Ulti Desmarnita, Fenti Hasnani
Poltekkes
Kemenkes Jakarta I,
Indonesia
E-mail:
[email protected], [email protected],
|
KEYWORDS health cadres, risk pregnancy, pregnant women |
ABSTRACT High-risk pregnancy is a condition of pregnancy that is a factor in the
occurrence of danger and severe complications for both the mother and the
fetus in the womb and can cause death, illness, disability, discomfort and
dissatisfaction. The health of pregnant women can be maintained through
health care efforts using antenatal care. These efforts aim to reduce
maternal mortality with various interventions according to the problems of
pregnant women at risk. Risk factors for pregnant women are proactively
introduced or informed by health workers or trained officers in the
community, such as health cadres. Health cadres will easily monitor and
assist pregnant women at risk if they understand risky pregnancies,
especially during the pandemic. For that we need the right media in conveying
health information, especially about monitoring high risk pregnant women in
the form of books. Objective: to optimize the role of health cadres in
conducting education using books. Method: the activity begins with a pretest,
inserting material to get to know the contents of the book, and studying the
book. Followed by taking cases, concluding the category of at-risk pregnant
women by cadres in the Neglasari District, Tangerang City. Results: there was
a good understanding of cadres in the pretest 7 people (35%), and an increase
in good understanding in the posttest 17 people (85%). The conclusion of
education using books can increase the knowledge of cadres about pregnant
women at risk during the pandemic. Recommendation: Increased understanding of
pregnant women at risk for health cadres can use books, including for health
worker or other health services during a pandemic in the community. |
INTRODUCTION
Government policy in health development is holistic,
namely looking at health problems that are influenced by many cross-sectoral
factors. Development in other sectors must also pay attention to its impact on
the health sector. This is in line with The Law of the Republic of Indonesia
Number 36 of 2009 concerning health which states that the purpose of health
development is to increase awareness, willingness and ability for everyone to
realize optimal health. Accompanied by the current Covid-19 pandemic, it
continues to improve public health, especially for pregnant women and its focus
on pregnant women at risk.
�������� There is an increasing global
awareness that good quality care is key to keeping mothers and babies alive and
well. Currently, every year there are 303,000 female deaths during pregnancy
and childbirth, 2.6 million stillbirths, and 2.7 million infant deaths during
the first 28 days of life. Between 1990 and 2015, maternal mortality worldwide
fell by about 44%. Between 2016 and 2030, as part of the Sustainable
Development Goals (SDGs), the target is to reduce the global maternal mortality
ratio to less than 70 per 100,000 live births. Better treatment can prevent
many of these deaths. (WHO, 2017).�
������� The maternal mortality rate (MMR) in
Indonesia is still high, in 2012 it amounted to 359/100,000 live births and in
2015 it amounted to 305/100,000 live births. Efforts to accelerate the decline
of MMR in Indonesia are carried out by ensuring that every mother is able to
access quality maternal health services, such as pregnant women's health
services, childbirth assistance by trained health workers in health service
facilities, postpartum care for mothers and babies, special care and referrals
in case of complications, ease of obtaining maternity / maternity leave and
family planning services. (Indonesian Health
Profile, 2017). The government has carried out improvement efforts with
various programs such as the integrated ANC, Ante Natal group, childbirth
planning and complication prevention (P4K) program, Desa Siaga and other
programs, but some data indicators still show problems. Based on data from the
Indonesian Health Profile in 2017, the coverage of pregnancy visits (K4) in
Indonesia reached 86.57% while the data on childbirth by health workers in
health facilities only reached 83.14%, so there is still a considerable
difference of 3.43%. (Indonesian Health Profile,
2017).
