4.1.1 Karakteristik pasien maternal di RS Panti Rapih Yogyakarta yaitu lebih banyak melahirkan bayi dengan berat badan normal (92,3%), mengkonsumsi suplemen kalsium tidak sesuai (59,3%), berusia 20-30 tahun (60,8%), pendidikan terakhir S1 (52,1%), bekerja sebagai pegawai swasta (40,7%), melakukan antenatal care ≥4 kali selama kehamilan (98,5%) dan belum pernah mengalami abortus (89,2%)
4.1.2 Usia, jumlah antenatal care, jumlah riwayat abortus dan paritas cenderung bukan merupakan faktor-faktor risiko terhadap terjadinya BBLR
4.1.3 Penggunaan suplemen kalsium selama kehamilan cenderung bukan merupakan salah satu faktor risiko terhadap terjadinya BBLR.
4.2 Rekomendasi
Penelitian ini memberikan rekomendasi untuk penelitian selanjutnya yaitu:
4.2.1 Penelitian lebih lengkap dalam mengambil data responden yakni dengan data rekam medis disertai wawancara responden
4.2.2 Penelitian serupa dengan rancangan cohort prospective.
Daftar Pustaka
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gynaecology, 117 (7), 821–829.
American Hospital Formulary Services, 2005. AHFS Drug Information, American Society of Health-System Pharmacists Inc., USA, pp. 2531-2537.
Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan RI, 2013. Laporan Hasil Riset Kesehatan Dasar Tahun 2013, Jakarta.
Bonzini, M., Coggon, D., and Palmer, K.T., 2007. Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review. Occupational and Environmental Medicine, 64 (4), 228–243.
Brown, J.S., Adera, T., and Masho, S.W., 2008. Previous abortion and the risk of low birth weight and preterm births. Journal of epidemiology and community health, 62 (1), 16– 22.
Buppasiri, P., Lumbiganon, P., Thinkhamrop, J., Ngamjarus, C., and Laopaiboon, M., 2008. Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes. Cochrane Database of Systematic Reviews, 10, 1-90.
Chaman, R., Amiri, M., Raei, M., and Ajami, M., 2013. Low Birth Weight and Its Related Risk Factors in Northeast Iran. Iran Journal of Pediatrics, 23 (6), 701–704.
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Charan, J., and Biswas, T., 2013. How to Calculate Sample Size for Different Study Designs in Medical Research?. Indian Journal of Psychological Medicine, 35 (2), 121-126. Dinas Kesehatan Provinsi D. I. Yogyakarta, 2012. Buku Profil Kesehatan Provinsi D I
Yogyakarta Tahun 2011, Semarang.
Gardiner, P.M., Nelson, L., Shellhaas, C.S., Dunlop, A.L., Long, R., Andrist, S., and Jack, B.W., 2008. The clinical content of preconception care: nutrition and dietary supplements. American Journal of Obstetrics and Gynecology, S345-S356.
Jayant, D., Phalke, D.B., Bangal, V.B., Peeyuusha, D., and Sushen, B., 2011. Maternal risk factors for low birth weight neonates: a hospital based case-control study in rural area of western Maharashtra, India. National Journal of Community Medicine, 2 (3), 394– 398.
Kanjanasingh, T., Smanchat, B., and Prommas, S., 2013. The Association between Antenatal Care and Low Birth Weight newborn at Bhumibol Adulyadej Hospital, Thailand. Royal Thai Air Force Medical Gazette, 59 (2), 9–13.
Koo, W., 2012. Study of the effect of calcium supplementation during pregnancy on the risk of preterm birth or low birthweight infants is inconclusive. Evidence-Based Medicine, 17 (6), 186-187.
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Lips, P., 2012. Interaction between Vitamin D and calcium. Scandinavian Journal of Clinical and Laboratory Investigation, 72 (Suppl 243), 60–64.
Matthews, T.J. and MacDorman, M.F., 2013. Infant mortality statistics from the 2010 period linked birth/infant death data set. National Vital Statistics Report, 62 (8), 1–26.
Mumbare, S.S., Maindarkar, G., Darade, R., Yenge, S., Tolani, M.K., and Patole, K., 2012. Maternal risk factors associated with term low birth weight neonates: A matched-pair case control study. Indian Pediatrics, 49 (1), 25–28.
Muula, A.S., Siziya, S., and Rudatsikira, E., 2011. Parity and maternal education are associated with low birth weight in Malawi. African Health Sciences, 11 (1), 65-71. Negandhi, P.H., Negandhi, H.N., Zodpey, S.P., Ughade, S.N., and Biranjan, J.R., 2015. Risk
Factors for Low Birth Weight in an Indian Urban Setting : A Nested Case Control Study. Asia-Pacific Journal of Public Health, 26 (5), 461-469.
