Nutrition, Health Status, Programs and Policy for Pregnant ... fileCause of Maternal Mortality...

Email: [email protected]

Nutrition, Health Status, Programs and Policy for

Pregnant and Lactating Women in Indonesia

TrihonoSenior Health Advisor

Jakarta, 12 August 2014


Outline of Presentation

1. Maternal Mortality Ratio (MMR)2. Coverage of maternal health services3. Quality of maternal health services4. Health & nutrition status of pregnant

women5. Policy & programs6. Conclusion

Focus on pregnant women


Maternal Mortality Ratioin Indonesia

Source: Prof. Terence H Hull


MMR 1994 - 2012

390

334307

228

359

0

100

200

300

400

500

1989-1994 1993-1997 1998-2002 2003-2007 2008-2012

MM

R/1

00.0

00 L

H

Reference Period

Source: IDHS 1994 - 2012

Email: [email protected]: IDHS 1994 - 2012


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.:

Cause of Maternal Mortality (Population Census 2010)Kode ICD 10,

WHO

Underlying cause of

maternal death

RegionIndonesia

Sumatera Jawa-Bali Kalimantan Sulawesi IBT

O00-O08 Pregnancy with abortive

outcome

3.7 4.2 2.7 5.6 4.2 4.1

O10-O16 Oedema, proteinuria, and

hypertensive disorder (HDK)

33.3 33.1 34.9 32.6 25.8 32.4

O44-O46 Placenta previa, premature

separation of placenta and

Antepartum haemorrhage

4.4 2.7 4.3 2.3 3.6 3.3

O30-O43, O47-

O48

Other maternal care related

to fetus and amniotic cavity

and possible delivery

problems

3.0 1.7 0.0 0.8 0.1 1.6

O64-O66 Obstructed Labour 0.5 1.1 0.0 0.6 1.0 0.8

O72 Postpartum haemorrhage

(PPP)

16.4 16.8 28.1 26.3 29.8 20.3

O20-O29, O60-

O63, O67-O71,

O73-O75, O81-

O84

Other complications of

pregnancy and delivery

11.1 6.0 2.9 7.9 5.9 7.2

O85-O99 Complication predominantly

related puerperium and other

conditions

27.6 34.3 27.1 23.9 29.7 30.2

Total100.0

(N=1737)

100.0

(N=3334)

100.0

(N=587)

100.0

(N=979)

100.0

(N=887)

1000

(N=7524)

32.4

20.3


Period of Maternal Death

Period N (%)

Pregnant < 20 weeks 543 7.2

Pregnant > 20 weeks 1,372 18.2

Labor 974 12.9

Post partum 4,634 61.6

Total 7,523 100.0

Source: Follow up study of maternal mortality of PC 2010


Place of Maternal Death

42%

29%

16%

13%

Government Hospital

Home

Private Hospital

Others

Source: Follow up study of maternal mortality of PC 2010


Coverage ofMaternal Health Services


Coverage of ANC, 1991 - 2012

0.0

20.0

40.0

60.0

80.0

100.0

1991 1994 1997 2002 2007 2012

55.163.1

70.481.0 81.5

87.8

Ku

nju

ng

an

AN

C (

%)

