Uraian Materi
Kalor
Pengertian Suhu, Kalor, dan Energi Dalam
Pengertian kalor secara sederhana adalah energi yang berpindah. Definisi dari kalor itu sendiri adalah sebagai energi yang berpindah dari benda yang bersuhu lebih tinggi ke benda yang bersuhu lebih rendah ketika kedua benda bersentuhan.
Kalor timbul diakibatkan oleh perbedaan suhu, maka sampai dengan pertengahan abad ke delapan belas, istilah kalor dan suhu memiliki arti yang sama. Joseph Black pada tahun 1760 merupakan orang pertama yang menyatakan perbedaan antara suhu dan kalor. Menurutnya, suhu adalah derajat panas atau dinginnya suatu benda yang diukur oleh termometer, sedangkan kalor adalah sesuatu yang mengalir dari benda panas ke benda lebih dingin untuk menyamakan suhunya. Jadi, suhu sesungguhnya adalah ukuran energi rata-rata partikel dalam suatu benda. Sedangkan dalam istilah fisika, istilah “kalor” selalu mengacu pada energi yang berpindah dari suatu benda ke benda lain karena perbedaan suhu.
Secara sederhana, dapat dinyatakan beda antara suhu, kalor, dan energi dalam, sebagai berikut. Suhu merepresentasikan energi kinetic satu molekul zat. Energi dalam menyatakan ukuran energi seluruh molekul dalam zat. Sedangkan kalor adalah perpindahan sebagian energi dalam dari suatu zat ke zat lain karena adanya perbedaan suhu.
Perpindahan Kalor dan Teori yang Menjelaskannya
Teori Kalorik
Teori kalorik menyatakan bahwa benda bersuhu tinggi mengandung lebih banyak kalorik daripada benda bersuhu rendah. Ketika kedua benda disentuhkan, benda kaya kalorik kehilangan sebagian kaloriknya yang diberikan kepada benda miskin kalorik sampai kedua benda mencapai suhu yang sama (tercapai kesetimbangan termal).
Teori kalorik dapat menjelaskan pemuaian benda ketika dipanaskan dan proses hantaran kalor dalam sebuah calorimeter dengan memuaskan. Akan tetapi, teori kalorik tidak dapat menjelaskan mengapa kedua telapak tangan terasa hangat ketika menggesek-gesekkannya. Dalam kasus ini, kalor dihasilkan oleh usaha karena gesekan dan jelas menunjukkan bahwa kalor adalah salah satu bentuk energi.
Teori Kinetik
Teori ini merupakan penyempurnaan dari teori kalorik yang tidak bisa menjelaskan fenomena yang disebutkan diatas. Ketika benda panas menyentuh benda dingin, partikel-partikel dalam benda panas menabrak partikel-partikel dalam benda dingin. Tabrakan-tabrakan ini memindahkan energi ke partikel-partikel benda dingin. Energi termal partikel-partikel benda dingin bertambah sehingga suhunya naik. Begitu partikel-partikel dalam benda dingin menjadi lebih energetic, partikel-partikel ini mulai memindahkan energinya kembali ke partikel-partikel benda panas. Pada beberapa titik, kelajuan energi dari benda panas ke benda dingin sama dengan kelajuan pemindahan energi dari bneda dingin ke benda panas. Kedua benda dikatakan mencapai kesetimbangan termal. Pada keadaan ini, suhu benda panas akan sama dengan suhu benda dingin.
Sebelum simbang termal
Benda Panas Benda dingin
Energi dipindahkan dari benda panas ke benda dingin
Setelah seimbang termal
Ketika kesetimbangan termal tercapai, pemindahan energi diantara dua benda adalah sama.
Perpindahan Kalor dan Cara Perpindahannya
Jika benda panas disentuhkan dengan benda dingin, tak lama kemudian suhu benda panas akan turun, sedangkan suhu benda dingin akan naik. Hal ini terjadi karena benda panas memberikan kalor kepada benda dingin dan ini juga dapat disebut sebagai perpindahan kalor.
Hal diatas menyimpulkan bahwa kalor berpindah dari benda bersuhu tinggi ke benda yang bersuhu lebih rendah.
Ada tiga cara perpindahan kalor, yaitu: 1. Konduksi, 2. Konveksi (aliran), dan 3. Radiasi (pancaran).
Perpindahan Kalor secara Konduksi
Jika ada sebuah batang logam lalu salah satu ujungnya dipanaskan sengan nyala api sebuah lilin. Lama kelamaan ujung batang logam yang kita pegang (tidak terkena api) akan terasa hangat atau jika terlalu lama akan menjadi panas walaupun ujung batang logam tersebut tidak bersentuhan langsung dengan sumber kalor (api lilin). Pada proses perpindahan kalor dari bagian ujung yang panas ke ujung sendok yang dingin tidak terjadi perpindahan partikel-partikel dalam batang logam tersebut. Proses perpindahan kalor tanpa disertai perpindahan partikel dinamakan konduksi.
Gambar partikel-partikel pada ujung batang yang dipanasi bergetar lebih cepat daripada partikel-partikel pada ujung yang tidak dipanasi.
Perpindahan kalor secara konduksi dapat terjadi dalam dua proses berikut :
Pemanasan pada satu ujung zat menyebabkan partikel-partikel pada ujung itu bergetar lebih cepat dan suhunya naik, atau energi kinetiknya bertambah. Partikel-partikel yang energi kinetiknya lebih besar ini memberikan sebagian energi kinetiknya kepada partikel-partikel tetangganya melalui tumbukan sehingga partikel-partikel ini memiliki energi kinetik lebih besar. Demikian seterusnya sampai kalor mencapai ujung yang dingin (tidak dipanasi). Proses perpindahan kalor ini berlangsung lambat karena untuk memindahkan lebih banyak kalor diperlukan beda suhu yang tinggi diantara kedua ujung.
Dalam logam, kalor dipindahkan melalui elektron-elektron bebas yang terdapat dalam struktur atom logam. Elektron bebas ialah elektron yang dengan mudah dapat berpindah dari satu atom ke atom yang lain. Di tempat yang dipanaskan, energi elektron-elektron bertambah besar. Oleh karena elektron bebas mudah berpindah, pertambahan energy ini dengan cepat dapat diberikan ke elektron-elektron lain yang letaknya lebih jauh melalui tumbukan. Dengan cara ini kalor berpindah lebih cepat. Oleh karena itu, logam tergolong konduktor yang sangat baik.
Berdasarkan kemampuan menghantarkan kalor, zat dibagi atas dua golongan besar yaitu konduktor dan isolator. Konduktor ialah zat yang mudah menghantar kalor. Isolator ialah zat yang sukar menghantar kalor.
Adapun factor-faktor yang mempengaruhi laju konduksi kalor, diantaranya:
Beda suhu, makin besar suhu maka makin cepat perpindahan kalor. ∆T = T1 – T2
Ketebalan dinding permukaan benda, makin tebal dinding maka makin lambat perpindahan kalor.
Luas permukaan benda, makin besar luas permukaan maka makin cepat perpindahan kalor.
Konduktivitas termal zat merupakan ukuran kemampuan zat menghantarkan kalor.
Daya konduksi kalor dirumuskan:
Q/t=kA∆T/d
Perpindahan Kalor secara Konveksi
Jika kita meletakkan tangan kita diatas lilin kira-kira 10 cm, kita akan merasakan udara hangat yang naik dari nyala lilin. Ketika udara ynag dekat nyala lilin dipanasi, udara itu memuai dan massa jenisnya menjadi lebih kecil. Udara hangat dengan massa jenis lebih kecil akan naik dan tempatnya digantikan oleh udara dingin yang massanya jauh lebih besar. Proses perpindahan kalor dari suatu bagian fluida ke bagian lain fluida oleh pergerakan fluida itu sendiri dinamakan konveksi.
Ada dua jenis konveksi, yaitu konveksi alamiah dan konveksi paksa. Contoh di atas adalah contoh konveksi alamiah. Pada konveksi alamiah, pergerakan fluida terjadi akibat perbedaan masa jenis. Bagian fliuda yang menerima kalor memuai dan masa jenisnya menjadi lebih kecil sehingga bergerak ke atas tempatnya digantikan oleh bagian fluida dingin yang jatuh ke bawah karena masa jenisnya lebih besar. Peristiwa ini mirip dengan mengapungya suatu benda karena masa jenis benda lebih kecil dari pada masa jenis zat cair.
Contoh-contoh konveksi dalam keseharian adalah sebagai berikut:
Ketika membakar sesuatu, konveksi udara secara alami saat udara panas didekat nyala api memuai dan masa jenisnya menjadi lebih kecil. Udara dingin yang masa jenisnya lebih besar yang berada disekitar api menekan udara panas ke atas, sehingga terjadilah arus konveksi udara. Arus konveksi udara inilah yang membawa asap bergerak ke atas.
Angin laut dan angin darat, yang dimanfaatkan nelayan untuk berlayar mencari ikan terjadi melalui konveksi alami udara. Pada siang hari, tanah lebih cepat menjadi panas daripada laut sehingga udara di atas daratan lebih panas daripada udara di atas laut. Oleh karena itu udara di atas daratan naik dan tempatnya digantikan oleh udara di atas laut, terjadilah angin laut. Pada malam hari, tanah lebih cepat dingin daripada laut sehingga udara di atas daratan lebih dingin daripada udara di atas laut. Oleh karena itu, udara di atas laut naik dan tempatnya digantikan oleh udara di atas daratan, terjadilah angin darat.
Contoh konveksi paksa adalah pada pengering rambut. Kipas menarik udara disekitarnya dan meniupkan udara tersebut melalui elemen pemanas. Dengan cara ini dihasilkan suatu arus konveksi paksa udara panas.
Faktor-faktor yang mempengaruhi laju kalor konveksi adalah sebagai berikut:
Laju kalor Q/t ketika sebuah benda panas memindahkan kalor ke fluida sekitarnya secara konveksi sebanding dengan luas permukaan benda A yang bersentuhan dengan fluida dan beda suhu ∆T di antara benda dan fluida. Secara matematis ditulis:
Q/t=hA∆T
Dengan h adalah koefisien konveksi dengan nilai yang bergantung pada bentuk dan kedudukan permukaan, yaitu tegak, miring, mendatar, menghadap ke bawah, atau menghadap ke atas. Nilai h diperoleh dengan percobaan.
Perpindahan Kalor secara Radiasi
Kalor dari Matahari tidak dapat melalui atmosfir secara konduksi ke bumi karena udara yang terdapat di atmosfir tergolong konduktor paling buruk. Kalor dari Matahari juga tidak dapat sampai ke Bumi melalui konveksi karena konveksi selalu diawali dengan pemanasan Bumi terlebih dahulu. Selain itu, perpindahan kalor secara konduksi atau konveksi tidak mungkin melalui ruang hampa yang terdapat diantara atmosfir Bumi dan Matahari.
Kalor dari Matahari dapat sampai ke Bumi melalui ruang hampa tanpa zat perantara (medium). Perpindahan kalor seperti ini disebut radiasi. Perpindahan kalor dapat melalui ruang hampa karena energi kalor dibawa dalam bentuk gelombang elektromagnetik. Jadi, radiasi atau pancaran adalah perpindahan energi kalor dalam bentuk gelombang elektromagnetik.
Penyerap Kalor Radiasi yang Baik dan Buruk
Beberapa permukaan zat menyerap kalor radiasi lebih baik daripada permukaan zat lainnya. Contohnya saja warna putih dan hitam. Warna hitam menyerap kalor lebih baik dari warna putih.
Ini dikarenakan:
Permukaan yang hitam dan kusam adalah penyerap kalor radiasi yang baik sekaligus pemancar kalor radiasi yang baik pula;
Permukaan yang putih dan mengkilap adalah penyerap kalor radiasi yang buruk sekaligus pemancar kalor yang buruk pula;
Jika diinginkan agar kalor yang merambat secara radiasi berkurang, permukaan harus dilapisi suatu bahan agar mengkilap.
Faktor-Faktor yang Mempengaruhi Laju Kalor Radiasi
Pada tahun 1884, Ludwig Boltzmann menurunkan hubungan antara daya total yang dipancarkan oleh benda hitam sempurna dengan pangkat empat suhu mutlaknya. Persamaan yang didapat dikenal sebagai hukum Stefan-Boltzmann, yang berbunyi: energi yang dipancarkan oleh suatu permukaan hitam dalam bentuk radiasi kalor tiap satuan waktu (Q/t) sebanding dengan luas permukaan (A) dan sebanding dengan pangkat empat suhu mutlak permukaan itu (T4).
Secara matematis ditulis:
Q/t= σAT4
Tetapan σ (sigma) dikenal sebagai tetapan Stefan-Boltzmann dan dalam satuan SI mempunyai nilai
σ = 5,67 X 10-8 W m-2 K-4
tidak semua benda dapat dianggap sebagai banda hitam sempurna. Oleh karena itu, diperlukan sedikit penambahan faktor pengali. Maka persamaan diatas menjadi:
Q/t= eσAT4
Dengan e adalah koefisien yang disebut emisivitas. Emisivitas adalah suatu ukuran seberapa besar pemancaran radiasi kalor suatu benda dibandingkan dengan benda hitam sempurna. Nilainya terletak diantara 0 sampai 1 (0≤e≤1) dan bergantung pada jenis zat dan keadaan permukaan. e = 1 untuk benda hitam sempurna sedangkan e = 0 untuk pemantul sempurna (penyerap paling jelek).
Pemanfaatan Radiasi
Pendiangan rumah
Rumah kaca dan efek rumah kaca
Ketika sinar matahari mengenai kaca sebuah rumah kaca, cahaya tampak dapat menembus kaca, sedangkan ultraviolet dan inframerah dipantulkan kembali oleh kaca. Kalor radiasi cahaya tampak diserap oleh tanah dan tanaman didalam rumah kaca sehiongga tanah dan tanaman menjadi hangat. Tanah dan tanaman yang hangat dapat kita golongkan sebagai sumber yang lebih dingin dibandingkan dengan Matahari yang suhunya sangat tinggi. Tanah dan tanaman sebagai sumber kalor yang lebih dingin akan memancarkan kembali kalor yang diterimanya dalam bentuk radiasi inframerah dengan panjang gelombang lebih panjang. Energy kalor radiasi inframerah yang dipancarkan kembali ini tidak mampu menembus kaca, sebagai hasilnya energy kalor ini terperngkap di dalam rumah kaca, dan rumah kaca menjadi hangat. Suhu di dalam rumah kaca bisa tetap tinggi dibandingkan dengan suhu diluarnya. Keadaan ini membuat tanaman dapat tumbuh dengan subur.
Untuk mempertahankan suhu di dalam rumah kaca tetap tinggi bukanlah kalor radiasi langsung dari matahari, tetapi kalor radiasi yang dipancarkan kembali dalam bentuk radiasi inframerah yang panjang gelombangnya lebih panjang, yang terkurung didalam rumah kaca.
Panel Surya
Panel surya adalah suatu perangkat yang digunakan untuk menyerap radiasi dari matahari. Kalor radiasi dari matahari diserap oleh permukaan hitam dan dihantarkan secara konduks melalui logam. Bagian dalam panel dijaga agar tetap hangat kemudian sirkulasi air melalui wadah logam akan membawa kalor menjauh untuk dimanfaatkan pada sistem pemanas air domestik atau memanasi kolam renang.
Selasa, 14 September 2010
Selasa, 01 Juni 2010
MAKALAH
TUGAS IPTEK
JURNAL INTERNASIONAL TENTANG
LINGKUNGAN DAN STATUS GIZI
Disusun oleh :
Ambar Wicaksono PO7131107002
Diah Fitri Helviana PO7131107013
Warih Suminar PO7131107026
Susiana Indri Utami PO7131106112
GIZI REGULER III
DEPARTEMEN KESEHATAN REPUBLIK INDONESIA
POLITEKNIK KESEHATAN YOGYAKRTA
JURUSAN GIZI
2009
Nutritional Status Assessment in Semiclosed Environments: Ground-Based and Space Flight Studies in Humans1 ,2
Scott M. Smith3, Janis E. Davis-Street*, Barbara L. Rice*, Jeannie L. Nillen*, Patricia L. Gillman* and Gladys Block{dagger}
Life Sciences Research Laboratories, NASA Lyndon B. Johnson Space Center Houston TX 77058; * Enterprise Advisory Services Inc., Houston, TX 77058; {dagger} Epidemiology and Public Health Nutrition, University of California-Berkeley, Berkeley, CA 94720
3To whom correspondence should be addressed. E-mail: scott.m.smith1@jsc.nasa.gov.
ABSTRACT
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Adequate nutrition is critical during long-term spaceflight, as is the ability to easily monitor dietary intake. A comprehensive nutritional status assessment profile was designed for use before, during and after flight. It included assessment of both dietary intake and biochemical markers of nutritional status. A spaceflight food-frequency questionnaire (FFQ) was developed to evaluate intake of key nutrients during spaceflight. The nutritional status assessment protocol was evaluated during two ground-based closed-chamber studies (60 and 91 d; n = 4/study), and was implemented for two astronauts during 4-mo stays on the Mir space station. Ground-based studies indicated that the FFQ, administered daily or weekly, adequately estimated intake of key nutrients. Chamber subjects maintained prechamber energy intake and body weight. Astronauts tended to eat 40-50% of WHO-predicted energy requirements, and lost >10% of preflight body mass. Serum ferritin levels were lower after the chamber stays, despite adequate iron intake. Red blood cell folate concentrations were increased after the chamber studies. Vitamin D stores were decreased by > 40% on chamber egress and after spaceflight. Mir crew members had decreased levels of most nutritional indices, but these are difficult to interpret given the insufficient energy intake and loss of body mass. Spaceflight food systems can provide adequate intake of macronutrients, although, as expected, micronutrient intake is a concern for any closed or semiclosed food system. These data demonstrate the utility and importance of nutritional status assessment during spaceflight and of the FFQ during extended-duration spaceflight.
KEY WORDS: • weightlessness • food-frequency questionnaire • dietary intake • humans
INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Nutrition is a critical concern for extended-duration space missions (1Citation ,2)Citation and is critical to maintaining crew health, safety and productivity. Monitoring of nutritional status before, during and after long (>30 d) space missions will help provide optimal nutritional support of astronauts.
Loss of body weight is a primary consequence of altered nutrition and is frequently observed during spaceflight (1Citation ,2)Citation . Other current dietary concerns for spaceflight include excessive intakes of sodium and iron, and insufficient intakes of water and vitamin D (1Citation ,2)Citation . Additionally, long-term dependence on closed or semiclosed food systems increases the likelihood of inadequate intakes of key nutrients. This is a significant concern for extended-duration space missions, either in low Earth orbit (e.g., International Space Station) or beyond (e.g., missions to Mars).
Dietary intake during spaceflight is often inadequate, with crew members typically consuming 60–70% of predicted energy requirements (1Citation ,2)Citation . The ability to identify crew members who are not eating or drinking enough while on orbit is necessary to mitigate undernutrition. Spaceflight research often includes detailed recording of all foods consumed. Although this yields extremely accurate data, this method requires considerable time and effort, and thus is not suitable for routine medical monitoring during spaceflight.
Many of the physiologic changes that occur during flight have nutritional implications (2)Citation . Loss of bone and muscle tissue, fluid shifts (3)Citation and hematologic alterations (e.g., reduced RBC mass) occur in astronauts. Environmental factors such as radiation also play an important role in the ability of humans to live and work in space.
To ensure adequate nutritional support for astronauts, we developed a comprehensive nutritional assessment profile. It includes pre- and postflight assessment of a battery of biochemical markers of nutritional status, and a limited in-flight protocol, including dietary intake assessment and body mass measurement. The ground-based assessments were intended to be comprehensive (covering essentially all nutritional components, e.g., body composition, musculoskeletal status, vitamins or minerals). Due to resource constraints (e.g., crew time, freezer volume) on orbit, the in-flight assessment was limited to a dietary intake assessment and body mass determinations. The dietary intake assessment was implemented in the form of a food-frequency questionnaire (FFQ).4 The FFQ was designed to provide a quick and easy, yet reasonably accurate method for crew members to provide dietary intake information to the ground. It was targeted at specific nutrients (energy, protein, fluid, sodium, iron and calcium) to reduce complexity of the questionnaire.
We report here results from two types of studies, i.e., ground-based, semiclosed chamber studies (60- and 91-d durations) and spaceflight studies of astronauts residing on the Russian Mir space station (~4-mo durations). The ground studies had the following two key objectives: 1) to assess nutritional status of crew members consuming a space-like food system, and 2) to validate and use an FFQ designed specifically for use with semiclosed spaceflight food systems. The flight studies reported here represent the initial implementation of this nutritional assessment protocol.
SUBJECTS AND METHODS
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Two types of studies were conducted, i.e., ground-based, semiclosed chamber studies and flight studies aboard the Mir space station. The semiclosed environment of each provided unique opportunities to examine the effect of a limited food system on dietary intake and nutritional status and to assess and implement means of monitoring dietary intake.
Environment
Chamber studies. Two ground-based studies that involved prolonged (60- and 91-d) stays in an enclosed chamber facility at the NASA Johnson Space Center in Houston were conducted. The cylindrical chamber was 20 ft (6.1 m) in diameter, with three levels, namely, a work/galley area, a mechanical area and living quarters. The primary objective of studies with this chamber was to test regenerative air and water system technology for use on potential planetary missions. A group of ~20 "supplemental" projects was included to maximize return from habitation of the semiclosed chamber environment. These projects tested objectives relevant to spaceflight or confinement, and included psychological studies, in situ training assessments, and sleep and behavioral studies. We report here the results of one such "supplemental" study, which was designed to assess the nutritional effect of a semiclosed space-like food system and validate a dietary intake questionnaire for semiclosed food systems.
Flight studies. These studies were conducted with two astronauts on missions to Mir as part of the NASA Mir Science Program. The missions included launch from and return to Earth on board a U.S. space shuttle and residence for ~4 mo on Mir.
Subjects
Chamber studies. Subjects for the 60-d study were 1 woman and 3 men; subjects for the 91-d study were 2 women and 2 men. The ages of the 5 male subjects ranged from 26 to 36 y, and prechamber body mass ranged from 56.8 to 83.4 kg [body mass index (BMI) = 23.0 ± 3.4 kg/m2, mean ± SD]. The ages of the 3 female subjects ranged from 28 to 41 y, and prechamber body mass ranged from 57.4 to 69.4 kg (BMI = 22.4 ± 3.3 kg/m2). All subjects were required to pass an Air Force Class III physical examination for clearance to participate in the study.
Flight studies. Two men aged 40 to 54 y with preflight body mass in the range from 70.5 to 88.6 kg participated in these studies. These ranges reflect data for all male astronauts (n = 6) who resided on Mir as part of the NASA Mir Science Program (see subject confidentiality, below).
Subject confidentiality. Because the number of subjects in these studies is small and their participation in the chamber studies and NASA Mir missions has been highly publicized, additional restrictions are required to maintain subject confidentiality. Specifically, data from the chamber studies are not presented by gender because only one woman participated in the 60-d study. Only two crew members participated in the flight studies. Because individual results are reported here, details of individual subject characteristics are minimized, and data in the figures have been truncated for one subject to eliminate identification of subjects based on flight duration.
All procedures for both the ground-based and flight studies were reviewed by the Johnson Space Center Institutional Review Board to ensure ethical use of human subjects. Informed consent was obtained from all subjects.
