ABSTRAK PREVALENSI DAN HUBUNGAN ANTARA TERJADINYA INFEKSI VIRUS HEPATITIS B PADA IBU HAMIL DENGAN TINGKAT PENGETAHUAN IBU DAN PERILAKU BERISIKO IBU DI BALI
Infeksi virus hepatitis B (VHB) di Indonesia merupakan masalah kesehatan masyarakat yang penting dan termasuk endemisitas sedang sampai tinggi dengan prevalensi 3-20%, dan menurut Tim Hepatitis Nasional wanita hamil di Indonesia dengan HbsAg positif 3.6%. Penelitian ini bertujuan untuk mengetahui prevalensi dan hubungan antara terjadinya infeksi VHB pada ibu hamil dengan pekerjaan suami, tingkat pengetahuan ibu dan perilaku berisiko ibu di RS Rujukan Provinsi Bali. Metode yang digunakan adalah cross sectional (studi observasional analitik), bertempat di poliklinik dan Instalasi Rawat Darurat (IRD) Kebidanan RSUP Sanglah Denpasar, RSUD Gianyar, RSUD Karangasem, RSUD Buleleng dan RSUD Negara, dimana terdapat dokter yang sedang menjalani pendidikan PPDS Obstetri dan Ginekologi (Obgin) dan dilaksanaakan selama kurang lebih 12 minggu dari bulan Oktober sampai dengan Desember 2015. Sebanyak 400 ibu hamil diambil dengan tehnik random sampling. Diagnosis VHB ditegakkan dengan rapid test dan dianalisis dengan menggunakan uji Chi-Square. Terdapat 11 kasus ibu hamil yang positif VHB (2,75%). Tidak terdapat perbedaan distribusi karateristik sosiodemografi pasien antara kelompok ibu hamil dengan VHB positif dengan ibu hamil tanpa VHB (p>0,05). Tidak terdapat hubungan yang bermakna antara tingkat pengetahuan ibu dengan kejadian infeksi VHB pada ibu hamil (masing-masing p=0,379 dan p=0,205). Namun terdapat hubungan yang sangat bermakna antara perilaku berisiko ibu dengan kejadian infeksi VHB pada ibu hamil (p<0,05). Adapun simpulan dari penelitian ini yaitu terdapat hubungan yang bermakna antara perilaku berisiko ibu dengan kejadian infeksi VHB pada ibu hamil, tidak terdapat hubungan yang bermakna antara tingkat pengetahuan ibu dengan kejadian infeksi VHB pada ibu hamil di RS Rujukan Provinsi Bali. Kata Kunci : Infeksi VHB, prevalensi, perilaku berisiko, tingkat pengetahuan
ABSTRACT PREVALENCE AND RELATIONSHIP BETWEEN HEPATITIS B INFECTION IN PREGNANCY WITH MATERNAL EDUCATION LEVEL, AND HIGH RISK BEHAVIOUR IN BALI Hepatitis B virus (HBV) infection in Indonesia is an important public health problem, and remains as a moderate to high endemicity, with 3-20% prevalence. HbsAg positive cases count for 3,6% of all pregnancy in Indonesia, as reported by The National Hepatitis Taskforce. This study was aimed to know the prevalence and the relationship between hepatitis B infection in pregnancy and partner’s job, maternal education level, and maternal high risk behaviour at referal hospitals in Bali. This was a cross sectional study (analytic observational study), conducted in obstetric polyclinic and emergency department of Sanglah Central Public Hospital, Gianyar Regency Hospital, Karangasem Regency Hospital, Buleleng Regency Hospital, and Negara Regency Hospital, where obstetric and gynaecology registrars were placed, for 12 weeks from October until December 2015. Four hundred pregnant women were included using random sampling technique. Diagnosis of hepatitis B infection was made by rapid test and analyzed using Chi-Square Test. Hepatitis B were positive in 11 pregnant women (2,75%). No difference was found in sociodemographic distribution between VHB positive and non VHB group (p>0,05). The relationship between VHB infection in pregnancy and maternal educational level were not significant (respectively, p=0,379 and p=0,205). However significant relationship was found between maternal high risk behaviour and VHB infection in pregnancy (p<0,05). So we concluded that there was a significant relationship between maternal high risk behaviour and VHB infection in pregnancy. Conversely, there was no relationship between maternal educational level, and VHB infection in pregnancy at referal hospitals in Bali. Key words: VHB infection, prevalence, high risk behaviour, partner’s job, educational level.