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Paul, M.W., Smith, M., Robinson, L., and Segal, J., 2015. Calcium and Bone Health, http://www.helpguide.org/articles/healthy-eating/calcium-and-your-bones.htm, Help Guide, diakses tanggal 24 Februari 2016.
Roudbari, M., Yaghmaeei, M., and Soheili, M., 2007. prevalence and risk factors of low-birth-weight infants in Zahedan, Islamic Republic of Iran. Eastern Mediterranean Health Journal, 13, 835–845.
Shah, P.S., 2010. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstetricia et Gynecologica, 89, 862–875.
Sharma, S.R., Giri, S., Timalsina, U., Bhandari, S.S., Basyal, B., Wagle, K., and Shrestha, L., 2015. Low birth weight at term and its determinants in a tertiary hospital of Nepal : a case control study. Plos One, 10 (4), 1-10.
Thomas, M., Weisman, S.M., 2006. Calcium Supplementation During Pregnancy and Lactation: Effects on the Mother and the Fetus. American Journal of Obstetrics and Gynecology, 194, 937-945.
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13 Lampiran 1. Surat Ijin Penelitian
14 Lampiran 2. Ethical Clearance
15
16 Lampiran 4. Definisi Operasional Penelitian
Variabel Definisi Operasional Cara Pengukuran
Skala Penilaian
Suplementasi kalsium
Ukuran banyaknya suplemen yang diperoleh melalui peresepan dokter dan dilihat dalam rekam medis. Suplementasi kalsium normal yaitu 1500-2000 mg/hari (WHO, 2013). Rasio yang diubah ke Kategorikal 0= suplementasi sesuai 1= suplementasi tidak sesuai Berat badan bayi lahir
Diperoleh dari rekam medis pasien maternal, akan masuk ke dalam kriteria BBLR apabila berat bayi <2500 gram (WHO, 2013).
Rasio yang diubah ke Kategorikal
0= berat bayi lahir normal
1= berat bayi lahir rendah
Antenatal care
Jumlah antenatal care yang dilakukan pasien maternal selama kehamilan, diperoleh dari rekam medis pasien maternal
Rasio yang diubah ke Kategorikal 0= ≥4 kali antenatal care selama kehamilan 1= <4 kali antenatal care selama kehamilan Usia maternal Usia maternal saat pengambilan
data, diperoleh dari rekam medis pasien maternal Rasio yang diubah ke Kategorikal 0= 20-30 tahun 1= 31-35 tahun Riwayat abortus
Jumlah riwayat abortus sebelum pengambilan data, diperoleh dari rekam medis pasien maternal
Rasio yang diubah ke Kategorikal 0= tidak pernah mengalami abortus 1= ≥1 kali pernah mengalami abortus Paritas Jumlah kelahiran hidup sebelum
pengambilan data, diperoleh dari rekam medis pasien maternal
Rasio yang diubah ke kategorikal 0= tidak berisiko (2-3) 1= berisiko (1 dan ≥4)
17
19 Lampiran 6. Perhitungan Besar Sampel Minimum
Variabel kualitatif Ukuran Sampel= � −�/ � −� � = , , − , , = , , , , = , , = 140,75≈ 140sampel Keterangan:
= Nilai standar normal variabel (pada tipe eror I 5% (p<0,05) sebesar 1,96)
P = Proporsi populasi berdasarkan penelitian sebelumnya
20
Lampiran 7. Uji Normalitas Berat Badan Bayi Lahir di RS Panti Rapih Yogyakarta
Explore
Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent BBnumeric 194 100,0% 0 0,0% 194 100,0%
Descriptives
Statistic Std. Error
BBnumeric Mean 3043,2010 31,90400
95% Confidence Interval for Mean Lower Bound 2980,2758 Upper Bound 3106,1263 5% Trimmed Mean 3045,4811 Median 3100,0000 Variance 197465,871 Std. Deviation 444,37132 Minimum 1085,00 Maximum 4165,00 Range 3080,00 Interquartile Range 621,25 Skewness -,386 ,175 Kurtosis 1,242 ,347 Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig. BBnumeric ,081 194 ,004 ,975 194 ,002
21
22
Lampiran 8. Uji T Suplementasi Kalsium Terhadap BBLR
T-Test
Group Statistics
codingCA N Mean Std. Deviation Std. Error Mean BBnumeric ,00 115 3046,5565 433,71159 40,44381 1,00 79 3038,3165 462,20873 52,00255
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
BBnumeric Equal variances
assumed 1,026 ,312 ,127 192 Equal variances not
assumed ,125 160,675
Independent Samples Test
t-test for Equality of Means
Sig. (2-tailed) Mean Difference Std. Error Difference BBnumeric Equal variances