Food systems
Chamber studies. The food system for the 60-d study was designed to be similar to that planned for use on the International Space Station. Commercial products comparable to foods on the International Space Station Daily Menu Food List were located in local grocery stores and incorporated into a standardized menu that included fresh, frozen and thermostabilized items. Energy requirements were calculated for each subject based on the WHO equation (4)Citation , adjusted for moderate activity (specifically 1.7 for men, 1.6 for women). Macronutrient contents of the standardized menu were calculated using the Daily Nutritional Requirements for Spaceflight (2Citation ,5)Citation .
A 20-d cycle menu was repeated throughout each chamber test period. Although only foods from the menu were allowed, subjects were not required to eat exactly the planned menu. The menu was adjusted only when an item could not be supplied due to seasonal availability or some other reason. Food preparation equipment for this study consisted of two microwave ovens. A side-by-side refrigerator/freezer was available for food storage.
The food system for the 91-d study was developed in a similar manner, but it was designed to be similar to that planned for use on a planetary (e.g., Moon, Mars) base. Accordingly, during the 91-d study, the 20-d cycle menu consisted of a 50% vegetarian diet, defined as <=4 servings of meat/wk. Additionally, an experimental diet was used for 10 d of the 91-d study (d 31–40). It consisted entirely of food items that could be produced in a regenerative food system.
During the 91-d study, food preparation equipment included a combination microwave/convection oven, a bread-making machine, a blender and a portable stove-top burner. A side-by-side refrigerator/freezer was also available for food storage.
Flight studies. The food system used on board Mir consisted of about half U.S. space foods and half Russian space foods (6)Citation . Because refrigeration was not available for food items, all foods were shelf-stable—dehydrated, thermostabilized (e.g., canned) or in natural form. Although a 6-d cycle menu was planned, actual eating patterns during flight rarely followed the scheduled menu. About once per mission, a cargo vehicle arrived with a limited number of fresh food items (e.g., fruits, vegetables). These items typically are edible for <1 wk.
Dietary intake assessment
Chamber studies. Before entering the chamber, the subjects completed a standard dietary assessment questionnaire (7)Citation to assess their usual diet over the past year. During their chamber stay, subjects completed a specialized FFQ (described below) to assess intake over 24-h (24-h FFQ) or 7-d (7-d FFQ) periods. The 24-h FFQ was administered 3 times/wk during wk 4 and 7 of the 60-d study, and wk 1, 4, 6, 9 and 12 of the 91-d study. The 7-d FFQ was administered once per week during wk 1, 3, 6 and 8 of the 60-d study, and wk 2, 5, 8, 10 and 13 of the 91-d study. Five-day weighed food records were completed for wk 2 and 5 of the 60-d study and wk 3, 7 and 11 of the 91-d study. During the weighed record sessions, subjects were provided a digital scale and log book, and were instructed to weigh and record all food, fluids, vitamin and mineral supplements, and medicines consumed. A research dietitian (B.L.R.) met with the subjects before the prechamber data collection session to provide training for all diet intake assessment methods.
Three of the 60-d chamber subjects reported occasional use of vitamin and mineral supplements, and one 91-d study subject reported daily supplement use. Intake data herein represent total nutrient intake from the foods consumed as well as supplements.
Flight studies. About 6 mo before flight, crew members completed the same standard dietary assessment questionnaire (7)Citation as the chamber subjects. During the flight, crew members filled out a specialized spaceflight FFQ (see below) once per week, and the data were transmitted to mission control in Moscow via telemetry. The files were then encrypted, and sent to the NASA Johnson Space Center in Houston. A nutrient estimation algorithm was applied to the data, and the resulting nutrient intake information was reported to the flight surgeon.
One subject reported use of a vitamin A, C and E supplement during the preflight study period. During flight, the other subject reported occasional use of a multivitamin and mineral supplement. The intake data presented herein include total nutrient intake from both food and supplements.
Food-frequency questionnaire (FFQ)
Chamber studies. The FFQ used in the chamber was constructed by one of the authors (G.B.) using the key nutrient contents of the >200 food items on the menu list. Nutrient data for all foods (except milk and dried cereals for the 60-d study, see below) were obtained using the Nutrition Data System (NDS-R, Version 4.01/29, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN, Food and Nutrient Database 29 released Dec. 1996). For the 60-d study, nutrients in milk and dried cereal were obtained using values provided by Block et al. (7)Citation . Specific nutrients targeted by the FFQ were energy, protein, calcium, sodium, iron and water. Two versions of the chamber FFQ were presented, one asking about dietary intake for the past 24 h, the other asking about the past 7 d. Questionnaire responses for these ground-based studies were handwritten.
Flight studies. The spaceflight FFQ, based on the key nutrient contents of the food items available from the U.S. and Russian space food lists, was constructed by one of the authors (G.B.). Nutrient content of foods was obtained via proximate analysis performed by the NASA Johnson Space Center Water and Food Analytical Laboratory. Nutrients studied were energy, protein, calcium, sodium, iron and water. A computerized FFQ was developed and was included on the laptop computers on board Mir. Completion of this questionnaire required ~10 min/wk.
Biochemical assessment of nutritional status (chamber and flight studies)
A complete biochemical nutritional assessment profile was developed for use with crew members before and after extended-duration space missions. This profile was intended to be comprehensive and to provide information on virtually all aspects of nutritional status (e.g., body composition, bone and muscle markers, vitamins, minerals). Due to technical (e.g., tests not operational at the time) and manuscript length limitations, not all tests are reported herein. A comprehensive data set from these studies will be published in a future NASA technical memorandum.
Most analytical determinations were completed using standard, commercial techniques. Serum total protein (3.0% CV), calcium (3.0% CV), cholesterol (4.5% CV), triglycerides (4.5% CV), electrolytes (sodium, 1.5% CV; potassium, 3.0% CV; chloride, 3.0% CV), aspartate aminotransferase (5.3% CV), alanine aminotransferase (5.3% CV) and total alkaline phosphatase (5.3% CV) were analyzed using a Beckman SYNCHRON CX7 automated clinical chemistry system (Beckman Coulter, Brea, CA). Serum albumin (<5.0% CV) and transthyretin (1.5% CV) were analyzed using the Beckman Appraise and Array 360 instruments, respectively (Beckman Coulter). Urine creatinine (4.5% CV) was analyzed on the Beckman CX3 system (Beckman Coulter).
Hemoglobin (<1.5% CV), hematocrit (calculated) and mean corpuscular volume (< 2% CV) were determined using a Coulter MaxM instrument (Beckman Coulter). Serum ferritin (<10% CV) and transferrin (3.63% CV) were analyzed using the Beckman Access and Array 360 instruments, respectively (Beckman Coulter). Transferrin receptors (5.7% CV) were measured using a commercially available ELISA (Ramco Laboratories, Houston, TX). RBC folate (6.4% CV) was measured using a commercially available radioreceptor assay (Diagnostic Products, Los Angeles, CA).
For the 60-d study and the flight studies, ferritin iron content was also determined by a modified version of the procedure developed by Herbert et al. (8)Citation . Briefly, the iron content of ferritin was determined after separation of ferritin from other iron-containing proteins. This was accomplished by the immunoprecipitation of serum ferritin with rabbit antihuman polyclonal antibody (Accurate Scientific, Westbury, NY) bound to immobilized rProtein A cross-linked to agarose beads (RepliGen, Cambridge, MA). Iron was released from the ferritin by digestion with 1 mol/L HNO3 (GFS Chemicals, Columbus, OH) in a 75°C water bath. The hydrolysate was then diluted with deionized water (Milli-Q UF Water System, Millipore Corp., Bedford, MA) and analyzed for iron content by an Elan 6000 inductively coupled plasma mass spectrometer (Perkin Elmer, Norwalk, CT) equipped with a microconcentric nebulizer (Cetac Technologies, Omaha, NE). The intra-assay CV for this assay was 9.3%, and the interassay CV was 10.5%.
Ionized calcium (1.5% CV) was determined using ion-sensitive electrode techniques (i-STAT, Princeton, NJ). Serum intact parathyroid hormone (5.85% CV) was measured by RIA (Nichols Institute Diagnostics, San Juan Capistrano, CA). Vitamin D metabolites 25-hydroxyvitamin D (9.1% CV) and 1,25-dihydroxyvitamin D (16.2% CV) were also determined using commercially available kits (DiaSorin, Stillwater, MN). Bone-specific alkaline phosphatase (5.6% CV) was measured by ELISA (Metra Biosystems, Palo Alto, CA).
RBC superoxide dismutase (<9% CV), glutathione peroxidase (<9% CV) and serum oxygen-radical absorbance capacity (<7% CV) were measured spectrophotometrically using commercially available kits (Randox Laboratories, Crumlin, Antrim, UK). HPLC techniques (9)Citation were used to determine 8-hydroxy-2'-deoxyguanosine (5.13% CV) in urine.
Biosample collection
Chamber studies. Blood samples were collected before (entry - 6 d) and after (egress + 4 d) the 60-d test. For the 91-d study, blood samples were collected before (entry - 9 d), twice during [immediately before and after the 10-d regenerative food system test, i.e., chamber d 30 (CD30) and 40], and after (egress + 4 d) the chamber stay. Urine was collected for 48 h before, every day during and 2 d after the chamber studies. Pre- and postchamber urine collections began on the day of blood collection. All urine voids were collected during the chamber studies, but few analytes were measured in all samples. However, complete urine analysis was conducted once (on CD32) during the 60-d chamber study and 3 times during the 91-d chamber study (CD30, CD40, CD60).
Blood samples from fasting subjects were collected immediately after awakening, at the same time of day, to minimize the effect of diurnal changes in endocrine and biochemical markers. For the 60-d chamber study, a total of 52 mL of blood was collected over ~70 d; for the 91-d chamber study, a total of 98 mL of blood was collected over ~100 d.
All urine samples were collected as individual voids. During the chamber studies, urine samples were stored in a refrigerator in the chamber and were transferred to the outside in one of the 2 or 3 daily exchanges of equipment and other material through an airlock. Urine samples were processed in the laboratory daily as follows: 24-h pools were created, and aliquots were either analyzed immediately or frozen for batch analysis upon completion of the study.
Flight studies. The nutritional assessment protocol was conducted twice before flight (~6 mo and 2 wk before launch), and within hours of landing after the flight. Blood samples were collected before (twice) and after the flight; urine was collected over two 48-h periods before and one 48-h period after the flight.
Blood samples were collected by standard phlebotomy techniques. With the exception of samples collected on the day of landing, all blood samples were collected in the morning after an 8-h fast. Blood samples were processed for individual analytes and stored at -20°C until analysis. Before and after flight, urine voids were collected into individual containers and stored with ice packs or refrigerated until processing, which occurred within 24 h of collection. Twenty-four-hour pools were created, and aliquots were prepared and stored at -20°C until analysis.
Body mass
Pre- and postflight body mass measurements of astronauts and all body mass measurements for the chamber studies were performed using a calibrated scale. During flight, body mass was determined biweekly using the Mir body mass measuring device. Pre- and postchamber and pre- and postflight anthropometric measurements were also completed, although those data are not reported here.
Statistical analysis
Chamber studies. Data are expressed as means ± SD, except in cases in which data represent means of means, for which SEM is used (see table footnotes for indications). Dietary data were analyzed using repeated-measures ANOVA. The class variable was assessment tool (24-h FFQ, 7-d FFQ, weighed records), and the dependent variables were the nutrients. Post-hoc Tukey tests were performed to assess specific differences between sessions. Significance was assigned to differences of P < 0.05. Statistical analyses were performed using SigmaStat (SPSS, Chicago, IL). Prechamber dietary intake data are presented, but these were not included in the statistical analyses because the differences between prechamber and in-chamber intakes were not the primary research question.
Biochemical analyte data for the 60-d study were analyzed using paired t tests, except when in-chamber analyses were available. In these cases, and for the 91-d chamber study, data were analyzed using repeated-measures ANOVA. The class variable was study phase (prechamber, in-chamber, postchamber phases), and dependent variables were the indices measured. This analysis identified effects of the semiclosed food system on indices of nutritional status. Because of the repeated-measures design of this study, each subject served as his or her own control. Data from the RBC transketolase assay for thiamin status were not subjected to statistical analysis because this assay is qualitative rather than quantitative.
Flight studies. Because only two crew members participated in the flight studies, statistical analyses were not performed on these data. Data from individual subjects are presented.
JURNAL INTERNASIONAL TENTANG
LINGKUNGAN DAN STATUS GIZI
Disusun oleh :
Ambar Wicaksono PO7131107002
Diah Fitri Helviana PO7131107013
Warih Suminar PO7131107026
Susiana Indri Utami PO7131106112
GIZI REGULER III
DEPARTEMEN KESEHATAN REPUBLIK INDONESIA
POLITEKNIK KESEHATAN YOGYAKRTA
JURUSAN GIZI
2009
Nutritional Status Assessment in Semiclosed Environments: Ground-Based and Space Flight Studies in Humans1 ,2
Scott M. Smith3, Janis E. Davis-Street*, Barbara L. Rice*, Jeannie L. Nillen*, Patricia L. Gillman* and Gladys Block{dagger}
Life Sciences Research Laboratories, NASA Lyndon B. Johnson Space Center Houston TX 77058; * Enterprise Advisory Services Inc., Houston, TX 77058; {dagger} Epidemiology and Public Health Nutrition, University of California-Berkeley, Berkeley, CA 94720
3To whom correspondence should be addressed. E-mail: scott.m.smith1@jsc.nasa.gov.
ABSTRACT
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Adequate nutrition is critical during long-term spaceflight, as is the ability to easily monitor dietary intake. A comprehensive nutritional status assessment profile was designed for use before, during and after flight. It included assessment of both dietary intake and biochemical markers of nutritional status. A spaceflight food-frequency questionnaire (FFQ) was developed to evaluate intake of key nutrients during spaceflight. The nutritional status assessment protocol was evaluated during two ground-based closed-chamber studies (60 and 91 d; n = 4/study), and was implemented for two astronauts during 4-mo stays on the Mir space station. Ground-based studies indicated that the FFQ, administered daily or weekly, adequately estimated intake of key nutrients. Chamber subjects maintained prechamber energy intake and body weight. Astronauts tended to eat 40-50% of WHO-predicted energy requirements, and lost >10% of preflight body mass. Serum ferritin levels were lower after the chamber stays, despite adequate iron intake. Red blood cell folate concentrations were increased after the chamber studies. Vitamin D stores were decreased by > 40% on chamber egress and after spaceflight. Mir crew members had decreased levels of most nutritional indices, but these are difficult to interpret given the insufficient energy intake and loss of body mass. Spaceflight food systems can provide adequate intake of macronutrients, although, as expected, micronutrient intake is a concern for any closed or semiclosed food system. These data demonstrate the utility and importance of nutritional status assessment during spaceflight and of the FFQ during extended-duration spaceflight.
KEY WORDS: • weightlessness • food-frequency questionnaire • dietary intake • humans
INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Nutrition is a critical concern for extended-duration space missions (1Citation ,2)Citation and is critical to maintaining crew health, safety and productivity. Monitoring of nutritional status before, during and after long (>30 d) space missions will help provide optimal nutritional support of astronauts.
Loss of body weight is a primary consequence of altered nutrition and is frequently observed during spaceflight (1Citation ,2)Citation . Other current dietary concerns for spaceflight include excessive intakes of sodium and iron, and insufficient intakes of water and vitamin D (1Citation ,2)Citation . Additionally, long-term dependence on closed or semiclosed food systems increases the likelihood of inadequate intakes of key nutrients. This is a significant concern for extended-duration space missions, either in low Earth orbit (e.g., International Space Station) or beyond (e.g., missions to Mars).
Dietary intake during spaceflight is often inadequate, with crew members typically consuming 60–70% of predicted energy requirements (1Citation ,2)Citation . The ability to identify crew members who are not eating or drinking enough while on orbit is necessary to mitigate undernutrition. Spaceflight research often includes detailed recording of all foods consumed. Although this yields extremely accurate data, this method requires considerable time and effort, and thus is not suitable for routine medical monitoring during spaceflight.
Many of the physiologic changes that occur during flight have nutritional implications (2)Citation . Loss of bone and muscle tissue, fluid shifts (3)Citation and hematologic alterations (e.g., reduced RBC mass) occur in astronauts. Environmental factors such as radiation also play an important role in the ability of humans to live and work in space.
To ensure adequate nutritional support for astronauts, we developed a comprehensive nutritional assessment profile. It includes pre- and postflight assessment of a battery of biochemical markers of nutritional status, and a limited in-flight protocol, including dietary intake assessment and body mass measurement. The ground-based assessments were intended to be comprehensive (covering essentially all nutritional components, e.g., body composition, musculoskeletal status, vitamins or minerals). Due to resource constraints (e.g., crew time, freezer volume) on orbit, the in-flight assessment was limited to a dietary intake assessment and body mass determinations. The dietary intake assessment was implemented in the form of a food-frequency questionnaire (FFQ).4 The FFQ was designed to provide a quick and easy, yet reasonably accurate method for crew members to provide dietary intake information to the ground. It was targeted at specific nutrients (energy, protein, fluid, sodium, iron and calcium) to reduce complexity of the questionnaire.
We report here results from two types of studies, i.e., ground-based, semiclosed chamber studies (60- and 91-d durations) and spaceflight studies of astronauts residing on the Russian Mir space station (~4-mo durations). The ground studies had the following two key objectives: 1) to assess nutritional status of crew members consuming a space-like food system, and 2) to validate and use an FFQ designed specifically for use with semiclosed spaceflight food systems. The flight studies reported here represent the initial implementation of this nutritional assessment protocol.
SUBJECTS AND METHODS
TOP
ABSTRACT
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Two types of studies were conducted, i.e., ground-based, semiclosed chamber studies and flight studies aboard the Mir space station. The semiclosed environment of each provided unique opportunities to examine the effect of a limited food system on dietary intake and nutritional status and to assess and implement means of monitoring dietary intake.
Environment
Chamber studies. Two ground-based studies that involved prolonged (60- and 91-d) stays in an enclosed chamber facility at the NASA Johnson Space Center in Houston were conducted. The cylindrical chamber was 20 ft (6.1 m) in diameter, with three levels, namely, a work/galley area, a mechanical area and living quarters. The primary objective of studies with this chamber was to test regenerative air and water system technology for use on potential planetary missions. A group of ~20 "supplemental" projects was included to maximize return from habitation of the semiclosed chamber environment. These projects tested objectives relevant to spaceflight or confinement, and included psychological studies, in situ training assessments, and sleep and behavioral studies. We report here the results of one such "supplemental" study, which was designed to assess the nutritional effect of a semiclosed space-like food system and validate a dietary intake questionnaire for semiclosed food systems.
Flight studies. These studies were conducted with two astronauts on missions to Mir as part of the NASA Mir Science Program. The missions included launch from and return to Earth on board a U.S. space shuttle and residence for ~4 mo on Mir.
Subjects
Chamber studies. Subjects for the 60-d study were 1 woman and 3 men; subjects for the 91-d study were 2 women and 2 men. The ages of the 5 male subjects ranged from 26 to 36 y, and prechamber body mass ranged from 56.8 to 83.4 kg [body mass index (BMI) = 23.0 ± 3.4 kg/m2, mean ± SD]. The ages of the 3 female subjects ranged from 28 to 41 y, and prechamber body mass ranged from 57.4 to 69.4 kg (BMI = 22.4 ± 3.3 kg/m2). All subjects were required to pass an Air Force Class III physical examination for clearance to participate in the study.
Flight studies. Two men aged 40 to 54 y with preflight body mass in the range from 70.5 to 88.6 kg participated in these studies. These ranges reflect data for all male astronauts (n = 6) who resided on Mir as part of the NASA Mir Science Program (see subject confidentiality, below).
Subject confidentiality. Because the number of subjects in these studies is small and their participation in the chamber studies and NASA Mir missions has been highly publicized, additional restrictions are required to maintain subject confidentiality. Specifically, data from the chamber studies are not presented by gender because only one woman participated in the 60-d study. Only two crew members participated in the flight studies. Because individual results are reported here, details of individual subject characteristics are minimized, and data in the figures have been truncated for one subject to eliminate identification of subjects based on flight duration.
All procedures for both the ground-based and flight studies were reviewed by the Johnson Space Center Institutional Review Board to ensure ethical use of human subjects. Informed consent was obtained from all subjects.
Food systems
Chamber studies. The food system for the 60-d study was designed to be similar to that planned for use on the International Space Station. Commercial products comparable to foods on the International Space Station Daily Menu Food List were located in local grocery stores and incorporated into a standardized menu that included fresh, frozen and thermostabilized items. Energy requirements were calculated for each subject based on the WHO equation (4)Citation , adjusted for moderate activity (specifically 1.7 for men, 1.6 for women). Macronutrient contents of the standardized menu were calculated using the Daily Nutritional Requirements for Spaceflight (2Citation ,5)Citation .
A 20-d cycle menu was repeated throughout each chamber test period. Although only foods from the menu were allowed, subjects were not required to eat exactly the planned menu. The menu was adjusted only when an item could not be supplied due to seasonal availability or some other reason. Food preparation equipment for this study consisted of two microwave ovens. A side-by-side refrigerator/freezer was available for food storage.
The food system for the 91-d study was developed in a similar manner, but it was designed to be similar to that planned for use on a planetary (e.g., Moon, Mars) base. Accordingly, during the 91-d study, the 20-d cycle menu consisted of a 50% vegetarian diet, defined as <=4 servings of meat/wk. Additionally, an experimental diet was used for 10 d of the 91-d study (d 31–40). It consisted entirely of food items that could be produced in a regenerative food system.
During the 91-d study, food preparation equipment included a combination microwave/convection oven, a bread-making machine, a blender and a portable stove-top burner. A side-by-side refrigerator/freezer was also available for food storage.
Flight studies. The food system used on board Mir consisted of about half U.S. space foods and half Russian space foods (6)Citation . Because refrigeration was not available for food items, all foods were shelf-stable—dehydrated, thermostabilized (e.g., canned) or in natural form. Although a 6-d cycle menu was planned, actual eating patterns during flight rarely followed the scheduled menu. About once per mission, a cargo vehicle arrived with a limited number of fresh food items (e.g., fruits, vegetables). These items typically are edible for <1 wk.
Dietary intake assessment
Chamber studies. Before entering the chamber, the subjects completed a standard dietary assessment questionnaire (7)Citation to assess their usual diet over the past year. During their chamber stay, subjects completed a specialized FFQ (described below) to assess intake over 24-h (24-h FFQ) or 7-d (7-d FFQ) periods. The 24-h FFQ was administered 3 times/wk during wk 4 and 7 of the 60-d study, and wk 1, 4, 6, 9 and 12 of the 91-d study. The 7-d FFQ was administered once per week during wk 1, 3, 6 and 8 of the 60-d study, and wk 2, 5, 8, 10 and 13 of the 91-d study. Five-day weighed food records were completed for wk 2 and 5 of the 60-d study and wk 3, 7 and 11 of the 91-d study. During the weighed record sessions, subjects were provided a digital scale and log book, and were instructed to weigh and record all food, fluids, vitamin and mineral supplements, and medicines consumed. A research dietitian (B.L.R.) met with the subjects before the prechamber data collection session to provide training for all diet intake assessment methods.
Three of the 60-d chamber subjects reported occasional use of vitamin and mineral supplements, and one 91-d study subject reported daily supplement use. Intake data herein represent total nutrient intake from the foods consumed as well as supplements.
