Tesis

Intervensi Edukasi Laktasi Pranatal Untuk Meningkatkan Praktik Inisiasi Menyusu Dini (Penelitian Prognostik dalam Eksperimental)= Antenatal Lactation Education Intervention to Improve Early Breastfeeding Initiation Practice (Prognostic Research in A Clinical Trial)

Latar Belakang: Mempromosikan IMD pada satu jam pertama kelahiran bayi, merupakan strategi penting dalam mengurangi kecacatan dan kematian perinatal dan anak dibawah 2 tahun, juga terbukti mendukung keberhasilan pemberian ASI eksklusif. Proporsi ibu yang menjalankan IMD di Indonesia sebanyak 39% termasuk rendah. Rendahnya pelaksanaan IMD salah satunya disebabkan rendahnya pengetahuan ibu mengenai IMD. Dari berbagai penelitian dibuktikan metode intervensi edukasi laktasi pranatal adalah metode paling efektif dan lebih mampu laksana sehingga penelitian ini diharapkan dapat membuktikan dengan adanya intervensi edukasi laktasi pranatal dapat meningkatkan efektivitas praktik IMD. Serta dapat diketahui faktor-faktor prognostik yang dapat mempengaruhi efektivitas IMD. Tujuan: Diketahuinya efektivitas praktik IMD, hubungan antara pemberian edukasi laktasi pranatal dengan efektivitas IMD serta faktor-faktor ibu yang berhubungan dengan efektivitas IMD. Metode: Uji klinis dilanjutkan dengan desain prognostik selama periode Oktober 2014 hingga Maret 2015 di Poliklinik Kebidanan dan Kamar Bersalin, Departemen Obstetri dan Ginekologi RSCM Jakarta. Hasil: Dilakukan analisa pada 220 subyek, didapatkan 160 subjek (72.7%) mengalami IMD yang efektif. Pada kelompok intervensi 80% subyek mengalami efektivitas IMD. Terdapat hubungan yang bermakna antara kelas edukasi pranatal dengan efektivitas IMD, dengan nilai p 0.006 dan RR 1.25. Pada analisa bivariat faktor ibu berhubungan bermakna dengan efektivitas IMD adalah edukasi laktasi pranatal (p 0.006), cara bersalin (p 0.006), durasi persalinan (p 0.000) dan status gizi normal (p 0.020). Pada analisa multivariat didapatkan faktor ibu berhubungan bermakna dengan efektivitas IMD adalah edukasi laktasi pranatal, durasi persalinan, umur 25-34 tahun dan ≥ 35 tahun, status gizi overweight dan normal. Persamaan yang dihasilkan: y = -3.477 + 0.976*edukasi laktasi pranatal + 0.958*umur 25-34 tahun + 1.859*umur ≥ 35 tahun + 1.621*durasi persalinan + 1.584*status nutrisi overweight + 2.405*status nutrisi normal. Dengan hasil uji kualitas regresi memiliki kalibrasi baik (p 0.87), dengan diskriminasi sedang (AUC 0.75). Kesimpulan: Adanya intervensi edukasi laktasi pranatal dapat meningkatkan efektivitas praktik IMD.
Kata Kunci: edukasi laktasi pranatal, faktor ibu, efektivitas IMD



Background: Promoting Early Breastfeeding Initiation (EBI) within the first hour birth is an important strategy in reducing morbidity and mortality of neonatal and children under 2 years, also proved to support the success of exclusive breastfeeding. The proportion of women who practice EBI in Indonesia as much as 39%, remaining low. The low implimentation of EBI is due to lack of knowledge of mothers about EBI. From various studies demonstrated Antenatal Lactation Education Intervention methods is the most effective methods. This research is expected to prove Antenatal Lactation Education Intervention can improve effectiveness of EBI practice. And can be known prognostic factors that can affect the effectiveness of EBI practice. Objective: To obtain EBI effectiveness, Antenatal Lactation Education Intervention and EBI effectiveness association, as well maternal factors and EBI effectiveness association. Method: This was a clinical trial continued with prognostic design conducted at Obstetric Clinic and Delivery Room, RSCM, Jakarta during a period of October 2014 until March 2015. Result: Analysis conducted on 220 subjects, showed 160 subjects (72.7%) experienced EBI effectiveness. In the intervention group 80% of the subjects experienced the effectiveness of EBI. There is a significant association between antenatal lactation education intervention and the effectiveness of EBI with the p value 0.006 and RR 1.25. The bivariate analysis showed maternal factors that significantly associated with EBI effectiveness were the Antenatal Lactation Education Intervention (p 0.006), delivery mode (p 0.006), duration of labor (p 0.000) and normal nutritional status (p 0.020). In the multivariate analysis found maternal factors that significantly associated with EBI effectiveness were antenatal lactation education intervention, duration of labor, age 25-34 years and ≥ 35 years old, overweight and normal nutritional status. The equation result : y = -3477 + 0976 * antenatal lactation education intervention + 0958 * aged 2534 years + 1859 * ≥ 35 years of age + 1,621 * 1,584 * + delivery duration nutritional status overweight + 2405 * normal nutritional status. With the regression quality test results was a good calibration (p 0.87),with a medium level of discrimination (AUC 0.75). Conclusion: Antenatal lactation education intervention can improve the effectiveness of EBI practice.
Keywords: antenatal lactation education, maternal factor, EBI effectiveness