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Abstrak :
ABSTRAK
Manajemen Terpadu Balita Sakit (MTBS) merupakan suatu pendekatan terpadu tatalaksana balita sakit di pelayanan kesehatan dasar, meliputi upaya kuratif, promotif dan preventif. MTBS bertujuan untuk menurunkan angka kematian bayi dan balita. Penelitian ini merupakan penelitian deskriptif bertujuan untuk mengetahui gambaran pasien (usia, jenis kelamin, berat badan, tinggi/panjang badan, kunjungan, keluhan) dan menilai pelaksanaan MTBS sesuai bagan MTBS. Subjek penelitian ini berasal dari sumber sekunder yaitu format MTBS pasien yang berkunjung ke poli MTBS berjumlah 96 sampel, ditentukan berdasarkan simple random sampling. Instrumen yang digunakan merupakan instrumen yang dibuat oleh peneliti sendiri berdasarkan algoritma MTBS. Hasil penelitian ini menunjukkan keseluruhan pasien yang berkunjung merupakan kategori balita, sebagian besar perempuan dengan kunjungan pertama lebih banyak, dan sebagian besar memiliki tingkat keluhan sedang (≥2 - <5). Gambaran pelaksanaan MTBS untuk penilaian MTBS sebagian besar ?tidak lengkap?, klasifikasi ?sesuai?, tindakan/pengobatan ?sesuai lengkap?, dan untuk konseling keseluruhan ?ada namun tidak lengkap?. Ketersediaan sarana dan prasarana didapatkan tidak lengkap. Monitoring, evaluasi dan supervisi perlu ditingkatkan untuk memberikan pelayanan MTBS yang berkualitas.

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ABSTRACT
Integrated Management of Childhood Illness (IMCI) is an integrated implementation for chilldhood illness in the primary care, included curative, promotive, and preventive efforts. IMCI aims to reduce mortality of children under five years old. The research is descriptive and it's aim is to know the patients description (age, sex, weight, height, visits, grievance) and to assess the IMCI implementation according the IMCI chart. Subject of this research is derived from secondary sources that is patient IMCI format who visits IMCI polyclinic, amounted to 96 samples, and determined by simple random sampling. The used Instrument is made by the researcher based IMCI algorithm. Results of this research show that the overall of patients who visit are children under five years old, most are female, first visit, and most of them have middle grievance (≥2-<5). Description of IMCI implementation by IMCI assess, most of them are ?not complete?, clasification ?congruent?, action/medication ?appropriate and complete?, and overall of counseling ?existing but incomplete?. The availability of facilities and infrastructur is incomplete. Monitoring, evaluation, and supervision need to enhanced to give the best quality care of IMCI.

Abstrak :
Tesis ini membahas kualitas penanganan balita sakit dengan gejala ISPA yang mempakan analisis lanjutan data survei evaluasi MTBS di 8 Kabupaten. Penelitian ini adalah penelitian kuantitatif dengan desain cross sectional dan cluster di puskesmas. Besar sampel pada penelitian ini sebanyak 421 balita sakit dengan gejala ISPA dari 635 besar sampel yang diambil oleh Puslitkes-UI. Hasil p¢neIitian ini menunjukkan bahwa kualitas penanganan balita sakit dengan gejaia ISPA masih rendah. Disarankan agar dilakukan bagi kepala puskesmas untuk membentuk tim MTBS, membuat job description yang jelas, bagi dinkes provinsi atau kabupaten melakukan penyegaran pelatihan petugas MTBS, melakukan monev minimal 2 kali dalam setahun, memfasilitasi sarana di puskesmas. ......The study is exploring the quality of care for under-five children with the ARI symptoms ofthe continued analysis towards data of evaluation survey of the Integrated Management of Childhood Illness (IMCI/MTBS) at 8 districts. The study is a quantitative study with a crosvsectional and cluster designs at puskesmas. The number ofthe sample is 421 children with Acute Respiratory Infection (ARI/ISPA) symptom out of 635 sample of ill children that taken by thc CHRUI. The study revealed that thc quality of care for the under-live with ARI symptoms is still low. Suggestions arc delivered to the head of puskcsmas to develop a team of IMCI, to the Province and District Health Authority to carry out the Reiieshcd Training for MTBS providers and to pcrfomi monitoring and evaluation for at least twice a year, and to provide facilitation on the puskcsmas.

