Berita Kedokteran Masyarakat, Vol. 26, No. 4, Desember 2010 z 211 Evaluasi Pelayanan Manajemen Terpadu Balita Sakit, Nurhayati, dkk. EVALUASI PELAYANAN MANAJEMEN TERPADU BALITA SAKIT TERHADAP KESEMBUHAN PNEUMONIA PADA ANAK BALITA EVALUATION ON STANDARD INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS SERVICES TOWARD THE RECOVERY OF UNDER-FIVE PNEUMONIA Nurhayati 1 , Djaswadi Dasuki 2 , Tunjung Wibowo 3 1 Dinas Kesehatan Kabupaten Bungo 2 Bagian Ilmu Kesehatan Masyarakat, FK UGM, Yogyakarta 3 Bagian Ilmu Kesehatan Anak, RSUP. Dr. Sardjito, Yogyakarta ABSTRACT Background: Infant and under-five children mortality remains a major problem in Indonesia, especially caused by infectious diseases such as pneumonia. Based on the 2002-2003 Indonesia’s Demographic and Health Survey, infant and under-five mortality rates are 35 per 1000 live births and 46 per 1000 live births, respectively. Nationally, Health Office has implemented Integrated Management of Childhood Illness (IMCI) in primary health centers (PHCs) since 1997 to improve the coverage of pneumonia finding in under-five children. In 2005, infant mortality rate in Jambi Province was still high, that is, 41 per 1000 live births while infant mortality rate in Bungo District was 93 per 6108 live births 15,2%. Each year, there are 9 babies and 1 under five child that die and for the average there is one under five child (10%) who die because of pneumonia. In other words, there are three under five children who die every year in primary health center due to pneumonia. To avoid the death of infant and under five children, primary health center should implement standard IMCI program, yet in field it has still been facing obstacles and constraints. Objective: To investigate the results of standard IMCI service toward the recovery of under-five pneumonia in primary health centers of Bungo District in 2007. Method: This was a prospective cohort study. Sampling technique was purposive sampling. There were two groups in this study, namely case group which was exposed with the standard IMCI service and group which was exposed with non standard IMCI service. One hundred and twenty-four subjects were under-five children 2 months-5 years of age presenting pneumonia with α = 0.05 and β = 20%. Data were analyzed with univariable, bivariable, and multivariable analyses logistic regression and hypothesis test used was chi-square with p<0.05, CI 95%. Results: There was a significant relationship between the standard IMCI service, the distance to the PHC and the mothers’ education and the recovery of under-five pneumonia (OR=3.14 CI 95%=1.59-6.21 p=0.00; OR=1.68 CI 95%=1.09-2.57 p=0.00; OR=0.57 CI 95%=0.35-0.92 p=0.02, respectively). However, family income had an insignificant relationship with under-five pneumonia. Conclusion: The standard IMCI services have a greater chance toward the recovery of under-five pneumonia compared to non standard IMCI services. Keywords: services, standard, IMCI, recovery, pneumonia, under-five children PENDAHULUAN Angka kematian bayi dan anak masih menjadi masalah yang serius secara global terutama di Negara yang sedang berkembang termasuk di Indonesia. Dari data Survei Demografi dan Kesehatan Indonesia (SDKI) tahun 2002-2003 didapat angka kematian bayi 35 per 1000 dan angka kematian balita (AKABA) 46 per 1000 kelahiran hidup. 1 Sebagian besar kematian tersebut atau hampir 12 juta anak meninggal sebelum usia lima tahun dan (70%) di antaranya disebabkan karena penyakit infeksi, ISPA, diare, malaria, kekurangan gizi dan campak dengan komplikasinya atau gabungan dari penyakit itu. 2 Upaya World Health Organization (WHO) untuk menurunkan angka kematian dan kesakitan secara global adalah mengenalkan Sick Child Initiative (SCI) atau Integrated Management of Childhood Illness (IMCI) yaitu langkah-langkah pengambilan keputusan dalam mengelola anak balita sakit. 3 Dalam usaha meningkatkan cakupan penemuan dan meningkatkan tatalaksana pneumonia pada anak balita Depkes telah menerapkan Manajemen Terpadu Balita Sakit (MTBS) di Unit Pelayanan Kesehatan Dasar. 4 Pada tahun 2015 yang akan datang Indonesia akan menurunkan angka kematian dua pertiganya atau sekitar 31 per 1000 kelahiran hidup tertuang dalam Tujuan Pembangunan Milenium (Millennium Development Goals/MDG). 5 Survei Kesehatan Rumah Tangga, SKRT 6 menunjukkan 36% kematian anak balita akibat pneumonia. Hal ini didukung data