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Transcript of ABSTRACT - sinta.unud.ac.id · iii ABSTRACT PATTERN OF MEDICATION AND KNOWLEDGE ABOUT DRUGS USED...
iii
ABSTRACT
PATTERN OF MEDICATION AND KNOWLEDGE ABOUT DRUGS
USED DURING PREGNANCY IN NORTH DENPASAR II PUBLIC
HEALTH CENTER BALI
Introduction: Pregnancy is a special condition that needs more attention
regarding the health. Nutrition and health of the mother can directly affect the baby
which caused many unwanted outcomes. Even if drugs can cause unwanted effects,
the need of drugs for several cases such as hypertension, asthma, epilepsy, infection,
etc., are needed. Drugs i.e. vitamin and mineral is also needed since a pregnant
women require it more than normal people. This research aims to study about the
pattern of drug use in pregnant women in Bali especially in North Denpasar.
Methods: This research is a descriptive study, cross sectional survey design.
Questionnaire had been given to 96 respondents at private midwife practice in North
Denpasar II Public Health Center, Bali coverage area on August – October 2014.
Results: There were 93.7% pregnant women who used drugs. Total of 216
drugs prescribed with average of 2.24 prescriptions per women. Majority of it was
iron supplement which is 26.1%. The drugs were prescribed most on first trimester
with 47.7%. The drugs category was 97.7% belong to category A drugs and 2.3%
was category B drugs. The knowledge of respondent was majority moderate (59,
4%) and there were only 12,5% % with good knowledge.
Conclusion: Research revealed that the majority of drugs taken were iron
and the most prescribed drugs were on first trimester. Almost half of the respondent
has moderate knowledge but only few have good knowledge, more education about
drugs and pregnancy was encouraged to the midwife and public health center.
Keyword: pregnancy, pharmacoepidemiology, drugs, pattern, knowledge
iv
ABSTRAK
GAMBARAN PENGOBATAN DAN PENGETAHUAN MENGENAI
PENGGUNAAN OBAT SELAMA KEHAMILAN DI PUSKESMAS
DENPASAR UTARA II BALI
Latar Belakang: Kehamilan adalah kondisi istimewa dimana perhatian
mengenai kesehatan lebih dibutuhkan. Nutrisi dan kesehatan ibu dapat
mempengaruhi bayi secara langsung dan dapat menyebabkan hasil yang tidak
diinginkan. Meskipun obat dapat menyebabkan efek yang tidak diinginkan, obat
untuk beberapa kasus seperti hipertensi, asma, epilepsi, infeksi, dll tetap diperlukan.
Obat seperti vitamin dan mineral juga dibutuhkan karena ibu hamil
membutuhkannya lebih banyak daripada orang normal. Penelitian ini bertujuan
untuk mengetahui pola penggunaan obat pada ibu hamil di Bali khususnya
Denpasar Utara.
Metode: Penelitian ini merupakan penelitian deskriptif, cross-sectional
dengan bentuk survey. Kuesioner diberikan kepada 96 responden pada bidan
praktik swasta di daerah cakupan Puskesmas Denpasar Utara II pada bulan Agustus
– Oktober 2014.
Hasil: Terdapat 93,7% ibu hamil yang menggunakan obat dengan jumlah
resep 216 obat dengan rata-rata 2,24 resep per ibu hamil. Mayoritas obat adalah
suplemen besi yaitu 26.1%. obat diresepkan paling banyak pada trimester satu
sebesar 47,7%. Sebanyak 97,7% obat merupakan kategori A dan 2,3% kategori B.
pengetahuan responden mayoritas sedang (59, 4%) dan hanya terdapat 12,5% yang
mempunyai pengetahuan baik.
Simpulan: Penelitian menunjukkan bahwa mayoritas obat yang diberikan
merupakan suplemen besi dan obat paling banyak diberikan pada trimester pertama.
Hampir setengah dari responden mempunyai pengetahuan cukup tetapi sedikit yang
mempunyai pengetahuan baik. Penyuluhan mengenai obat dan kehamilan
disarankan pada bidan dan puskesmas.