Flight studies. About 6 mo before flight, crew members completed the same standard dietary assessment questionnaire (7)Citation as the chamber subjects. During the flight, crew members filled out a specialized spaceflight FFQ (see below) once per week, and the data were transmitted to mission control in Moscow via telemetry. The files were then encrypted, and sent to the NASA Johnson Space Center in Houston. A nutrient estimation algorithm was applied to the data, and the resulting nutrient intake information was reported to the flight surgeon.
One subject reported use of a vitamin A, C and E supplement during the preflight study period. During flight, the other subject reported occasional use of a multivitamin and mineral supplement. The intake data presented herein include total nutrient intake from both food and supplements.
Food-frequency questionnaire (FFQ)
Chamber studies. The FFQ used in the chamber was constructed by one of the authors (G.B.) using the key nutrient contents of the >200 food items on the menu list. Nutrient data for all foods (except milk and dried cereals for the 60-d study, see below) were obtained using the Nutrition Data System (NDS-R, Version 4.01/29, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN, Food and Nutrient Database 29 released Dec. 1996). For the 60-d study, nutrients in milk and dried cereal were obtained using values provided by Block et al. (7)Citation . Specific nutrients targeted by the FFQ were energy, protein, calcium, sodium, iron and water. Two versions of the chamber FFQ were presented, one asking about dietary intake for the past 24 h, the other asking about the past 7 d. Questionnaire responses for these ground-based studies were handwritten.
Flight studies. The spaceflight FFQ, based on the key nutrient contents of the food items available from the U.S. and Russian space food lists, was constructed by one of the authors (G.B.). Nutrient content of foods was obtained via proximate analysis performed by the NASA Johnson Space Center Water and Food Analytical Laboratory. Nutrients studied were energy, protein, calcium, sodium, iron and water. A computerized FFQ was developed and was included on the laptop computers on board Mir. Completion of this questionnaire required ~10 min/wk.
Biochemical assessment of nutritional status (chamber and flight studies)
A complete biochemical nutritional assessment profile was developed for use with crew members before and after extended-duration space missions. This profile was intended to be comprehensive and to provide information on virtually all aspects of nutritional status (e.g., body composition, bone and muscle markers, vitamins, minerals). Due to technical (e.g., tests not operational at the time) and manuscript length limitations, not all tests are reported herein. A comprehensive data set from these studies will be published in a future NASA technical memorandum.
Most analytical determinations were completed using standard, commercial techniques. Serum total protein (3.0% CV), calcium (3.0% CV), cholesterol (4.5% CV), triglycerides (4.5% CV), electrolytes (sodium, 1.5% CV; potassium, 3.0% CV; chloride, 3.0% CV), aspartate aminotransferase (5.3% CV), alanine aminotransferase (5.3% CV) and total alkaline phosphatase (5.3% CV) were analyzed using a Beckman SYNCHRON CX7 automated clinical chemistry system (Beckman Coulter, Brea, CA). Serum albumin (<5.0% CV) and transthyretin (1.5% CV) were analyzed using the Beckman Appraise and Array 360 instruments, respectively (Beckman Coulter). Urine creatinine (4.5% CV) was analyzed on the Beckman CX3 system (Beckman Coulter).
Hemoglobin (<1.5% CV), hematocrit (calculated) and mean corpuscular volume (< 2% CV) were determined using a Coulter MaxM instrument (Beckman Coulter). Serum ferritin (<10% CV) and transferrin (3.63% CV) were analyzed using the Beckman Access and Array 360 instruments, respectively (Beckman Coulter). Transferrin receptors (5.7% CV) were measured using a commercially available ELISA (Ramco Laboratories, Houston, TX). RBC folate (6.4% CV) was measured using a commercially available radioreceptor assay (Diagnostic Products, Los Angeles, CA).
For the 60-d study and the flight studies, ferritin iron content was also determined by a modified version of the procedure developed by Herbert et al. (8)Citation . Briefly, the iron content of ferritin was determined after separation of ferritin from other iron-containing proteins. This was accomplished by the immunoprecipitation of serum ferritin with rabbit antihuman polyclonal antibody (Accurate Scientific, Westbury, NY) bound to immobilized rProtein A cross-linked to agarose beads (RepliGen, Cambridge, MA). Iron was released from the ferritin by digestion with 1 mol/L HNO3 (GFS Chemicals, Columbus, OH) in a 75°C water bath. The hydrolysate was then diluted with deionized water (Milli-Q UF Water System, Millipore Corp., Bedford, MA) and analyzed for iron content by an Elan 6000 inductively coupled plasma mass spectrometer (Perkin Elmer, Norwalk, CT) equipped with a microconcentric nebulizer (Cetac Technologies, Omaha, NE). The intra-assay CV for this assay was 9.3%, and the interassay CV was 10.5%.
Ionized calcium (1.5% CV) was determined using ion-sensitive electrode techniques (i-STAT, Princeton, NJ). Serum intact parathyroid hormone (5.85% CV) was measured by RIA (Nichols Institute Diagnostics, San Juan Capistrano, CA). Vitamin D metabolites 25-hydroxyvitamin D (9.1% CV) and 1,25-dihydroxyvitamin D (16.2% CV) were also determined using commercially available kits (DiaSorin, Stillwater, MN). Bone-specific alkaline phosphatase (5.6% CV) was measured by ELISA (Metra Biosystems, Palo Alto, CA).
RBC superoxide dismutase (<9% CV), glutathione peroxidase (<9% CV) and serum oxygen-radical absorbance capacity (<7% CV) were measured spectrophotometrically using commercially available kits (Randox Laboratories, Crumlin, Antrim, UK). HPLC techniques (9)Citation were used to determine 8-hydroxy-2'-deoxyguanosine (5.13% CV) in urine.
Biosample collection
Chamber studies. Blood samples were collected before (entry - 6 d) and after (egress + 4 d) the 60-d test. For the 91-d study, blood samples were collected before (entry - 9 d), twice during [immediately before and after the 10-d regenerative food system test, i.e., chamber d 30 (CD30) and 40], and after (egress + 4 d) the chamber stay. Urine was collected for 48 h before, every day during and 2 d after the chamber studies. Pre- and postchamber urine collections began on the day of blood collection. All urine voids were collected during the chamber studies, but few analytes were measured in all samples. However, complete urine analysis was conducted once (on CD32) during the 60-d chamber study and 3 times during the 91-d chamber study (CD30, CD40, CD60).
Blood samples from fasting subjects were collected immediately after awakening, at the same time of day, to minimize the effect of diurnal changes in endocrine and biochemical markers. For the 60-d chamber study, a total of 52 mL of blood was collected over ~70 d; for the 91-d chamber study, a total of 98 mL of blood was collected over ~100 d.
All urine samples were collected as individual voids. During the chamber studies, urine samples were stored in a refrigerator in the chamber and were transferred to the outside in one of the 2 or 3 daily exchanges of equipment and other material through an airlock. Urine samples were processed in the laboratory daily as follows: 24-h pools were created, and aliquots were either analyzed immediately or frozen for batch analysis upon completion of the study.
Flight studies. The nutritional assessment protocol was conducted twice before flight (~6 mo and 2 wk before launch), and within hours of landing after the flight. Blood samples were collected before (twice) and after the flight; urine was collected over two 48-h periods before and one 48-h period after the flight.
Blood samples were collected by standard phlebotomy techniques. With the exception of samples collected on the day of landing, all blood samples were collected in the morning after an 8-h fast. Blood samples were processed for individual analytes and stored at -20°C until analysis. Before and after flight, urine voids were collected into individual containers and stored with ice packs or refrigerated until processing, which occurred within 24 h of collection. Twenty-four-hour pools were created, and aliquots were prepared and stored at -20°C until analysis.
Body mass
Pre- and postflight body mass measurements of astronauts and all body mass measurements for the chamber studies were performed using a calibrated scale. During flight, body mass was determined biweekly using the Mir body mass measuring device. Pre- and postchamber and pre- and postflight anthropometric measurements were also completed, although those data are not reported here.
Statistical analysis
Chamber studies. Data are expressed as means ± SD, except in cases in which data represent means of means, for which SEM is used (see table footnotes for indications). Dietary data were analyzed using repeated-measures ANOVA. The class variable was assessment tool (24-h FFQ, 7-d FFQ, weighed records), and the dependent variables were the nutrients. Post-hoc Tukey tests were performed to assess specific differences between sessions. Significance was assigned to differences of P < 0.05. Statistical analyses were performed using SigmaStat (SPSS, Chicago, IL). Prechamber dietary intake data are presented, but these were not included in the statistical analyses because the differences between prechamber and in-chamber intakes were not the primary research question.
Biochemical analyte data for the 60-d study were analyzed using paired t tests, except when in-chamber analyses were available. In these cases, and for the 91-d chamber study, data were analyzed using repeated-measures ANOVA. The class variable was study phase (prechamber, in-chamber, postchamber phases), and dependent variables were the indices measured. This analysis identified effects of the semiclosed food system on indices of nutritional status. Because of the repeated-measures design of this study, each subject served as his or her own control. Data from the RBC transketolase assay for thiamin status were not subjected to statistical analysis because this assay is qualitative rather than quantitative.
Flight studies. Because only two crew members participated in the flight studies, statistical analyses were not performed on these data. Data from individual subjects are presented.
MAKALAH
TUGAS IPTEK
JURNAL INTERNASIONAL
PENGETAHUAN DAN SIKAP IBU
DENGAN STATUS GIZI BALITA
Disusun Oleh :
1. Anggita Brilian R PO 7131107003
2. Diah Kusuma Ningrum PO 7131107014
3. Rahmasari Utami PO 7131107032
4. Sevia Wahyuningrum PO 7131107033
DEPARTEMEN KESEHATAN REPUBLIK INDOENSIA
POLITEKNIK KESEHATAN YOGYAKARTA
JURUSAN GIZI
2009
Pengetahuan dan Sikap Ibu Mengenai Kelangsungan Hidup Masa Anak-anak
PENGARANG
Pantat. Prof. Thamer Kadum Yousif Al Hilfy
MBChB/FICMS
Athraa Essa/MSC
ABSTRAK
Latar belakang:
Sejak akhir konflik di Irak pada April 2003 dan dimulainya fungsi sistem kesehatan, yang terdiri 1200 PHCC yang kira untuk menyediakan layanan kesehatan kepada masyarakat, yang masih merupakan Angka Kematian Ibu (AKI) adalah 244/100.000 kelahiran hidup; Mortalitas anak (MR) <5 tahun adalah 131/1000 kelahiran hidup dan bayi MR 108/1000 kelahiran hidup. Angka-angka ini menunjukkan dampak dari pelayanan kesehatan yang tidak memadai pada kehidupan ibu dan anak, juga di beberapa bagian, pengetahuan sikap dan praktek ibu terhadap layanan yang diberikan dapat memainkan peran yang besar dalam angka-angka tinggi ini.
Penerima manfaat langsung akan masyarakat luas, terutama ibu-ibu yang menghadiri pusat PHC mencari pelayanan kesehatan yang ideal untuk kepentingan keluarga. Para petugas kesehatan di pusat-pusat PHC yang tepat akan mendapatkan umpan balik dari hasil penelitian ini, ke arah yang lebih baik menyediakan layanan kesehatan bagi ibu dan anak-anak mereka (1).
Manfaat tidak langsung akan kesehatan para pembuat kebijakan di tingkat tinggi di pemerintahan, direktur umum obat pencegah di Kementerian Pendidikan Tinggi dan penelitian ilmiah, dan organisasi non-pemerintah pemimpin masyarakat.
Tujuan:
Untuk mengevaluasi pengetahuan, praktik dan sikap ibu terhadap kelangsungan hidup masa anak-anak.
Tujuan:
1. Identifikasi hubungan antara karakteristik ibu dan anak-anak bertahan hidup.
2. Mengenali hubungan antara pelayanan perawatan ibu dan anak-anak bertahan hidup.
Menjelaskan hubungan antara penyediaan pelayanan anak usia dan kelangsungan hidup, status gizi dan menyusui, pemantauan pertumbuhan, penyakit pernapasan, diare, dan status imunisasi.
Metodologi:
Sebuah studi kohort penampang silang pada sampel yang dipilih secara acak ibu yang mempunyai anak kurang dari 2 tahun, menghadiri pusat-pusat perawatan kesehatan primer (PHCCs) di kota Tikrit dari Oktober 2004 hingga akhir Juni 2005 adalah termasuk dalam kajian ini.
Sebuah kuesioner khusus dipersipkan untuk tujuan ini, mewawancarai ibu yang mempunyai anak kurang dari 2 tahun, menghadiri PHCCs ini.
Hasil:
Kami menemukan bahwa mayoritas para ibu ibu rumah tangga (82,3%), kelompok umur terutama antara 25-34 tahun (86,9%). Hanya sekitar 31% adalah berpendidikan tinggi. Kebanyakan sampel ibu percaya bahwa ASI adalah makanan terbaik bagi bayi mereka , dan mengakui bahwa ASI memiliki banyak keuntungan untuk bayi, ibu dan keluarga mereka. Hanya sekitar 45% dari para ibu memiliki kebiasaan positif terhadap menyusui. ASI eksklusif adalah rendah di antara ibu menyusui (28,9%). Sekitar 35,2% ibu tidak tahu tentang apa makanan pelengkap yang harus ditambahkan dalam berbagai kelompok usia anak.
Anak-anak yang tidak punya kartu pemantauan pertumbuhan berjumlah 24,2% dan hanya 49,2% dari kartu ibu ibu itu. Sekitar 82,8% ibu-ibu yang diteliti tertunda luar PHC janji yang diberikan oleh pekerja untuk kunjungan rutin mereka, yang mencerminkan kepentingan mereka yang miskin dan ketidakpedulian ibu ini untuk layanan PHC.
Kesimpulan:
Pengetahuan dan praktek ibu itu, umumnya, tidak memuaskan terhadap penyakit diare dan perawatan antenatal, sementara pengetahuan ibu tentang tanda-tanda risiko ARI sekitar 65%.
Hasil ini menunjukkan bahwa promosi payudara ibu menyusui dan mendidik tentang pengetahuan dan praktik yang benar mengenai perawatan perinatal dan penyakit diare bagi anak-anak, dianjurkan.
PENDAHULUAN
Perawatan kesehatan primer (PHC) menyediakan layanan kesehatan dasar bagi individu, keluarga, kelompok rentan, dan masyarakat pada umumnya. Perawatan kesehatan primer (PHC) adalah pendekatan pertama mencari publik untuk perawatan medis, preventif dan kuratif. Ini adalah tanggung jawab masyarakat jaringan luas dari pusat-pusat kesehatan dan unit, dan mungkin kadang-kadang menjangkau orang-orang dalam komunitas mereka (1).
Perawatan kesehatan dasar sangat penting perawatan kesehatan berdasarkan ilmiah dan praktis metode dapat diterima secara sosial, dan teknologi membuat diakses secara universal individu dan keluarga di masyarakat melalui partisipasi penuh mereka, dan pada biaya yang masyarakat dan negara mampu mempertahankan pada setiap tahap pembangunan mereka di masyarakat. Ini adalah kontak tingkat pertama individu, keluarga dan masyarakat, dengan sistem kesehatan nasional, membawa perawatan kesehatan sedekat mungkin dengan tempat orang tinggal dan bekerja, dan merupakan elemen pertama dari proses perawatan kesehatan berkelanjutan (2) . Deklarasi berlangsung untuk menentukan perawatan kesehatan dasar termasuk pencegahan, promosi kesehatan, kuratif, dan rehabilitasi layanan.
Pekerjaan gerakan kesehatan perempuan penting dalam menetapkan arah kebijakan kesehatan. Itu adalah gerakan perempuan yang memelopori pendekatan politik untuk kesehatan dan perawatan kesehatan, membawa mereka dari domain pribadi ke ranah politik, pemahaman bahwa "kendali atas tubuh kita sendiri" akan mustahil tanpa perubahan sosial dan ekonomi (3 ).
Ini, untuk kami, adalah yang paling sangat membebaskan feminis pengertian dan pemahaman bahwa penindasan secara sosial kita, dan bukan biologis, ditahbiskan untuk bertindak atas pemahaman ini adalah untuk meminta lebih dari "kendali atas tubuh kita sendiri", itu adalah untuk meminta dan perjuangan untuk, kontrol atas pilihan sosial yang tersedia bagi kita, dan kontrol atas semua lembaga-lembaga masyarakat yang sekarang mendefinisikan pilihan ini (4).
Berbeda dengan deklarasi Alma Ata, Kesehatan Kanada telah menentukan perawatan kesehatan primer sebagai "titik kontak pertama untuk Kanada dengan sistem kesehatan, sering kali melalui dokter keluarga" (5).
Definisi ini, menyegarkan dalam keringkasan & kesederhanaan, daun terjawab pertanyaan-pertanyaan penting, termasuk apa yang merupakan komponen penting dari perawatan kesehatan primer.
Lain di mana, Kesehatan Kanada telah membuat komitmen yang kuat untuk memahami pentingnya determinan non-medis kesehatan dan penanggulangan praktek keterampilan; layanan kesehatan; dukungan sosial jaringan; gender dan denting. Komitmen tanggal kembali ke laporan tahun 1979 saat itu Menteri Kesehatan federal, Mare Lapland, A New Perspective di Kanada Kesehatan (6). Kesehatan Kanada juga memiliki komitmen untuk mengungkapkan kedua analisis berbasis jender dan strategi Kesehatan perempuan. Analisis Jender berbasis kebijakan dan konsep Exploring dalam Gender dan Kesehatan.
Setiap mereformasi sistem perawatan kesehatan dasar harus mencakup berbagai macam layanan perawatan kesehatan reproduksi dan pengiriman mereka harus diorganisir dalam cara-cara yang mengenali perempuan yang mempromosikan keberagaman dan otonomi perempuan, pengendalian dan kesehatan.
Kedua ada ketentuan lebih umum di kalangan wanita seperti kanker payudara, gangguan makan, depresi dan luka-luka yang diakibatkan diri (7).
KESEHATAN IBU DAN ANAK
Ibu dan anak-anak adalah kelompok rentan yang memerlukan perawatan khusus melalui perawatan ibu; untuk menikah perempuan di masa melahirkan anak, terutama yang hamil dan menyusui, dan melalui penitipan anak; untuk anak-anak di bawah lima tahun (bayi dan anak-anak prasekolah. (1).
Ibu kelompok rentan yang membutuhkan program-program kesehatan ibu khusus, karena:
• Mereka berisiko morbiditas (bahaya kesehatan) dan kematian selama kehamilan, persalinan dan puerperium, dan yang sebagian besar dapat dicegah dan dikontrol melalui perawatan ibu.
• Kesehatan ibu merupakan kebutuhan dasar kesehatan janin dan hasil yang menguntungkan kehamilan.
• Ibu yang bertanggung jawab untuk promosi kesehatan dan budaya anak-anak, dan kesejahteraan keluarga, sehingga harus sehat, dan sadar persyaratan kesehatan (1).
Di negara-negara berkembang, lebih dari 500.000 wanita meninggal setiap tahun dari komplikasi yang berkaitan dengan kehamilan dan kelahiran anak. Banyak perempuan lain menderita kehamilan dan komplikasi yang terkait dengan pengiriman, yang dihasilkan dalam jangka panjang masalah kesehatan. Kematian seorang wanita saat melahirkan sering berarti kematian untuk bayi yang baru lahir, dan kematian dan cacat diterjemahkan menjadi emosional, sosial, dan ekonomi bagi perempuan kesulitan anak-anak yang lebih tua, seluruh keluarga mereka, dan bahkan masyarakat (8).
Ibu dan kematian bayi dapat dicegah dengan memastikan bahwa kualitas tinggi ibu dan bayi baru lahir dapat diakses perawatan kesehatan dan komplikasi kesehatan ibu diakui, dirujuk, dan dirawat oleh ahli kesehatan, atau mereka mencari perawatan terhalang oleh hambatan-hambatan budaya seperti status perempuan dalam keluarga dan dalam masyarakat. Mereka mungkin menunda pengobatan mereka sendiri ketika sakit, agar dapat membayar untuk merawat anggota keluarga, atau mereka mungkin tidak berusaha peduli sama sekali (7).
Di Irak, sebuah studi tentang distribusi frekuensi pendidikan kehamilan, oleh staf PHCC pada aspek kesehatan ibu yang berbeda, menunjukkan bahwa pendidikan tentang pentingnya ASI adalah 48,71%, sedangkan faktor-faktor berisiko pada kehamilan dan persalinan 40,95%, dan bimbingan oleh dokter atau farmasi tentang penggunaan obat-obatan, ditemukan di 90,1% (9). (Tabel (I))
METODOLOGI
Desain dari Studi:
Studi ini merupakan studi kohort lintas seksi, dan dilakukan selama periode dari Oktober 2004 sampai akhir Juni 2005.
Karakteristik sosio-demografis:
Kajian ini dilakukan di pusat-pusat PHC Kota Tikrit, yang melayani sebagian besar masyarakat yang berbeda tingkat ekonomi sosial. Cluster sampling digunakan Kota Tikrit membagi ke dalam 5 sektor (Al-Alam, Ibnu-Sinaa, Alrazee, Ibnu-bergegas, dan Al-Rbidaa PHCC).
Pemerintahan Salahaldeen memiliki perkiraan populasi (1162490). Mewakili kota Tikrit (159.721) dari jumlah penduduk. Dari penduduk kota Tikrit, 20% di kelompok usia reproduksi (15-45) tahun, dan satu lagi 20% dari penduduk di bawah usia 5 tahun (71).
Study Groups:
Random sampling dari masing-masing PHCC diambil dari Oktober 2004 hingga akhir Juni 2005, dengan mewawancarai wanita yang mengunjungi PHCC untuk Ibu dan Anak pelayanan kesehatan yang memiliki anak kurang dari 2 tahun. Ukuran sampel adalah 5% dari wanita dalam kelompok usia reproduksi, setara dengan sekitar 760. Lima PHCCs dipilih.
Kunjungan harian dilakukan oleh penyidik sendiri. Dalam setiap hari, salah satu PHCCs dikunjungi selama jangka waktu 6 bulan. Wawancara dengan setiap wanita yang mengunjungi pusat-pusat dilakukan secara terpisah dan dengan privasi lengkap, sehingga jawaban (terutama tentang pendapat mereka) kurang dipengaruhi oleh mendengar jawaban dari orang lain. Setiap pertanyaan diajukan dalam bahasa yang sederhana. Sejumlah perempuan yang diwawancarai 760 dari semua pusat.
Sumber perawatan kesehatan:
Seperti dalam PHCCs di Irak, pusat-pusat di Kota Tikrit menyediakan paket komprehensif layanan kesehatan primer. Ada 5 PHCCs di kota Tikrit, dan mereka semua memberikan perawatan kehamilan dan kesehatan anak ibu, dan satu (1) rumah sakit umum utama dan (2) rumah sakit kecil, dan ada beberapa klinik asuransi kesehatan dan banyak klinik-klinik swasta.
Penekanan utama adalah pada perawatan kesehatan ibu dan anak, kesehatan sekolah, perawatan kuratif dan penyakit menular.
Di antara program-program yang memiliki prioritas tinggi adalah program perluasan imunisasi (EPI), terapi rehidrasi oral (ORT) untuk mengendalikan penyakit diare, dan manajemen kasus penyakit pernapasan akut.