�������� The big problem faced by developing
countries in the world like Indonesia is maternal death and pain. In developing
countries 25-50% of reproductive age deaths are caused due to pregnancy-related
matters (Khomsah, 2012).� Estimates from WHO that around 15% of
all pregnant women will experience complications related to pregnancy so that
this threatens the lives of mothers and babies.�
In Indonesia, pregnancy complications occur 6.5% of pregnant women (Riskesdas, 2013). One of the main problems of
complications related to pregnancy and childbirth that has an impact on the
occurrence of maternal and infant mortality with all watershed problems, both
from health and non-health aspects is the non-detection of high risks in
pregnant women and late referrals (Sartika, 2013). Various
efforts are needed to recognize 15% of pregnancy-related complications in order
to have special protection for this group. Protection efforts include providing
communication, information, education in the community so that all elements of
society really feel the need for a service. Obstetric protection in
reproductive health is an effort to protect the community by utilizing all
available resources to achieve the desired pregnancy period safely (Kaput, 2016).
�������� Current health maintenance efforts in
pregnancy (antenatal care) must focus on interventions that have been shown to
be beneficial in reducing maternal mortality to be effective in improving the
health status of mothers and newborns (Khomsah,
2012).� The antenatal care
approach is a complete and continuous health effort through promotive and
preventive efforts that start from the beginning of pregnancy to near delivery,
continued by curative efforts as an adequate childbirth aid according to the
level of risk and health recovery (rehabilitative) with puerperium, lactation /
breastfeeding and Family Planning (Immanudin,
2009).�
�� ��������Efforts to maintain the health of
pregnant women are carried out on a family basis where husbands and families
need to be given information about the condition of pregnant women as early as
possible. The introduction of risk factors in pregnant women is carried out
proactively and early detection by health workers or trained officers in the
community, for example health cadres. Early detection to determine risk factors
and complications, as well as adequate treatment as early as possible, is the key
to success in reducing maternal mortality and the babies they give birth to
(Ministry of Health, 2003). Antenatal early detection activities carried out
through home visits are the first step in maintaining the health of pregnant
women and are one of the anticipatory efforts to prevent maternal death (Sartika, 2010).
In accordance with The Law of the Republic of
Indonesia Number 36 of 2009 chapter 16 article 174 concerning health, the
public is given the opportunity to participate both individually and organizedly
in the implementation of health efforts. Community participation in health care
programs is a partnership relationship as an approach that has a significant
influence on the success of the program.�
Partnership is the main goal in the concept of community as a resource
that needs to be optimized (community
resource), where community health service workers must have the skills to
understand and work together with community members in creating change in
society (Notoatmodjo in Khomsan, 2012). Forms of community participation in the
health sector include participating as health cadres. The role of health cadres
in maternal health programs is to inform all health problems related to the
health of pregnant women, and to be a driver for existing community groups.
Cadres are the human resources of the citizens of the community to the
community and are elected by the community. Cadres directly mobilize the
community in carrying out health-related activities and through cooperation
between health workers, families and community leaders, it is hoped that
problems can be addressed gradually.�
������� Health education is an effort or
activity to help individuals, groups, and communities in improving the ability
of both knowledge, attitudes, and skills to achieve an optimal healthy life (Suliha et al., 2012). The use of appropriate
methods in an educational process is very important, in order to match the
expected goals. A good method will have an effective impact in achieving the
goal. According to Ybarra et al. (2017) that
in the delivery of education using many methods will be more effective to
increase public knowledge, especially health cadres. So far, in providing
health education, what is often used is the face-to-face method or lectures.
This method is indeed easier to do, but it is less effective in people's
understanding of deadly diseases (Muninjaya, 2013).