Kata Kunci: kehamilan, farmakoepidemiologi, obat, gambaran, pengetahuan
v
LIST OF CONTENT
INSIDE COVER .................................................................................................... i
APPROVAL SHEET ............................................................................................ ii
ABSTRACT ......................................................................................................... iii
ABSTRAK ........................................................................................................... iv
LIST OF CONTENT ............................................................................................ v
LIST OF TABLE ............................................................................................... viii
LIST OF FIGURE ................................................................................................ ix
LIST OF ABBREVIATION ................................................................................. x
LIST OF ATTACHMENT ................................................................................... xi
CHAPTER I INTRODUCTION
1.1 Background ............................................................................................... 1
1.2 Statement of the Problem .......................................................................... 4
1.3 Purposes .................................................................................................... 4
1.3.1 General Purpose ............................................................................ 4
1.3.2 Specific Purposes .......................................................................... 4
1.4 Benefit ....................................................................................................... 4
1.4.1 Benefit for Science ........................................................................ 4
1.4.2 Benefit for Health and Community ............................................... 5
CHAPTER II LITERATURE REVIEW
2.1 Pregnancy .................................................................................................. 6
2.1.1 Gestational age .............................................................................. 6
2.1.2 Fetus development ........................................................................ 6
2.1.3 Maternal Physiology ..................................................................... 8
vi
2.2 Uses of Drugs during Pregnancy ............................................................ 10
2.2.1 Epidemiology .............................................................................. 10
2.2.2 Common Drugs Used .................................................................. 11
2.2.3 Drugs classification ..................................................................... 13
2.3 Teratogen................................................................................................. 13
2.3.1 Dose and timing of exposure ...................................................... 14
2.3.2 Known effect of drugs uses during pregnancy ........................... 15
2.4 Conceptual Framework ........................................................................... 16
CHAPTER III RESEARCH METHOD
3.1 Study Design, Time, and Location of Study ........................................... 17
3.2 Population and Sample ............................................................................ 17
3.2.1 Population variability .................................................................. 17
3.2.2 Sample criteria ............................................................................ 17
3.2.3 Number of sample ....................................................................... 18
3.3 Research Variable ................................................................................... 18
3.4 Operational Definition of Variables ........................................................ 19
3.5 Research Instrument ................................................................................ 20
3.6 Study Protocol ......................................................................................... 21
3.7 Data Analysis .......................................................................................... 22
3.7.1 Univariate Analysis ..................................................................... 22
CHAPTER IV RESULT AND DISCUSSION
4.1 Characteristic of Respondent ................................................................. 23
4.2 Pattern of Drugs Used ............................................................................ 24
4.3 Knowledge of Respondent ..................................................................... 31
vii
CHAPTER V CONCLUSSION AND RECOMMENDATION
5.1 Conclusion ............................................................................................. 35
5.2 Recommendation ................................................................................... 35
REFERENCES .................................................................................................... 36
ATTACHMENT ................................................................................................. 40
viii
LIST OF TABLE
Table 4.1 Socio Demographic Characteristic of Respondent ............................. 23
Table 4.2 Proportion of Drugs Type Consumed by Respondent ........................ 24
Table 4.3 Cross-tabulation of Drugs Type and Gravid ....................................... 25
Table 4.4 Cross-tabulation of Total Drugs Type and Last Formal Education .... 25
Table 4.5 Proportion of Drug Type Prescribed Based on Time of Consumption25
Table 4.6 Category of Drugs Consumed By Pregnant Women .......................... 30
Table 4.7 Respondent’s Level of Knowledge ..................................................... 31
Table 4.8 Proportion of True and False Statement in Each Level of knowledge 32
ix
LIST OF FIGURE
Figure 2.1 Classification of drugs by US FDA ................................................... 13
Figure 2.2 Conceptual Framework of the Study ................................................. 16
x
LIST OF ABBREVIATION
CDC : Center of Disease Control and Prevention
ORS : oral rehydration salt
SVR : Systemic vascular resistence
US FDA : United States of Food and Drugs Association
WHO : World Health Organization
xi
LIST OF ATTACHMENT
Attachment I Inform Consent.............................................................................. 40
Attachment II Questionnaire ............................................................................... 41
Attachment III Ethical Clearance ........................................................................ 44
Attachment IV Ijin Rekomendasi Badan Kesatuan Bangsa dan Politik ............. 45
Attachment V Ijin Penelitian Dinas Kesehatan ................................................... 46
Attachment VI Surat Perintah Tugas Puskesmas II Denpasar Utara .................. 47
Attachment VII Curriculum Vitae ...................................................................... 48
1
CHAPTER I
INTRODUCTION
1.1. Background
Pregnancy is a special condition that needs more attention regarding the
health. Nutrition and health of the mother can directly affect the baby which
caused many unwanted outcomes. The use of drugs during pregnancy needs a
special attention because the health and life of both the mother and the child is at
stake. An irresponsible use of drugs and inadequate intake of nutrition can cause
not only structural but also functional malformation. Congenital anomalies were
happened 3 – 4% of all pregnancies (Food and Drugs Administration, 2005)
(Malm, 2005). The cause of congenital anomaly generally couldn’t be assigned
for 50% of the cases. However, some of risk factors already assigned including
socioeconomic factor, genetic factor, infection, maternal nutrition status, and
environmental factor. One of the environmental factors is drugs exposure which
estimated for causing birth defect as big as 10% (Black & Hill, 2003).