Perintis Studi dan Pretest:
Sebuah uji coba skala kecil studi ini dilakukan pada sampel dari 30 kasus termasuk bayi dengan orangtua mereka, untuk mengidentifikasi daerah-daerah ambiguitas dalam kuesioner dan untuk memiliki sebuah gagasan tentang waktu yang diperlukan dan lainnya poin praktis sebelum studi akhir diluncurkan.
Pengembangan Kuesioner dan Pengumpulan Data:
Kuesioner dikembangkan untuk mengumpulkan informasi berikut dan variabel dari semua yang terlibat perempuan (studi populasi, lihat lampiran):
Kuesioner yang berkaitan dengan:
1. Pendidikan / pekerjaan ibu.
2. Menyusui / Nutrisi.
3. Pemantauan pertumbuhan.
4. Penyakit diare.
5. Infeksi saluran pernafasan akut-ARI (penyakit pernafasan).
6. Imunisasi.
7. Penitipan anak.
Analisis Statistik:
Data yang dikumpulkan di (760) ibu dan bayi mereka dipelajari, dan teknik statistik konvensional yang diterapkan ke data dalam studi persentase distribusi berdasarkan frekuensi, grafik batang, diagram lingkaran dan tabel representasi.
HASIL
Dari data yang dikumpulkan secara acak dari 5 pusat kesehatan di kota Tikrit, data yang dikumpulkan sesuai dengan kuesioner pra-set seprai, 760 ibu-ibu menghadiri ke PHC di mana dikenai survei.
Hasil studi menunjukkan bahwa sebagian besar anak-anak ditimbang 85,79% pada kunjungan pendaftaran, sementara 14,21% tidak dicatat (Tabel 1). Kekecewaan ibu adalah tinggi (82,89%) sementara mereka yang menghadiri satu waktu hanya 17,11% (Tabel 2)
Tabel 1. Distribution of study sample according to the weights recorded at registration
Berat badan No %
tercatat 652 85.79
tidak tercatat 108 14.21
total 760 100.00
Table 2. Distribution of study sample according to their attendance of appointments
Attendance to appointment No %
at time 130 17.11
delayed 630 82.89
total total 760 100.00
Hasil studi menunjukkan tertinggi persen dari ibu ibu rumah tangga (86,89%) berada di dalam kelompok umur 25-34 tahun, sedangkan tertinggi persen ibu-ibu bekerja (33,87%) adalah dalam kelompok usia (35-44) tahun (Tabel 3 ). Para ibu yang sedang menghadiri pendidikan tinggi di 31% saja, sedangkan tertinggi persen memiliki pendidikan menengah 50% (Tabel 4).
Table 3. The relationship between age of mother and their work status
Mother age group Work status Total women at age group % of total
Housewife % of age group Employed % of age group
12-24 180 71.43 72 28.57 252 33.16
25-34 334 86.98 50 13.02 384 50.53
35-44 82 66.13 42 33.87 124 16.32
Total 596 78.42 164 21.58 760 100.0
Significant (P value < 0.05)
Table 4. Distribution of study sample according to mothers' education
mother education No. %
cannot read and write 54 7.11
read and write (primary) 90 11.84
intermediate & secondary 380 50.00
University & post graduate 236 31.05
Total 760 100.00
Hasil anak-anak menurut jenis makan menunjukkan bahwa sebagian besar bayi menyusui 44,74%, 35,53% adalah botol pakan dan 19,74% adalah campuran makan. (Tabel 5)
Table 5. Distribution of women according to type of feeding of their infants
Type of feeding No. %
breast fed 340 44.74
bottle fed 270 35.53
mixed 150 19.74
total 760 100.00
Para ibu yang menyusui anak-anak mereka selama satu jam pertama setelah melahirkan itu hanya 30,26% dan ibu yang menyusui mulai 1-8 jam setelah melahirkan adalah 31,84% (Tabel 6). Yang paling umum disajikan makanan tambahan untuk bayi dari 1-2 tahun adalah madu atau gula 92% (Tabel 7).
Table 6. First time mothers who breast-fed their children
Time of starting breast feeding No. %
During 1st hour after delivery 230 30.26
From 1-8 hours after delivery 242 31.84
More than 8 hours 238 31.32
Don't remember 50 6.58
Total 760 100.00
Table 7. Type of extra-food presented to the babies aged 1-2 years
Type yes no Total no. of cases
No. % No. %
water / herbal teas 259 78.48 71 21.52 330
semi-solid food ( gruel porridge or semolina) 330 76.74 100 23.26 330
fruits or juices 300 69.77 130 30.23 330
carrot squash, mango or papaya 232 53.95 198 46.05 330
leafy green vegetables (spinach) 216 50.23 214 49.77 330
meat or fish 190 44.19 240 55.81 330
lentil peanuts or beans 240 55.81 190 44.19 330
eggs or yogurts 342 79.53 88 20.47 330
honey or adding sugar 396 92.09 34 7.91 330
adding fat or oil 260 60.47 170 39.53 330
Para ibu yang tahu bahwa menghindari susu botol akan tetap menyusui bayi mereka adalah 35,26%, sementara orang-orang yang percaya bahwa ASI eksklusif adalah perilaku yang benar agar mereka tetap menyusui, merupakan sekitar 28,95% (Tabel 8).
Hasil penelitian menunjukkan bahwa 43,95% memberi makanan kaya zat besi untuk bayi mereka, sementara 35,26% tidak tahu sama sekali tentang apa yang harus ditambahkan sesuai dengan usia anak (Tabel 9).
Table 8. Type of extra-food presented to the babies aged 1-2 years
Attitude No %
Does not know 132 17.37
exclusive breast feeding 220 28.95
avoid bottle feeding 268 35.26
frequent sucking to stimulate production 140 18.42
Totals 760 100.00
Table 9. Type of additional foods
Knowledge regarding food type No. %
Does not know 268 35.26
add oil to food 158 20.79
give food rich in Iron 334 43.95
Totals 760 100.00
Hasil penelitian menunjukkan bahwa hanya 2,1% dari ibu-ibu mengetahui peran vitamin. A dan makanan apa yang mengandung bahwa vitamin (Tabel 10).
Table 10. Mother knowledge about the importance of Vitamin A
Question They know Does not know Total
No. % No. %
Which Vitamin prevent night blindness? 16 2.11 744 97.89 760
Which types of food contain Vitamin A? 16 2.11 744 97.89 760
Bukti diare selama dua minggu terakhir di antara anak-anak, adalah 47,37%
(Table 11) . Hasil penelitian menunjukkan bahwa tinggi ibu persen (37,63%) berhenti menyusui sama sekali selama diare (Tabel 12). Sekitar 38,89% ibu memberi cairan lebih dari biasanya selama diare, sedangkan 11.11% dari mereka berhenti sama sekali
(Table 13) .
Table 11. Evidence of diarrhoea during the last two weeks among infants
Evidence of diarrhoea No %
Present 360 47.37
Absent 400 52.63
Totals 760 100.00
Table 12. Attitude towards breastfeeding during diarrhoea
Evidence of breast feeding No. %
more than usual 156 20.53
same as usual 134 17.63
less than usual 30 3.95
stopped completely 286 37.63
child does not breast feed 26 3.42
does not know 128 16.84
totals 760 100.00
Table 13. Provision of fluid during diarrhoea
Provision of fluid No. %
more than usual 140 38.89
same as usual 90 25.00
less than usual 60 16.67
stopped completely 40 11.11
exclusive breast feeding 30 8.33
totals 360 100.00
Hasil juga menunjukkan bahwa sekitar separuh dari ibu-ibu memberikan antibiotik atau ante-obat diare selama diare (52,78%), sementara 16.67% memberikan Rehidrasi Oral Therapy (ORT) hanya (Table14). Yang tinggi persen (95%) dari ibu-ibu mencari nasihat medis untuk anak-anak mereka (Tabel 15) dan tertinggi persen ibu dalam studi pergi ke rumah sakit umum - 44,44% (Tabel 16).
Table 14. Type of treatment during diarrhoea
Type of treatment No. %
nothing 18 5.00
ORT 60 16.67
sugar-salt solution 22 6.11
cereal based ORT 30 8.33
infusion or other fluids 40 11.11
Anti-diarrhoeal medicine or antibiotics 190 52.78
total 360 100.00
Table 15. Evidence of seeking advice and/or treatment for the diarrhoea
Evidence of seeking advice No. %
Present 342 95.00
Absent 18 5.00
total 360 100.00
Table 16. Source of advice and/or treatment for the diarrhoea
Source of advice No. %
General Hospital 152 44.44
Health center/clinic 100 29.24
Private clinic/ doctor 46 13.45
Pharmacy 20 5.85
Village health worker 10 2.92
Traditional healer 6 1.75
Relatives and friends 8 2.34
Total 342 100.00
Sebagian besar ibu mencari nasehat atau pengobatan untuk anak ketika sakit yang sulit bernapas, dan sebagian besar ibu-ibu membawa anak mereka ke rumah sakit umum 24,5% dan 30% untuk pusat kesehatan (Tabel 17).
Table 17. Source of advice and/or treatment when child is suffering from difficult breathing
Source of advice No. %
General hospital 187 42.50
Health center 132 30.00
Private clinic 42 9.50
Pharmacy 27 6.10
Village health worker 18 4.09
Traditional healer 12 2.72
Traditional birth attendant 6 1.36
Relatives and friends 16 3.63
Total 440 100.00
Hasilnya menunjukkan bahwa hanya sekitar 18,4% dari ibu-ibu tahu persis jumlah vaksin toksoid tetanus diperlukan selama kehamilan (Tabel 18).
Sebagian besar anak-anak telah diimunisasi, sekitar 82%, sementara 4% tidak tahu apakah anak-anak telah diimunisasi sama sekali (Tabel 19).
Table 18. Knowledge of the number of immunizations the pregnant women needs for protection
Knowledge No. %
one 172 22.63
two 140 18.42
more than two 110 14.47
none 194 25.53
does not know 144 18.95
total 760 100.00
Table 19. Presence of immunization card for the child
Presence of card No. %
Available 630 82.89
Not Available 130 17.11
Total 760 100.00
Hasilnya menunjukkan bahwa hanya 49,2% ibu memiliki kartu ibu (Table20), dan bahwa hanya 43,8% ibu-ibu yang memiliki kartu ibu yang divaksinasi dua kali, terhadap tetanus selama kehamilan (Tabel 21).
Table 20. Presence of Maternal card
Presence of card No. %
Present 374 49.21
Absent 386 50.79
Total 760 100.00
Table 21. Number of Tetanus Toxoid vaccination in the maternal card
Times No. %
one 190 50.80
two 164 43.85
none 20 5.35
total 374 100.00
Sekitar 95% ibu-ibu memiliki ruang untuk mencatat kunjungan kehamilan di kartu ibu (Tabel 22), dan hanya 38% ibu memiliki satu kunjungan antenatal dicatat dalam kartu mereka (Tabel 23). Hanya 17,9% sedang hamil (Tabel 24).
Table 22. Presence of space to record antenatal care visits
Presence No. %
yes 356 95.19
no 18 4.81
total 374 100.00
Table 23. Evidence of recording mother's antenatal visit
Evidence No. %
one 136 38.20
two or more 218 61.24
none 2 0.56
total 356 100.00
Table 24. Evidence of current pregnancy
Evidence No. %
Present 136 17.89
Absent 624 82.11
total 760 100.00
Sekitar 54% ibu-ibu berharap untuk menjadi hamil dalam 2 tahun berikutnya (Table25). Penggunaan kontrasepsi adalah 86,84% (Tabel 26). Sekitar 33% ibu-ibu yang diteliti pergi ke PHCC pada trimester terakhir kehamilan (Tabel 27).
Table 25. Evidence of desire to become pregnant in the next 2 years
Evidence No. %
Present 340 54.48%
Absent 225 36%
Does not know 59 9.5%
total 624 100.00
Table 26. Usage of methods to avoid pregnancy (contraception)
Usage of contraceptives No. %
Present 264 86.84
Absent 40 13.16
total 304 100.00
Table 27. First time of visiting health professional after getting pregnant
Type No. %
first trimester 1-3 months 154 20.26
middle of pregnancy 4-6 months 234 30.79
last trimester 7-9 months 250 32.89
no need to see health professional 64 8.42
does not now 58 7.63
total 760 100.00
Hasil penelitian menunjukkan bahwa 24,2% ibu tidak tahu makanan apa yang baik bagi wanita untuk mencegah anemia (Tabel 28).
Table 28. Knowledge of types of food that are beneficial for pregnant women to prevent anaemia
Knowledge of type of food No. %
Does not know 184 24.21
Proteins rich in iron (egg, fish, meat) 340 44.74
Leafy green vegetables 236 31.05
total 760 100.00
Para ibu yang tahu jawaban yang benar mengenai berat badan selama kehamilan adalah 22,89% (Tabel 29).
Table 29. Knowledge of how much weight a women should gain during pregnancy
Knowledge of weight No. %
10-12 kg. 174 22.89
gain weight of the baby 374 49.21
does not know 212 27.89
total 760 100.00
DISKUSI
Sejak tahun 1960-an, kehidupan keluarga program-program di negara-negara maju telah menghasilkan hasil yang positif dalam hal peningkatan baik pengetahuan tentang perkembangan anak dan orangtua-anak keterampilan interaksi antara keluarga, serta mengubah sikap orangtua. Program-program tersebut juga telah ditemukan untuk meningkatkan kemungkinan bahwa orangtua remaja akan kembali ke sekolah dan memperoleh pendidikan yang lebih tinggi secara signifikan. Sebagai perbandingan, ibu-ibu remaja yang belum mengikuti kelas mengasuh anak telah ditemukan untuk menunjukkan lebih banyak dependensi, isolasi yang lebih besar, kurang minat dalam kegiatan-kegiatan, lebih stres membesarkan anak-anak mereka, dan lebih banyak harapan yang tidak realistis dari anak-anak mereka (72).
Studi Distribusi Contoh:
Data yang dikumpulkan telah menunjukkan bahwa mayoritas para ibu ibu rumah tangga 82,3%, dengan sebagian besar dari mereka pada kelompok umur 25-34 tahun (yakni 86,9%). Hanya sekitar 31% dari mereka mempunyai pendidikan tinggi. Data-data ini diharapkan di negara kita, terutama di provinsi kami, dan sebuah kelaziman kebiasaan pedesaan terlihat di sini-khususnya mereka yang peduli dengan perempuan yang bekerja dan meninggalkan sekolah pada awal periode kehidupan akademik.
Sekitar 82,8% dari ibu-ibu yang diteliti tertunda luar PHC janji yang diberikan oleh pekerja untuk kunjungan rutin mereka, yang mungkin mencerminkan = mereka minat miskin dan ketidakpedulian ibu-ibu untuk layanan PHC. Situasi politik juga dapat memainkan peran.
Pengetahuan dan Sikap Menyusui
Data dari 86 negara menunjukkan bahwa terdapat perbedaan yang sangat besar dalam praktek menyusui antar negara, antara kelompok-kelompok penduduk di dalam kabupaten, dan dalam kelompok-kelompok yang berbeda selama periode waktu (73). Sebuah tren menurun dalam menyusui telah dicatat secara luas di berbagai negara di Timur Tengah, terutama di daerah perkotaan di mana ibu-ibu dengan mengangkat status sosial ekonomi resor untuk botol-cukup makan awal (74).
Dalam studi saat ini, sebagian besar ibu-ibu mencicipi percaya bahwa ASI adalah makanan terbaik bagi bayi-bayi mereka dan tahu bahwa ASI memiliki banyak keuntungan untuk bayi, ibu dan keluarga, tetapi hanya sekitar 45% dari ibu-ibu memiliki sikap positif terhadap pemberian ASI, dan hanya 30% dari para ibu menyusui anak-anak mereka selama satu jam pertama kehidupan. Grover et al (75) di India juga menemukan bahwa meskipun mayoritas responden memiliki pengetahuan yang baik terhadap pemberian ASI, persentase menyusui dalam studi ini juga lebih rendah dari seharusnya, dan hanya sekitar 9,1% dari mereka disusui anak-anak mereka selama satu jam pertama kehidupan. Promosi menyusui adalah salah satu intervensi penting untuk mengurangi kematian bayi dan meningkatkan perkembangan bayi di seluruh dunia (76), dengan demikian penting untuk mendorong ibu untuk mulai menyusui sedini mungkin. Hal ini melihat dalam studi yang kami saat ini sekitar 62% ibu-ibu mulai menyusui bayinya dalam 8 jam pertama setelah melahirkan, yang setuju dengan apa Skema (77) di Libya melihat di ruang kerjanya (yaitu 65%).
Dalam penelitian ini, tingkat pemberian ASI eksklusif sangat rendah di antara ibu menyusui (yakni 28,9%). Li et al (76) dalam sebuah penelitian di Thailand juga memperhatikan tingkat yang relatif rendah pemberian ASI eksklusif di kalangan ibu-ibu di bawah penelitian dibandingkan dengan total jumlah ibu menyusui. Antenatal rencana untuk menyusui eksklusif dan menyusui bayi yang baru lahir di rumah sakit setelah lahir mungkin memainkan peran kunci dalam masa pemberian ASI eksklusif. Temuan ini menunjukkan pentingnya penguatan pralahir pelaksanaan pendidikan kesehatan tentang menyusui (76).
ASI eksklusif selama enam bulan ini semakin banyak diperlihatkan untuk menjadi pusat kesehatan bayi dan bahkan kesehatan ibu karena dampaknya pada jarak kelahiran. Penelitian sebelumnya telah terlalu sering didasarkan pada definisi yang tidak memadai pemberian ASI eksklusif, dan dengan demikian telah meremehkan pentingnya. Bahkan pemberian air glukosa segera setelah melahirkan atau memberi makan air komplementer, tidak diperlukan dan praktek-praktek berbahaya (78).
Penggunaan botol menyusui membuat kegagalan lebih mungkin untuk sejumlah alasan, termasuk puting kebingungan bagi bayi. Dalam studi saat ini, sekitar 35% dari ibu-ibu tahu bahwa susu botol menghindari mempromosikan pemeliharaan mereka praktek menyusui. Suplemen yang diberikan oleh cangkir tidak memenuhi kebutuhan mengisap bayi, dan ini dapat menjelaskan mengapa secara tradisional makanan pendamping ASI dari usia dini lebih mudah untuk mempertahankan bersama terus menyusui dari botol-menyusui tampaknya (79).
Pelengkap makanan termasuk semua makanan yang diberikan kepada anak selain susu. Jangka waktu komplementer makanan adalah sangat penting untuk kesehatan dan kesejahteraan anak. Di satu pihak, sebelum 6 bulan, ASI menawarkan perlindungan umum untuk anak-anak dari penyakit diare dan infeksi lain. Selain itu, penundaan pengenalan makanan lain menawarkan beberapa perlindungan (77)
Di sisi lain, setelah 4-6 bulan, pertumbuhan tidak dapat dipertahankan pada ASI saja. Menurut WHO, International Pediatric Association dan badan-badan lain, pengenalan makanan pelengkap harus dimulai pada usia 4-6 bulan (77).
Lebih dari 35,7% ibu-ibu dalam penelitian ini adalah menambah makanan pelengkap dari 4 bulan lebih awal dari kehidupan anak, dibandingkan dengan 17,9% dicatat oleh Skema (77) di Libya dan 87,9% dilihat oleh Saowakontha (80) di desa Thailand. Sekitar 58,6% ibu-ibu dalam penelitian ini adalah memperkenalkan suplemen sebelum usia 6 bulan, sedangkan Al-Sekait (81) telah disebutkan bahwa studi di Sudan menunjukkan sekitar 76% -91% dari ibu-ibu ada memperkenalkan suplemen sebelum usia 6 bulan. Perbedaan tinggi ini menunjukkan kesenjangan besar antara pengetahuan dan sikap ibu-ibu di daerah-daerah berbeda dari negara-negara berkembang komplementer mengenai makanan dan usaha besar yang harus dilakukan untuk mengatasi latar belakang miskin ini para ibu di wilayah ini, termasuk negara kita.
Tujuan dari makanan komplementer adalah mentransfer anak dari ASI ke makanan keluarga. Makanan pelengkap praktik telah disurvei di sebagian besar negara-negara Arab (82,83). Pola umum dalam studi ini sebagian besar sama seperti dalam strata sosial ekonomi yang sesuai.
Air, jus, semisolid makanan, telur, dan menambahkan gula dan madu merupakan suplemen yang paling umum diberikan untuk anak-anak oleh ibu-ibu dalam studi saat ini, yang setuju dengan apa yang Shembesh melihat di Libya (77), Serenius di Arab Saudi (82), dan apa Patwardan di Timur Tengah telah dilakukan (84).
Pengaruh budaya memainkan peran utama dalam keputusan tentang makanan yang harus diperkenalkan dan pada usia berapa (82). Sekitar 35,2% dari ibu-ibu dalam studi saat ini tidak tahu tentang apa yang harus ditambahkan tepat untuk anak di usianya, tetapi mereka mengikuti saran perempuan yang lebih tua dalam keluarga atau teman-teman mereka. Sebuah pertanyaan sederhana tentang peran vitamin A dan makanan apa yang mengandung bahwa vitamin menunjukkan bahwa hanya 2,1% dari ibu-ibu tahu jawaban yang benar, yang memberikan kita petunjuk tentang latar belakang miskin.
Pertumbuhan Monitoring
Studi baru-baru ini mengevaluasi efektivitas program pemantauan pertumbuhan telah diteliti pendidikan mereka dan kemampuan pencegahan. Pendukung mengklaim bahwa pemantauan pertumbuhan dapat efektif jika masyarakat dan ibu-ibu lebih aktif terlibat dalam proses penimbangan dan pengukuran, dan jika teknologi ini dipahami oleh semua sebagai bantuan untuk pencegahan penyakit dan promosi kesehatan bukan sebagai "kuratif" prosedur. Yang lain berpendapat bahwa teori ini jarang mungkin untuk dilaksanakan. Cara-cara di mana pemantauan pertumbuhan preventif dapat dimungkinkan masih dalam eksplorasi, mengingat bahwa alasan seperti itu sangat tertanam "kuratif" pemantauan pertumbuhan harapan tidak sepenuhnya dipahami. Pemahaman tersebut memerlukan analisis pemantauan pertumbuhan dalam konteks Gobi (pemantauan pertumbuhan, terapi rehidrasi oral, menyusui, dan imunisasi) kerangka kelangsungan hidup anak (85).
Setelah ini pentingnya pemantauan pertumbuhan anak-anak, persentase anak-anak (24,3%) dengan tidak ada pertumbuhan kartu pemantauan, dan persentase anak-anak (14,2%) yang tidak ditimbang sama sekali selama 4 bulan terakhir usia mereka dianggap tinggi persentase.
Pengetahuan Ibu dan Sikap Mengenai Diare
Wabah diare terus berkembang, mengakibatkan lebih dari 3 juta kematian (86). Dalam studi saat ini, sekitar setengah dari ibu mengatakan bahwa anak-anak mereka memiliki diare selama dua minggu terakhir, yang menunjukkan kepada kita seberapa besar masalah dalam masyarakat kita, terutama di musim panas.