The lack of maximum provision of health information in the community,
especially to cadres, so this encourages cadres to look for other sources of information,
which can meet their curiosity. From the description above, training activities
have been carried out for cadres related to early detection of pregnant women
at risk. This needs to be conveyed the results of community service activities
in the form of reports.���
������� Based on the implementation of
activities that have been carried out, the goal is to provide information on
the form of community service activities. Providing information on the results
of these activities about optimizing the role of health cadres in conducting
education using books. The title of the book about monitoring high-risk
pregnant women during the pandemic on the assistance activities of Health
Cadres in monitoring high-risk pregnant women during the pandemic
������� �This activity is very beneficial for the
community, especially for Health Cadres. Where there is an increase in
knowledge and confidence of health cadres in monitoring at-risk pregnant women,
assessing the importance of paying attention to at-risk pregnant women. In
addition, there is a continuation of cooperation between the educational
institutions of the Ministry of Health Poltekkes Jakarta I and the Poltekkes of
the Ministry of Health of Banten with the Puskesmas of Neglasari District,
Tangerang City in carrying out their work programs, especially in improving
health monitoring of pregnant women at risk. Activities are considered useful
so that they can continue in the next activity through grants
����������� This community service activity is
in direct partnership with the Head of the Puskesmas Neglasari District,
Tangerang City and the Regional Health Cadre of Neglasari District, Tangerang
City. The activity permit was given by the Head of the Puskesmas Neglasari
District, Tangerang City. The activity directly met with health cadres directly
in the Campus Hall of the Department of Nursing, Poltekkes, Ministry of Health,
Banten, Tangerang City. �The cadres conveyed the results of work,
namely data on pregnant women and actions taken in accordance with the tasks or
achievements that
Expected.
RESEARCH METHODS
The method or method of implementing community service activities is
carried out by, for the first time there is an approach with the Tangerang City
Health Office, followed by permits to the Head of the Neglasari District Health
Center and the Lurah of each Health Cadre activity area. After that, approach
again and coordinate with the Health Cadre. The book was distributed to health
cadres, then studied, and continued to visit and take cases in high-risk
pregnant women within five days. Health cadres conduct studies and actions
according to the information obtained through entering materials and books.
Health Cadres received assistance, by continuing presentations, and discussions
and assessments of knowledge with pretest and posttest.
The time for the implementation of the activity is on August 23-29, 2022.
The activity is carried out at 09.00-12.00 WIB, offline. The implementation of
activities in the Campus Hall of the Department of Nursing, Poltekkes, Ministry
of Health, Banten.
Activities are carried out in the preparatory stage, namely: Starting
from the beginning of July 2022, starting with making proposals, preparing
scouting, distributing tasks, and exploring the location of activities. The
team consists of 4 lecturers and 3 students majoring in Nursing, Nursing Study
Program. In the preparation stage, the Community Service team of the Poltekkes
of the Ministry of Health Jakarta I and the Poltekkes of the Ministry of Health
of Banten together with partners, namely the Neglasari Tangerang Health Center,
coordinated with each other to determine the villages that were the target of
the activity, namely Karang Anyar village, Karang Sari Village and Neglasari
village. Furthermore, the team determined the location of training activities
at the Poltekkes of the Ministry of Health Banten.Preliminary survey,
including, studying the picture of high-risk pregnant women, the willingness of
health cadres. Searching for references, preparing, compiling and checking
materials for the preparation of books that will be used by health cadres.
RESULTS
AND DISCUSSION
Result
������
Training for High-Risk Pregnant Women Assistance Cadres is carried out
through several main stages, namely: preparation, implementation and
evaluation. The following are the characteristics of cadre trainees in early
detection of high-risk pregnant women in the Neglasari Tangerang Puskesmas Work
area.�
Table
1
Characteristics
of Cadre Training Participants in Early Detection of High-Risk Pregnant Women
in the Neglasari Puskesmas Work Area
�
|
No. |
Variable |
Number of N= 20 people |
Frequency (%) |
|
1 |
Age |
|
|
|
|
< 30 years |
1 |
5 |
|
|
31 � 40 years old |
4 |
20 |
|
|
>41 years old |
15 |
75 |
|
2 |
Work |
|
|
|
|
Housewives |
20 |
100 |
|
|
Private (traders, farmers, etc.) |
0 |
0 |
|
3 |
Final Education |
|
|
|
|
High School |
16 |
80 |
|
|
SLTP |
4 |
20 |
|
4 |
Long Time As A Cadre |
|
|
|
|
< 5 years |
3 |
15 |
|
|
5 � 10 years |
7 |
35 |
|
|
>10 years |
10 |
50 |
�From the table above, it can be seen that the
cadres who took part in the training were mostly over 41 years old with 15
people (75%). All cadres totaling 20 people (100%) are housewives with the
majority of the last education being high school totaling 16 people (80%).