DAFTAR ISI
Halaman SAMPUL DALAM ..........................................................................................
i
PRASYARAT GELAR. ..................................................................................
ii
LEMBAR PERSETUJUAN ............................................................................
iii
PENETAPAN PANITIA PENGUJI ................................................................
iv
SURAT PERNYATAAN BEBAS PLAGIAT ................................................
v
UCAPAN TERIMA KASIH............................................................................
vi
ABSTRAK. ......................................................................................................
viii
ABSTRACT.....................................................................................................
ix
DAFTAR ISI ....................................................................................................
x
DAFTAR TABEL. ...........................................................................................
xiii
DAFTAR GAMBAR .......................................................................................
xiv
DAFTAR SINGKATAN .................................................................................
xv
BAB I PENDAHULUAN ...............................................................................
1
1.1 Latar Belakang ................................................................................
1
1.2 Rumusan Masalah ...........................................................................
5
1.3 Tujuan Penelitian .............................................................................
6
1.3.1 Tujuan umum ........................................................................
6
1.3.2 Tujuan khusus........................................................................
6
1.4 Manfaat Penelitian ...........................................................................
6
1.4.1 Manfaat bagi pengetahuan.....................................................
6
1.4.2 Manfaat bagi pelayanan.........................................................
7
BAB II TINJAUAN PUSTAKA ...................................................................
8
2.1 Definisi Hepatitis B .........................................................................
8
2.2 Epidemiologi ....................................................................................
9
2.3 Etiopatogenesis Hepatitis B Dalam Kehamilan ..............................
10
2.4 Patofisiologi, Manifestasi Klinis dan Komplikasi Hepatitis B Terhadap Kehamilan .......................................................................
15
2.4.1 Patofisiologi hepatitis B dalam kehamilan ............................
15
2.4.2 Manifestasi klinis ...................................................................
17
2.5 Diagnosis Hepatitis B ......................................................................
21
2.6 Terapi dan Pencegahan Tranmisi Vertikal Hepatitis B Dalam Kehamilan ...........................................................................
24
2.7 Prognosis .........................................................................................
29
BAB III KERANGKA BERPIKIR, KONSEP DAN HIPOTESIS PENELITIAN ..................................................................................................
31
3.1 Kerangka Berpikir ...........................................................................
31
3.2 Konsep Penelitian ............................................................................
33
3.3 Hipotesis Penelitian .........................................................................
33
BAB IV METODE PENELITIAN ..................................................................
34
4.1 Rancangan Penelitian ......................................................................
34
4.2 Waktu dan Tempat Penelitian .........................................................
34
4.3 Penentuan Sumber Data ..................................................................
34
4.3.1 Populasi ..................................................................................
34
4.3.2 Sampel ....................................................................................
35
4.3.3 Besaran sampel .......................................................................
35
4.3.4 Teknik pengambilan sampel ...................................................
35
4.4 Variabel Penelitian ..........................................................................
37
4.5 Instrumen Penelitian ........................................................................
40
4.6 Prosedur Penelitian ..........................................................................
40
4.7 Alur Penelitian .................................................................................
42
4.8 Analisis Data ...................................................................................
43
BAB V HASIL PENELITIAN ........................................................................
44
5.1 Distribusi Karakteristik Sosiodemografi (Umur, Pendidikan, dan Pekerjaan Ibu) ...........................................................................
44
5.2 Hubungan antara Tingkat Pengetahuan dengan Kejadian Infeksi Virus Hepatitis B pada Ibu Hamil ...................................................
45
5.3 Hubungan antara Perilaku Berisiko dengan Kejadian Infeksi Virus Hepatitis B pada Ibu Hamil ...................................................
46
BAB VI PEMBAHASAN................................................................................
47
6.1 Prevalensi Pengidap VHB pada Ibu Hamil .....................................
49
6.2 Karakteristik Sosiodemografi ( Umur, Pendidikan dan Pekerjaan Ibu) ........................................................................... 6.3 Hubungan antara Tingkat Pengetahuan dengan Kejadian
50
Infeksi Virus Hepatitis B pada Ibu Hamil .......................................
