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ABSTRAK Nama : Mira Sri Gumilar Program Studi : Epidemiologi Judul : Hubungan Merokok Dengan Risiko Kehamilan Ektopik Pada Wanita Usia 15-49 Tahun Di Indonesia Tahun 2012 Pembimbing : Prof. Dr. dr. Nasrin Kodim, MPH Angka Kematian Ibu (AKI) merupakan indikator utama kesehatan ibu. Pada tahun 2015, angka kematian ibu mengalami penurunan menjadi sebesar 305 per 100.000 kelahiran hidup, namun angka ini masih belum memenuhi target MDGs. Apabila dibandingkan secara global, AKI di Indonesia masih berada di atas AKI Global. Tiga penyebab terbesar kematian ibu di Indonesia disebabkan oleh perdarahan, hipertensi, dan infeksi. Perdarahan dan komplikasi kehamilan pada masa kehamilan bisa terjadi pada awal kehamilan dan akhir kehamilan. Perdarahan dan komplikasi kehamilan pada masa awal kehamilan dapat disebabkan oleh aborsi dan kehamilan ektopik. Berdasarkan beberapa penelitian, salah satu faktor risiko kehamilan ektopik yaitu merokok. Prevalensi perokok wanita di Indonesia setiap tahun mengalami peningkatan terutama pada tahun 2010 prevalensi perokok wanita adalah sebesar 4% dan menduduki urutan ke 17 di dunia. Tujuan penelitian ini adalah diketahuinya besaran masalah kehamilan ektopik di Indonesia, mengetahui sebaran variabel kehamilan ektopik dan merokok berdasarkan provinsi, dan diketahuinya hubungan antara merokok dengan terjadinya kehamilan ektopik di Indonesia. Penelitian ini menggunakan desain penelitian cross sectional. Variabel dependen pada penelitian ini adalah kejadian kehamilan ektopik dan variabel independen utamanya adalah merokok, sedangkan variabel kovariat terdiri dari status pendidikan, metode penggunaan kontrasepsi, jumlah paritas ibu, riwayat menderita Penyakit Menular Seksual (PMS), status urban dan perokok pasif. Sumber data dalam penelitian ini adalah data (Survei Demografi dan Kesehatan Indonesia) SDKI tahun 2012. Kriteria responden pada penelitian ini adalah responden wanita yang diwawancarai dengan kuisioner wanita SDKI 2012. Jumlah responden yang dianalisis adalah sebesar 32.269 wanita yang eligibel. Analisis yang dilakukan terdiri dari analisis univariat, bivariat dan multivariat. Penelitian ini menunjukan prevalensi kehamilan ektopik di Indonesia adalah sebesar 0,56% dan prevalensi merokok sebesar 3,31%. Analisis bivariat menunjukan responden yang merokok memiliki risiko 2,64 kali untuk mengalami kehamilan ektopik dibandingkan dengan yang tidak merokok. Setelah dikontrol dengan variabel pendidikan, metode penggunaan kontrasepsi, riwayat menderita penyakit menular seksual (PMS), dan status urban, responden yang merokok memiliki risiko 3,28 kali untuk mengalami kehamilan ektopik. Hasil penelitian ini menunjukan bahwa merokok memiliki hubungan dengan risiko terjadinya kehamilan ektopik. Kata kunci: Kehamilan ektopik, Merokok, Indonesia
ABSTRACT Name : Mira Sri Gumilar Study Program : Epidemiology Title : The Association Between Smoking and Ectopic Pregnancy Risk in Women Aged 15-49 Years in Indonesia 2012 Counsellorr : Prof. Dr. dr. Nasrin Kodim, MPH Maternal mortality rate is a primary indicator for maternal health. In 2015, maternal mortality rate has decreased to 305 for 100.000 live birth, nevertheless this rate does not meet with the MDGs target. Indonesia’s maternal mortality rate is still above from global rate. In Indonesia, there are Three cases that caused maternal death, bleeding, hypertension, and infection. Bleeding can be occurred in early pregnancy or in the end of pregnancy. Bleeding in early pregnancy can be caused by abortion and ectopic pregnancy. Some research showed that one of the risk factor of ectopic pregnancy was smoking. Prevalence of female smoker in Indonesia is 4% in 2010 and increasing in every year. Indonesia has 17 th in rank of prevalence female smoker in the world. This study aim to know about prevalence ectopic pregnancy in Indonesia that can showing the problem about ectopic pregnancy, to know the distribution of ectopic pregnancy and female smoker by province in Indonesia, and to know about the association between smoking and ectopic pregnancy. This study is cross sectional study with ectopic pregnancy as a dependent