ANALISIS PERAN FAKTOR PENYEBAB KEMATIAN MATERNAL YANG DAPAT DICEGAH TERHADAP KETERLAMBATAN RUJUKAN DAN PENANGANAN DI KABUPATEN KARAWANG PROVINSI JAWA BARAT
Authors: Ati Jasmi , Wirakusumah Firman F , Sukandar Hadyana , Husin Farid , Hidayat Yudi Mulyana , Yudatmo Unggul 
Published: December 2019

Maternal mortality rate is an important indicator of public health quality. Most of the causes of maternal mortality are preventable factors such as patients, health workers, health facilities and referral. The purpose of this study was to analyze of the role of factors maternal mortality could have been prevented to delays in referral and treatment. This is a sequential explanatory mixed method research. The first stage is carried out through quantitative cross sectional study with data capture as much as 65 maternal mortality could have been prevented retrieved from 2015’s Maternal Perinatal Audit (AMP) documents in Karawang Regency. The second stage is through qualitative approach with Focused Group Discussion (FGD) and in-depth interviews.The results of quantitative research shows that the majority (52 cases or 80,0%) of maternal mortality could have been prevented with delays in referral and treatment and there is a significant role of patient factors, health workers, health facilities with delays in referral and treatment while the referral factor does not have a significant role. Qualitative research results indicate that maternal mortality is caused by patient factors such as mother’s attitude toward risk, delayed and/or refusing treatment; factors of health workers due to lack of early detection, poor quality of service, lack of skilled professionals and late treatment; health facilities factors due to poor facility; referral factors such as referral refusal, referral inaccuracies and referral delays due to patient’s financial factor and team coordination and cross-sectoral cooperation is also contributing factors. The failure of early detection and decision-making due to lack of capacity of health personnel to recognize and capture high-risk cases and failure to effectively provide information, education and communication (KIE) are factors that cause delays in referral and treatment. Therefore, active participation of society, stakeholders, health professionals and policy makers are required to improve the quality of obstetric care to reduce maternal mortality.

Kematian maternal menjadi indikator penting derajat kesehatan masyarakat. Sebagian besar penyebab kematian maternal dapat dicegah meliputi faktor pasien, tenaga kesehatan, fasilitas kesehatan dan rujukan. Tujuan penelitian ini adalah menganalisis peran faktor penyebab kematian maternal yang dapat dicegah terhadap keterlambatan rujukan dan penanganan. Desain penelitian menggunakan sequensial eksplanatory mixed method. Tahap pertama secara kuantitatif yaitu cross sectional dengan pengambilan data dari dokumen Audit Maternal Perinatal (AMP) tahun 2015 sebanyak 65 kematian maternal yang dapat dicegah di Kabupaten Karawang. Tahap kedua secara kualitatif melalui Focus Group Discussion (FGD) dan wawancara mendalam. Hasil penelitian kuantitatif menunjukkan sebagian besar kematian maternal yang dapat dicegah mengalami keterlambatan rujukan dan penanganan yaitu 52 kasus (80,0%) dan terdapat peran yang bermakna dari faktor pasien, tenaga kesehatan, fasilitas kesehatan terhadap keterlambatan rujukan dan penanganan sedangkan faktor rujukan tidak terdapat peran yang bermakna. Hasil penelitian kualitatif didapatkan penyebab dari faktor pasien karena karakteristik ibu berisiko, terlambat mencari penanganan dan menolak pengobatan, dari faktor tenaga kesehatan karena kurangnya deteksi dini dan kualitas pelayanan, kurangnya tenaga profesional dan terlambat penanganan, dari faktor fasilitas kesehatan karena kurang fasilitas, dari faktor rujukan karena menolak rujukan, kurang tepatnya rujukan dan keterlambatan rujukan terkait biaya dan koordinasi tim serta kerja sama lintas sektor juga merupakan faktor yang berperan. Keterlambatan deteksi dini dan pengambilan keputusan karena kurangnya kemampuan tenaga kesehatan mengenali dan menjaring kasus risiko tinggi serta tidak efektif memberikan komunikasi informasi dan edukasi (KIE) yang menyebabkan keterlambatan rujukan dan penanganan. Diperlukan peran serta masyarakat, stakeholder, tenaga kesehatan dan pengambil kebijakan dalam meningkatkan kualitas pelayanan kebidanan untuk menurunkan kematian maternal.