International Journal of Economics, Commerce and Management Research Studies
Volume 1, Issue 1, August - 2018
IJECMRS18AG33 www.ijecmrs.com 71
Mortality Maternal Maping at Jember District
(2012-2014) Faiqatul Hikmah1, Sustin Farlinda2, Mas Ulafatul Fitri3, Mochammad Choirur Roziqin4
Jurusan Kesehatan, Program Studi Rekam Medik
Abstract:- The maternal mortality rate in Jember
occupy tenth rank about 116,44 of 100.000 live births
based on health profile province of east java in 2012. In
2012 the number of cases maternal mortality about 43
cases, in 2013 about 36 cases and in 2014 about 31 cases.
A mapping system is a the act of to be done to monitor
distribution Maternal Mortality, that level Maternal
Mortality can be minimize smallest possible . This
mapping system using Quantum GIS application version
1.8.0. The purpose of this study is to mapping areas that
related with Maternal Mortality in Jember. The kind of
research is qualitative using waterfall method. In this
research , Quantum GIS used to make digital maps that
can be connected with databases characteristic of an
area. The result of this research is a digital map show
cases Maternal Mortality in Jember with the highest
cases located in Kaliwates Sub-district about 10 cases.
Suggested to the health department suppressed the
number of cases maternal mortality in Jember and in
other researcher able to develop digital maps by
displaying map dynamic and connect to digital maps
with internet network.
Keywords:- Mapping, Mortality, Maternal Mortality,
Quantum GIS.
I. INTRODUCTION
World Health Organization (WHO) estimates the rate
of maternal mortality all over the world is about 529,000 in year of 2000 and in 2005 the rate increased up to 536,000
maternal mortality. Nigeria, in this case, place the second
highest rate after India. In 2007, it was around 1100 /
100.000 live births (Mojekwu, 2012).
The rate in Indonesia is the fourth highest (220 /
100.000 live births) among east asian countries, followed by
Cambodia, Timor-Leste and Laos. And the number is higher
than average rate of maternal mortality in ASEAN
(Dwicaksono and Setiawan, 2013).
The trends in maternal mortality in Indonesia from
1994 to 2007 showed a significant decrease number of loss
from year to year. According to last Survey of Demography
and Indonesian Health (Survei Demografi dan Kesehatan
Indonesia), in 2007, the rate was 228 mortalities per 100.000
live births. This number was decreased from 390 loss per
100.000 lives in 1994. WHO put a target 102 mortalities per
100.000 live births in 2015, in Millenium Development goal
(Andromeda, 2012).
According to the Health Profile of East Java Province,
Jember ranked 10th in 2012. There were about 116.44 losses
in 100,000 live births. Based on Health Department in
Jember district, the rate of mortality had been changed
during 2012-2014. The data in Health Department of Jember
district showed that in 2012, the rate of mortality was about
116.44 per 100,000 lives. The rate was decreased up to
101.30 losses per 100,000 lives in 2013, and decreased up to 31 cases only in 2014. According to the survey conducted
by Health Department of Jember district, there were 43
mothers lost their lives per 36,928 live births, 36 mortalities
per 35,537 in 2013, and 31 mother in 2014. Those rate were
from the entire sub districts in Jember.
Health Department of Jember district noted that three
causes of mortality related to pregnancy and childbirth.
They are bleeding (30%), Eclampsy (42%) and other causes.
Actually the causes are able to be handled by the medical
officer if the patient is brought to the closest Community
Health Center with adequate medical equipment and
medicine helped by the medical personal. Another factor of
mortality is caused by the limited access to health services
for their childbirths. For that reason, Health Department of
Jember district conducts monitoring to reduce the rate of maternal mortality by promoting reproduction health,
developing health facilities, and giving services according to
SOP of safe childbirth in Health Center. In addition, a
companion is given to those during pregnancy, especially
who are at higher risk. The monitoring program arranged by
Health Department of Jember district results the best if it is
supported by area mapping of maternal mortality. In this
case, Jember district has no such area mapping. This
mapping is expected to monitor and solve maternal
mortality.