assumed ,899 8,24007 65,10200 Equal variances not
assumed ,901 8,24007 65,87842
Independent Samples Test
t-test for Equality of Means 95% Confidence Interval of the Difference
Lower Upper
BBnumeric Equal variances assumed -120,16689 136,64703 Equal variances not assumed -121,85918 138,33931
23 Lampiran 9. Uji T Usia Maternal Terhadap BBLR
T-Test
Group Statistics
codingUMUR N Mean Std. Deviation Std. Error Mean BBnumeric ,00 118 3043,8814 422,22858 38,86929 1,00 76 3042,1447 479,61606 55,01574
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
BBnumeric Equal variances
assumed ,363 ,547 ,027 192
Equal variances not
assumed ,026 145,346
Independent Samples Test
t-test for Equality of Means
Sig. (2-tailed) Mean Difference Std. Error Difference BBnumeric Equal variances
assumed ,979 1,73662 65,52791 Equal variances not
assumed ,979 1,73662 67,36136
Independent Samples Test
t-test for Equality of Means 95% Confidence Interval of the Difference
Lower Upper
BBnumeric Equal variances assumed -127,51041 130,98364 Equal variances not assumed -131,39772 134,87095
24
Lampiran 10. Uji T Jumlah Antenatal Care Terhadap BBLR
T-Test
Group Statistics
codingANC N Mean Std. Deviation Std. Error Mean BBnumeric ,00 3 3200,0000 232,43279 134,19513 1,00 191 3040,7382 446,78941 32,32855
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
BBnumeric Equal variances
assumed 1,270 ,261 ,615 192
Equal variances not
assumed 1,154 2,239
Independent Samples Test
t-test for Equality of Means
Sig. (2-tailed) Mean Difference Std. Error Difference BBnumeric Equal variances
assumed ,539 159,26178 258,98245 Equal variances not
assumed ,357 159,26178 138,03430
Independent Samples Test
t-test for Equality of Means 95% Confidence Interval of the Difference
Lower Upper
BBnumeric Equal variances assumed -351,55430 670,07786 Equal variances not assumed -377,89016 696,41372
25
Lampiran 11. Uji T Jumlah Riwayat Abortus Terhadap BBLR
T-Test
Group Statistics
codingR.AB N Mean Std. Deviation Std. Error Mean BBnumeric ,00 173 3031,8555 437,63453 33,27274 1,00 21 3136,6667 498,14991 108,70522
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
BBnumeric Equal variances
assumed ,309 ,579 -1,021 192 Equal variances not
assumed -,922 23,899
Independent Samples Test
t-test for Equality of Means
Sig. (2-tailed) Mean Difference Std. Error Difference BBnumeric Equal variances
assumed ,309 -104,81118 102,67552 Equal variances not
assumed ,366 -104,81118 113,68333
Independent Samples Test
t-test for Equality of Means 95% Confidence Interval of the Difference
Lower Upper
BBnumeric Equal variances assumed -307,32801 97,70566 Equal variances not assumed -339,49474 129,87238
26 Lampiran 12. Uji T Paritas Terhadap BBLR
T-Test
Group Statistics
codingP N Mean Std. Deviation Std. Error Mean BBnumeric ,00 104 3036,3942 424,68815 41,64410 1,00 90 3051,0667 468,36368 49,36987
Independent Samples Test
Levene's Test for Equality of Variances
t-test for Equality of Means
F Sig. t df
BBnumeric Equal variances
assumed ,045 ,833 -,229 192 Equal variances not
assumed -,227 181,368
Independent Samples Test
t-test for Equality of Means
Sig. (2-tailed) Mean Difference Std. Error Difference BBnumeric Equal variances
assumed ,819 -14,67244 64,13245 Equal variances not
assumed ,821 -14,67244 64,58804
Independent Samples Test
t-test for Equality of Means 95% Confidence Interval of the Difference
Lower Upper
BBnumeric Equal variances assumed -141,16705 111,82218 Equal variances not assumed -142,11304 112,76817
27
Lampiran 13. Uji Chi-Square Suplementasi Kalsium Terhadap BBLR
Crosstabs
codingCA * codingBB Crosstabulation
codingBB Total ,00 1,00 codingCA ,00 Count 8 107 115 % within codingCA 7,0% 93,0% 100,0% 1,00 Count 7 72 79 % within codingCA 8,9% 91,1% 100,0% Total Count 15 179 194 % within codingCA 7,7% 92,3% 100,0% Chi-Square Tests Value df Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,238a 1 ,626 Continuity Correctionb ,046 1 ,830 Likelihood Ratio ,235 1 ,628