variable and smoking as main independent variable. Covariate variables for this study are education, contraception method, parity, history of sexually transmitted diseases, urban status and passive smoker. This study use Indonesia Demographic And Health Survey (IDHS) 2012. Responden’s criteria was women that to be interviewed with women questionnaire IDHS 2012. Thera are 32.269 woman who is elgible to include in this study. This study does three step analysis, univariate, bivariate, and multivariate analysis. The result shows that prevalence of ectopic pregnancy in Indonesia is 0,56% and prevalence of women smoking in Indonesia is 3,31%. From bivariate analysis shows that female smoker had 2,64 fold to experience ectopic pregnancy compared with non smoker female. After controlled by education, contraception method, history of sexually transmitted diseases, and responden’s residence, female smoker has 3,28 fold to experience ectopic pregnancy comparing with non smoker female. This study has showed that smoking has a relationship with ectopic pregnancy. Key words:Ectopic Pregnancy, Smoking, Indonesian
Hypertension is one of diseases caused world health problems. The prevalence of hypertension is predicted will be increase. Hypertension in Indonesia are dominated by the female population. One of the risk factors caused hypertension is the use of hormonal contraception. This study aims to determine the association between the last birth hormonal contraception and the prevalence of hypertension. The research design was cross-sectional from January to June 2023 used the 2018 Riskesdas data. The exposed group was 45,178 respondents who used hormonal contraception and the unexposed group was 30,845 who did not use hormonal contraception. The results showed that there was a significant association between the use of hormonal contraception and the prevalence of hypertension after controlling for age and body mass index with AdjPR 1.10 (95% CI 1.06–1.12). This study also assessed the association between types of hormonal contraception including 3-month injection contraception with AdjPR value of 1.08 (95% CI 1.05-1.12); 1-month injectable contraception with AdjPR value of 0.99 (95% CI 0.93-1.05), implant contraceptive AdjPR 0.90 (95% CI 0.84-0.96), and contraceptive pill AdjPR 1.30 (95% CI 1.23-1.35). This is expected to illustrate the importance of choosing the right contraception to prevent the hypertension
Kata kunci : Keluarga Berencana, Metode Kontrasepsi, Wanita Usia Subur
The use of contraception is a strategy to delay pregnancy and to do birth control,with the possibility of reducing fertility of ovum by spermatozoa. However,coverage of the use of contraceptive in Papua is still far from the target set. Thisstudy aims to determine the distribution of contraceptive use based on WUS 15-49years predisposing factors and enabling factors in Papua Province in 2012. Thisresearch used cross sectional design method with secondary data analysis ofDemographic Health Survey of Indonesia 2012. This study sample were womenage is 15-49 years, listed as respondents in the data IDHS 2012, and meet theinclusion and exclusion criteria. The results showed that the distribution ofcontraceptive use on WUS 15-49 years in Papua province was 14.6 percent. Theresults of analysis showed there is a significant relationship between thedistribution of contraceptive use on WUS with age >35 years (PR: 7.823; 95% CI3.210 to 19.067), higher education (PR: 4.751; 95% CI 2.884 to 7.827),employment status (PR: 0.435; 95% CI 0.318 to 0.595), number of parity 3-4children (PR: 3.254; 95% CI 2.286 to 4.633), urban residence (PR: 2.694; 95% CI1.960 to 3.703), middle income (PR: 2.666; 95% CI 1.798 to 3.953), higherknowledge (PR: 3.970; 95% CI 2.863 to 5.507), and have been exposed to familyplanning information (PR: 3,091; 95% CI 2.255 to 4.236) with a p value <0.005.Therefore, an increase in the effort required of health promotion, intensivecounseling and dissemination of information by health professionals about thebenefits of the importance of contraceptive use on WUS, providing qualitycontraceptive services in obtaining the tools/methods of family planning.
