Determinants Of Delays In Seeking Care In Maternal Referrals In Indonesia (Ecological Studies)

Abstract

Latar belakang: Keterlambatan rujukan dapat terjadi pada semua ibu hamil. Keterlambatan tahap pertama yaitu terlambat mencari perawatan. Penyebabnya yaitu kondisi social ekonomi, budaya, akses ke fasilitas kesehatan dan kualitas perawatan.Tujuan: Mengidentifikasi determinan sosial dari individu dan lingkungan yang mempengaruhi keterlambatan mencari perawatan di Indonesia.Metode: Desain yaitu studi ekologi menggunakan Laporan Riset Kesehatan Dasar 2018 dan Laporan Statistic Potensi Desa 2018 dengan unit analisis 34 Provinsi di Indonesia. Analisis bivariat menggunakan Scatter plot dan uji korelasi Pearson.Hasil: Variasi keterlambatan rujukan antar Provinsi sangat lebar dengan rentang 33,50% - 73,6%. Hasil uji bivariat membuktikan semakin tinggi prevalensi ibu hamil dengan eklampsia, biaya BPJS, budaya persalinan dukun bayi dan tinggal diwilayah puncak atau lereng gunung maka semakin tinggi prevalensi keterlambatan rujukan. Sebaliknya semakin tinggi prevalensi kunjungan K4 ANC dan kemudahan akses ke Fasilitas kesehatan maka semakin rendah prevalensi keterlambatan rujukan.Kesimpulan: Jenis komplikasi, kunjungan ANC, peserta BPJS, budaya persalinan dukun, akses ke fasilitas kesehatan dan topografi wilayah mempengaruhi keterlambatan rujukanSaran: Fasilitas kesehatan lebih intensif melakukan deteksi dini pre-eklampsia , edukasi tanda bahaya pada keluarga, dan persiapan persalinan dalam pelayanan ANC agar komplikasi cepat ditemukan dan keluarga cepat mencari perawatan serta mencapai fasilitas kesehatan. Kata Kunci: Maternal, Mencari perawata, Keterlambatan rujukan, ABSTRACT Background: Delays in referral can occur in all pregnant women. The first stage of delay is late seeking care. The causes are socio-economic conditions, culture, access to health facilities and quality of care.Objective: To identify social determinants specifically individual and environmental factors that influence delays in seeking care in Indonesia.Methode: Design is an ecological study using Basic Health Research 2018 Report and Village Potential Statistics 2018 Report with analysis units from 34 Provinces in Indonesia. Bivariate analysis used Scatter plot and Pearson correlation test.Result: Variations in referral delays between provinces are very wide with a range of 33.50% - 73.6%. The bivariate test results that the higher the prevalence of pregnant women experiencing eclampsia, National health insurance participants, the culture of birth to TBAs and living in mountain peaks or slopes, the higher the prevalence of delay in referrals. On the other hand, the higher the prevalence of ANC visits (K4) and the ease of access to health facilities, the lower the prevalence of delay in referrals.Conclusion: Types of complications, ANC visits, BPJS participants, culture TBAs, access to health facilities and regional topography influence referral delaysSuggestion: Health facilities are more intensive in carrying out early detection of pre-eclampsia, educating families about danger signs, and preparing for childbirth in ANC services so that complications are discovered quickly and families quickly seek care and reach health facilities Keywords: Delay in referral, maternal, seeking care