As the information technology develops, geographical
information system is very helpful in observing each region
in order that maternal mortality is identified. In this case, the
data related to the maternal mortality can be input to the
Quantum GIS which is, then, able to monitor in which place, maternal mortality is often occurred and it is called digital
mapping. Further, the digital mapping helps medical
personnel in monitoring and reducing the rate of maternal
mortality in one particular sub district in Jember. In
addition, the medical officer does not need to choose which
sub district has the highest rank of the rate since the
application provides the information systematically. For that
reason Community Health Center officer need to input the
current data to result the map of maternal mortality in
Jember district. So that, the system eases the medical officer
in monitoring the rate on each sub district by clicking only.
Objective
The objective of this research is to provide digital
mapping of maternal mortality spread in Jember district.
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II. METHOD
The research applies qualitative method. The
qualitative data in this research characteristic of particular
region. In this research, the researchers apply Quatum GIS
1.8.0 versiont to input the data of maternal mortality in the
entire Community Health Center in Jember district, including pregnance mortality, childbirth mortality, childbed
mortality.
III. RESULT AND DISCUSSION
The main requirement to create mapping of maternal
mortality is the data deals with maternal mortality. In this
case, the researcher gained the data from Health Department
of Jember, Health Services Division. The data needed for
maternal mortality mapping are described as follow:
The data of maternal mortality in each Community
Health Center in Jember District during 2012-2014.
The data of health services facilities, such as Community
Health Center and professional midwife at health care
facility.
The number of traditional midwife who have trained
(trained traditional midwife) and
traditional midwife at urban and rural area.
Data large area and population in Jember district.
All those data will be analyzed and then put all in the
system that the information system contribute the best helps
in solving every problem.
A. The Report of Maternal Mortality in Health Department
in Jember District.
The researchers conducted the research on january 1 to
August 1, 2015. The researchers looked up the data of
maternal mortality rate at the Health Department of Jember.
The data, then, was input to the database of digital mapping. The following table is the rate of maternal mortality spread
in Jember district in 2012 to 2014.
Sub District ∑ Maternal mortality
Kencong 2
Gumukmas 4
Puger 4
Wuluhan 6
Ambulu 1
Tempurejo 1
Silo 8 Mayang 2
Mumbulsari 4
Jenggawah 2
Ajung 5
Rambipuji 3
Balung 4
Umbulsari 2
Semboro 2
Jombang 3
Sumberbaru 7
Tanggul 5 Bangsalsari 5
Panti 5
Sukorambi 1
Arjasa 3
Pakusari 2
Kalisat 2
Ledokombo 2
Sumberjambe 1
Sukowono 3
Jelbuk 4
Kaliwates 10 Sumbersari 5
Patrang 2
Total 110
Table 1. The spread of maternal mortality in Jember district
in 2012 to 2014.
Source: Health Department of Jember 2012-2014
According to the data above, in Kaliwates sub district,
maternal mortality cases were the most frequently happened
in 2012 to 2014. Contrary, there was only a case of mortality
case in 4 different sub districts: Ambulu, Tempurejo,
Sukorambi, and Sumberjambe.
B. The Report of Health Services Facilities in Jember
District
In this sub theme, the researchers present the facilities
dealing with the number of Community Health Center,
urban midwife, verified midwife helper, and traditional
midwife helper. According to the data below, the number of
traditional midwife in urban and rural area is more than
trained traditional midwife. In this case, there were about
1,181 urban and rural area-traditional midwife while there
were 1,122 trained midwife. From the table, 430 urban midwifes were spread in Jember district.