Abstrak :
Dua belas juta anak di dunia meninggal setiap tahunnya sebelum, mencapai usia 5 tahun. Dari angka tersebut 70% kematian bayi dan balita di negara berkembang disebabkan oleh pneumonia, diare, campak, malaria dan gizi buruk (malnutrisi) atau kombinasi dari penyakit tersebut. Di Indonesia penyebab utama kematian bayi berdasarkan data WHO (1990) bahwa sekitar 450.000 kematian balita yang terjadi setiap tahunnya, diperkirakan 150.000 diantaranya disebabkan oleh penyakit pneumonia. Pendekatam MTBS (Manajemen Terpadu Balita Sakit) merupakan suatu pendekatan keterpaduan dalam tata laksana balita sakit yang datang berobat ke fasilitas rawat jalan pelayanan kesehatan dasar yang meliputi upaya promotif dan kuratif penyakit pneumonia, diare, campak, malaria, infeksi telinga dan malnutrisi. Melalui pendekatan MTBS dapat memberikan kualitas penanganan penyakit pada balita akan lebih baik sehingga efektifitas penanganan penyakit pada balita dapat ditingkatkan mulai dari penilaian (Anamnesa dan Pemeriksaan), menentukan klasifikasi dan tindakan serta pengobatan. Penelitian ini merupakan suatu evaluasi ekonomi yang menggunakan data sekunder ditinjau dari sisi provider, dengan tujuan mendapatkan gambaran alternatif terbaik dan kegiatan penanganan pneumonia di puskesmas MTBS dan puskesmas non-MTBS di Kabupaten Tanah Datar tahun 2003. Hasil penelitian menunjukkan bahwa penanganan pneumonia di puskesmas MTBS lebih "cost efektif? dibandingkan dengan puskesmas non-MTBS, dimana biaya satuan pada puskesmas MTBS adalah sebesar Rp 11.588,-dan pada puskesmas non MTBS sebesar Rp 42.629; Agar MTBS dapat dilaksanakan oleh semua Puskesmas disarankan agar MTBS dapat disosialisasikan kepada legislatif dan eksekutif dalam hal ini pemerintah Daerah untuk mendapatkan dukungan dana dalam menunjang program MTBS. ......Cost Effectiveness Analysis of Handling Pneumonia in IMCI Health Center and Non IMCI Health Center at District of Tanah Datar, 2003Twelve million Children in the world die every year before they reach 5 year old. From its number 70% baby's mortality and below 5-years Child in development country caused by Pneumonia, diarrhea, measles, dengue and malnutrition or combine of these issues. In Indonesia, major causes of baby mortality based on WHO data (1990) about 450,000 in every year, estimate 150,000 is caused by Pneumonia. MTBS (Manajemen Terpadu Balita Sakit = Integrated Management on Baby Illness) approach is an integrated approach on baby illness management who come have treatment in inpatient unit facilities. Basis of health include curative and promotive effort against Pneumonia, diarrhea, measles, dengue, earache (infection), and malnutrition. Through MTBS approach expect it can give better handling quality on baby illness, so its handling effectiveness increase, initially at appraisal (Anamnesis and Examination), classification determination, action and treatment. This research as an economic evaluation used secondary data in the view of provider side purpose to gain a best alternative description from Pneumonia handling activities both MTBS and Non-MTBS Puskesmas (Health Center in Sub-district region) at district of Tanah Atas year of 2003. This result of this research show that handling pneumonia in puskesmas with is more cost effective compared with non MTBS, that the unit cost in puskesmas with MTBS is Rp 11.588,- and non MTBS is Rp 42.629,﷓. In order that MTBS can be used in of Puskesmas, its suggest doing MTBS socialization toward legislative and judicative agencies in this case is Local Government to get financial support to successes MTBS program.