Keywords: Family Planning, Methods of Contraception, Women of Reproductive Age
Kehamilan Tidak Diinginkan (KTD) terjadi setidaknya sebanyak 121 juta kasus secara global dari tahun 2015-2019. Tingginya angka prevalens ini menunjukkan bahwa KTD merupakan salah satu masalah kesehatan masyarakat yang dapat membawa banyak dampak negatif baik dalam bidang kesehatan, sosial dan finansial. Dari seluruh KTD yang terjadi secara global, setengahnya berakhir dengan aborsi. Kematian Ibu yang mengalami KTD juga berhubungan dengan karena kurangnya perawatan antenatal yang dapat meningkatkan risiko komplikasi kehamilan akibat ketidaktahuannya tentang kehamilannya. Kunci untuk mencegah KTD adalah menggunakan kontrasepsi dengan begitu WUS dan PUS dapat merencanakan atau menunda kehamilan. Untuk memahami KTD lebih baik dapat dilakukan dengan mengenali faktor apa saja yang berhubungan dengan KTD. Bertujuan untuk mengetahui faktor apa saja yang berhubungan dengan Kehamilan Tidak Diinginkan. Penelitian ini menggunakan desain studi cross-sectional menggunakan data sekunder SDKI 2017. Sampel penelitian adalah Wanita Usia Subur yang sedang hamil saat survei dilakukan. Prevalensi kehamilan tidak diinginkan adalah sebesar 7,5% dengan 6,8% merupakan kehamilan yang tidak tepat waktu dan 0,7% kehamilan tidak diinginkan sama sekali. Faktor Intrapersonal, yakni; Usia, [PR 0,59 CI 95%: 0,37-0,97 p-value 0,036], Status Perkawinan [PR 6,03 CI 95% 3,7-9,9 p-value 0,000] dan Paritas [PR 0,42 CI 95% 0,26-0,67 p-value 0,000) dan Faktor Struktural, yaitu; Wilayah Tempat Tinggal [PR 1,625 CI 95% 1,06-2,57 , nilai p = 0,024] memiliki hubungan yang signifikan dengan Kejadian Kehamilan Tidak Diinginkan di Indonesia tahun 2017. Diperlukan lebih banyak edukasi kesehatan reproduksi yang tak hanya mencakup aspek biologis namun juga akibat dari sosial, mental dan finansial dari KTD. Pemerintah juga perlu menetapkan UU yang lebih ketat terhadap usia minimal perkawinan dan memastikan WUS mendapatkan akses yang baik terhadap kontrasepsi. Selain itu juga surveilans bagi akseptor KB perlu lebih diperhatikan agar perencanaan kehamilan dapat lebih efektif untuk menghindari KTD.
There are approximately 121 million unintended pregnancies globally from 2015 to 2019. Those high numbers show that unplanned pregnancy is still a significant public health problem, especially when half of all unintended pregnancies ended up in abortion. Unwanted pregnancy also brings other negative effects aside from the health aspect, such as social and financial problems. Women who are experiencing unintended pregnancy tend to neglect their, and the fetus’ health such as missing antenatal care, which risks higher pregnancy complications that can lead to maternal death. Maternal and Neonatal Death Rate is one of the indicators for the 3rd SDGs. Contraception is the key to preventing unplanned or unintended pregnancy. It is important to find out what are the factors contributing to Unintended Pregnancies so that we have the correct information that would be considered for making an effective preventative public health policy and health laws. This study aims to recognize the factors related to unintended pregnancy, in hopes that by knowing the risk factors, unintended pregnancy can be prevented. This study was conducted using cross-sectional studies and uses Indonesian DHS 2017 Secondary Data, the sample for this study is women of childbearing age who were currently pregnant during the survey. The prevalence of unintended pregnancy in Indonesia is 7,5%, which consist of 6,8% of mistimed pregnancy and 0,7% of unwanted pregnancy. Intrapersonal Factors such as Age [PR 0,59 CI 95%: 0,37-0,97 p-value 0,036], Marriage Status [PR 6,03 CI 95% 3,7-9,9 p-value 0,001] and Parity [PR 0,42 CI 95% 0,26-0,67 p-value 0,001) and Structural Factor such as Place of Residence [PR 1,625 CI 95% 1,06-2,57 , p value = 0,024] has statistically significant association (p-value <0,05) with the cases of Unintended Pregnancy in Indonesia 2017. More reproductive health education is needed which does not only cover biological aspects but also the social, mental and financial consequences of unwanted pregnancy. The government also needs to enact stricter laws regarding the minimum age for marriage and ensure that women of childbearing age can have good access to contraception. In addition, surveillance for family planning acceptors needs to be paid more attention so that pregnancy planning can be more effective in preventing unwanted pregnancies. Keywords: Unintended Pregnancy, Unwanted Pregnancy, Women of Childbearing Age, Factors related to unintended pregnancy
Kata kunci: BBLR; kehamilan remaja
Low Birth Weight (LBW) in Indonesia has the prevalence of 7,3 % according to IDHS 2012. Some research showed that more LBW occurences happened to mother aged 15-19 at the time of birth. This study aims to prove the association between adolescent pregnancy and low birth weight after controlling all the confounding variables. The method used for this study is case-control (1:1) by analyzing IDHS 2012. The selected cases are 871 with 871 controls. Covariate variables are education, parity, complication during pregnancy, complication at birth, months of pregnancy at first antenatal visit and number of antenatal visit. The result of the study is that there is a significant association between adolescent pregnancy after controlling all confounding variables which are education, complication during pregnancy and months of pregnancy at first antenatal visit and number of antenatal visit (OR: 2,65; p value= 0,013; 95% CI: 1,232-5,712).
Key words: LBW; adolescent pregnancy