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Sub District
∑
Com
Healt
h
Center
Profe
s.l
midw
ife
Trained
traditional
midwife
Urban
and rural
area-trad.
midwife
Kencong 2 15 35 35
Gumukmas 2 13 28 29
Puger 2 20 56 57
Wuluhan 2 18 29 29
Ambulu 3 24 40 40
Tempurejo 2 16 47 49
Silo 2 17 66 68
Mayang 1 11 36 36
Mumbulsari 1 11 40 40
Jenggawah 2 12 45 45
Ajung 1 10 18 18
Rambipuji 2 18 19 21
Balung 2 14 24 24
Umbulsari 2 13 39 39
Semboro 1 8 18 18
Jombang 1 10 16 16
Sumberbaru 2 18 68 83
Tanggul 2 21 41 41
Bangsalsari 2 21 58 58
Panti 1 10 24 25
Sukorambi 1 8 24 25
Arjasa 1 9 43 43
Pakusari 1 7 21 21
Kalisat 1 13 44 44
Ledokombo 1 13 50 57
Sumberjambe 1 12 45 45
Sukowono 1 14 47 47
Jelbuk 1 10 34 45
Kaliwates 3 17 24 24
Sumbersari 2 14 31 36
Patrang 1 13 23 23
Jumlah 49 430 1133
1181
Table 2. The health services facilities in Jember District in
2012 to 2014
Source: Health Department of jember District 2014
C. The Report of Central Statistics departement
According to the Central Statistics department the
large area of jember is about 3,293.34 km². It is divided in to
31 sub districts.
Table 3. Population Data in Jember District 2010
Source: Central Statistics Bureau
The largest sub district in Jember is Tempurejo: it is
about 524.46 km². The narrowest sub district is Kaliwates.
The wide area of this sub district is about 24.94 km².
In 2013, 2,587,188 people lived in Jember district. The most crowded one was in Wuluhan: 130,742 lived in there.
Contraly, in Jelbuk there were only 32,243 people lived in
there where the large area is 65.06 km². Among the citizens,
there were 1,278,725 women. In this case, the highest
number of women were in Bangsal Sari, about 64,204
women and the lowest number of women was found in
Jelbuk where 15,659 women lived in there.
No Sub District Large Area (Km²)
1 Kencong 65,92
2 Gumukmas 82,98
3 Puger 148,99
4 Wuluhan 137,18
5 Ambulu 104,56
6 Tempurejo 524,46
7 Silo 309,98
8 Mayang 63,78
9 Mumbulsari 95,13
10 Jenggawah 51,02
11 Ajung 56,61
12 Rambipuji 52,8
13 Balung 47,12
14 Umbulsari 70,52
15 Semboro 45,43
16 Jombang 54,3
17 Sumberbaru 166,37
18 Tanggul 199,99
19 Bangsalsari 175,28
20 Panti 160,71
21 Sukorambi 60,63
22 Arjasa 43,75
23 Pakusari 29,11
24 Kalisat 53,48
25 Ledokombo 146,92
26 Sumberjambe 138,24
27 Sukowono 44,04
28 Jelbuk 65,06
29 Kaliwates 24,94
30 Sumbersari 37,05
31 Patrang 36,99
Total 3.293,34
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No Sub District ∑ Population ∑ Women
Population
1 Kencong 73.530 36.428
2 Gumukmas 92.239 45.233 3 Puger 130.513 63.769
4 Wuluhan 130.742 63.281
5 Ambulu 121.250 58.898
6 Tempurejo 77.505 37.897
7 Silo 118.954 58.211
8 Mayang 51.878 25.975
9 Mumbulsari 70.310 34.877
10 Jenggawah 90.862 44.490
11 Ajung 84.304 41.372
12 Rambipuji 92.155 45.627
13 Balung 87.275 43.183
14 Umbulsari 79.740 39.323 15 Semboro 51.160 25.368
16 Jombang 55.933 30.208
17 Sumberbaru 122.799 61.087
18 Tanggul 95.024 47.265
19 Bangsalsari 129.067 64.204
20 Panti 67.609 33.547
21 Sukorambi 41.154 20.453
22 Arjasa 39.298 19.485
23 Pakusari 44.697 22.378
24 Kalisat 79.531 39.568
25 Ledokombo 68.683 34.214 26 Sumberjamb
e
59.899 29.731
27 Sukowono 62.863 31.410
28 Jelbuk 32.243 15.959
29 Kaliwates 113.654 57.001
30 Sumbersari 112.970 56.442
31 Patrang 103.897 51.841
Total 2.587.188 1.278.725
Tabel 4:- The Number of Population on Each Sub District in
2013
Source: Genereal Directorate of Population and Civil
Registration, Ministry of Home Affairs 2013
No Sub District MM
2012-2013
1 Kencong 100,2
2 Gumukmas 130,2
3 Puger 79,7
4 Wuluhan 144,7
5 Ambulu 30,2
6 Tempurejo 41,3
7 Silo 217,6
8 Mayang 65,1
9 Mumbulsari 101,1
10 Jenggawah 37,5
11 Ajung 217,8
12 Rambipuji 79
13 Balung 127,4
14 Umbulsari 46,8
15 Semboro 143
16 Jombang 68,3
17 Sumberbaru 115,3
18 Tanggul 156,3
19 Bangsalsari 107,1
20 Panti 203,5
21 Sukorambi 93,3
22 Arjasa 258,8
23 Pakusari 78,5
24 Kalisat 43,1
25 Ledokombo 0
26 Sumberjambe 0