Abstrak :
Keberhasilan suatu program berhubungan dengan kinerja petugasnya. Penelitian ini bertujuan untuk mengetahui kinerja petugas Manajemen Terpadu Balita Sakit (MTBS) dan hubungan antara variabel indepeden yang terdiri dari faktor individu (umur, masa kerja, pengetahuan dan motivasi), dan faktor organisasi (pelatihan, fasilitas, kepemimpinan) dengan variabel dependen yaitu kinerja petugas MTBS. Jenis penelitian yang digunakan adalah kuantitatif dengan rancangan penelitian cross sectional. Jumlah sampel 50 responden petugas MTBS.Pengumpulan data dilakukan dengan pengisisan kuesioner dan wawancara serta observasi.Pengolahan data dengan menggunakan perangkat lunak computer, analisis data dengan univariat, bivariat dengan uji statistik chi-square dan multivariat dengan uji statistik multipel regresi logistik. Hasil penelitian menunjukkan bahwa 62% petugas MTBS mempunyai kinerja baik. Terdapat hubungan antara umur, masa kerja, pengetahuan, motivasi, fasilitas dan kepemimpinan dengan kinerja petugas MTBS. Faktor dominan yang mempengaruhi kinerja petugas MTBS adalah masa kerja dan kepemimpinan. ......The success of a program related to the performance of its officers This study aims to determine the performance of Integrated Management of Childhood Illness (IMCI) officers and determine the relationship between the independent variables consisting of individual factors (age,length of work, knowledge and motivation) and organizational factors (training, facilities, leadership) with the dependent variable which is the performance of IMCI officer. This type of research is quantitative with cross sectional study design. The sample of 50 respondents IMCI officer.Collecting data by filling the questionnaire and interviewing and observation.Processing data using computer software, data analysis with univariate, bivariate statistical test chi-square and multivariate multiple logistic regression statistical test. The results of this study showed that 62% good performance of IMCI officer. There was correlation between age, length of work,knowledge, motivation, training and leadership with performance of IMCI officer. The dominant factor affecting performance is the IMCI officers working life and leadership.

Abstrak :
Analysis on the Compliance Rate of Health Personnel towards the Integrated Management of Childhood Illness at DKI Jakarta Health Center Year 2001The Ministry of Health Republic of Indonesia in collaboration with the World Health Organization, since 1997, has developed an approach in managing sick child under-five at the primary health services known as Integrated Management of Childhood Illness (IMCI). Today, IMCI has been implemented in 26 provinces (of 30 provinces present) covering 128 districts/municipalities in Indonesia. The province of DKI Jakarta, using regional budget 2000, has started socializing the IMCI to 14 health centers in 5 regions of Jakarta. How is the compliance of health worker in implementing the IMCI has never been studied. The objective of this study is to have a outline information on factors related to the health worker's compliance towards IMCI implementation at HC in Jakarta. The study will use "cross-sectional" design with quantitative and qualitative approach and total sample of 23 IMCI-implement health workers. Data collection is conducted by direct observation to the health workers during sick child examination using a checklist. After the observation, the health workers will fill in a questionnaire. Some secondary data will also be collected using the checklist for Monitoring IMCI record and checklist for supporting facilities. The result of the study shows that of 23 IMCI-implement health workers in DKI Jakarta 21.72% comply with interval value 58.61% - 90.28%, with cut off point value 80. The Internal factors is proven to have significant correlation with health worker's compliance with p = 0.04. While the external factors is proven to have significant correlation with human resources/MMCI facilities with p = 0.02 and leader's commitment with p = 0.009. In conclusion, the compliance rate of HC personnel in DKI Jakarta towards IMCI has not adequate. It is suggested to the Provincial Health Services DKI Jakarta to provide a health policy in managing sick child under-five using IMCI approach and at the same time improving quality of its monitoring and supervision. Health Center needs to have a clear task description for each of their personnel and a continued monitoring/supervision. A reward system should also be considered. The Ministry of Health needs to review the IMCI Monitoring and Supervision Checklist also considers Cut of Point of IMCI compliance rate and finalizing the Essential Drug for IMCI.