Menurut pedoman WHO untuk pengelolaan diare, anti-diare, anti-amuba dan anti-bacterials memiliki peran kecil (87). Walaupun demikian, terlalu sering menggunakan agen antimikroba telah dilaporkan untuk pengelolaan kondisi diare (88). Dalam studi saat ini, walaupun sekitar 96% dari ibu mencari nasihat medis untuk anak-anak mereka dengan diare dari tenaga medis, sekitar 53% dari anak-anak mereka mengambil antimikroba untuk perawatan. Ini menunjukkan penyalahgunaan lebar antimikroba ini oleh personel medis, yang mengarah pada gilirannya untuk bertahap lonjong dalam penggunaan terapi rehidrasi oral (ORT) dari waktu ke waktu. Dalam studi saat ini, penggantian fluida untuk anak-anak dengan diare hanya dipraktekkan oleh 38,9% ibu dengan benar, yang sesuai dengan apa yang Datta et al (89) ditemukan di India (yaitu hanya sekitar 40% dari ibu yang benar memberikan ORT untuk anak-anak mereka).
Pendidikan kesehatan masyarakat adalah sangat penting untuk manajemen kasus yang efektif, karena memiliki potensi untuk membangun hubungan yang produktif antara layanan kesehatan dan masyarakat, untuk meningkatkan kemampuan keluarga untuk mengenali tanda-tanda bahaya diare pada anak-anak dan untuk mendorong tepat dan perawatan awal mencari perilaku (90). Sekitar 13% ibu tidak tahu apa tanda-tanda diare memerlukan perhatian medis; lainnya mencari nasihat medis segera setelah anak-anak mereka demam atau muntah.
Pendidikan kesehatan yang efektif hanya dapat diberikan atas dasar pemahaman yang akurat yang berlaku pengetahuan, sikap dan praktek masyarakat (90). Studi ini menunjukkan bahwa pengetahuan dan sikap ibu tidak memuaskan, karena sekitar 44% ibu-ibu yang membawa anak mereka ke rumah sakit umum segera setelah mereka melihat episode diare, dan hanya sekitar 16% dari para ibu yang memberikan lebih banyak cairan untuk mereka anak-anak, sementara kurang dari 6% itu sering memberikan makanan kecil untuk anak-anak mereka. Anehnya, sekitar 17% ibu-ibu bahkan tidak tahu apa yang harus dilakukan setelah anak-anak mereka sembuh dari diare.
Pengetahuan dan Sikap Ibu Tentang ARI:
Pengendalian infeksi pernafasan akut (ISPA) adalah besar masalah kesehatan masyarakat di negara-negara berkembang. Anak penyakit pernafasan adalah salah satu masalah besar yang mempengaruhi anak-anak di Irak dalam kelompok studi. Ini juga mengonsumsi lebih besar dari anggaran pemerintah di sektor kesehatan primer. Pelaksanaan manajemen kasus protokol memerlukan partisipasi masyarakat untuk mengurangi morbiditas dan kematian dari ARI. Program pendidikan kesehatan hanya dapat efektif bila didesain untuk memperhitungkan pengetahuan yang berlaku, sikap dan praktek (KAP) masyarakat terhadap ARI pada anak-anak mereka (91).
Dalam studi saat ini, ibu mengatakan bahwa lebih dari 52% dari anak-anak mereka menderita batuk dan / atau sulit bernapas dalam dua minggu terakhir. Persentase tinggi ini menunjukkan besarnya masalah ini di kota Tikrit. Semua ibu menyadari kedua gejala, tetapi ketika mereka yang positif "batuk" jawaban yang ditanya tentang perkembangan selanjutnya sulit bernapas selama sakit, delapan belas wanita (yaitu 4,5%) tidak tahu, dan 12% wanita bahkan tidak mencari nasihat medis untuk anak-anak mereka sulit bernapas, yang sesuai dengan apa yang Simiyu (91) di Kenya ditemukan, di ibu-ibu memiliki pengetahuan yang baik dalam bentuk ringan ARI tetapi tidak bentuk-bentuk yang parah.
Hal itu juga melihat bahwa sekitar 7% dari ibu-ibu meminta nasihat bagi anak-anak sakit mereka dari personil non-medis, dan sekitar 14,7% tidak tahu gejala-gejala utama yang seharusnya membuat mereka membawa anak-anak mereka ke rumah sakit, yang menunjukkan pengetahuan mereka yang miskin dan / atau sikap mengenai kondisi serius anak-anak mereka. Penting untuk memahami bahwa rendahnya pemanfaatan layanan kesehatan bagi ARI moderat dapat mengakibatkan kematian yang tinggi terus tertunda karena sakit parah identifikasi anak-anak.
KAP ARI Sebuah survei di Irak pada 1995 (92) mengungkapkan bahwa 46% dari total 900 sampel ibu tertutup, bisa mendeteksi tanda-tanda risiko infeksi ARI terkait, dengan penelitian ini menunjukkan jumlah yang lebih tinggi (sekitar 65%), yang mungkin , karena diagnosis yang lebih baik dan manajemen yang lebih baik, yang dapat menyebabkan meningkatkan pengetahuan ibu tentang ARI.
Namun, metode pengobatan pada 71% masih percaya pada penggunaan antibiotik dan 64% kembali ke obat batuk. Di Utara Irak, survei dilakukan di tiga Governorat Utara pada bulan Desember 1994 dengan 30-klaster survei imunisasi. Survei menunjukkan bahwa ibu tidak sepenuhnya menyadari tanda-tanda dan gejala awal infeksi pernapasan pada anak-anak mereka dan kapan harus mencari nasihat medis, seperti terlihat dalam keterbatasan pengetahuan mereka tentang pernapasan cepat sebagai indikasi ARI. Namun, pengetahuan mereka tentang pernapasan sulit sebagai indikator infeksi pernafasan akut dan menghubungkan bahwa dengan prognosis kesehatan anak-anak mereka, adalah baik (92).
Pengetahuan dan Sikap Ibu Tentang Imunisasi
Immunization is a timely step for prevention of mortality and morbidity due to communicable diseases in the 0-5 year age group. The delivery system of immunization has many inherent problems to which an addition may be made by the people themselves, with their prejudices, carelessness and apathy (93) . In the current study, a small percentage of mothers (ie 4%) were not vaccinating their children -or do not know if their children have received immunization at all, in spite of all the programs held for vaccinating young children, which emphasizes what we have mentioned above.
Anehnya, sekitar seperempat dari ibu-ibu tidak tahu mengapa imunisasi diberikan kepada para ibu selama kehamilan; orang lain memberikan jawaban berbeda. Juga, hanya sekitar 18,4% dari ibu-ibu tahu jawaban yang benar tentang tahap-tahap imunisasi terhadap tetanus. El-sherbini (94) di Mesir juga menemukan bahwa sekitar 25,5% ibu tidak memiliki dasar dan penting pengetahuan tentang perawatan kehamilan. Meningkatkan ibu 'pengetahuan tentang tetanus adalah penting untuk meningkatkan cakupan tetanus toksoid. Selain itu, kehamilan akan menyebabkan kontak dengan sumber-sumber tetanus toksoid dan karenanya meningkatkan kemungkinan memiliki imunisasi (95).
Dua pertanyaan diajukan mengenai ketersediaan ruang di kartu ibu mereka, untuk merekam peristiwa-peristiwa seperti itu, dan jumlah vaksinasi tetanus kali dilaporkan dalam kartu itu. Meskipun ada ruang untuk mencatat informasi ini, (sekitar 96% dari kartu) , hanya 43,8% dari mereka adalah ibu vaksinasi dilaporkan dua kali, yang juga menunjukkan pengetahuan dan sikap buruk tentang imunisasi toksoid tetanus.
Pengetahuan dan Sikap Ibu Tentang Kehamilan dan Keluarga Berencana:
In the current study, about 17.9% of mothers were pregnant, and 54.5% of the remaining wish to be pregnant in the next two years. Also, about 13% of females who don't want to be pregnant or who have not decided yet to be pregnant in the next two years, are not currently using contraceptive methods to avoid pregnancy. These percentages show us the poor family planning of these females.
In the current study, a low level of knowledge and attitude regarding family planning was found, in contrast to what Aja et al (96) in Nigeria found, The findings in their study showed a high awareness level with a moderately positive attitude, and generally a low level of practice.
Mengenai kunjungan perawatan kehamilan, sekitar 38% dari ibu hanya memiliki satu kehamilan kunjungan selama kehamilan terakhir, dan 2 (yaitu 0,5%) perempuan tidak punya kunjungan sama sekali. This explains the poor knowledge and attitude of mothers towards the benefits of maternal care, especially if we know that about one-third (33%) of the mothers under study attend PHC centers at the last trimester of pregnancy and not before.
As an example of mothers' poor knowledge, about 22.9% of mothers know that (10 -12 kg) will be gained during pregnancy, the remaining either don't know or gave a wrong response. Also, about 24% of mothers don't know what food is good for women to prevent anaemia during pregnancy; even the answers about the question regarding the amount of food taken and whether it changed during pregnancy, was disappointing.
Mengingat fakta-fakta ini, adalah penting untuk menilai pengetahuan dan sikap dari populasi wanita yang berbeda mengenai isu-isu yang berkaitan dengan kesehatan ibu dan anak. Hal ini akan memungkinkan kita untuk menerapkan program-program yang sesuai untuk meningkatkan kesehatan perempuan dan anak-anak, dan memerangi penyebaran beberapa penyakit menular.
KESIMPULAN DAN SARAN
Kesimpulan:
1. Only about 31% of these mothers attended high education academies.
2. About 82.8% were delayed beyond their appointment given by PHC workers for their routine visits, which reflected their indifference and poor interest towards PHC services.
3. The knowledge and attitude of mothers is, generally, not satisfactory regarding diarroheal disease for their children.
4. Sekitar 65% ibu-ibu dalam studi kami memiliki pengetahuan yang baik tentang tanda-tanda ini dibandingkan dengan 46% pada tahun 1995.
5. Poor knowledge and attitude of mothers concerning immunization against tetanus, and also regarding antenatal care.
Saran:
1. To Ministry of Health- Directory of Health Education:
• Promotion of breast-feeding among mothers through educating them about beneficial effects by periodic conferences.
• Educating the mothers about the best KAP regarding ARI, diarrhoeal disease, and perinatal care through multiple periodic conferences and mass media.
2. To our Colleagues in Medical Colleges: Further studies should be held to evaluate the practices of mothers regarding childhood survival.
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Sumber : http://www.mejfm.com/journal/Jan2007/mother-child.htm
JURNAL INTERNASIONAL
PENGETAHUAN DAN SIKAP IBU
DENGAN STATUS GIZI BALITA
Disusun Oleh :
1. Anggita Brilian R PO 7131107003
2. Diah Kusuma Ningrum PO 7131107014
3. Rahmasari Utami PO 7131107032
4. Sevia Wahyuningrum PO 7131107033
DEPARTEMEN KESEHATAN REPUBLIK INDOENSIA
POLITEKNIK KESEHATAN YOGYAKARTA
JURUSAN GIZI
2009
Pengetahuan dan Sikap Ibu Mengenai Kelangsungan Hidup Masa Anak-anak
PENGARANG
Pantat. Prof. Thamer Kadum Yousif Al Hilfy
MBChB/FICMS
Athraa Essa/MSC
ABSTRAK
Latar belakang:
Sejak akhir konflik di Irak pada April 2003 dan dimulainya fungsi sistem kesehatan, yang terdiri 1200 PHCC yang kira untuk menyediakan layanan kesehatan kepada masyarakat, yang masih merupakan Angka Kematian Ibu (AKI) adalah 244/100.000 kelahiran hidup; Mortalitas anak (MR) <5 tahun adalah 131/1000 kelahiran hidup dan bayi MR 108/1000 kelahiran hidup. Angka-angka ini menunjukkan dampak dari pelayanan kesehatan yang tidak memadai pada kehidupan ibu dan anak, juga di beberapa bagian, pengetahuan sikap dan praktek ibu terhadap layanan yang diberikan dapat memainkan peran yang besar dalam angka-angka tinggi ini.
Penerima manfaat langsung akan masyarakat luas, terutama ibu-ibu yang menghadiri pusat PHC mencari pelayanan kesehatan yang ideal untuk kepentingan keluarga. Para petugas kesehatan di pusat-pusat PHC yang tepat akan mendapatkan umpan balik dari hasil penelitian ini, ke arah yang lebih baik menyediakan layanan kesehatan bagi ibu dan anak-anak mereka (1).
Manfaat tidak langsung akan kesehatan para pembuat kebijakan di tingkat tinggi di pemerintahan, direktur umum obat pencegah di Kementerian Pendidikan Tinggi dan penelitian ilmiah, dan organisasi non-pemerintah pemimpin masyarakat.
Tujuan:
Untuk mengevaluasi pengetahuan, praktik dan sikap ibu terhadap kelangsungan hidup masa anak-anak.
Tujuan:
1. Identifikasi hubungan antara karakteristik ibu dan anak-anak bertahan hidup.
2. Mengenali hubungan antara pelayanan perawatan ibu dan anak-anak bertahan hidup.
Menjelaskan hubungan antara penyediaan pelayanan anak usia dan kelangsungan hidup, status gizi dan menyusui, pemantauan pertumbuhan, penyakit pernapasan, diare, dan status imunisasi.
Metodologi:
Sebuah studi kohort penampang silang pada sampel yang dipilih secara acak ibu yang mempunyai anak kurang dari 2 tahun, menghadiri pusat-pusat perawatan kesehatan primer (PHCCs) di kota Tikrit dari Oktober 2004 hingga akhir Juni 2005 adalah termasuk dalam kajian ini.
Sebuah kuesioner khusus dipersipkan untuk tujuan ini, mewawancarai ibu yang mempunyai anak kurang dari 2 tahun, menghadiri PHCCs ini.
Hasil:
Kami menemukan bahwa mayoritas para ibu ibu rumah tangga (82,3%), kelompok umur terutama antara 25-34 tahun (86,9%). Hanya sekitar 31% adalah berpendidikan tinggi. Kebanyakan sampel ibu percaya bahwa ASI adalah makanan terbaik bagi bayi mereka , dan mengakui bahwa ASI memiliki banyak keuntungan untuk bayi, ibu dan keluarga mereka. Hanya sekitar 45% dari para ibu memiliki kebiasaan positif terhadap menyusui. ASI eksklusif adalah rendah di antara ibu menyusui (28,9%). Sekitar 35,2% ibu tidak tahu tentang apa makanan pelengkap yang harus ditambahkan dalam berbagai kelompok usia anak.
Anak-anak yang tidak punya kartu pemantauan pertumbuhan berjumlah 24,2% dan hanya 49,2% dari kartu ibu ibu itu. Sekitar 82,8% ibu-ibu yang diteliti tertunda luar PHC janji yang diberikan oleh pekerja untuk kunjungan rutin mereka, yang mencerminkan kepentingan mereka yang miskin dan ketidakpedulian ibu ini untuk layanan PHC.
Kesimpulan:
Pengetahuan dan praktek ibu itu, umumnya, tidak memuaskan terhadap penyakit diare dan perawatan antenatal, sementara pengetahuan ibu tentang tanda-tanda risiko ARI sekitar 65%.
Hasil ini menunjukkan bahwa promosi payudara ibu menyusui dan mendidik tentang pengetahuan dan praktik yang benar mengenai perawatan perinatal dan penyakit diare bagi anak-anak, dianjurkan.
PENDAHULUAN
Perawatan kesehatan primer (PHC) menyediakan layanan kesehatan dasar bagi individu, keluarga, kelompok rentan, dan masyarakat pada umumnya. Perawatan kesehatan primer (PHC) adalah pendekatan pertama mencari publik untuk perawatan medis, preventif dan kuratif. Ini adalah tanggung jawab masyarakat jaringan luas dari pusat-pusat kesehatan dan unit, dan mungkin kadang-kadang menjangkau orang-orang dalam komunitas mereka (1).
Perawatan kesehatan dasar sangat penting perawatan kesehatan berdasarkan ilmiah dan praktis metode dapat diterima secara sosial, dan teknologi membuat diakses secara universal individu dan keluarga di masyarakat melalui partisipasi penuh mereka, dan pada biaya yang masyarakat dan negara mampu mempertahankan pada setiap tahap pembangunan mereka di masyarakat. Ini adalah kontak tingkat pertama individu, keluarga dan masyarakat, dengan sistem kesehatan nasional, membawa perawatan kesehatan sedekat mungkin dengan tempat orang tinggal dan bekerja, dan merupakan elemen pertama dari proses perawatan kesehatan berkelanjutan (2) . Deklarasi berlangsung untuk menentukan perawatan kesehatan dasar termasuk pencegahan, promosi kesehatan, kuratif, dan rehabilitasi layanan.
Pekerjaan gerakan kesehatan perempuan penting dalam menetapkan arah kebijakan kesehatan. Itu adalah gerakan perempuan yang memelopori pendekatan politik untuk kesehatan dan perawatan kesehatan, membawa mereka dari domain pribadi ke ranah politik, pemahaman bahwa "kendali atas tubuh kita sendiri" akan mustahil tanpa perubahan sosial dan ekonomi (3 ).
Ini, untuk kami, adalah yang paling sangat membebaskan feminis pengertian dan pemahaman bahwa penindasan secara sosial kita, dan bukan biologis, ditahbiskan untuk bertindak atas pemahaman ini adalah untuk meminta lebih dari "kendali atas tubuh kita sendiri", itu adalah untuk meminta dan perjuangan untuk, kontrol atas pilihan sosial yang tersedia bagi kita, dan kontrol atas semua lembaga-lembaga masyarakat yang sekarang mendefinisikan pilihan ini (4).
Berbeda dengan deklarasi Alma Ata, Kesehatan Kanada telah menentukan perawatan kesehatan primer sebagai "titik kontak pertama untuk Kanada dengan sistem kesehatan, sering kali melalui dokter keluarga" (5).
Definisi ini, menyegarkan dalam keringkasan & kesederhanaan, daun terjawab pertanyaan-pertanyaan penting, termasuk apa yang merupakan komponen penting dari perawatan kesehatan primer.
Lain di mana, Kesehatan Kanada telah membuat komitmen yang kuat untuk memahami pentingnya determinan non-medis kesehatan dan penanggulangan praktek keterampilan; layanan kesehatan; dukungan sosial jaringan; gender dan denting. Komitmen tanggal kembali ke laporan tahun 1979 saat itu Menteri Kesehatan federal, Mare Lapland, A New Perspective di Kanada Kesehatan (6). Kesehatan Kanada juga memiliki komitmen untuk mengungkapkan kedua analisis berbasis jender dan strategi Kesehatan perempuan. Analisis Jender berbasis kebijakan dan konsep Exploring dalam Gender dan Kesehatan.
Setiap mereformasi sistem perawatan kesehatan dasar harus mencakup berbagai macam layanan perawatan kesehatan reproduksi dan pengiriman mereka harus diorganisir dalam cara-cara yang mengenali perempuan yang mempromosikan keberagaman dan otonomi perempuan, pengendalian dan kesehatan.
Kedua ada ketentuan lebih umum di kalangan wanita seperti kanker payudara, gangguan makan, depresi dan luka-luka yang diakibatkan diri (7).
KESEHATAN IBU DAN ANAK
Ibu dan anak-anak adalah kelompok rentan yang memerlukan perawatan khusus melalui perawatan ibu; untuk menikah perempuan di masa melahirkan anak, terutama yang hamil dan menyusui, dan melalui penitipan anak; untuk anak-anak di bawah lima tahun (bayi dan anak-anak prasekolah. (1).
Ibu kelompok rentan yang membutuhkan program-program kesehatan ibu khusus, karena:
• Mereka berisiko morbiditas (bahaya kesehatan) dan kematian selama kehamilan, persalinan dan puerperium, dan yang sebagian besar dapat dicegah dan dikontrol melalui perawatan ibu.
• Kesehatan ibu merupakan kebutuhan dasar kesehatan janin dan hasil yang menguntungkan kehamilan.
• Ibu yang bertanggung jawab untuk promosi kesehatan dan budaya anak-anak, dan kesejahteraan keluarga, sehingga harus sehat, dan sadar persyaratan kesehatan (1).
Di negara-negara berkembang, lebih dari 500.000 wanita meninggal setiap tahun dari komplikasi yang berkaitan dengan kehamilan dan kelahiran anak. Banyak perempuan lain menderita kehamilan dan komplikasi yang terkait dengan pengiriman, yang dihasilkan dalam jangka panjang masalah kesehatan. Kematian seorang wanita saat melahirkan sering berarti kematian untuk bayi yang baru lahir, dan kematian dan cacat diterjemahkan menjadi emosional, sosial, dan ekonomi bagi perempuan kesulitan anak-anak yang lebih tua, seluruh keluarga mereka, dan bahkan masyarakat (8).
Ibu dan kematian bayi dapat dicegah dengan memastikan bahwa kualitas tinggi ibu dan bayi baru lahir dapat diakses perawatan kesehatan dan komplikasi kesehatan ibu diakui, dirujuk, dan dirawat oleh ahli kesehatan, atau mereka mencari perawatan terhalang oleh hambatan-hambatan budaya seperti status perempuan dalam keluarga dan dalam masyarakat. Mereka mungkin menunda pengobatan mereka sendiri ketika sakit, agar dapat membayar untuk merawat anggota keluarga, atau mereka mungkin tidak berusaha peduli sama sekali (7).
Di Irak, sebuah studi tentang distribusi frekuensi pendidikan kehamilan, oleh staf PHCC pada aspek kesehatan ibu yang berbeda, menunjukkan bahwa pendidikan tentang pentingnya ASI adalah 48,71%, sedangkan faktor-faktor berisiko pada kehamilan dan persalinan 40,95%, dan bimbingan oleh dokter atau farmasi tentang penggunaan obat-obatan, ditemukan di 90,1% (9). (Tabel (I))
METODOLOGI
Desain dari Studi:
Studi ini merupakan studi kohort lintas seksi, dan dilakukan selama periode dari Oktober 2004 sampai akhir Juni 2005.
Karakteristik sosio-demografis:
Kajian ini dilakukan di pusat-pusat PHC Kota Tikrit, yang melayani sebagian besar masyarakat yang berbeda tingkat ekonomi sosial. Cluster sampling digunakan Kota Tikrit membagi ke dalam 5 sektor (Al-Alam, Ibnu-Sinaa, Alrazee, Ibnu-bergegas, dan Al-Rbidaa PHCC).
Pemerintahan Salahaldeen memiliki perkiraan populasi (1162490). Mewakili kota Tikrit (159.721) dari jumlah penduduk. Dari penduduk kota Tikrit, 20% di kelompok usia reproduksi (15-45) tahun, dan satu lagi 20% dari penduduk di bawah usia 5 tahun (71).
Study Groups:
Random sampling dari masing-masing PHCC diambil dari Oktober 2004 hingga akhir Juni 2005, dengan mewawancarai wanita yang mengunjungi PHCC untuk Ibu dan Anak pelayanan kesehatan yang memiliki anak kurang dari 2 tahun. Ukuran sampel adalah 5% dari wanita dalam kelompok usia reproduksi, setara dengan sekitar 760. Lima PHCCs dipilih.
Kunjungan harian dilakukan oleh penyidik sendiri. Dalam setiap hari, salah satu PHCCs dikunjungi selama jangka waktu 6 bulan. Wawancara dengan setiap wanita yang mengunjungi pusat-pusat dilakukan secara terpisah dan dengan privasi lengkap, sehingga jawaban (terutama tentang pendapat mereka) kurang dipengaruhi oleh mendengar jawaban dari orang lain. Setiap pertanyaan diajukan dalam bahasa yang sederhana. Sejumlah perempuan yang diwawancarai 760 dari semua pusat.