Reference period

4+

2-3

1

0



Coverage of ANC-4 by Provinces, 2010 - 2013

61.4

70.0

0.0

20.0

40.0

60.0

80.0

100.0

Ma

luku

Pa

pua

Pa

bar

Ma

lut

Su

lbar

Su

lte

ng

Ka

lte

ng

Su

ltra

Go

ron

talo

NT

T

Su

lse

l

Ka

lbar

Su

mse

l

Su

mu

t

Ja

mb

i

Sulu

t

Ka

lse

l

Ace

h

Be

ngku

lu

Sum

bar

Ria

u

Ka

ltim

Ba

nte

n

IND

ON

ES

IA

Ba

bel

NT

B

Ja

ba

r

Ja

tim

La

mp

un

g

Ke

p.R

iau

DK

I

Ja

teng

Bali

DIY

2010 2013

Source: Riskesdas 2010 - 2013


Coverage of SBA: 2010 - 2013

79.0

86.9

0.0

20.0

40.0

60.0

80.0

100.0

Pa

pua

Ma

luku

Ma

lut

Su

lbar

NT

T

Pa

bar

Ka

lte

ng

Su

lte

ng

Ka

lbar

Su

ltra

Su

lse

l

Sulu

t

Ja

ba

r

Ba

nte

n

Ka

lse

l

Ria

u

IND

ON

ES

IA

Ja

mb

i

Su

mse

l

Lam

pung

Ka

ltim

Ba

bel

Ace

h

Goro

nta

lo

NT

B

Su

mb

ar

Su

mu

t

Jatim

Be

ngku

lu

Ke

p.R

iau

Ja

teng

DK

I

Bali

DIY

2010 2013



Coverage of PNC: 2010 - 2013

46.8

81.7

0.0

20.0

40.0

60.0

80.0

100.0

Ma

luku

Pa

pua

Pa

bar

NT

T

Ma

lut

Su

lbar

Ka

lbar

Ka

lte

ng

Su

lte

ng

Ja

ba

r

Ke

p.R

iau

La

mp

un

g

Sum

sel

Su

ltra

Ba

nte

n

Sulu

t

Su

lse

l

IND

ON

ES

IA

Ba

bel

Su

mb

ar

Ka

lse

l

Ria

u

Ka

ltim

Su

mu

t

Ace

h

Ja

mb

i

Ja

tim

NT

B

Go

ron

talo

Ja

teng

DK

I

Bali

Be

ngku

lu

DIY

2010 2013



Paradoxical condition

• Coverage of maternal health services is increasing, but Maternal Mortality Ratio is not decreasing.

• Caused by:1. Poor quality of maternal health services2. Health & nutrition status of pregnant

women3. Other social determinants


Quality of Maternal Health Services


0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

BA

LI

DI Y

OG

YAK

AR

TA

JAM

BI

DK

I JA

KA

RTA

NU

SA T

ENG

GA

RA

TIM

UR

JAW

ATE

NG

AH

JAW

ATI

MU

R

BA

NTE

N

NU

SA T

ENG

GA

RA

BA

RA

T

JAW

AB

AR

AT

RIA

U

SUM

ATE

RA

SEL

ATA

N

SUM

ATE

RA

BA

RA

T

KA

LIM

AN

TAN

BA

RA

T

LAM

PU

NG

KA

LIM

AN

TAN

TIM

UR

GO

RO

NTA

LO

SULA

WES

I TEN

GA

H

SULA

WES

I SEL

ATA

N

SUM

ATE

RA

UTA

RA

PA

PU

A

KEP

. RIA

U

AC

EH

KA

LIM

AN

TAN

TEN

GA

H

SULA

WES

I UTA

RA

KA

LIM

AN

TAN

SEL

ATA

N

BEN

GK

ULU

KEP

. BA

NG

KA

BEL

ITU

NG

SULA

WES

I TEN

GG

AR

A

SULA

WES

I BA

RA

T

MA

LUK

U

MA

LUK

UU

TAR

A

PA

PU

AB

AR

AT

IND

ON

ESIA

21.0

Proportion of CEONC (Comprehensive Emergency Obstetric & Neonatal Care) Hospital

Sumber: Riset Fasilitas Kesehatan 2011


10.5610.5810.71

13.4413.6113.7313.8714.0414.2914.3514.7714.8515.1115.3815.5715.85

16.7818.0318.64

19.4619.7420.19

21.8522.2222.8123.1423.30

24.1924.32

26.2426.32

33.7433.85

37.58

0 10 20 30 40 50 60 70 80 90

Maluku

Papua Barat

DKI Jakarta

Sumatera Utara

Papua

Kalimantan Barat

Bengkulu

Bangka Belitung

Kalimantan Selatan

Jawa Barat

Kalimantan Tengah

Maluku Utara

DI Aceh

Riau

Sulawesi Utara

Lampung

Sumatera Selatan

Sulawesi Tenggara

Indonesia

Sulawesi Selatan

Jawa Tengah

Kalimantan Timur

Nusa Tenggara Timur

Sulawesi Barat

Jambi

DI Yogyakarta

Banten

Sumatera Barat

Gorontalo

Jawa Timur

Bali

Sulawesi Tengah

Kepulauan Riau

Nusa Tenggara Barat

Proportion of BEONC (Basic Emergency Obstetric & Neonatal Care) Health Center

19Sumber: Riset Fasilitas Kesehatan 2011


Health & Nutrition Status of Pregnant Women


Pregnant women + hypertension, 2007

5.87.0

9.812.5

18.1

25.0

44.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Hip

ert

en

si (%

)

Umur Ibu hamil (Tahun)

Source: Riskesdas 2007


Pregnant women + hypertension, 2013

6.3

3.1

0

1

2

3

4

5

6

7

Hypertension Diagnosed hypertension



Pregnant women + DM, 2007

0.500.45

0.36

0.50

0.73

1.64

0.52

0.00

0.40

0.80

1.20

1.60

2.00

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Dia

be

tes

(%

)

Umur Ibu Hamil



Pregnant women + Malaria, 2007

2.4 2.5 2.4 2.4

3.5

4.4

6.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Ma

lari

a (

%)

Umur Ibu hamil (tahun)



Proportion of Anemia in Pregnant Women by urban/rural, 2013

36.437.8 37.1

0.0

10.0

20.0

30.0

40.0

50.0

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


Nutrition status of pregnant women, weight gain during pregnancy (kg)