Abstrak :
Manajemen Terpadu Balita Sakit (MTBS) merupakan suatu pendekatan terhadap balita sakit yang dilakukan secara terpadu dengan memadukan pelayanan promosi, pencegahan, serta pengobatan terhadap lima penyakit penyebab utama kematian pada bayi dan balita di negara berkembang, yaitu pnemonia, diare, campak, dan malaria serta malnutrisi. Sistem informasi MTBS merupakan salah satu sarana untuk memantau pelaksanaan MTBS yang sampai saat ini belum berjalan secara optimal. Penelitian ini bertujuan untuk memperbaiki sistem informasi MTBS. Studi ini telah mengembangkan suatu sistem informasi MTBS di tingkat kabupaten/kota dengan menggunakan program aplikasi Microsoft Acces dan Microsoft Visual Basic 6.0. Dengan diterapkannya aplikasi ini akan memudahkan pelaksanaan pemantauan terhadap pelaksanaan MTBS di Propinsi Jawa Tengah khususnya di Kabupaten Kebumen. Selain itu juga untuk mengetahui cakupan, angka kejadian dan rasio pemakaian obat. Studi kasus dilakukan untuk Program ISPA dan Diare, karena tingginya angka kesakitan da kematian balita yang disebabkan kedua penyakit tersebut. Dari hasil uji coba skstem informasi tersebut dengan menggunakan data Kabupaten Kebumen diketahui bahwa ketidaktepatan petugas Puskesmas Prembun pada bulan Desember tahun 2002 dalam mengklasifikasikan keluhan batuk dan diare balita umur 2 bulan sampai 5 tahun masing-masing adalah 19,05% dan 28,57%, Untuk keluhan diare umur 1 minggu sampai 2 bulan adalah 100%. Sedangkan ketidaktepatan petugas Puskesmas Prembun pada bulan Desember tahun 2002 dalam menentukan tindakan untuk keluhan batuk balita umur 2 bulan sampai 5 tahun masing-masing adalah 57,14%, Sedangkan di Puskesmas Kebumen II pada bulan Januari tahun 2003 angka kejadian diare 34,63 dan cakupan diare 42,69%. Pada bulan Februari tahun 2003 di Puskesmas Kebumen 11 cakupan pnemonia desa Tersobo 16,67% dan desa Prembun 2,7%. Sedangkan angka kejadian untuk desa Tersobo 12,82 dan desa Prembun 2,43. Rasio pemakaian obat kedua desa tersebut 0,33. Pada bulan Februari tahun 2003 cakupan penderita pnemonia Puskesmas Kebumen II 6,52% dan Puskesmas Prembun 10%. Angka kejadian Puskesmas Kebumen II 6,04 dan Puskesmas Prembun 9,3. Rasio pemakaian obat untuk kedua puskesmas tersebut 0,33. Selanjutnya disarankan agar sistem ini dapat dipergunakan dan diterapkan di semua Kabupaten /Kota. Daftar bacaan : 24 (1989 - 2002) Development Information System of Integrated Management of Childhood Illness (IMCI) to District/Municipal Level (Cases Study for ARI and Diarrhea Program at Kebumen District Central Java Province)Integrated Management of Childhood Illness (IMCI) ks an approach toward child illness which is integrated with promotion service, prevention, and also treatment to five diseases those are pneumonia, diarrhea, measles, and malaria as the main causal factors of death in baby and child at developing countries. IMCI information system in a tool to monitor carrying out of IMCI which is not run optimal yet until now. This research aims to improve IMCI informatkon system. This study has developed an IMCI information to district/municipal level by using Microsoft Access and Microsoft Visual Basic 6.0 application program. By using this application it will be copy to monitoring the implementation of IMCI at Central Java Province, especially at Kebumen District. It is also to knowing coverage, incidence rate, and medicine use ratio. Case study of ARI and Diarrhea is done because thekr illness rate and death rate are high. For the try out of this system by using data of Kebumen District it is known that incorrect of health workers Prembun Public Health Centre on December 2002 in classifying complaint of cough and diarrhea to child who have age 2 month until 5 years old are 19.01% and 28.57%. For diarrhea complaint in one week to 2 month is 100%. While an incorrect of health workers Prembun Public Health Centre on December 2002 in taking action to complaint of cough to child who have age 2 month until 5 years old are 57.14%. While in Kebumen II Public Health Centre on January 2003 incidence rate of diarrhea 34.63 and coverage 42.69% On February 2003 Kebumen II Public Health Centre at coverage pneumonka of Tersobo village 16.67% and Prembun village 2.7%. Incidence rate Tersobo village 12.82 and Prembun village 2.43, Ratio of medicine used each villages are 0.33. On February 2003 coverage pneumonia of Kebumen II Public Health Centre 6.52% and Prembun Public Health Centre 10%. Inckdence rates Kebumen II Public Health Centre 6.04 and Prembun Public Health Centre 9.3. Ratio of medicine used each Public Health Care 0.33..The suggestion for further research is this system can be used and implemented at all district/municipal level. References : 24 (1989 - 2002)