51
6.4 Hubungan antara Periaku Berisiko dengan Kejadian Infeksi VHB pada Ibu Hamil di RSU Rujukan Provinsi Bali .........
54
BAB VII SIMPULAN DAN SARAN .............................................................
57
7.1 Simpulan..........................................................................................
57
7.2 Saran. ...............................................................................................
57
DAFTAR PUSTAKA ......................................................................................
58
DAFTAR LAMPIRAN. ...................................................................................
64
Daftar Lampiran 1 Ethical Clearance ……………………………………….
64
Daftar Lampiran 2 Ijin Penelitian ....................................................................
65
Daftar Lampiran 3 Informasi Pasien ………………………………………..
66
Daftar Lampiran 4 Informed Consent ……………………………………… .
67
Daftar Lampiran 5 Kuesioner Penelitian ……………………… …………….
68
Daftar Lampiran 6 Anggaran Dana Penelitian ………………………………
73
Daftar Lampiran 7 Hasil Analisis Statisti ........................................................
74
DAFTAR TABEL
Halaman 2.1
Interpretasi Hasil Tes Serologi Pada Hepatitis B. ................................
5.1
Karakteristik Sosiodemogrfai (Umur, Pendidikan, dan Pekerjaan Ibu) ...............................................................................
5.2
45
Hubungan antara Tingkat Pengetahaun dengan Kejadian Infeksi Virus Hepatitis B pada Ibu Hamil..................................................................
5.4
23
45
Hubungan antara Perilaku Berisiko dengan Kejadian Infeksi Virus Hepatitis B pada Ibu Hamil....................................................................................................
DAFTAR GAMBAR
46
Halaman 2.1 Serologi Infeksi Hepatitis B ...................................................................... 2.2
Alur Skrining Infeksi Virus Hepatitis B Selama Kehamilan Penyedia Layanan Antenatal. .............................................................................................
2.3
22
Indikasi Terapi pada Pasien Terinfeksi VHB Kronik dengan Sirosis atau Reaktivasi dari Infeksi Kronis Virus Hepatitis B..........................................................
2.4
20
26
Indikasi Terapi untuk Pasien Terinfeksi VHB Kronis HBeAg Negatif Non Sirosis. .......................................................................................................... 27
3.1
Konsep Penelitian. ...............................................................................
33
4.1
Alur Penelitian. ....................................................................................
42
DAFTAR SINGKATAN
IPTEKDOK
: lmu Pengetahuan dan Teknologi Kedokteran
AASLD
: American Assciciation for Stufy of The Liver Diseases
AKB
: Angka Kematian Bayi
AKI
: Angka Kematian Ibu
ALT
: Alanine Aminotransferase
APASL
: Asia-Pacific Asscociation for Study of The Liver
AST
: Aspartate Aminotransferase
BB
: Berat Badan
CDC
: Centers for Disease and Control
DNA
: Deoxyribonucleic Acid
EASL
: Asscociation for Study of The Liver
EIA
: Enzim Immunoassay
VHB
: Virus Hepatitis B
HCC
: Hepatitis C Chronic
VHC
: Virus Hepatitis C
HIV
: Human Immunodefficiency Virus
IFN
: Interferon
IRD
: Instalansi Rawat Darurat
KG
: Kilo Gram
MG
: Mili Gram
PCR
: Polymerase Chain Reaction
PEG
: Poly-ethylen Glycol
PMI
: Palang Merah Indonesia
PPHI
: Perhimpunan Peneliti Hati Indonesia
RBV
: Ribavirin
RNA
: Ribonuclic Acid
SOPG
: Dokter Spesialis Obstetri dan Ginekologi
RSUD
: Rumah Sakit Umum Daerah
RSUP
: Rumah Sakit Umum Pusat
ssRNA
: Single Straine Ribonuclic Acid
TNF-α
: Tumor Necrosis Factor-alpha
TNF-β1
: Tumor Necrosis Factor-beta 1
UNAIDS
: Joint United Nations Programme on HIV/AIDS
WHO
: World Health Organization
