Nutrition, Health Status, Programs and Policy for Pregnant and Lactating Women in Indonesia

Transkripsi

1 Nutrition, Health Status, Programs and Policy for Pregnant and Lactating Women in Indonesia Trihono Senior Health Advisor Jakarta, 12 August 2014

2 Outline of Presentation 1. Maternal Mortality Ratio (MMR) 2. Coverage of maternal health services 3. Quality of maternal health services 4. Health & nutrition status of pregnant women 5. Policy & programs 6. Conclusion Focus on pregnant women

3 Maternal Mortality Ratio in Indonesia

4 Source: Prof. Terence H Hull

5 MMR/ LH MMR Reference Period Source: IDHS

6 Source: IDHS

7 Follow up study on maternal death (Population Census 2010) Pregnancy related death data was collected during Population Census 2010 More than 8,000 cases identified, 50% (>4,000 cases) were revisited for verbal autopsy in 2011 Analysis for identifying cause of death was done, the results i.e.:

8 Cause of Maternal Mortality (Population Census 2010) Kode ICD 10, WHO O00-O08 Underlying cause of maternal death Pregnancy with abortive outcome Region Indonesia Sumatera Jawa-Bali Kalimantan Sulawesi IBT O10-O16 Oedema, proteinuria, and hypertensive disorder (HDK) O44-O46 O30-O43, O47- O48 Placenta previa, premature separation of placenta and Antepartum haemorrhage Other maternal care related to fetus and amniotic cavity and possible delivery problems O64-O66 Obstructed Labour O72 Postpartum haemorrhage (PPP) O20-O29, O60- O63, O67-O71, O73-O75, O81- O84 O85-O99 Other complications of pregnancy and delivery Complication predominantly related puerperium and other conditions Total (N=1737) (N=3334) (N=587) (N=979) (N=887) 1000 (N=7524)

9 Period of Maternal Death Period N (%) Pregnant < 20 weeks Pregnant > 20 weeks 1, Labor Post partum 4, Total 7, Source: Follow up study of maternal mortality of PC 2010

10 Place of Maternal Death 13% 16% 29% 42% Government Hospital Home Private Hospital Others Source: Follow up study of maternal mortality of PC 2010

11 Coverage of Maternal Health Services

12 Kunjungan ANC (%) Coverage of ANC, Reference period Source: IDHS

13 Maluku Papua Pabar Malut Sulbar Sulteng Kalteng Sultra Gorontalo NTT Sulsel Kalbar Sumsel Sumut Jambi Sulut Kalsel Aceh Bengkulu Sumbar Riau Kaltim Banten INDONESIA Babel NTB Jabar Jatim Lampung Kep.Riau DKI Jateng Bali DIY Coverage of ANC-4 by Provinces, Source: Riskesdas

14 Papua Maluku Malut Sulbar NTT Pabar Kalteng Sulteng Kalbar Sultra Sulsel Sulut Jabar Banten Kalsel Riau INDONESIA Jambi Sumsel Lampung Kaltim Babel Aceh Gorontalo NTB Sumbar Sumut Jatim Bengkulu Kep.Riau Jateng DKI Bali DIY Coverage of SBA: Source: Riskesdas

15 Maluku Papua Pabar NTT Malut Sulbar Kalbar Kalteng Sulteng Jabar Kep.Riau Lampung Sumsel Sultra Banten Sulut Sulsel INDONESIA Babel Sumbar Kalsel Riau Kaltim Sumut Aceh Jambi Jatim NTB Gorontalo Jateng DKI Bali Bengkulu DIY Coverage of PNC: Source: Riskesdas

16 Paradoxical condition Coverage of maternal health services is increasing, but Maternal Mortality Ratio is not decreasing. Caused by: 1. Poor quality of maternal health services 2. Health & nutrition status of pregnant women 3. Other social determinants

17 Quality of Maternal Health Services

18 BALI DI YOGYAKARTA JAMBI DKI JAKARTA NUSA TENGGARA TIMUR JAWATENGAH JAWATIMUR BANTEN NUSA TENGGARA BARAT JAWABARAT RIAU SUMATERA SELATAN SUMATERABARAT KALIMANTAN BARAT LAMPUNG KALIMANTAN TIMUR GORONTALO SULAWESI TENGAH SULAWESI SELATAN SUMATERAUTARA PAPUA KEP. RIAU ACEH KALIMANTAN TENGAH SULAWESI UTARA KALIMANTAN SELATAN BENGKULU KEP. BANGKA BELITUNG SULAWESI TENGGARA SULAWESI BARAT MALUKU MALUKUUTARA PAPUABARAT INDONESIA Proportion of CEONC (Comprehensive Emergency Obstetric & Neonatal Care) Hospital Sumber: Riset Fasilitas Kesehatan 2011