Sumber perawatan kesehatan:
Seperti dalam PHCCs di Irak, pusat-pusat di Kota Tikrit menyediakan paket komprehensif layanan kesehatan primer. Ada 5 PHCCs di kota Tikrit, dan mereka semua memberikan perawatan kehamilan dan kesehatan anak ibu, dan satu (1) rumah sakit umum utama dan (2) rumah sakit kecil, dan ada beberapa klinik asuransi kesehatan dan banyak klinik-klinik swasta.
Penekanan utama adalah pada perawatan kesehatan ibu dan anak, kesehatan sekolah, perawatan kuratif dan penyakit menular.
Di antara program-program yang memiliki prioritas tinggi adalah program perluasan imunisasi (EPI), terapi rehidrasi oral (ORT) untuk mengendalikan penyakit diare, dan manajemen kasus penyakit pernapasan akut.
Perintis Studi dan Pretest:
Sebuah uji coba skala kecil studi ini dilakukan pada sampel dari 30 kasus termasuk bayi dengan orangtua mereka, untuk mengidentifikasi daerah-daerah ambiguitas dalam kuesioner dan untuk memiliki sebuah gagasan tentang waktu yang diperlukan dan lainnya poin praktis sebelum studi akhir diluncurkan.
Pengembangan Kuesioner dan Pengumpulan Data:
Kuesioner dikembangkan untuk mengumpulkan informasi berikut dan variabel dari semua yang terlibat perempuan (studi populasi, lihat lampiran):
Kuesioner yang berkaitan dengan:
1. Pendidikan / pekerjaan ibu.
2. Menyusui / Nutrisi.
3. Pemantauan pertumbuhan.
4. Penyakit diare.
5. Infeksi saluran pernafasan akut-ARI (penyakit pernafasan).
6. Imunisasi.
7. Penitipan anak.
Analisis Statistik:
Data yang dikumpulkan di (760) ibu dan bayi mereka dipelajari, dan teknik statistik konvensional yang diterapkan ke data dalam studi persentase distribusi berdasarkan frekuensi, grafik batang, diagram lingkaran dan tabel representasi.
HASIL
Dari data yang dikumpulkan secara acak dari 5 pusat kesehatan di kota Tikrit, data yang dikumpulkan sesuai dengan kuesioner pra-set seprai, 760 ibu-ibu menghadiri ke PHC di mana dikenai survei.
Hasil studi menunjukkan bahwa sebagian besar anak-anak ditimbang 85,79% pada kunjungan pendaftaran, sementara 14,21% tidak dicatat (Tabel 1). Kekecewaan ibu adalah tinggi (82,89%) sementara mereka yang menghadiri satu waktu hanya 17,11% (Tabel 2)
Tabel 1. Distribution of study sample according to the weights recorded at registration
Berat badan No %
tercatat 652 85.79
tidak tercatat 108 14.21
total 760 100.00
Table 2. Distribution of study sample according to their attendance of appointments
Attendance to appointment No %
at time 130 17.11
delayed 630 82.89
total total 760 100.00
Hasil studi menunjukkan tertinggi persen dari ibu ibu rumah tangga (86,89%) berada di dalam kelompok umur 25-34 tahun, sedangkan tertinggi persen ibu-ibu bekerja (33,87%) adalah dalam kelompok usia (35-44) tahun (Tabel 3 ). Para ibu yang sedang menghadiri pendidikan tinggi di 31% saja, sedangkan tertinggi persen memiliki pendidikan menengah 50% (Tabel 4).
Table 3. The relationship between age of mother and their work status
Mother age group Work status Total women at age group % of total
Housewife % of age group Employed % of age group
12-24 180 71.43 72 28.57 252 33.16
25-34 334 86.98 50 13.02 384 50.53
35-44 82 66.13 42 33.87 124 16.32
Total 596 78.42 164 21.58 760 100.0
Significant (P value < 0.05)
Table 4. Distribution of study sample according to mothers' education
mother education No. %
cannot read and write 54 7.11
read and write (primary) 90 11.84
intermediate & secondary 380 50.00
University & post graduate 236 31.05
Total 760 100.00
Hasil anak-anak menurut jenis makan menunjukkan bahwa sebagian besar bayi menyusui 44,74%, 35,53% adalah botol pakan dan 19,74% adalah campuran makan. (Tabel 5)
Table 5. Distribution of women according to type of feeding of their infants
Type of feeding No. %
breast fed 340 44.74
bottle fed 270 35.53
mixed 150 19.74
total 760 100.00
Para ibu yang menyusui anak-anak mereka selama satu jam pertama setelah melahirkan itu hanya 30,26% dan ibu yang menyusui mulai 1-8 jam setelah melahirkan adalah 31,84% (Tabel 6). Yang paling umum disajikan makanan tambahan untuk bayi dari 1-2 tahun adalah madu atau gula 92% (Tabel 7).
Table 6. First time mothers who breast-fed their children
Time of starting breast feeding No. %
During 1st hour after delivery 230 30.26
From 1-8 hours after delivery 242 31.84
More than 8 hours 238 31.32
Don't remember 50 6.58
Total 760 100.00
Table 7. Type of extra-food presented to the babies aged 1-2 years
Type yes no Total no. of cases
No. % No. %
water / herbal teas 259 78.48 71 21.52 330
semi-solid food ( gruel porridge or semolina) 330 76.74 100 23.26 330
fruits or juices 300 69.77 130 30.23 330
carrot squash, mango or papaya 232 53.95 198 46.05 330
leafy green vegetables (spinach) 216 50.23 214 49.77 330
meat or fish 190 44.19 240 55.81 330
lentil peanuts or beans 240 55.81 190 44.19 330
eggs or yogurts 342 79.53 88 20.47 330
honey or adding sugar 396 92.09 34 7.91 330
adding fat or oil 260 60.47 170 39.53 330
Para ibu yang tahu bahwa menghindari susu botol akan tetap menyusui bayi mereka adalah 35,26%, sementara orang-orang yang percaya bahwa ASI eksklusif adalah perilaku yang benar agar mereka tetap menyusui, merupakan sekitar 28,95% (Tabel 8).
Hasil penelitian menunjukkan bahwa 43,95% memberi makanan kaya zat besi untuk bayi mereka, sementara 35,26% tidak tahu sama sekali tentang apa yang harus ditambahkan sesuai dengan usia anak (Tabel 9).
Table 8. Type of extra-food presented to the babies aged 1-2 years
Attitude No %
Does not know 132 17.37
exclusive breast feeding 220 28.95
avoid bottle feeding 268 35.26
frequent sucking to stimulate production 140 18.42
Totals 760 100.00
Table 9. Type of additional foods
Knowledge regarding food type No. %
Does not know 268 35.26
add oil to food 158 20.79
give food rich in Iron 334 43.95
Totals 760 100.00
Hasil penelitian menunjukkan bahwa hanya 2,1% dari ibu-ibu mengetahui peran vitamin. A dan makanan apa yang mengandung bahwa vitamin (Tabel 10).
Table 10. Mother knowledge about the importance of Vitamin A
Question They know Does not know Total
No. % No. %
Which Vitamin prevent night blindness? 16 2.11 744 97.89 760
Which types of food contain Vitamin A? 16 2.11 744 97.89 760
Bukti diare selama dua minggu terakhir di antara anak-anak, adalah 47,37%
(Table 11) . Hasil penelitian menunjukkan bahwa tinggi ibu persen (37,63%) berhenti menyusui sama sekali selama diare (Tabel 12). Sekitar 38,89% ibu memberi cairan lebih dari biasanya selama diare, sedangkan 11.11% dari mereka berhenti sama sekali
(Table 13) .
Table 11. Evidence of diarrhoea during the last two weeks among infants
Evidence of diarrhoea No %
Present 360 47.37
Absent 400 52.63
Totals 760 100.00
Table 12. Attitude towards breastfeeding during diarrhoea
Evidence of breast feeding No. %
more than usual 156 20.53
same as usual 134 17.63
less than usual 30 3.95
stopped completely 286 37.63
child does not breast feed 26 3.42
does not know 128 16.84
totals 760 100.00
Table 13. Provision of fluid during diarrhoea
Provision of fluid No. %
more than usual 140 38.89
same as usual 90 25.00
less than usual 60 16.67
stopped completely 40 11.11
exclusive breast feeding 30 8.33
totals 360 100.00
Hasil juga menunjukkan bahwa sekitar separuh dari ibu-ibu memberikan antibiotik atau ante-obat diare selama diare (52,78%), sementara 16.67% memberikan Rehidrasi Oral Therapy (ORT) hanya (Table14). Yang tinggi persen (95%) dari ibu-ibu mencari nasihat medis untuk anak-anak mereka (Tabel 15) dan tertinggi persen ibu dalam studi pergi ke rumah sakit umum - 44,44% (Tabel 16).
Table 14. Type of treatment during diarrhoea
Type of treatment No. %
nothing 18 5.00
ORT 60 16.67
sugar-salt solution 22 6.11
cereal based ORT 30 8.33
infusion or other fluids 40 11.11
Anti-diarrhoeal medicine or antibiotics 190 52.78
total 360 100.00
Table 15. Evidence of seeking advice and/or treatment for the diarrhoea
Evidence of seeking advice No. %
Present 342 95.00
Absent 18 5.00
total 360 100.00
Table 16. Source of advice and/or treatment for the diarrhoea
Source of advice No. %
General Hospital 152 44.44
Health center/clinic 100 29.24
Private clinic/ doctor 46 13.45
Pharmacy 20 5.85
Village health worker 10 2.92
Traditional healer 6 1.75
Relatives and friends 8 2.34
Total 342 100.00
Sebagian besar ibu mencari nasehat atau pengobatan untuk anak ketika sakit yang sulit bernapas, dan sebagian besar ibu-ibu membawa anak mereka ke rumah sakit umum 24,5% dan 30% untuk pusat kesehatan (Tabel 17).
Table 17. Source of advice and/or treatment when child is suffering from difficult breathing
Source of advice No. %
General hospital 187 42.50
Health center 132 30.00
Private clinic 42 9.50
Pharmacy 27 6.10
Village health worker 18 4.09
Traditional healer 12 2.72
Traditional birth attendant 6 1.36
Relatives and friends 16 3.63
Total 440 100.00
Hasilnya menunjukkan bahwa hanya sekitar 18,4% dari ibu-ibu tahu persis jumlah vaksin toksoid tetanus diperlukan selama kehamilan (Tabel 18).
Sebagian besar anak-anak telah diimunisasi, sekitar 82%, sementara 4% tidak tahu apakah anak-anak telah diimunisasi sama sekali (Tabel 19).
Table 18. Knowledge of the number of immunizations the pregnant women needs for protection
Knowledge No. %
one 172 22.63
two 140 18.42
more than two 110 14.47
none 194 25.53
does not know 144 18.95
total 760 100.00
Table 19. Presence of immunization card for the child
Presence of card No. %
Available 630 82.89
Not Available 130 17.11
Total 760 100.00
Hasilnya menunjukkan bahwa hanya 49,2% ibu memiliki kartu ibu (Table20), dan bahwa hanya 43,8% ibu-ibu yang memiliki kartu ibu yang divaksinasi dua kali, terhadap tetanus selama kehamilan (Tabel 21).
Table 20. Presence of Maternal card
Presence of card No. %
Present 374 49.21
Absent 386 50.79
Total 760 100.00
Table 21. Number of Tetanus Toxoid vaccination in the maternal card
Times No. %
one 190 50.80
two 164 43.85
none 20 5.35
total 374 100.00
Sekitar 95% ibu-ibu memiliki ruang untuk mencatat kunjungan kehamilan di kartu ibu (Tabel 22), dan hanya 38% ibu memiliki satu kunjungan antenatal dicatat dalam kartu mereka (Tabel 23). Hanya 17,9% sedang hamil (Tabel 24).
Table 22. Presence of space to record antenatal care visits
Presence No. %
yes 356 95.19
no 18 4.81
total 374 100.00
Table 23. Evidence of recording mother's antenatal visit
Evidence No. %
one 136 38.20
two or more 218 61.24
none 2 0.56
total 356 100.00
Table 24. Evidence of current pregnancy
Evidence No. %
Present 136 17.89
Absent 624 82.11
total 760 100.00
Sekitar 54% ibu-ibu berharap untuk menjadi hamil dalam 2 tahun berikutnya (Table25). Penggunaan kontrasepsi adalah 86,84% (Tabel 26). Sekitar 33% ibu-ibu yang diteliti pergi ke PHCC pada trimester terakhir kehamilan (Tabel 27).
Table 25. Evidence of desire to become pregnant in the next 2 years
Evidence No. %
Present 340 54.48%
Absent 225 36%
Does not know 59 9.5%
total 624 100.00
Table 26. Usage of methods to avoid pregnancy (contraception)
Usage of contraceptives No. %
Present 264 86.84
Absent 40 13.16
total 304 100.00
Table 27. First time of visiting health professional after getting pregnant
Type No. %
first trimester 1-3 months 154 20.26
middle of pregnancy 4-6 months 234 30.79
last trimester 7-9 months 250 32.89
no need to see health professional 64 8.42
does not now 58 7.63
total 760 100.00
Hasil penelitian menunjukkan bahwa 24,2% ibu tidak tahu makanan apa yang baik bagi wanita untuk mencegah anemia (Tabel 28).
Table 28. Knowledge of types of food that are beneficial for pregnant women to prevent anaemia
Knowledge of type of food No. %
Does not know 184 24.21
Proteins rich in iron (egg, fish, meat) 340 44.74
Leafy green vegetables 236 31.05
total 760 100.00
Para ibu yang tahu jawaban yang benar mengenai berat badan selama kehamilan adalah 22,89% (Tabel 29).
Table 29. Knowledge of how much weight a women should gain during pregnancy
Knowledge of weight No. %
10-12 kg. 174 22.89
gain weight of the baby 374 49.21
does not know 212 27.89
total 760 100.00
DISKUSI
Sejak tahun 1960-an, kehidupan keluarga program-program di negara-negara maju telah menghasilkan hasil yang positif dalam hal peningkatan baik pengetahuan tentang perkembangan anak dan orangtua-anak keterampilan interaksi antara keluarga, serta mengubah sikap orangtua. Program-program tersebut juga telah ditemukan untuk meningkatkan kemungkinan bahwa orangtua remaja akan kembali ke sekolah dan memperoleh pendidikan yang lebih tinggi secara signifikan. Sebagai perbandingan, ibu-ibu remaja yang belum mengikuti kelas mengasuh anak telah ditemukan untuk menunjukkan lebih banyak dependensi, isolasi yang lebih besar, kurang minat dalam kegiatan-kegiatan, lebih stres membesarkan anak-anak mereka, dan lebih banyak harapan yang tidak realistis dari anak-anak mereka (72).
Studi Distribusi Contoh:
Data yang dikumpulkan telah menunjukkan bahwa mayoritas para ibu ibu rumah tangga 82,3%, dengan sebagian besar dari mereka pada kelompok umur 25-34 tahun (yakni 86,9%). Hanya sekitar 31% dari mereka mempunyai pendidikan tinggi. Data-data ini diharapkan di negara kita, terutama di provinsi kami, dan sebuah kelaziman kebiasaan pedesaan terlihat di sini-khususnya mereka yang peduli dengan perempuan yang bekerja dan meninggalkan sekolah pada awal periode kehidupan akademik.
Sekitar 82,8% dari ibu-ibu yang diteliti tertunda luar PHC janji yang diberikan oleh pekerja untuk kunjungan rutin mereka, yang mungkin mencerminkan = mereka minat miskin dan ketidakpedulian ibu-ibu untuk layanan PHC. Situasi politik juga dapat memainkan peran.
Pengetahuan dan Sikap Menyusui
Data dari 86 negara menunjukkan bahwa terdapat perbedaan yang sangat besar dalam praktek menyusui antar negara, antara kelompok-kelompok penduduk di dalam kabupaten, dan dalam kelompok-kelompok yang berbeda selama periode waktu (73). Sebuah tren menurun dalam menyusui telah dicatat secara luas di berbagai negara di Timur Tengah, terutama di daerah perkotaan di mana ibu-ibu dengan mengangkat status sosial ekonomi resor untuk botol-cukup makan awal (74).
Dalam studi saat ini, sebagian besar ibu-ibu mencicipi percaya bahwa ASI adalah makanan terbaik bagi bayi-bayi mereka dan tahu bahwa ASI memiliki banyak keuntungan untuk bayi, ibu dan keluarga, tetapi hanya sekitar 45% dari ibu-ibu memiliki sikap positif terhadap pemberian ASI, dan hanya 30% dari para ibu menyusui anak-anak mereka selama satu jam pertama kehidupan. Grover et al (75) di India juga menemukan bahwa meskipun mayoritas responden memiliki pengetahuan yang baik terhadap pemberian ASI, persentase menyusui dalam studi ini juga lebih rendah dari seharusnya, dan hanya sekitar 9,1% dari mereka disusui anak-anak mereka selama satu jam pertama kehidupan. Promosi menyusui adalah salah satu intervensi penting untuk mengurangi kematian bayi dan meningkatkan perkembangan bayi di seluruh dunia (76), dengan demikian penting untuk mendorong ibu untuk mulai menyusui sedini mungkin. Hal ini melihat dalam studi yang kami saat ini sekitar 62% ibu-ibu mulai menyusui bayinya dalam 8 jam pertama setelah melahirkan, yang setuju dengan apa Skema (77) di Libya melihat di ruang kerjanya (yaitu 65%).
Dalam penelitian ini, tingkat pemberian ASI eksklusif sangat rendah di antara ibu menyusui (yakni 28,9%). Li et al (76) dalam sebuah penelitian di Thailand juga memperhatikan tingkat yang relatif rendah pemberian ASI eksklusif di kalangan ibu-ibu di bawah penelitian dibandingkan dengan total jumlah ibu menyusui. Antenatal rencana untuk menyusui eksklusif dan menyusui bayi yang baru lahir di rumah sakit setelah lahir mungkin memainkan peran kunci dalam masa pemberian ASI eksklusif. Temuan ini menunjukkan pentingnya penguatan pralahir pelaksanaan pendidikan kesehatan tentang menyusui (76).
ASI eksklusif selama enam bulan ini semakin banyak diperlihatkan untuk menjadi pusat kesehatan bayi dan bahkan kesehatan ibu karena dampaknya pada jarak kelahiran. Penelitian sebelumnya telah terlalu sering didasarkan pada definisi yang tidak memadai pemberian ASI eksklusif, dan dengan demikian telah meremehkan pentingnya. Bahkan pemberian air glukosa segera setelah melahirkan atau memberi makan air komplementer, tidak diperlukan dan praktek-praktek berbahaya (78).
Penggunaan botol menyusui membuat kegagalan lebih mungkin untuk sejumlah alasan, termasuk puting kebingungan bagi bayi. Dalam studi saat ini, sekitar 35% dari ibu-ibu tahu bahwa susu botol menghindari mempromosikan pemeliharaan mereka praktek menyusui. Suplemen yang diberikan oleh cangkir tidak memenuhi kebutuhan mengisap bayi, dan ini dapat menjelaskan mengapa secara tradisional makanan pendamping ASI dari usia dini lebih mudah untuk mempertahankan bersama terus menyusui dari botol-menyusui tampaknya (79).
Pelengkap makanan termasuk semua makanan yang diberikan kepada anak selain susu. Jangka waktu komplementer makanan adalah sangat penting untuk kesehatan dan kesejahteraan anak. Di satu pihak, sebelum 6 bulan, ASI menawarkan perlindungan umum untuk anak-anak dari penyakit diare dan infeksi lain. Selain itu, penundaan pengenalan makanan lain menawarkan beberapa perlindungan (77)
Di sisi lain, setelah 4-6 bulan, pertumbuhan tidak dapat dipertahankan pada ASI saja. Menurut WHO, International Pediatric Association dan badan-badan lain, pengenalan makanan pelengkap harus dimulai pada usia 4-6 bulan (77).
Lebih dari 35,7% ibu-ibu dalam penelitian ini adalah menambah makanan pelengkap dari 4 bulan lebih awal dari kehidupan anak, dibandingkan dengan 17,9% dicatat oleh Skema (77) di Libya dan 87,9% dilihat oleh Saowakontha (80) di desa Thailand. Sekitar 58,6% ibu-ibu dalam penelitian ini adalah memperkenalkan suplemen sebelum usia 6 bulan, sedangkan Al-Sekait (81) telah disebutkan bahwa studi di Sudan menunjukkan sekitar 76% -91% dari ibu-ibu ada memperkenalkan suplemen sebelum usia 6 bulan. Perbedaan tinggi ini menunjukkan kesenjangan besar antara pengetahuan dan sikap ibu-ibu di daerah-daerah berbeda dari negara-negara berkembang komplementer mengenai makanan dan usaha besar yang harus dilakukan untuk mengatasi latar belakang miskin ini para ibu di wilayah ini, termasuk negara kita.
Tujuan dari makanan komplementer adalah mentransfer anak dari ASI ke makanan keluarga. Makanan pelengkap praktik telah disurvei di sebagian besar negara-negara Arab (82,83). Pola umum dalam studi ini sebagian besar sama seperti dalam strata sosial ekonomi yang sesuai.
Air, jus, semisolid makanan, telur, dan menambahkan gula dan madu merupakan suplemen yang paling umum diberikan untuk anak-anak oleh ibu-ibu dalam studi saat ini, yang setuju dengan apa yang Shembesh melihat di Libya (77), Serenius di Arab Saudi (82), dan apa Patwardan di Timur Tengah telah dilakukan (84).
Pengaruh budaya memainkan peran utama dalam keputusan tentang makanan yang harus diperkenalkan dan pada usia berapa (82). Sekitar 35,2% dari ibu-ibu dalam studi saat ini tidak tahu tentang apa yang harus ditambahkan tepat untuk anak di usianya, tetapi mereka mengikuti saran perempuan yang lebih tua dalam keluarga atau teman-teman mereka. Sebuah pertanyaan sederhana tentang peran vitamin A dan makanan apa yang mengandung bahwa vitamin menunjukkan bahwa hanya 2,1% dari ibu-ibu tahu jawaban yang benar, yang memberikan kita petunjuk tentang latar belakang miskin.
Pertumbuhan Monitoring
Studi baru-baru ini mengevaluasi efektivitas program pemantauan pertumbuhan telah diteliti pendidikan mereka dan kemampuan pencegahan. Pendukung mengklaim bahwa pemantauan pertumbuhan dapat efektif jika masyarakat dan ibu-ibu lebih aktif terlibat dalam proses penimbangan dan pengukuran, dan jika teknologi ini dipahami oleh semua sebagai bantuan untuk pencegahan penyakit dan promosi kesehatan bukan sebagai "kuratif" prosedur. Yang lain berpendapat bahwa teori ini jarang mungkin untuk dilaksanakan. Cara-cara di mana pemantauan pertumbuhan preventif dapat dimungkinkan masih dalam eksplorasi, mengingat bahwa alasan seperti itu sangat tertanam "kuratif" pemantauan pertumbuhan harapan tidak sepenuhnya dipahami. Pemahaman tersebut memerlukan analisis pemantauan pertumbuhan dalam konteks Gobi (pemantauan pertumbuhan, terapi rehidrasi oral, menyusui, dan imunisasi) kerangka kelangsungan hidup anak (85).