27 Sukowono 165,1
28 Jelbuk 216,6
29 Kaliwates 222
30 Sumbersari 120
31 Patrang 35
Jumlah 3445,8
Tabel 5. The Number of Maternal Mortality in 2012-2013
Source: Health Department of Jember
Planning Stage
On this stage, secondary data is gathered. In this case,
the data of maternal mortality in Jember district is still raw.
Then, the data will be inputted in to Microsoft Excel 2010.
By then, the data is ready to be transferred to the application
that the researcher use.
Modeling Stage
The next step is modelling. Here, the researchers apply
Quantum GIS 1.8.0 to which the data is input. Modelling
process is executed based on the gathered data. By using the application, the researchers are able to digitalize the map. In
addition, Style feature can be used to arrange the appearance
of the map. As the result, the map will present various
colours to indicate the rate of mortality in one particular sub
district in Jember district. Point feature is to identify the
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Volume 1, Issue 1, August - 2018
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name of sub district, Community Health Center, Hospital,
and direction. In the end of the process, the application will perform the mapping statically, with no internet. For that
reason, it is a must to make sure the users have already
installed Quantum GIS 1.8.0.
D. Constructing Digital Map of Maternal Mortality Spread in Jember District.
There are some steps in constructing the digital map.
They are explained below.
Construction Stage This digital map is a map of health and a map of
maternal mortality spread in Jember district. On this stage
the researchers create a map. The step of making a map are
explaine as follow:
The very first step is digitalizing the map by creating
Polygon on Jember district map. Before that, Raster
layer is added on analog map of Jember district which is
saved in the folder. For choosing coordinate reference
system, choose WGS 84, EPSG:4326. Related folder
should be saved in the same folder that the application
can run well.
Fig 1:- Add the Raster layer
Fig 2:- The steps to choose coordinate reference system
dialog
As analog map is choosen and matched to the
coordinate refference system, save the map in the same folder. The analog map needs to be digitalized that the
computer can read it in the program.
Fig 3:- Add New Shafile layer
Fig 4:- Shafile layer is activated
After shafile layer is activated, then choose polygon
and add feture, such as the number of maternal mortality,
Community Health Center, profesional midwife at health
care facilities, trained traitional midwife, and urban and
rural area-traditional midwife. After that, make polygon on
the map. After that, activate toggle editing to start
digitalizing map.
Fig 5:- Activate toggle editing to digitalize the map
Fig 6:- Digitalizing the border of jember district using
toggle editing
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Fig 7:- Digitalizing the boder of sub district using toggle
editing
If you want to add table on the map, choose tool layer and then click open table. Here, the user may fill the
secondary data from their research result. Save the data in
one particular folder or local disk.
Fig 8:- Add the feature on the map
Fig 9:- Dialogue to input the secondary data on the map
After all the secondary data from Health Department
of Jember is completely input to the table feture, save the
work.
The next step is making dot or point.
The dot on the map is to indicate the name of sub
district, community health center and hospital. The first thing you need to do is clicking Tool, new Shafile layer by
selecting point on the dialog box.
Fig 10:- digitalizing subdistrict on Jember map
Coloring on Jember digital map
The number of Maternal Mortality case of each
subdistrict in Jember is represented by the color on digital
map. The color differenciate the number of case on one area.