Furthermore, it has been a majority cadre for more than 10 years totaling 10
people (50%).
� The evaluation results of the questionnaire
given to cadres before and after (pre and post) activities with the following
results:
Table
2
Frequency
Distribution of Participants' Knowledge Levels
Cadres
In Early Detection of High Risk Pregnant Women in
Working
Area of Puskesmas Neglasari
|
Cadre Knowledge Level |
Pretest |
|
Post |
|
|
|
N=20 |
Frequency (%) |
N=20 |
Frequency (%) |
|
Good |
7 |
35 |
17 |
85 |
|
Enough |
13 |
65 |
3 |
15 |
|
Less |
0 |
0 |
0 |
0 |
|
TOTAL |
20 |
100 |
20 |
100 |
�
The pretest
results showed that the number of cadres of trainees who already had a good
understanding of the material to be delivered was 7 people (35%), while 13
people (65%) had sufficient understanding and none of the trainees did not
understand high-risk pregnancy (RISTI) and how to do early detection.�
�
Discussion
���������
Tanjung (2003) quoted from Pratiwi (2012) stated that training is a teaching
and learning process towards certain knowledge and skills as well as an
attitude to be more skilled and able to carry out their responsibilities
better, and in accordance with standards. Training means changing behavior patterns,
because with training it will eventually lead to a change in behavior. Training
is a part of education that concerns the learning process, useful for acquiring
and improving skills outside the applicable educational system, in a relatively
short time and the method prioritizes practice over theory.�
����������
The knowledge and skills of posyandu cadres after being given a
refresher, the level of knowledge is 87% of cadre knowledge in the good
category (Laraeni, 2014). In line with the results of the research above, this
training at the time of postest was able to increase the knowledge of cadres in
the good category to 17 people (85%). This training is held to anticipate a
suboptimal understanding of the high risk of pregnancy. This is due to concerns
about the influence on the prevention of problems/complications due to high
risk pregnancy (RISTI). With the increasing incidence of complications during
pregnancy or maternal delivery, of course this is a contribution to the high
maternal mortality rate (MMR) and infant mortality rate (AKB) in particular the
work area of the Neglasari health center and in Indonesia in general.�
��������
The early detection of high-risk pregnancy (RISTI) activities carried
out by cadres can recognize early the existence of disorders in maternal
pregnancy so that cadres can quickly educate and persuade pregnant women to
routinely carry out pregnancy control at puskesmas, nurses, doctors, midwives,
maternity homes or other nearby health service institutions. Thus, the health
of the mother during pregnancy will be guaranteed, and planning the right
pregnancy process according to the condition of the mother and the fetus she
contains facilitates intervention during pregnancy so that the mother's health
will improve.�
����
����In the risk approach strategy,
screening activities are an important component in pregnancy services, which
must be followed by Communication, Information, and Education (IEC) to pregnant
women, husbands, and families, for safe delivery planning, planned referral
preparation is carried out when necessary. Through this activity, several risk
factors that exist in pregnant women have been able to predict / estimate the
possibility of various complications that will occur. Therefore, screening
activities must be carried out repeatedly so that early risk factors can be
found that develop in further gestational age. Knowledge is important for
cadres as community mobilizers as well as informers in Posyandu activities
(Fatimah, 2013). This increased level of knowledge is expected to affect the
ability of cadres to carry out early detection of high-risk pregnant women
(RISTI) so that they can achieve the target of the high-risk pregnant women
coverage program (RISTI) and reduce the maternal mortality rate (MMR) and
infant mortality rate (AKB) through Posyandu activities in the work area of the
Neglasari Banten Health Center.