Setelah ini pentingnya pemantauan pertumbuhan anak-anak, persentase anak-anak (24,3%) dengan tidak ada pertumbuhan kartu pemantauan, dan persentase anak-anak (14,2%) yang tidak ditimbang sama sekali selama 4 bulan terakhir usia mereka dianggap tinggi persentase.
Pengetahuan Ibu dan Sikap Mengenai Diare
Wabah diare terus berkembang, mengakibatkan lebih dari 3 juta kematian (86). Dalam studi saat ini, sekitar setengah dari ibu mengatakan bahwa anak-anak mereka memiliki diare selama dua minggu terakhir, yang menunjukkan kepada kita seberapa besar masalah dalam masyarakat kita, terutama di musim panas.
Menurut pedoman WHO untuk pengelolaan diare, anti-diare, anti-amuba dan anti-bacterials memiliki peran kecil (87). Walaupun demikian, terlalu sering menggunakan agen antimikroba telah dilaporkan untuk pengelolaan kondisi diare (88). Dalam studi saat ini, walaupun sekitar 96% dari ibu mencari nasihat medis untuk anak-anak mereka dengan diare dari tenaga medis, sekitar 53% dari anak-anak mereka mengambil antimikroba untuk perawatan. Ini menunjukkan penyalahgunaan lebar antimikroba ini oleh personel medis, yang mengarah pada gilirannya untuk bertahap lonjong dalam penggunaan terapi rehidrasi oral (ORT) dari waktu ke waktu. Dalam studi saat ini, penggantian fluida untuk anak-anak dengan diare hanya dipraktekkan oleh 38,9% ibu dengan benar, yang sesuai dengan apa yang Datta et al (89) ditemukan di India (yaitu hanya sekitar 40% dari ibu yang benar memberikan ORT untuk anak-anak mereka).
Pendidikan kesehatan masyarakat adalah sangat penting untuk manajemen kasus yang efektif, karena memiliki potensi untuk membangun hubungan yang produktif antara layanan kesehatan dan masyarakat, untuk meningkatkan kemampuan keluarga untuk mengenali tanda-tanda bahaya diare pada anak-anak dan untuk mendorong tepat dan perawatan awal mencari perilaku (90). Sekitar 13% ibu tidak tahu apa tanda-tanda diare memerlukan perhatian medis; lainnya mencari nasihat medis segera setelah anak-anak mereka demam atau muntah.
Pendidikan kesehatan yang efektif hanya dapat diberikan atas dasar pemahaman yang akurat yang berlaku pengetahuan, sikap dan praktek masyarakat (90). Studi ini menunjukkan bahwa pengetahuan dan sikap ibu tidak memuaskan, karena sekitar 44% ibu-ibu yang membawa anak mereka ke rumah sakit umum segera setelah mereka melihat episode diare, dan hanya sekitar 16% dari para ibu yang memberikan lebih banyak cairan untuk mereka anak-anak, sementara kurang dari 6% itu sering memberikan makanan kecil untuk anak-anak mereka. Anehnya, sekitar 17% ibu-ibu bahkan tidak tahu apa yang harus dilakukan setelah anak-anak mereka sembuh dari diare.
Pengetahuan dan Sikap Ibu Tentang ARI:
Pengendalian infeksi pernafasan akut (ISPA) adalah besar masalah kesehatan masyarakat di negara-negara berkembang. Anak penyakit pernafasan adalah salah satu masalah besar yang mempengaruhi anak-anak di Irak dalam kelompok studi. Ini juga mengonsumsi lebih besar dari anggaran pemerintah di sektor kesehatan primer. Pelaksanaan manajemen kasus protokol memerlukan partisipasi masyarakat untuk mengurangi morbiditas dan kematian dari ARI. Program pendidikan kesehatan hanya dapat efektif bila didesain untuk memperhitungkan pengetahuan yang berlaku, sikap dan praktek (KAP) masyarakat terhadap ARI pada anak-anak mereka (91).
Dalam studi saat ini, ibu mengatakan bahwa lebih dari 52% dari anak-anak mereka menderita batuk dan / atau sulit bernapas dalam dua minggu terakhir. Persentase tinggi ini menunjukkan besarnya masalah ini di kota Tikrit. Semua ibu menyadari kedua gejala, tetapi ketika mereka yang positif "batuk" jawaban yang ditanya tentang perkembangan selanjutnya sulit bernapas selama sakit, delapan belas wanita (yaitu 4,5%) tidak tahu, dan 12% wanita bahkan tidak mencari nasihat medis untuk anak-anak mereka sulit bernapas, yang sesuai dengan apa yang Simiyu (91) di Kenya ditemukan, di ibu-ibu memiliki pengetahuan yang baik dalam bentuk ringan ARI tetapi tidak bentuk-bentuk yang parah.
Hal itu juga melihat bahwa sekitar 7% dari ibu-ibu meminta nasihat bagi anak-anak sakit mereka dari personil non-medis, dan sekitar 14,7% tidak tahu gejala-gejala utama yang seharusnya membuat mereka membawa anak-anak mereka ke rumah sakit, yang menunjukkan pengetahuan mereka yang miskin dan / atau sikap mengenai kondisi serius anak-anak mereka. Penting untuk memahami bahwa rendahnya pemanfaatan layanan kesehatan bagi ARI moderat dapat mengakibatkan kematian yang tinggi terus tertunda karena sakit parah identifikasi anak-anak.
KAP ARI Sebuah survei di Irak pada 1995 (92) mengungkapkan bahwa 46% dari total 900 sampel ibu tertutup, bisa mendeteksi tanda-tanda risiko infeksi ARI terkait, dengan penelitian ini menunjukkan jumlah yang lebih tinggi (sekitar 65%), yang mungkin , karena diagnosis yang lebih baik dan manajemen yang lebih baik, yang dapat menyebabkan meningkatkan pengetahuan ibu tentang ARI.
Namun, metode pengobatan pada 71% masih percaya pada penggunaan antibiotik dan 64% kembali ke obat batuk. Di Utara Irak, survei dilakukan di tiga Governorat Utara pada bulan Desember 1994 dengan 30-klaster survei imunisasi. Survei menunjukkan bahwa ibu tidak sepenuhnya menyadari tanda-tanda dan gejala awal infeksi pernapasan pada anak-anak mereka dan kapan harus mencari nasihat medis, seperti terlihat dalam keterbatasan pengetahuan mereka tentang pernapasan cepat sebagai indikasi ARI. Namun, pengetahuan mereka tentang pernapasan sulit sebagai indikator infeksi pernafasan akut dan menghubungkan bahwa dengan prognosis kesehatan anak-anak mereka, adalah baik (92).
Pengetahuan dan Sikap Ibu Tentang Imunisasi
Immunization is a timely step for prevention of mortality and morbidity due to communicable diseases in the 0-5 year age group. The delivery system of immunization has many inherent problems to which an addition may be made by the people themselves, with their prejudices, carelessness and apathy (93) . In the current study, a small percentage of mothers (ie 4%) were not vaccinating their children -or do not know if their children have received immunization at all, in spite of all the programs held for vaccinating young children, which emphasizes what we have mentioned above.
Anehnya, sekitar seperempat dari ibu-ibu tidak tahu mengapa imunisasi diberikan kepada para ibu selama kehamilan; orang lain memberikan jawaban berbeda. Juga, hanya sekitar 18,4% dari ibu-ibu tahu jawaban yang benar tentang tahap-tahap imunisasi terhadap tetanus. El-sherbini (94) di Mesir juga menemukan bahwa sekitar 25,5% ibu tidak memiliki dasar dan penting pengetahuan tentang perawatan kehamilan. Meningkatkan ibu 'pengetahuan tentang tetanus adalah penting untuk meningkatkan cakupan tetanus toksoid. Selain itu, kehamilan akan menyebabkan kontak dengan sumber-sumber tetanus toksoid dan karenanya meningkatkan kemungkinan memiliki imunisasi (95).
Dua pertanyaan diajukan mengenai ketersediaan ruang di kartu ibu mereka, untuk merekam peristiwa-peristiwa seperti itu, dan jumlah vaksinasi tetanus kali dilaporkan dalam kartu itu. Meskipun ada ruang untuk mencatat informasi ini, (sekitar 96% dari kartu) , hanya 43,8% dari mereka adalah ibu vaksinasi dilaporkan dua kali, yang juga menunjukkan pengetahuan dan sikap buruk tentang imunisasi toksoid tetanus.
Pengetahuan dan Sikap Ibu Tentang Kehamilan dan Keluarga Berencana:
In the current study, about 17.9% of mothers were pregnant, and 54.5% of the remaining wish to be pregnant in the next two years. Also, about 13% of females who don't want to be pregnant or who have not decided yet to be pregnant in the next two years, are not currently using contraceptive methods to avoid pregnancy. These percentages show us the poor family planning of these females.
In the current study, a low level of knowledge and attitude regarding family planning was found, in contrast to what Aja et al (96) in Nigeria found, The findings in their study showed a high awareness level with a moderately positive attitude, and generally a low level of practice.
Mengenai kunjungan perawatan kehamilan, sekitar 38% dari ibu hanya memiliki satu kehamilan kunjungan selama kehamilan terakhir, dan 2 (yaitu 0,5%) perempuan tidak punya kunjungan sama sekali. This explains the poor knowledge and attitude of mothers towards the benefits of maternal care, especially if we know that about one-third (33%) of the mothers under study attend PHC centers at the last trimester of pregnancy and not before.
As an example of mothers' poor knowledge, about 22.9% of mothers know that (10 -12 kg) will be gained during pregnancy, the remaining either don't know or gave a wrong response. Also, about 24% of mothers don't know what food is good for women to prevent anaemia during pregnancy; even the answers about the question regarding the amount of food taken and whether it changed during pregnancy, was disappointing.
Mengingat fakta-fakta ini, adalah penting untuk menilai pengetahuan dan sikap dari populasi wanita yang berbeda mengenai isu-isu yang berkaitan dengan kesehatan ibu dan anak. Hal ini akan memungkinkan kita untuk menerapkan program-program yang sesuai untuk meningkatkan kesehatan perempuan dan anak-anak, dan memerangi penyebaran beberapa penyakit menular.
KESIMPULAN DAN SARAN
Kesimpulan:
1. Only about 31% of these mothers attended high education academies.
2. About 82.8% were delayed beyond their appointment given by PHC workers for their routine visits, which reflected their indifference and poor interest towards PHC services.
3. The knowledge and attitude of mothers is, generally, not satisfactory regarding diarroheal disease for their children.
4. Sekitar 65% ibu-ibu dalam studi kami memiliki pengetahuan yang baik tentang tanda-tanda ini dibandingkan dengan 46% pada tahun 1995.
5. Poor knowledge and attitude of mothers concerning immunization against tetanus, and also regarding antenatal care.
Saran:
1. To Ministry of Health- Directory of Health Education:
• Promotion of breast-feeding among mothers through educating them about beneficial effects by periodic conferences.
• Educating the mothers about the best KAP regarding ARI, diarrhoeal disease, and perinatal care through multiple periodic conferences and mass media.
2. To our Colleagues in Medical Colleges: Further studies should be held to evaluate the practices of mothers regarding childhood survival.
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Sumber : http://www.mejfm.com/journal/Jan2007/mother-child.htm
MAKALAH
TUGAS IPTEK
JURNAL KESEHATAN INTERNASIONAL
EKONOMI DAN STATUS GIZI
Disusun Oleh :
1. Asri Yekti Palestri ( PO 7131107006 )
2. Marlinda Prihantari ( PO 7131107024 )
3. Muthoharoh ( PO 7131107025 )
4. Destri Wiji Lestari ( PO 7131106086 )
REGULER TINGKAT III
DEPARTEMEN KESEHATAN REPUBLIK INDONESIA
POLITEKNIK KESEHATAN YOGYAKARTA
JURUSAN GIZI
2009
The Influence Of Maternal Socio-Economic And Nutritional Status On Foetal Malnutrition In Nigeria
• A multilevel analysis of the effect of household wealth inequality on under-five child under-nutrition: Evidence from the 2003 Nigeria Demographic and Health Survey
• Intestinal Parasitism In Rural And Urban Areas Of North Central Nigeria: An Update
• Pattern Of Depression And Family Support In A Nigerian Family Practice Population
• Anthropometric Measure And Sexual Dimorphism In Young Adult Nigerians Resident In Calabar
• Personal Dosimeter Use In Australian Nuclear Medicine Practice
Olusegun Joseph Adebami FWACP
Department Paediatrics and Child Health
Ladoke Akintola University of Technology Teaching Hospital
Gabriel Ademola Oyedeji FWACP, FRCP
Department of Paediatrics and Child Health
Obafemi Awolowo University Teaching Hospitals Complex
Joshua Owa Aderinsola FWACP, FNMCPaed
Department of Paediatrics and Child Health
Obafemi Awolowo University Teaching Hospitals Complex
Citation: O. J. Adebami, G. A. Oyedeji & J. O. Aderinsola : The Influence Of Maternal Socio-Economic And Nutritional Status On Foetal Malnutrition In Nigeria. . The Internet Journal of Third World Medicine. 2007 Volume 4 Number 1
Table of Contents
• Introduction
• Methods
• Results
• Babies, Sexes, Places of antenat
• Social Classes of Mothers
• Maternal Nutritional Status
• Education of Mothers
• Occupations of Mothers
• Discussion
• Corresponding Address
Abstract
Objective: To determine the role of maternal socio-economic and nutritional status in the aetiology of foetal malnutrition in Nigeria. Patients and Methods: This was a prospective study of the records of consecutive mothers who delivered singleton, term, live babies between January and August 2001 at the Wesley Guild Hospital, Ilesa, Nigeria. The socio-economic classes of the parents were determined; also the nutritional status of the mothers was determined using the body mass index (BMI). Foetal malnutrition/wasting was diagnosed using Clinical Assessment of Foetal Nutritional Status (CANS) and the score (CANSCORE) as adapted by Metcoff. 1 Babies were classified into those with foetal malnutrition (FM) and those without FM. The two groups were compared. Results: Of the 473 studied, 89 [18.8%] had FM. The BMI of the mothers ranged between 16.47 and 44.15 kg/m 2 . Twenty-five (5.4%) of the 473 mothers had low BMI (< 18.5 kg/m 2 ). The prevalence of low BMI (< 18.5 kg/m 2 ) was significantly higher among mothers whose infants had FM than in controls (72% versus 28%, χ 2 = 49.3 p = 0.0000). Significantly higher proportions of babies with foetal malnutrition were delivered by mothers of lower social groups (class IV and V) χ 2 = 7.6 p = 0.002. Thus, significantly greater numbers of babies with foetal malnutrition were delivered by mothers of the lower social group occupations for example petty trading (χ 2 =5.2, p< 0.02), subsistence farming (χ 2 = 7.0, p<0.01), messengers and similar unskilled labour jobs (χ 2 =5.2, p<0.02) compared with the higher social group occupation mothers. Conclusion: Improvement in the socio-economic and nutritional status of mothers is likely to reduce the prevalence of FM in Nigeria.
Introduction
Clinical evidence of wasting in a newborn, known as foetal malnutrition (FM) indicates failure to acquire the normal quantum of or loss of fat and muscle mass during intrauterine growth. 1 Perinatal problems and/or central nervous system sequelae are known to occur in babies with FM whether they are appropriate for gestational age (AGA) or small for gestational age (SGA). 1 Adverse conditions like poverty, undernutrition, infections and infestations may promote unsatisfactory pregnancy outcome. 2,3
Contributions of environmental factors to the aetiology of foetal malnutrition are varied and difficult to quantify but no doubt are influential on foetal growth. Previous reports have shown evidence of direct relationship between maternal physical work and birth outcome. 4,5 In relation to gestational age, pregnancy is divided into three trimesters of about 13 weeks with each trimester having a distinct pattern of growth. 1 The last trimester is characterized by rapid foetal growth. The most rapid period of normal foetal growth is in between 12 and 36 weeks gestation. Between 32 and 36 weeks, the rate of foetal weight gain reaches its peak at 200 to 225 grams per week and declines thereafter. 1 The aim of the present study was to examine the role of maternal socio-economic class and nutrition in the development of foetal malnutrition in Nigeria. The study was conducted at the maternity and neonatal units of the Wesley Guild Hospital (WGH), Ilesa, Southwestern Nigeria. This is the main referral health institution providing general and specialist Paediatrics and maternity services to the semi-urban Ijesa community of Osun State in Southwestern Nigeria.
Methods
Maternal data including name, age, hospital number, date of last menstrual period (LMP), parity, place of antenatal care (ANC), number of clinic attendances, total duration of pregnancy, duration of pregnancy at booking, maternal height, booking weight and the last weight before delivery were obtained and entered into a research proforma designed for the study.. Nutritional status of the mother was determined by calculating the body mass index (BMI). 6 The socio-economic classes of the parents were derived from the occupation and the educational levels attained by both parents as described by Oyedeji. 7
Each baby was weighed nude and gestational age assessed using Dubowitz score. 8 The diagnosis of foetal malnutrition was made using a simple, rapid and quantifiable method called Clinical Assessment of Foetal Nutritional Status (CANS) and the score (CANSCORE) adapted by Metcoff. 1 CANSCORE consists of nine ‘superficial' readily detectable signs of fetal malnutrition. This was based on inspection and hands–on estimates of loss of subcutaneous tissue and muscles. Hairs, Cheeks, Neck and Chin, Arms, Back, Buttock, Legs, Chest and abdomen were examined thus and then scored. The range of score for each varied between 1 and 4. Maximum score of 4 was awarded to each parameter with no evidence of malnutrition and lowest score of 1 was awarded to parameter with the worst evidence of malnutrition. The total rating of the nine CANS sign is the CANSCORE for the subject. The CANSCORE ranges between 9 (lowest) and 36 (highest). Babies with CANSCORE below 25 were diagnosed as having FM. Babies with CANSCORE of 25 and above were regarded as normal. Mothers of babies who had no sign of FM were used as controls and the findings in cases and controls were compared.
Results
Babies, Sexes, Places of antenatal care and Delivery
Four hundred and seventy three [473] term, singleton, live babies were studied. There were 246 [52.0%] males and 227 [48.0%] females giving a male: female ratio of 1.08:1. Gender distribution was similar in all the gestational age groups (p = 0.49). The mean gestational age for males was similar to that of females (39.11 ± 1.35 weeks versus 39.01± 1.39 weeks, t = 0.8, df = 1, p = 0.71). The distribution of mean weight and mean length of males and females in relation to gestational age is shown in Table I. The overall mean weight for the males was significantly higher than that of the females (p = 0.00001). Eighty-nine [18.8%] of the 473 babies studied fulfilled the criteria for the diagnosis of FM. The distribution of foetal malnutrition in relation to gestational age and sex is shown in Table II. Forty-three (17.5%) males and 46 [20.3%] females had features of FM, giving a male: female ratio of 1:1.09 among babies with FM. This was not a significant departure from the overall male/female ratio of 1.08:1 (p = 0.75).
Table 1: Mean weight and length of 473 babies in relation to gestational age.
Table 2: Distribution of foetal malnutrition in relation to gestational age and sex.
Among the 473 mothers, 394 had antenatal care in various health units. These were in the Wesley Guild Hospital (321), maternity centres (32), primary health centres (25), other government hospitals (6), and private clinics (10). Twenty-two (27.8%) of the 79 mothers who did not have antenatal care had babies with FM compared with 67 (17.0%) of 394 babies of mothers who received antenatal care (χ 2 p< 0.025).
Social Classes of Mothers
There were 34 mothers in social class I and 95 in class II whilst 123 were in class III; one hundred and forty five in class V and 76 in class V. Fifty (22.6%) of the babies of the 221 mothers in lower social classes IV and V had FM compared with 39 (15.5%) of the babies of the 252 mothers in social class I, II and III (χ 2 p= 0.047). Thus, 50 (56.2%) of the entire 89 babies with FM were delivered by 221 mothers in lower social classes IV and V and the remaining 39 by the 252 mothers in the higher social classes I to III. There was no baby with FM in social class I.
Maternal Nutritional Status
Table III shows the comparison of maternal Body mass index (BMI) in relation to whether the babies had or did not have FM. The BMI of the mothers varied between 16.47 and 44.15 kg/m 2 Significantly higher proportion of mothers of babies with FM than of controls had BMI <18.5 kg/m 2 (χ 2 = 49.3 p<0.0001). Also, lower proportion of mothers with BMI in the overweight range (BMI greater than 25 kg/m 2 ) had babies with FM (χ 2 =19.4, p<0.0005).
Table 3: Comparison of maternal Body mass index (BMI) in relation to whether the babies had or did not have FM.
Education of Mothers
Table IV shows the distribution of the babies in relation to the educational levels attained by their mothers. The prevalence of FM increased with decreasing educational levels among the mothers of babies with FM .Thus, 20(22.5%) of babies with FM belong to the mothers without formal education.
Table 4: The distribution of babies with or without FM in relation to education of the mothers.
Occupations of Mothers
Table V shows the occupation of the mothers and the prevalence of FM. The main occupations were teaching, trading, public services, farming, tailoring and hairdressing. The occupations which were significantly associated with the development of FM were the lower social classes ones like petty trading (χ 2 =5.2, p< 0.02), farming (χ 2 =7.0, p<0.01) and being messengers (house-maids, cleaners, messengers in private small- scale establishments), (χ 2 =5.2, p<0.02). Mothers who engaged in large scale businesses and the professionals had significantly lower proportions of babies with FM.
Table 5: The distribution of babies with or without FM in relation to occupation of the mothers
Discussion
The overall prevalence of fetal malnutrition (FM) in the present study was 18.8%. This is higher than 10.9% observed by Metcoff 1 (1994) in America but similar to the 19.6% in an Indian study 9 which used the CANSCORE method also used in the present study. The differences in the prevalence rates of FM in these communities may be due to differences in the nutritional status in communities of study.
Foetal malnutrition (FM), results from intrauterine difficulties in the baby and may lead to high risk delivery and perinatal problems. 1,9,10,11 It is known to affect body composition and impair brain development and behaviour in experimental animals. Cohort studies years after birth have revealed that babies with FM have significantly lower intelligence quotient (IQ) scores and performance than well-nourished infants. 11,12 Foetal malnutrition has also been found to be a predisposing factor to the development of handicaps, including spastic diplegia, seizures, visual problems, learning disabilities or mental retardation at a later years. 12,13
Mothers who engaged in low social group occupations viz: farming, messenger work and petty trading had significantly higher proportion of babies with FM. Often two or more adverse factors associated with lower social class may coexist. For example, the role of low socioeconomic status is intertwined with those of ignorance, the use of crude and energy sapping methods of farming, low nutritional status, inadequate rest and prolonged standing.
Maternal Body mass index of less than 18.5 kg/m 2 was associated with FM in the present study (p<0.0001). Low maternal BMI is caused by chronically low energy intake due to inadequate food supply at the household level. 10 Previous reports about foetal malnutrition have suggested multiple factors responsible for its aetiology. 9,11 Thus, direct relationship has been demonstrated between physical work and birth outcome. 4,14 Manual workers and mothers working standing most of the time have a higher chance of delivering SGA babies. 4 On the average, a baby born at 28 weeks gestation weighs about 1000 grams. Between 28 weeks and 40 weeks [the third trimester], the baby triples its weight. This is evidence that considerable body growth takes place during this period. 1 This however is the period when most mothers becomes busier at work after the body has adjusted to the initial symptoms of hormonal changes in pregnancy.