Through this color, the area with the high level of Maternal Mortality case can be read easily. To differecaite the color,
the subdistrict border should be activated. To start coloring,
select tool layer on subdistrict by double click on layer.
Look at the Fig 11.
Fig 11:- The number of case in active subdistrict
Fig 12:- layer property of active subdistrict border
Select style to start adjusting the color based on MM case in each subdistrict. Then, select the MM number to
categorize the data base on the expected color. The score
functions for coloring adjusment with the calssification of
each subdistrict filled on the previous digital map. In each
symbol, there is color adjusted by the case number to
differenciate high or low level of MM case by showing the
difference color. To add the color, select the classification.
To change the color, double click on symbol. This color will
change in every moment if MM case is changed or updated
based on the time of the accident.
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Testing is done by showing the digital map filled by the
atributes and layers supporting the digital map.
Digital map display of Maternal Mortality spread in
Jember district.
The use of color on digital map is to show Maternal
Mortality spread level in Jember. The color on digital map can be changed or updated based on the data happening on
particular time. The attributes on Maternal Mortality digital
map are:
The number Maternal Mortality
The number of health service facilities, Community
Health Center, profesional midwife, trained traditional
midwife and urban and rural area-traditional midwife.
The large area of Jember district
The number of society
The number of woman society
From those attributes, high or low level of Maternal
Mortality in each area in jember can be determined.
Fig 13:- digital map interface of Maternal Mortality in
Jember
Showing the atribute on digital map automatically
This step can show digital map atribute automatically.
Secondary data filled in attribute will appear when one area
on digital map is clicked. By doing this, public health officer
will easily study the high level of Maternal Mortality of
each area so that the completion to the problem can be done
directly, accurately, efficiently.
The most important is attribute and master data should
be saved in one folder. If it is not, it can change the digital map display and can cause attribute data on digital map
cannot be shown so that the information cannot be accessed
maximally.
Having entered to the folder, click the identification
fiture to show the atribute on master digital map.
Fig 14:- the icon of active identification fiture
Fig 15:- Map atribute display
a) Digital map Layout display of Maternal Mortality in
Jember
The digital map Layout is to interprate the map in form
of JPG or BMP. This JPG or BMP format file can be used
for presentation. The Layout on digital map has a direction and color scale lagend to guide the reader on understanding
the map.
The result of digital mapping on Maternal Mortality in
Jember
Fig 16:- Digital map of maternal Mortality in Jember
Fig 17:- The number of society Layout on digital map
(JPEG format file)
Based on health profile of East Java 2012, the rate of
maternal mortality for the high level is above 97,43 /100.000
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KH, for the everage category is under 97,43 /100.000 KH,
low category is 0. color low 0 (no data)
color medium <97,43/100.000 KH
color high > 97,43 /100.000 KH
E. Data analysis on digital map
Based on Health Minister’s decision of Indonesia No.
HK.02.02/MENKES/52/2015 about strategic planning of
ministry of health in 2015-2019 chapter I said that the main
factors of maternal mortality are hypertension while
pregnant and post partum bleeding. These factors can be
minimalized if antenatal care quality is well conducted.
Potential and challenge in decreasing maternal mortality and child is the number of medical officer in this case is midwife
which is widely spread in Indonesia but the competence is
inadequate.
Based on data maintained and served in 2012-2014,
the sub district that have high level Maternal Mortality in
Jember is:
Kaliwates
Based on the data of Maternal Mortality case in 2012-2014
got from health department in Jember, maternal mortality in Kaliwates were about 10 cases.
Geographical condition Explanation
1. Large of an area 24,94 km2
Table 6. geographic condition in Kaliwates
Condition Explanation
1. The number of society 113.654
2. The number of woman society 57.001
3. The number of MM 10 cases
4. Maternal Mortality cases in 2012: 3 cases
in 2013: 4 cases
in 2014: 3 cases
Table 7. MM case in Kaliwates
1. The number of Community Health Center 3
2. Profesional Midwife 17
3. The number of trained traiditonal midwife 24
4. Rural and urban area- traditional midwife 24
Table 8. the number health service facilities in Kaliwates
There are 3 Community Health Centers in Kaliwates:
Kaliwates, Mangli and Jember Kidul Commnunity Health
Center. This area is located on the center of the city. This
area is not large, but the population is crowded enough.