19 Proportion of BEONC (Basic Emergency Obstetric & Neonatal Care) Health Center Nusa Tenggara Barat Kepulauan Riau Sulawesi Tengah Bali Jawa Timur Gorontalo Sumatera Barat Banten DI Yogyakarta Jambi Sulawesi Barat Nusa Tenggara Timur Kalimantan Timur Jawa Tengah Sulawesi Selatan Indonesia Sulawesi Tenggara Sumatera Selatan Lampung Sulawesi Utara Riau DI Aceh Maluku Utara Kalimantan Tengah Jawa Barat Kalimantan Selatan Bangka Belitung Bengkulu Kalimantan Barat Papua Sumatera Utara DKI Jakarta Papua Barat Maluku Sumber: Riset Fasilitas Kesehatan

20 Health & Nutrition Status of Pregnant Women

21 Hipertensi (%) Pregnant women + hypertension, Umur Ibu hamil (Tahun) Source: Riskesdas 2007

22 Pregnant women + hypertension, Hypertension Diagnosed hypertension Source: Riskesdas 2013

23 Diabetes (%) Pregnant women + DM, Umur Ibu Hamil Source: Riskesdas 2007

24 Malaria (%) Pregnant women + Malaria, Umur Ibu hamil (tahun) Source: Riskesdas 2007

25 Proportion of Anemia in Pregnant Women by urban/rural, Perkotaan Perdesaan INDONESIA *) Nilai rujukan menurut WHO/MNH/NHD/MNN/11.1,2011 dan Kemenkes,1999 **) Cut off points anemia Ibu Hamil, Hb < 11,0 g/dl

26 Nutrition status of pregnant women, weight gain during pregnancy (kg) Source: Cohort study on child growth & development, 2013

27 Energy intake of pregnant women Trimester 1 Trimester 2 Trimester < Source: Cohort study on child growth & development, 2013

28 Protein intake of pregnant women Trimester 1 Trimester 2 Trimester < Source: Cohort study on child growth & development, 2013

29 Proportion of too young, too old, too close between pregnancies, too many children, Terlalu muda <20 tahun Terlalu tua >35 tahun Terlalu dekat <2 tahun Terlalu banyak >4 anak Source: Riskesdas 2013

30 Proportion reproductive women with risk of chronic malnourish : 2007 & = Hamil Tidak Hamil Hamil Tidak Hamil Source: Riskesdas 2007 & 2013

31 Pregnant women: weight gain vs height (N=220) kg 2,4 kg mgg Tahun 2013: N = 220 ibu hamil** < 150 Cm 150 Cm IOM 2009 Source: Cohort study on child growth & development, 2013

32 Pregnant women: weight gain vs body weight before pregnant BBPH < 45 BBPH 45 kg IOM 2009 Source: Cohort study on child growth & development, 2013

33 Other determinants

34 Mother s education vs maternal health services, SDKI 2012 Pendidikan Ibu Periksa Hamil dengan Nakes Mendapat Pil Zat Besi Persalinan di Faskes Penolong persalinan dg Nakes Kunjungan Nifas (1-2 hari) Tidak Sekolah Tidak tamat SD Tamat SD Tidak Tamat SLTP Tamat SLTP SMTA Source: Atmarita, 2013

35 Economic status vs maternal health services, SDKI 2012 Status Ekonomi Periksa Hamil dengan Nakes Mendapat Pil Zat Besi Persalinan di Faskes Penolong persalinan dg Nakes Kunjungan Nifas (1-2 hari) Terbawah Menengah Bawah Menengah Menengah Atas Teratas Source: Atmarita, 2013

36 TFR Total Fertility Rate: Kota+Desa Kota Desa Reference Period Source: IDHS

37 Age of married status Proporsi Remaja/Dewasa Muda Menurut Tempat Tinggal dan Status Kawin, Riskesdas 2010 Jenis Kelamin Kelompok Umur (Tahun) Kota Belum Kawin Kawin Desa Belum Kawin Kawin Laki-laki Perempuan ,9 0,1 99,9 0, ,7 1,3 97,8 2, ,9 17,1 71,7 28, ,9 0,1 99,7 0, ,8 7,2 82,5 17, ,9 53,1 14,4 85,6

38 Policy and Programs

39 Maternal health care Stated as the priority in health development Crash program of midwife education posted midwife in each village Maternal health insurance (Jampersal), now integrated into National Health Insurance Scheme of Indonesia Increasing the role and capability of midwife: education & training Decreasing the role TBA (Traditional Birth Attendance)

40 Maternal health care Increasing the BEONC Health Center Increasing the CEONC Hospital Improving the quality of services both in Health Center and Hospital Increasing the coverage of CPR (Contraception prevalence rate) Increasing the coverage of maternal health services Health promotion for mothers and adolescents.

41 Conclusion

42 Conclusion MMR in Indonesia still high need work hard to decrease MMR Coverage of maternal health services is increasing Poor quality of health services improving quality of services is a must Health & Nutrition status of pregnant women not yet optimum need innovative action Multi-sector interventions should be done in very good coordination

43 Thank you Terima kasih