The effect of prolonged standing on the baby has been hypothesized to be a result of diversion of blood from the feto-placental unit to the active muscles during strenuous movement/activity or reduction in venous return and blood volume during standing. 4,5 Prolonged and strenuous work may also affect the nutritional intake of the mothers because many may be too busy to have adequate rest and nutrition. This may partly explain why FM was generally found to be significantly commoner among the mothers in low social class (p<0.05) in the present study.
There is agreement among workers that maternal undernutrition is one of the causative factors of FM. 10,15 Improving maternal nutritional status in situations of poverty and starvation will therefore improve foetal outcome and reduce the prevalence of FM. 10 We note that, dietary supplementation during pregnancy has been shown to be highly effective in improving pregnancy outcomes and reducing perinatal mortality. 15 Also, it has been shown that some mothers who smoked during pregnancy but received nutritional supplementation from mid-pregnancy period had babies who were significantly heavier than babies of smokers who were not supplemented. 4 Improvement in values of BMI has been used as an index to monitor improvement in the nutritional status of pregnant mothers undergoing such dietary supplementation. 16 Aaron et al 17 similarly reported good pregnancy outcome when food supplementation during pregnancy was carried out in the rural villages of Guatemala. Chronic infusions of glucose and / or amino acids given to pregnant women to augment impaired foetal growth or nutrients added to the amniotic fluid have been shown to have apparent improvement of foetal growth. 1,16 It is therefore believed that food supplementation (as a foetal survival strategy), may be of immense benefit to the foetuses at risk of FM. 18,19 For better results, appropriate actions to improve maternal nutrition should be commenced early by improving the nutrition of the female child and adolescent. 21 Nonetheless, FM may be encountered among some high social class mothers in executive positions who work to the last days to their time of delivery, it is much commoner among babies of the low social class and illiterate mothers.
In order to reduce the prevalence of FM in African societies, the improvement of the socio-economic and nutritional status of women, female education, improved agricultural practices and assistance to pregnant mothers should receive much better attention than at present.
Corresponding Address
Dr. Olusegun Joseph Adebami
Department Paediatrics and Child Health,
Ladoke Akintola University of Technology Teaching Hospital,
Osogbo, Nigeria
E-mail: [segunadebami@yahoo.com]
Telephone: +2348037115347
References
1. Metcoff J. Clinical assessment of nutritional status at birth. Fetal malnutrition and SGA are not synonymous. Pediatr Clin North Am 1994; 41: 875 - 91 (s)
2. Ebrahim GJ. Perinatal Priorities in Developing Countries. In: Paediatrics Practice in Developing Countries. London, Macmillian Press 1987; 194-202. (s)
3. Dawodu A. Neonatology in developing countries: Problems, practices and prospects.Ann Trop Paediatr 1998; 78: 573 - 79. (s)
4. Tafari N, Naeye RL and Gobezie A. Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight. Br J Obstet Gynaecol 1980; 87: 222-26. (s)
5. Lenore JL, Jose V, Edgar K and Mercedes-de O. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study. Br J Obstet Gynaecol; 1990; 97: 62 -70. (s)
6. World Health Organization consultation on obesity. Classification according to Body Mass Index [BMI]. Geneva; 1997: 6. (s)
7. Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesa. Nig J Paediatr 1985; 12: 111-117. (s)
8. Dubowitz LMS, Dubowitz V and Goldberg C. Clinical Assessment of gestational age in the newborn infant. J Pediatr 1970; 77: 1-10. (s)
9. Jayant D and Rajkumar J. Study of the prevalence and high risk factors for fetal malnutrition in term newborns. Ann Trop Paediatr 1999; 19: 273 - 77 (s)
10. World Health Organization. The Newborn infant. In: World Health Organization Physical Status: The use and interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Services 1995; 854: 121-158. (s)
11. Scott KK and Usher RH. Epiphyseal development in fetal malnutrition syndrome. N Engl J Med 1964; 270: 822-24 (s)
12. Hill RM, Verniaud WM, Deter RL, Tennyson LM, Rettig GM, Zion TE et al. The effects of intrauterine malnutrition on the term infants. A 14-year progressive study. Acta Paediatr Scand 1984; 73: 482-487. (s)
13. Wynn M and Wynn A. The importance of nutrition around the time of the fetus at different stages of gestation. In: Bateman EC (ed). Applied Nutrition. London, Libby, 1981: 12-19. (s)
14. Oni GA. The effects of maternal age, education and parity on birth weight in a Nigerian community: The comparison of results from bivariate and multivariate analyses. J Trop Pediatr 1986; 32: 295-300. (s)
15. Sana Mc, Andrew MP, Timothy JC, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ 1997; 315: 786-790. (s)
16. Harding JE and Charlton V. Treatment of the growth - retarded fetus by augmentation of the substrate supply. Semin Perinatol 1989; 13: 211-223. (s)
17. Aaron L, Jean-Pierre, Herman D, Robert EK, Charles Y and Reynaldo M. Effects of food supplementation during pregnancy on birthweight. Pediatrics 1975; 56: 508-19. (s)
18. Apte SV and Iyengar L. Composition of the human fetus. Br J Nutr 1972; 27:305-312. (s)
19. Scott KK and Usher RH. Fetal malnutrition: Its incidence, causes and effects. Am J Obstet Gynaecol 1966;94: 951-63 (s)
20. World Health Organization. Pregnant and Lactating Women. In: World Health Organization Physical Status: The use and interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Services 1995; 854: 37-120. (s)
Sumber : (http://www.ispub.com/journal/the_internet_journal_of_third_world_medicine/volume _4_number_1_53/article/the_influence_of_maternal_socio_economic_and_nutritional_status_on_foetal_malnutrition_in_nigeria.html)
(Diambil : Tanggal 08 September 2009, 10:36)
JURNAL KESEHATAN INTERNASIONAL
EKONOMI DAN STATUS GIZI
Disusun Oleh :
1. Asri Yekti Palestri ( PO 7131107006 )
2. Marlinda Prihantari ( PO 7131107024 )
3. Muthoharoh ( PO 7131107025 )
4. Destri Wiji Lestari ( PO 7131106086 )
REGULER TINGKAT III
DEPARTEMEN KESEHATAN REPUBLIK INDONESIA
POLITEKNIK KESEHATAN YOGYAKARTA
JURUSAN GIZI
2009
The Influence Of Maternal Socio-Economic And Nutritional Status On Foetal Malnutrition In Nigeria
• A multilevel analysis of the effect of household wealth inequality on under-five child under-nutrition: Evidence from the 2003 Nigeria Demographic and Health Survey
• Intestinal Parasitism In Rural And Urban Areas Of North Central Nigeria: An Update
• Pattern Of Depression And Family Support In A Nigerian Family Practice Population
• Anthropometric Measure And Sexual Dimorphism In Young Adult Nigerians Resident In Calabar
• Personal Dosimeter Use In Australian Nuclear Medicine Practice
Olusegun Joseph Adebami FWACP
Department Paediatrics and Child Health
Ladoke Akintola University of Technology Teaching Hospital
Gabriel Ademola Oyedeji FWACP, FRCP
Department of Paediatrics and Child Health
Obafemi Awolowo University Teaching Hospitals Complex
Joshua Owa Aderinsola FWACP, FNMCPaed
Department of Paediatrics and Child Health
Obafemi Awolowo University Teaching Hospitals Complex
Citation: O. J. Adebami, G. A. Oyedeji & J. O. Aderinsola : The Influence Of Maternal Socio-Economic And Nutritional Status On Foetal Malnutrition In Nigeria. . The Internet Journal of Third World Medicine. 2007 Volume 4 Number 1
Table of Contents
• Introduction
• Methods
• Results
• Babies, Sexes, Places of antenat
• Social Classes of Mothers
• Maternal Nutritional Status
• Education of Mothers
• Occupations of Mothers
• Discussion
• Corresponding Address
Abstract
Objective: To determine the role of maternal socio-economic and nutritional status in the aetiology of foetal malnutrition in Nigeria. Patients and Methods: This was a prospective study of the records of consecutive mothers who delivered singleton, term, live babies between January and August 2001 at the Wesley Guild Hospital, Ilesa, Nigeria. The socio-economic classes of the parents were determined; also the nutritional status of the mothers was determined using the body mass index (BMI). Foetal malnutrition/wasting was diagnosed using Clinical Assessment of Foetal Nutritional Status (CANS) and the score (CANSCORE) as adapted by Metcoff. 1 Babies were classified into those with foetal malnutrition (FM) and those without FM. The two groups were compared. Results: Of the 473 studied, 89 [18.8%] had FM. The BMI of the mothers ranged between 16.47 and 44.15 kg/m 2 . Twenty-five (5.4%) of the 473 mothers had low BMI (< 18.5 kg/m 2 ). The prevalence of low BMI (< 18.5 kg/m 2 ) was significantly higher among mothers whose infants had FM than in controls (72% versus 28%, χ 2 = 49.3 p = 0.0000). Significantly higher proportions of babies with foetal malnutrition were delivered by mothers of lower social groups (class IV and V) χ 2 = 7.6 p = 0.002. Thus, significantly greater numbers of babies with foetal malnutrition were delivered by mothers of the lower social group occupations for example petty trading (χ 2 =5.2, p< 0.02), subsistence farming (χ 2 = 7.0, p<0.01), messengers and similar unskilled labour jobs (χ 2 =5.2, p<0.02) compared with the higher social group occupation mothers. Conclusion: Improvement in the socio-economic and nutritional status of mothers is likely to reduce the prevalence of FM in Nigeria.
Introduction
Clinical evidence of wasting in a newborn, known as foetal malnutrition (FM) indicates failure to acquire the normal quantum of or loss of fat and muscle mass during intrauterine growth. 1 Perinatal problems and/or central nervous system sequelae are known to occur in babies with FM whether they are appropriate for gestational age (AGA) or small for gestational age (SGA). 1 Adverse conditions like poverty, undernutrition, infections and infestations may promote unsatisfactory pregnancy outcome. 2,3
Contributions of environmental factors to the aetiology of foetal malnutrition are varied and difficult to quantify but no doubt are influential on foetal growth. Previous reports have shown evidence of direct relationship between maternal physical work and birth outcome. 4,5 In relation to gestational age, pregnancy is divided into three trimesters of about 13 weeks with each trimester having a distinct pattern of growth. 1 The last trimester is characterized by rapid foetal growth. The most rapid period of normal foetal growth is in between 12 and 36 weeks gestation. Between 32 and 36 weeks, the rate of foetal weight gain reaches its peak at 200 to 225 grams per week and declines thereafter. 1 The aim of the present study was to examine the role of maternal socio-economic class and nutrition in the development of foetal malnutrition in Nigeria. The study was conducted at the maternity and neonatal units of the Wesley Guild Hospital (WGH), Ilesa, Southwestern Nigeria. This is the main referral health institution providing general and specialist Paediatrics and maternity services to the semi-urban Ijesa community of Osun State in Southwestern Nigeria.
Methods
Maternal data including name, age, hospital number, date of last menstrual period (LMP), parity, place of antenatal care (ANC), number of clinic attendances, total duration of pregnancy, duration of pregnancy at booking, maternal height, booking weight and the last weight before delivery were obtained and entered into a research proforma designed for the study.. Nutritional status of the mother was determined by calculating the body mass index (BMI). 6 The socio-economic classes of the parents were derived from the occupation and the educational levels attained by both parents as described by Oyedeji. 7
Each baby was weighed nude and gestational age assessed using Dubowitz score. 8 The diagnosis of foetal malnutrition was made using a simple, rapid and quantifiable method called Clinical Assessment of Foetal Nutritional Status (CANS) and the score (CANSCORE) adapted by Metcoff. 1 CANSCORE consists of nine ‘superficial' readily detectable signs of fetal malnutrition. This was based on inspection and hands–on estimates of loss of subcutaneous tissue and muscles. Hairs, Cheeks, Neck and Chin, Arms, Back, Buttock, Legs, Chest and abdomen were examined thus and then scored. The range of score for each varied between 1 and 4. Maximum score of 4 was awarded to each parameter with no evidence of malnutrition and lowest score of 1 was awarded to parameter with the worst evidence of malnutrition. The total rating of the nine CANS sign is the CANSCORE for the subject. The CANSCORE ranges between 9 (lowest) and 36 (highest). Babies with CANSCORE below 25 were diagnosed as having FM. Babies with CANSCORE of 25 and above were regarded as normal. Mothers of babies who had no sign of FM were used as controls and the findings in cases and controls were compared.
Results
Babies, Sexes, Places of antenatal care and Delivery
Four hundred and seventy three [473] term, singleton, live babies were studied. There were 246 [52.0%] males and 227 [48.0%] females giving a male: female ratio of 1.08:1. Gender distribution was similar in all the gestational age groups (p = 0.49). The mean gestational age for males was similar to that of females (39.11 ± 1.35 weeks versus 39.01± 1.39 weeks, t = 0.8, df = 1, p = 0.71). The distribution of mean weight and mean length of males and females in relation to gestational age is shown in Table I. The overall mean weight for the males was significantly higher than that of the females (p = 0.00001). Eighty-nine [18.8%] of the 473 babies studied fulfilled the criteria for the diagnosis of FM. The distribution of foetal malnutrition in relation to gestational age and sex is shown in Table II. Forty-three (17.5%) males and 46 [20.3%] females had features of FM, giving a male: female ratio of 1:1.09 among babies with FM. This was not a significant departure from the overall male/female ratio of 1.08:1 (p = 0.75).
Table 1: Mean weight and length of 473 babies in relation to gestational age.
Table 2: Distribution of foetal malnutrition in relation to gestational age and sex.
Among the 473 mothers, 394 had antenatal care in various health units. These were in the Wesley Guild Hospital (321), maternity centres (32), primary health centres (25), other government hospitals (6), and private clinics (10). Twenty-two (27.8%) of the 79 mothers who did not have antenatal care had babies with FM compared with 67 (17.0%) of 394 babies of mothers who received antenatal care (χ 2 p< 0.025).
Social Classes of Mothers
There were 34 mothers in social class I and 95 in class II whilst 123 were in class III; one hundred and forty five in class V and 76 in class V. Fifty (22.6%) of the babies of the 221 mothers in lower social classes IV and V had FM compared with 39 (15.5%) of the babies of the 252 mothers in social class I, II and III (χ 2 p= 0.047). Thus, 50 (56.2%) of the entire 89 babies with FM were delivered by 221 mothers in lower social classes IV and V and the remaining 39 by the 252 mothers in the higher social classes I to III. There was no baby with FM in social class I.
Maternal Nutritional Status
Table III shows the comparison of maternal Body mass index (BMI) in relation to whether the babies had or did not have FM. The BMI of the mothers varied between 16.47 and 44.15 kg/m 2 Significantly higher proportion of mothers of babies with FM than of controls had BMI <18.5 kg/m 2 (χ 2 = 49.3 p<0.0001). Also, lower proportion of mothers with BMI in the overweight range (BMI greater than 25 kg/m 2 ) had babies with FM (χ 2 =19.4, p<0.0005).
Table 3: Comparison of maternal Body mass index (BMI) in relation to whether the babies had or did not have FM.
Education of Mothers
Table IV shows the distribution of the babies in relation to the educational levels attained by their mothers. The prevalence of FM increased with decreasing educational levels among the mothers of babies with FM .Thus, 20(22.5%) of babies with FM belong to the mothers without formal education.
Table 4: The distribution of babies with or without FM in relation to education of the mothers.
Occupations of Mothers
Table V shows the occupation of the mothers and the prevalence of FM. The main occupations were teaching, trading, public services, farming, tailoring and hairdressing. The occupations which were significantly associated with the development of FM were the lower social classes ones like petty trading (χ 2 =5.2, p< 0.02), farming (χ 2 =7.0, p<0.01) and being messengers (house-maids, cleaners, messengers in private small- scale establishments), (χ 2 =5.2, p<0.02). Mothers who engaged in large scale businesses and the professionals had significantly lower proportions of babies with FM.
Table 5: The distribution of babies with or without FM in relation to occupation of the mothers
Discussion
The overall prevalence of fetal malnutrition (FM) in the present study was 18.8%. This is higher than 10.9% observed by Metcoff 1 (1994) in America but similar to the 19.6% in an Indian study 9 which used the CANSCORE method also used in the present study. The differences in the prevalence rates of FM in these communities may be due to differences in the nutritional status in communities of study.
Foetal malnutrition (FM), results from intrauterine difficulties in the baby and may lead to high risk delivery and perinatal problems. 1,9,10,11 It is known to affect body composition and impair brain development and behaviour in experimental animals. Cohort studies years after birth have revealed that babies with FM have significantly lower intelligence quotient (IQ) scores and performance than well-nourished infants. 11,12 Foetal malnutrition has also been found to be a predisposing factor to the development of handicaps, including spastic diplegia, seizures, visual problems, learning disabilities or mental retardation at a later years. 12,13
Mothers who engaged in low social group occupations viz: farming, messenger work and petty trading had significantly higher proportion of babies with FM. Often two or more adverse factors associated with lower social class may coexist. For example, the role of low socioeconomic status is intertwined with those of ignorance, the use of crude and energy sapping methods of farming, low nutritional status, inadequate rest and prolonged standing.
Maternal Body mass index of less than 18.5 kg/m 2 was associated with FM in the present study (p<0.0001). Low maternal BMI is caused by chronically low energy intake due to inadequate food supply at the household level. 10 Previous reports about foetal malnutrition have suggested multiple factors responsible for its aetiology. 9,11 Thus, direct relationship has been demonstrated between physical work and birth outcome. 4,14 Manual workers and mothers working standing most of the time have a higher chance of delivering SGA babies. 4 On the average, a baby born at 28 weeks gestation weighs about 1000 grams. Between 28 weeks and 40 weeks [the third trimester], the baby triples its weight. This is evidence that considerable body growth takes place during this period. 1 This however is the period when most mothers becomes busier at work after the body has adjusted to the initial symptoms of hormonal changes in pregnancy.
The effect of prolonged standing on the baby has been hypothesized to be a result of diversion of blood from the feto-placental unit to the active muscles during strenuous movement/activity or reduction in venous return and blood volume during standing. 4,5 Prolonged and strenuous work may also affect the nutritional intake of the mothers because many may be too busy to have adequate rest and nutrition. This may partly explain why FM was generally found to be significantly commoner among the mothers in low social class (p<0.05) in the present study.
There is agreement among workers that maternal undernutrition is one of the causative factors of FM. 10,15 Improving maternal nutritional status in situations of poverty and starvation will therefore improve foetal outcome and reduce the prevalence of FM. 10 We note that, dietary supplementation during pregnancy has been shown to be highly effective in improving pregnancy outcomes and reducing perinatal mortality. 15 Also, it has been shown that some mothers who smoked during pregnancy but received nutritional supplementation from mid-pregnancy period had babies who were significantly heavier than babies of smokers who were not supplemented. 4 Improvement in values of BMI has been used as an index to monitor improvement in the nutritional status of pregnant mothers undergoing such dietary supplementation. 16 Aaron et al 17 similarly reported good pregnancy outcome when food supplementation during pregnancy was carried out in the rural villages of Guatemala. Chronic infusions of glucose and / or amino acids given to pregnant women to augment impaired foetal growth or nutrients added to the amniotic fluid have been shown to have apparent improvement of foetal growth. 1,16 It is therefore believed that food supplementation (as a foetal survival strategy), may be of immense benefit to the foetuses at risk of FM. 18,19 For better results, appropriate actions to improve maternal nutrition should be commenced early by improving the nutrition of the female child and adolescent. 21 Nonetheless, FM may be encountered among some high social class mothers in executive positions who work to the last days to their time of delivery, it is much commoner among babies of the low social class and illiterate mothers.
In order to reduce the prevalence of FM in African societies, the improvement of the socio-economic and nutritional status of women, female education, improved agricultural practices and assistance to pregnant mothers should receive much better attention than at present.
Corresponding Address
Dr. Olusegun Joseph Adebami
Department Paediatrics and Child Health,
Ladoke Akintola University of Technology Teaching Hospital,
Osogbo, Nigeria
E-mail: [segunadebami@yahoo.com]
Telephone: +2348037115347
References
1. Metcoff J. Clinical assessment of nutritional status at birth. Fetal malnutrition and SGA are not synonymous. Pediatr Clin North Am 1994; 41: 875 - 91 (s)
2. Ebrahim GJ. Perinatal Priorities in Developing Countries. In: Paediatrics Practice in Developing Countries. London, Macmillian Press 1987; 194-202. (s)
3. Dawodu A. Neonatology in developing countries: Problems, practices and prospects.Ann Trop Paediatr 1998; 78: 573 - 79. (s)
4. Tafari N, Naeye RL and Gobezie A. Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight. Br J Obstet Gynaecol 1980; 87: 222-26. (s)
5. Lenore JL, Jose V, Edgar K and Mercedes-de O. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study. Br J Obstet Gynaecol; 1990; 97: 62 -70. (s)
6. World Health Organization consultation on obesity. Classification according to Body Mass Index [BMI]. Geneva; 1997: 6. (s)
7. Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesa. Nig J Paediatr 1985; 12: 111-117. (s)
8. Dubowitz LMS, Dubowitz V and Goldberg C. Clinical Assessment of gestational age in the newborn infant. J Pediatr 1970; 77: 1-10. (s)
9. Jayant D and Rajkumar J. Study of the prevalence and high risk factors for fetal malnutrition in term newborns. Ann Trop Paediatr 1999; 19: 273 - 77 (s)
10. World Health Organization. The Newborn infant. In: World Health Organization Physical Status: The use and interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Services 1995; 854: 121-158. (s)
11. Scott KK and Usher RH. Epiphyseal development in fetal malnutrition syndrome. N Engl J Med 1964; 270: 822-24 (s)
12. Hill RM, Verniaud WM, Deter RL, Tennyson LM, Rettig GM, Zion TE et al. The effects of intrauterine malnutrition on the term infants. A 14-year progressive study. Acta Paediatr Scand 1984; 73: 482-487. (s)
13. Wynn M and Wynn A. The importance of nutrition around the time of the fetus at different stages of gestation. In: Bateman EC (ed). Applied Nutrition. London, Libby, 1981: 12-19. (s)
14. Oni GA. The effects of maternal age, education and parity on birth weight in a Nigerian community: The comparison of results from bivariate and multivariate analyses. J Trop Pediatr 1986; 32: 295-300. (s)
15. Sana Mc, Andrew MP, Timothy JC, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ 1997; 315: 786-790. (s)
16. Harding JE and Charlton V. Treatment of the growth - retarded fetus by augmentation of the substrate supply. Semin Perinatol 1989; 13: 211-223. (s)
17. Aaron L, Jean-Pierre, Herman D, Robert EK, Charles Y and Reynaldo M. Effects of food supplementation during pregnancy on birthweight. Pediatrics 1975; 56: 508-19. (s)
18. Apte SV and Iyengar L. Composition of the human fetus. Br J Nutr 1972; 27:305-312. (s)
19. Scott KK and Usher RH. Fetal malnutrition: Its incidence, causes and effects. Am J Obstet Gynaecol 1966;94: 951-63 (s)
20. World Health Organization. Pregnant and Lactating Women. In: World Health Organization Physical Status: The use and interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Services 1995; 854: 37-120. (s)
Sumber : (http://www.ispub.com/journal/the_internet_journal_of_third_world_medicine/volume _4_number_1_53/article/the_influence_of_maternal_socio_economic_and_nutritional_status_on_foetal_malnutrition_in_nigeria.html)
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