Mostly, the society in this area is not local citizen. Based on Maternal Mortality cases, Kaliwates has a high level of
Maternal Mortality with 10 cases in 2012-2014.
The result of the interview with midwife coordinator in every health center in Kaliwates said that the main factors of
Maternal Mortality are divided into:
A. Geographic condition
Kaliwates is the smallest area in Jember which is only 24,94 km2. Then, the number of the society is about 113.654
and 57.001 of woman. In this case, Kaliwates is in the center
of the city inhabited by nomadic society. Kaliwates has
crowded population. In this sub dsitrict, woman population
is higher than man. This condition results invalid data got by
midwife. Another side, skrining process for pregnant woman
from the beginning until puerperal by midwife region is not
maximum. This is proved by the data of maternal mortality
in 3 Community Health Centers in Kaliwates. This is based
on the interview result with the first respondent:
B. Life style factor Life style becomes important for young pregnant
women living in the city. Mostly, they do not expected their
body becomes fat because of pregnancy by consuming a lot
of food. This condition affects to the amount of nutrition
consumed by pregnant women that can cause chronic
malnutrition. Besides, they often suffer anemia which reach
more than 50 % of the pregnant woman. This information is
based on the interview to the second respondent.
There is target area monitored by social service for high
risk pregnant woman covered by one of Community Health
Centers in Kaliwates.
Risk factor
Every Community Health Center in Kaliwates has a
regional profesional midwife and every midwife region has
a sub Community Health Center which can cover high risk
pregnant woman. Tegal Besar is a region which has high
risk pregnant woman. This is proved by the data from
Januari - September reaching up to 96% of 100% of the
target in a year. Besides that, the causes of maternal
mortality are caused by bleeding and abnormality or
complication while pregnancy. This information is based on the third respondent information.
... ...each Community Health Center has regional profesional midwife. They are placed in sub Community Health Center. Each sub has data deal with high riskpregnant woman. The most recent data, from January to September, the highest number is located in Tegal Besar, about 97 cases
mencapai 96% jadi banyak sekali.
....commonly the awareness of pregnant woman is good. They regularly come to doctor regularly. Unfortunately, the youth life style affect them in consuming the nutrition for the baby. They are afraid of being fat. Since then, their health are not at their best. Even, they have less energy, anemia.
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IV. CONCLUSSION AND SUGGESTION
A. Conclussion
Based on the result and discussion on Maternal
Mortality in Jember in 2012 – 2014 can be concluded that:
The number of Maternal Mortality in Jember was 110
cases from 2012-2014, which include 43 cases in 2012, 36 cases in 2013, and 31 cases in 2014. Meanwhile, Maternal
Mortality cases force to 20 – 34 years old in 2012-2013.
This age is categorized as productive and fragile which
can be infected by deseases.
Maternal Mortality digital mapping is conducted on 31
subdistricts based on the data gained from Health
Depatment which cover: the data of maternal mortality in
2012-2014, the data of health service facilities: health
service, regional profesional midwife, trained traditional
midwife, urban and rural area-traditional midwife, large
area, and the number of the society in Jember.
Maternal Mortality digital map in 2013-2014 shows that
there are four subdistricts with high level of Maternal
Mortality cases, including: Kaliwates, Sumberbaru, Silo
and Wuluhan. Kaliwates is in the highest level and
Sumberjambe is in the lowest level.
B. Suggestion
Digital mapping is expected to compress the number of
Maternal Mortality cases in Jember, especially for the
area with the high level of death.
Maternal Mortality digital mapping can be used as
references by health depertment in Jember to conduct the
training for traditional midwife formally and joining
medical services.
For the next researcher, the dinamic (WebGIS) digital
map display will be more beneficial to be developed.
Connecting digital map to internet services.
Developing digital map supported by modern devices for
acurate GIS result.
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