Akses Remaja dengan Komplikasi Kehamilan terhadap Pelayanan Persalinan dan Kelangsungan Hidup Anak di Indonesia
Access of Adolescents with Pregnancy Complications to Delivery Services and Child Survival in Indonesia
Abstract
Abstract
Age-Specific Death Rate (ASDR) cases of maternal death are highest in the adolescent group (<20 years). Adolescent pregnancy is a risky pregnancy, so it is necessary to deliver at health facilities. A complication of pregnancy in adolescents is also at risk of childhood mortality. The study aims to assess the access of pregnant adolescents with complications to delivery facilities and the relation with the survival of the child. This study is a secondary data analysis of the 2017 Indonesia Demographic and Health Survey (IDHS). The unit of analysis of live births five years preceding survey, and mother's age birth before 35 years (14,634 live births). There are 2 dependent variables: access to delivery services (skill birth attendant and health facilities); and survival of the child (neonatal, infant and under-five mortality). Interest variables is multiple high-risk category, a combination of morbidity status (complications during pregnancy) and age adolescents (<20 years) compared adults (20-34 years). Covariate variables are parity and characteristics (mother’s education, residence and wealth index). Statistical test with logistic regression, 95%CI. All pregnancies with complications were significant association with neonatal and infant mortality. Specifically adolescent pregnancy with complications is also significantly associated with under-five mortality. In adolescents with pregnancy complications had OR neonatal mortality=7.4, OR infant mortality=4.56 and OR infant mortality=3.73, compared with adults pregnant without complication. Pregnancies ages 20-34 with complications having neonatal OR=1.95 and OR infant mortality=1.64. Pregnant adolescents are significantly associated with facilities of delivery (OR<1). The conclusions are: the access of adolescents with pregnancy complications to childbirth at the health facility is still low; adolescent pregnancy with complications is significantly related to childhood mortality and the highest risk of neonatal mortality.
ABSTRAK
Age Spesific Death Rate (ASDR) kasus kematian maternal tertinggi pada kelompok remaja (<20 tahun). Kehamilan pada usia remaja merupakan kehamilan berrisiko, sehingga mereka perlu akses ke fasilitas persalinan yang aman. Kehamilan dengan komplikasi pada remaja juga berisiko terhadap kematian anaknya. Tujuan studi untuk menilai akses remaja yang hamil dengan komplikasi terhadap pelayanan persalinan dan mengetahui status kelangsungan hidup anaknya. Studi ini merupakan analisis data sekunder Survei Demografi dan Kesehatan Indonesia (SDKI) 2017. Unit analisis adalah kelahiran hidup periode lima tahun sebelum survey dan saat dilahirkan usia ibu belum mencapai 35 tahun (14.634 kelahiran hidup). Variabel dependen yang diteliti ada 2: akses ke pelayanan persalinan (tenaga kesehatan dan fasilitas pelayanan kesehatan); dan kelangsungan hidup anak (kematian: neonatal, bayi, dan balita). Variabel interes adalah status ganda yaitu kombinasi status komplikasi kehamilan dan umur risiko remaja dibandingkan umur tidak berisiko (20-34 tahun). Variabel kovariat: paritas dan karakteristik (pendidikan, tempat tinggal dan indeks kekayaan). Uji statistik dengan regresi logistik, 95%CI. Semua kehamilan dengan komplikasi berhubungan signifikan dengan kematian neonatal dan bayi bila dibandingkan dengan kehamilan usia 20-34 tanpa komplikasi. Khusus kehamilan remaja dengan komplikasi juga berhubungan signifikan dengan kematian balita. Pada remaja dengan komplikasi kehamilan mempunyai OR kematian neonatal=7,4, OR kematian bayi=4,56 dan OR kematian balita=3,73. Kehamilan usia 20-34 dengan komplikasi mempunyai OR neonatal=1,95 dan OR kematian bayi=1,64. Remaja hamil berhubungan signifikan dengan persalinan di fasyankes (OR<1). Kesimpulan studi ini adalah akses remaja dengan kehamilan komplikasi terhadap persalinan di fasyankes masih rendah. Kehamilan remaja dengan komplikasi berhubungan signifikan dengan kematian anak, dan risiko paling tinggi terhadap kematian neonatus.
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