���������
Posyandu is a Community-Based Health Business (UKBM) program that
provides integrated health services and monitoring.� Posyandu cadres who are members of the
community who are selected from and by the community, willing and able to work
together in various community activities are voluntarily trained to deal with
individual health problems and posyandu services on a regular basis.�
��������
The role of cadres in the Maternal and Child Health Program (MCH) is to
collect data on pregnant women in their work areas so that puskesmas get the
right targets for achieving health service targets. The results of recording
the targets of pregnant women by cadres become a source of data for MCH
officers to carry out health services for pregnant women in accordance with the
target number of pregnant women. So that MCH officers can follow up if the
target obtained is not in accordance with the number of targets of pregnant
women in their work area.�
The activities of
cadres will be determined by the local Puskesmas, considering that in general
cadres are not professionals but only help in health services. In this case, it
is necessary to limit the duties carried out, both regarding the number and
type of services. The duties of cadres include health services and community
development, but are limited to the areas or tasks that have been taught to
them.�
Cadres must be
fully aware of the limitations they have. The cadre is not expected to be able
to solve all the problems it faces. Cadres are expected to be able to solve
common problems that occur in society. The role of cadres in the Maternal and
Child health program is to inform all health problems related to the health of
pregnant women, newborns and be able to be a driver for existing community
groups or organizations. One of the functions of cadres in maternal and child
health is to help motivate pregnant women to conduct pregnancy checkups at health
workers.�
Posyandu cadres
who are members of the community who are selected from and by the community,
willing and able to work together in various community activities are
voluntarily trained to deal with individual health problems and posyandu services
on a regular basis. The role of public health cadres who are one of the
spearheads of success in order to accelerate the decline of MMR and AKB, cadres
are not just an extension of health workers who are able to reach the wider
community and are often regarded as a liaison between health centers and the
community. Therefore, the initial effort that can be done by cadres in the
community is to carry out early detection of high-risk cases in pregnant women
and childbirth.
Assistance is
carried out from the beginning of pregnancy until after delivery. During
pregnancy, cadres carry out assistance by monitoring the mother's condition and
motivating them to carry out regular pregnancy check-ups and give birth in
health services that are in accordance with the risks of pregnancy. Pregnant
women who always have regular check-ups will be detected early if there are
pregnancy complications and can immediately manage pregnancy
complications.�
CONCLUSION
The results of
community service activities on optimizing the role of health cadres are
summarized as follows:
��� There are 20 Health Cadre participants
participating in all stages of activities or meetings. The characteristics of
the cadre showed that over 41 years old amounted to 15 people (75%). All cadres
totaling 20 people (100%) are housewives, the last education was high school
totaling 16 people (80%). The length of time as a cadre of more than 10 years
amounted to 10 people (50%).
�Cadre's knowledge has increased monitoring of
high-risk pregnant women during the pandemic. As for the results, namely, the
pretest results showed that the number of cadres had a good understanding of 7
people (35%), while 13 people (65%) had sufficient understanding. After the
posttest showed that the number of cadres had a good understanding of 17 people
(85%), while 3 people (15%) had a sufficient understanding of high-risk
pregnancy (RISTI) and how to do early detection.���������������������� At the mentoring stage,
cadres can identify at-risk pregnant women in their respective regions. Can
conclude that the patients or pregnant women studied entered in low-risk
pregnancies (KRR), high-risk pregnancies (KRT), very high-risk pregnancies
(KRST). As well as changes in the behavior of health cadres about monitoring
high-risk pregnant women where there are plans for cadres to follow up in
helping pregnant women at risk.
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Copyright holders:
Ulti Desmarnita, Fenti Hasnani (2023)
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Devotion - Journal of Research and
Community Service
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