GAMBARAN KEMATIAN IBU DI KABUPATEN MAJALENGKA TAHUN 2015 (STUDY KUALITATIF)

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Abstrak: Kematian ibu di Kabupaten Majalengka termasuk dalam peringkat 16 (atau peringkat 10 terbawah) dari 27 kabupaten/ kota yang ada di Propinsi Jawa Barat tahun 2015. Penelitian ini bertujuan untuk mengetahui gambaran kematian ibu di Kabupaten Majalengka Tahun 2015. Metode penelitian yang digunakan metode kualitatif melalui pendekatan studi naratif. Populasi penelitian ibu yang meninggal dunia saat hamil, bersalin, dan nifas di Wilayah Puskesmas Kabupaten Majalengka Tahun 2015 sebanyak 20 orang, dan yang dijadikan partisipan berjumlah 13 orang. Instrumen penelitian menggunakan kuesioner yang di adopsi dari hasil penelitian Febriana Prodi Magister Epidemiologi  Program Pasca Sarjana Undip Tahun 2007 serta dokumen autopsi verbal kematian maternal dan perinatal. Pengambilan data melalui wawancara dan dokumentasi. Analisis data secara kualitatif melalui tahapan reduksi data, penyajian data dan penarikan kesimpulan. Hasil penelitian lebih dari setengahnya ibu meninggal pada periode nifas penyebab tertinggi kematian ibu karena Hipertensi Dalam Kehamilan (HDK). Faktor determinan jauh : lebih dari setengahnya pendidikan ibu SMP, sebagian besar tidak bekerja dan rata-rata pendapatan keluarga sesuai dengan UMR Kabupaten Majalengka. Faktor determinan antara : sebagian besar ibu tidak mengalami KEK dan anemia, usia ibu meninggal pada usia 20-35 tahun, lebih dari setengahnya terjadi pada primipara, jangkauan pelayanan kesehatan dari lama rujukan sampai tiba di pelayanan kesehatan ditempuh sekitar 1-2 jam dan hampir seluruh ibu melakukan pemeriksaan kehamilan sampai persalinan dengan tenaga kesehatan. Faktor determinan dekat yang berpengaruh terhadap kematian ibu adalah komplikasi pada kehamilan, persalinan dan nifas. Hambatan dan masalah rujukan pada ibu yang meninggal dikarenakan keluarga terlambat merujuk ibu ke fasilitas kesehatan, jarak yang jauh dari fasilitas kesehatan, akses BPJS serta masalah transportasi yang lama menunggu. Akses pelayanan kesehatan jarak tempuh paling jauh +15 Km dan paling dekat +1 Km. Kecepatan dan ketepatan tenaga kesehatan (baik bidan maupun dokter) dalam mengambil keputusan, merujuk, melakukan penanganan tindakan kegawatdaruratan serta stabilisasi kondisi pasien merupakan faktor penting dalam menyelamatkan  nyawa ibu, karena kematian ibu sering terjadi karena keterlambatan dalam penentuan diagnosa komplikasi, terlambat mengambil keputusan, terlambat merujuk dan terlambat ditangani.

Abstract: Maternal mortality in Majalengka District was in the 16^th ranking (or the 10th lowest) of 27 districts/cities in West Java Province by 2015. This study aims to determine the description of maternal mortality in Majalengka District in 2015. The study method used was qualitative method through narrative study approach. The populations of the study were mothers who died during pregnancy, childbirth, and postpartum in the work area of Public Health Centers in District Majalengka in 2015 as many as 20 people, and the participants were 13 people. The study instrument used questionnaire which was adopted from the study result of Febriana, Epidemiology Master Study Program of Postgraduate Program of Diponegoro University in 2007 and document of verbal autopsy of maternal and perinatal mortality. Data collection was performed through observation, interview and documentation. Qualitative data analysis was conducted through the stages of data reduction, data presentation and conclusion. The results of this study showed that more than half of mothers died during the postpartum period with the highest cause of maternal mortality due to Hypertension In Pregnancy (PIH), the distant determinant factors were: more than half had junior high school education, most of them were unemployed and the average family income was in accordance with Minimum Wage in Majalengka District; the intermediate determinant factors were: most of the mothers did not experience Chronic Energy Deficiency (CED) and anemia, the women died at the age of 20-35 years, more than half deaths occurred in primiparous, health service coverage from referral duration until arrived at health service took about 1-2 hours and almost all mothers did prenatal care until delivery with health personel; the outcome determinant factors affecting maternal mortality were complications during pregnancy, childbirth and postpartum. The referral obstacles and problems in women who died were due to the family performed late referral to health facilities, long distance from health facilities, access to health insurance (BPJS) and long time in waiting transportation. The longest distance of health service access was +15 Km and the closest was +1 Km. The speed and accuracy of health workers (both midwives and doctors) in making decision, referral, performing emergency measures and stabilizing the condition of the patient were important factors in saving the lives of mothers, because maternal mortality often occurs due to delay in the determination of complication diagnosis, delay in making decision, delay in performing referral and delay in receiving care.