Source: Cohort study on child growth & development, 2013


Energy intake of pregnant women

87.5

42.4

70

44.4

67.2

51.8 50.1

67.2

45.3

79.2

47.5

71.2

80.1

69.865.2

0

20

40

60

80

100

120

< 20 20 - 24 25 - 29 30 - 34 ≥ 35

Trimester 1

Trimester 2

Trimester 3



67.2

39.234.2

50.1

30.5

46.9 44.8 48.1 49.4 49.8

70.2

48.456.9 58.2 55.8

0.0

20.0

40.0

60.0

80.0

100.0

120.0

< 20 20 - 24 25 - 29 30 - 34 ≥ 35

Trimester 1

Trimester 2

Trimester 3

Protein intake of pregnant women



Proportion of too young, too old, too close between pregnancies, too many children, 2013

0

10

20

30

40

Terlalu muda<20 tahun

Terlalu tua >35tahun

Terlalu dekat<2 tahun

Terlalu banyak>4 anak

8.412.1

33.7

7.1



Proportion reproductive women with risk of chronic malnourish : 2007 & 2013

31

.3

23

.8

16

.1

12

.7

12

.6

10

.3

5.6

30

.9

18

.2

13

.1

10

.2

8.9

7.9

8.1

0.0

10.0

20.0

30.0

40.0

50.0

15-19 20-24 25-29 30-34 35-39 40-44 45-49

2007

Hamil Tidak Hamil

38

.5

30

.1

20

.9

21

.4

17

.3

17

.6 20

.7

46

.6

30

.6

19

.3

13

.6

11

.3

10

.7

11

.8

0.0

10.0

20.0

30.0

40.0

50.0

15-19 20-24 25=29 30-34 35-39 40-44 45-49

2013

Hamil Tidak Hamil

Source: Riskesdas 2007 & 2013


Pregnant women: weight gain vs height (N=220)

kg

2,4 kg

mgg

Tahun 2013: N = 220 ibu hamil**

9.0

10.310.7

9.1

7.3

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

4 8 12 16 20 24 28 32 36 37 38 39 40

< 150 Cm ≥ 150 Cm IOM 2009



Pregnant women: weight gain vs body weight before pregnant

8.2

10.0

10.7

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

11.0

12.0

4 8 12 16 20 24 28 32 36 37 38 39 40

BBPH < 45 BBPH ≥ 45 kg IOM 2009



Other determinants


Mother’s education vs

maternal health services, SDKI 2012

Pendidikan IbuPeriksa Hamil

dengan Nakes

Mendapat Pil

Zat Besi

Persalinan di

Faskes

Penolong

persalinan dg

Nakes

Kunjungan

Nifas (1-2 hari)

Tidak Sekolah 64.0 36.7 21.1 31.8 38.8

Tidak tamat SD 88.5 61.5 38.0 61.1 66.5

Tamat SD 94.0 70.4 47.1 72.8 75.9

Tidak Tamat SLTP 97.4 77.6 61.0 85.7 78.5

Tamat SLTP 98.4 80.0 79.8 94.3 86.9

SMTA+ 99.1 86.3 86.4 96.8 89.5

Source: Atmarita, 2013


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 86.9 61.6 29.7 57.5 59.3

Menengah Bawah 95.8 74.8 57.2 81.8 82.4

Menengah 97.7 77.5 66.2 89.7 83.5

Menengah Atas 99.0 79.5 79.1 93.2 85.3

Teratas 99.4 84.6 88.1 96.6 91.1

Source: Atmarita, 2013


Total Fertility Rate: 1981-2012

4.3

3.3

3.022.85 2.78 2.6 2.6 2.6

3.7

2.82.6

2.31 2.4 2.4 2.32.4

4.5

3.6

3.243.15

2.98

2.7 2.8 2.8

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1981-1983 1984-1987 1988-1991 1992-1994 1995-1997 1998-2002 2003-2007 2008-2012

TF

R

Reference Period

Kota+Desa

Kota

Desa



Age of married status

Proporsi Remaja/Dewasa Muda Menurut Tempat Tinggal dan Status Kawin, Riskesdas 2010

Jenis Kelamin

Kelompok Umur

(Tahun)

Kota Desa

Belum Kawin

Kawin Belum Kawin

Kawin

Laki-laki

10-14 99,9 0,1 99,9 0,1

15-19 98,7 1,3 97,8 2,2

20-24 82,9 17,1 71,7 28,3

Perempuan

10-14 99,9 0,1 99,7 0,3

15-19 92,8 7,2 82,5 17,5

20-24 46,9 53,1 14,4 85,6


Policy and Programs


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)


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.


Conclusion


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


Thank youTerima kasih

Date post:	22-Jun-2019
Category:	Documents
Upload:	votuong
View:	213 times
Download:	0 times

Nutrition, Health Status, Programs and Policy for Pregnant ... fileCause of Maternal Mortality...

Documents