 3,8). Based on the case above, it is suggested that the effort of health promotion program raise need to be performed by having health guidance acturties continuously to the community about reproduction health especially in the case of recognition towards child-birth danger signal. One of them is to raise the acturty of KIE at the time of pregnancy examination which along this time it forms education facility to improve mothers knowledge concerning their pregnancies and child-births.

Abstrak :
The study was a double-blind, controlled, randomized by episode in two sub-district rural areas ± 200 km from Jakarta, in which 1,185 children under three years of age were assigned to receive 4-5 mg element zinc/kg bw/day as a daily dose in two divided doses for the consecutive days during diarrhea Children were visited at their home every week for 12 months and they also underwent oral rehydration therapy. After 12 months observation there were 2, 410 episodes, 131 were excluded due to lack of information. Among children of zinc supplementation group there was 11% reduction (95% confidence interval, 3 to 18%) in the risk of continued diarrhea. In children with watery diarrhea there was a decreased of 12% (95% confidence interval, 3 to 21%) in the number of days in the zinc supplementation group. The reduction in the likelihood of diarrheal duration was 18% (95% confidence interval, 4 to 43%) in children who were given antibiotics before enrollment. Among children who had 3 episodes during 12 months observations there was a greater reduction in diarrheal duration (RR. in the zinc supplementation group = 0.79; 95% confidence interval, 0.64 - 0.97). Zinc supplementation in children with stunted growth was associated with 8% reduction of the risk of continued diarrhea, but statistically not significant (95% confidence interval, -9 to 21%). Children in zinc group had a lower proportion of persistent diarrhea (z 14 days) than control group zinc supplementation resulted in a 44% (95% confidence interval, 2 - 70%) reduction in the incidence of persistent diarrhea. These findings suggest that zinc supplementation in children with acute diarrhea significantly reduced the duration of diarrhea and the risk of persistent diarrhea. Zinc supplementation may have a significant effect on childhood diarrhea-related mortality.

Abstrak :
Pemerintah di dunia sedang berkembang memberi semua ibu hamil mendapat antenatal care, memberi tablet besi dan asam folat (IFO) sedini mungkin dalam jumlah cukup. Lembaga Internasional di dunia mendorong pemberian suplemen mikronutrien multipel (MNM) pada ibu hamil, dimaksudkan memberi efek positip pada pertumbuhan fetus dalam umur gestasi cukup bulan. Pemberian MNM pada semua ibu hamil hasilnya inkonsisten. Penelitian ini bertujuan melihat efek MNM khusus pada ibu hamil tanpa komplikasi terhadap outcome kelahiran yaitu: pertumbuhan (berat lahir), perkembangan (lingkar kepala lahir) dan maturitas (umur gestasi) bayinya. Harapannya adalah setiap bayi lahir bisa dibekali dengan pertumbuhan, perkembangan dan maturitas yang optimal sebagai satu kesatuan hasil kelahiran. Masih diragukan apakah suplementasi MNM pada ibu hamil lebih baik jika dibandingkan dengan IFO untuk memperbaiki antropometri dan umur gestasi. Pertanyaan tersebut ingin dipecahkan melalui pemberian suplemen MNM pada ibu hamil tanpa komplikasi dibandingan IFO. Penelitian ini mengeluarkan faktor yang menyebabkan hambatan pertumbuhan fetus dari populasi studi, memanfaatkan data sekunder studi SUMMIT di Pulau Lombok 2001 ? 2004, desainnya randomized control trial double blind. Analisis data melihat efek MNM terhadap rata-rata tiga outcome dengan statistik MANOVA; terhadap masing-masing outcome secara tersendiri yaitu berat lahir di bawah normal, lingkar kepala di bawah normal dan umur gestasi di bawah normal; terhadap status gizi prahamil rendah dibanding status gizi prahamil baik. Suplementasi MNM meningkatkan rata-rata berat lahir 38,52g lebih tinggi dibanding IFO, secara statistik bermakna. Risiko terjadinya berat lahir <2.600 g pada suplementasi IFO ibu hamil tanpa komplikasi sebesar 1,2 kali dibanding MNM, apabila menggunakan batas α=0,10 secara statistik bermakna, 90%CI: 1,00-1,46. Jika pemberian IFO diganti dengan MNM, akan tercegah sebanyak 13/1.000 bayi dengan berat lahir <2.600 g. Kejadian berat lahir <2.600 g pada pemberian IFO bisa dikurangi 15,1% dari kejadian 83/1.000 bayi lahir bila diganti MNM. Risiko terjadinya berat lahir <2.600 g pada suplementasi IFO jika diganti dengan MNM lebih jelas pada IMT prahamil <18,50 sebesar 1,7 kali bila menggunakan batas α=0,10 secara statistik bermakna, 90%CI: 1,08-2,65. Jika pemberian IFO pada ibu hamil tanpa komplikasi dengan status gizi prahamil rendah diganti dengan MNM, akan tercegah sebanyak 70/1.000 bayi dengan berat lahir <2.600g. Kejadian berat lahir <2.600g pada pemberian IFO ibu hamil tanpa komplikasi dengan IMT prahamil <18,50 bisa dikurangi 40,7% dari kejadian 172/1.000 bayi lahir bila diganti MNM.

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Government on developing countries care to all pregnant women for ANC access, give iron?folic acid (IFO) as soon as possible. International agencies on the world stimulate multiple micronutrients (MMN) suplement to pregnant women, that is aimed for giving good of fetal growth in appropriate gestation age. MMN distribution for all pregnant women still have inconsisten result. The purposes of this study look for MMN effect especially on pregnant women without complication for birth outcome: growth (birth weight), development (head circumference at birth) and maturity (gestation age). It is doubted that MMN suplementation on pregnant women is better than IFO for increasing anthropometry and gestation age. This research need specific care with restrict factors that delay fetal growth, using SUMMIT secondary data at Lombok Island 2001-2004 with RCT double blind design. Analyzing data was looking the MMN effect for three mean outcome values by MANOVA statistic, was looking the MMN effect for each outcome individually: birth weight below normal cut-off, head circumference at birth below normal cut-off and gestasion age below normal cut-off, was look at low prepregnancy BMI stratum comparing by normal prepregnancy BMI. MMN suplementation increases mean birth weight as 38,52g more than IFO with statistical significant. The risk of <2,600 g birth weight happened at IFO supplementation on pregnant women without complication were 1.2 time comparing with MNM. If it used at α=0.05 level, it was not statistical significant, but when it used at α=0.10 level, it was statistical significant with 90%CI: 1.00-1.46. If IFO supplementation on pregnant women without complication be replaced by MNM, it would prevent as 13/1,000 infant with <2,600 g birth weight. Incidence of <2.600 g birth weight at IFO supplementation on pregnant women without complication could be decreased 15.1% of 83/1,000 at birth babies happened if it were replaced by MNM. The risk of <2,600 g birth weight happened at IFO supplementation on pregnant women without complication if it be replaced by MNM were clearer on pregnant women without complication at <18.50 prepregnancy BMI stratum as 1.7 time. If it used at α=0.05 level, it was not statistical significant, but when it used at α=0.10 level, it was statistical significant with 90%CI:1.08-2.65. If IFO supplementation on pregnant women without complication at low nourish prepregnancy status were replace with MNM, it would be prevent as 70/1,000 infant with <2,600g birth weight. Incidence of <2,600g birth weight at IFO supplementation on pregnant women without complication at <18.50 prepregnancy BMI stratum could be decreased as 40,7% of 172/1,000 at birth babies happened if it were replaced by MNM.