Fisher's Exact Test ,785 ,410
Linear-by-Linear Association ,237 1 ,627 N of Valid Cases 194
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 6,11. b. Computed only for a 2x2 table
Risk Estimate
Value
95% Confidence Interval Lower Upper Odds Ratio for codingCA
(,00 / 1,00) ,769 ,267 2,214 For cohort codingBB = ,00 ,785 ,297 2,077 For cohort codingBB = 1,00 1,021 ,938 1,111 N of Valid Cases 194
28
Lampiran 14. Uji Chi-Square Usia Maternal Terhadap BBLR
Crosstabs
codingUMUR * codingBB Crosstabulation
codingBB Total ,00 1,00 codingUMUR ,00 Count 9 109 118 % within codingUMUR 7,6% 92,4% 100,0% 1,00 Count 6 70 76 % within codingUMUR 7,9% 92,1% 100,0% Total Count 15 179 194 % within codingUMUR 7,7% 92,3% 100,0% Chi-Square Tests Value df Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,005a 1 ,946 Continuity Correctionb ,000 1 1,000 Likelihood Ratio ,005 1 ,946
Fisher's Exact Test 1,000 ,575
Linear-by-Linear Association ,005 1 ,946 N of Valid Cases 194
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 5,88. b. Computed only for a 2x2 table
Risk Estimate
Value
95% Confidence Interval Lower Upper Odds Ratio for codingUMUR
(,00 / 1,00) ,963 ,329 2,825 For cohort codingBB = ,00 ,966 ,358 2,605 For cohort codingBB = 1,00 1,003 ,922 1,091 N of Valid Cases 194
29
Lampiran 15. Uji Chi-Square Jumlah Antenatal Care Terhadap BBLR
Crosstabs
codingANC * codingBB Crosstabulation
codingBB Total ,00 1,00 codingANC ,00 Count 0 3 3 % within codingANC 0,0% 100,0% 100,0% 1,00 Count 15 176 191 % within codingANC 7,9% 92,1% 100,0% Total Count 15 179 194 % within codingANC 7,7% 92,3% 100,0% Chi-Square Tests Value df Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,255a 1 ,613 Continuity Correctionb ,000 1 1,000 Likelihood Ratio ,487 1 ,485
Fisher's Exact Test 1,000 ,784
Linear-by-Linear Association ,254 1 ,614 N of Valid Cases 194
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is ,23. b. Computed only for a 2x2 table
Risk Estimate
Value
95% Confidence Interval Lower Upper For cohort codingBB = 1,00 1,085 1,041 1,131 N of Valid Cases 194
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Lampiran 16. Uji Chi-Square Jumlah Riwayat Abortus Terhadap BBLR
Crosstabs
codingR.AB * codingBB Crosstabulation
codingBB Total ,00 1,00 codingR.AB ,00 Count 12 161 173 % within codingR.AB 6,9% 93,1% 100,0% 1,00 Count 3 18 21 % within codingR.AB 14,3% 85,7% 100,0% Total Count 15 179 194 % within codingR.AB 7,7% 92,3% 100,0% Chi-Square Tests Value df Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1,418a 1 ,234 Continuity Correctionb ,575 1 ,448 Likelihood Ratio 1,190 1 ,275
Fisher's Exact Test ,211 ,211
Linear-by-Linear Association 1,410 1 ,235 N of Valid Cases 194
a. 1 cells (25,0%) have expected count less than 5. The minimum expected count is 1,62. b. Computed only for a 2x2 table
Risk Estimate
Value
95% Confidence Interval Lower Upper Odds Ratio for codingR.AB
(,00 / 1,00) ,447 ,115 1,735 For cohort codingBB = ,00 ,486 ,149 1,582 For cohort codingBB = 1,00 1,086 ,908 1,299 N of Valid Cases 194
31
Lampiran 17. Uji Chi-Square Paritas Terhadap BBLR
Crosstabs
codingP * codingBB Crosstabulation
codingBB Total ,00 1,00 codingP ,00 Count 9 95 104 % within codingP 8,7% 91,3% 100,0% 1,00 Count 6 84 90 % within codingP 6,7% 93,3% 100,0% Total Count 15 179 194 % within codingP 7,7% 92,3% 100,0% Chi-Square Tests Value df Asymptotic Significance (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,267a 1 ,605 Continuity Correctionb ,061 1 ,805 Likelihood Ratio ,269 1 ,604
Fisher's Exact Test ,789 ,405
Linear-by-Linear Association ,266 1 ,606 N of Valid Cases 194
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 6,96. b. Computed only for a 2x2 table
Risk Estimate
Value
95% Confidence Interval Lower Upper Odds Ratio for codingP (,00
/ 1,00) 1,326 ,453 3,882
For cohort codingBB = ,00 1,298 ,481 3,506 For cohort codingBB = 1,00 ,979 ,903 1,061 N of Valid Cases 194
32