The famous thalidomide tragedy resulted in the births of 6000 – 8000
malformed babies worldwide. A tragic reminder that drugs cannot be taken
lightly, this number does not include the probably considerable number of
abortions and fetal deaths associated with thalidomide exposure. The first report
of a suspected association between thalidomide and severe congenital
malformations were published in 1961 by McBride. Typical malformations were
bilateral shortened or missing limbs (phocomelia or amelia), but defects in other
organ systems (gastrointestinal, cardiovascular, eye and ear anomalies) were also
common (Malm, 2005). The guidance for evaluating the risk of drug exposure in
2
human pregnancies from Food and Drug Administration (FDA) has cited that the
use of any drug at any time during pregnancy can harm the developing embryo or
fetus. Based on study by Black (2003), more than 80 percent of pregnant women
in United States take over the counter drugs (OTC) or prescription drugs during
pregnancy and at least 10 percent of birth defects are thought to result from
maternal drug exposures (Food and Drugs Administration, 2005).
The used of prescription and OTC by pregnant women are reported high in
several countries (Black & Hill, 2003) (Rohra et al., 2008) (Stephansson et al.,
2011) (Kureshee & Dhande, 2013). Study conducted on Western India revealed
that the majority uses of drugs were from Category A (71.2%) and Category B
(16.5%) were prescribed for diseases encountered during pregnancy. These are
followed by those from Category C (9.09%) and D (1.12%) drugs that are mostly
prescribed to prevent complications caused by various disease conditions.
Category X drug was prescribed (0.7%) in cases of threatened miscarriages,
missed abortions and preterm labor. From all of them, only 24.55% of the women
believed that drug use in pregnancy could be harmful to both mother and baby,
while 2.59% believed that drugs use dangerous only to the mother and 4.39%
believed that drugs use is safe throughout pregnancy (Kureshee & Dhande,
2013). Study in Brazil, revealed that medicines with evidence of fetal risk
(category D and X) were used by less than 12% of pregnant women (Bertoldi et
al., 2012). This is contrary to the result of a study conducted in France, in which
the percentage of exposure to category D drugs was very high (59%) (Lacroix et
al., 2000).
3
The teratogenic effects of the drugs depends on several factors, which are
the quantity, the absorption, the metabolism, the protein binding ability, the cell
storages, the size, and the solubility of drug on the fat which determine the ability
of the drugs to cross the placental barrier (Gondo, 2007).
Even if drugs can cause unwanted effects, the need of drugs for several
cases such as hypertension, asthma, epilepsy, infection, etc., are needed. However,
the benefits of using drugs should be bigger than the disadvantages. Not only for
chronic illness, drugs i.e. vitamin and mineral is also needed since a pregnant
women require it more than normal people. Nonetheless not few women doesn’t
aware about it and didn’t consume it due to misperception regarding the
supplement benefit. The physiology changed caused by pregnancy should also be
considered by the physician when prescribing drugs. During pregnancy,
cardiovascular, respiratory, liver, and renal functions are changing. Not only
those, but also changes in the expression and activity of transport proteins and
enzymes systems. All the changes can cause pregnancy induce pharmacokinetic,
pharmacodynamics, and efficacy changes which need special attention from the
physician (Feghali & Mattison, 2011).
Pharmacoepidemiological studies can measure the extent of prescription
and effect of drug use in pregnant women. Recently no pharmacoepidemiological
study of drugs used on pregnancy is available in Indonesia, therefore, it becomes
important to know the proportion and pattern of drug used in pregnancy, as well
as the knowledge regarding drug use in pregnancy in Indonesia, especially in Bali.
4
1.2. Statement of the Problem
1) How much the prevalence of pregnant women using drugs in North
Denpasar II Public Health Center?
2) How is the pattern of drugs use in pregnancy?
3) How well the knowledge of pregnant women about drugs used in
pregnancy?
1.3. Purposes
1.3.1. General Purpose
This research aims to study about the drug use in pregnant women in Bali
especially in North Denpasar.
1.3.2. Specific Purposes
1) To study the prevalence of drug use in pregnant women in Bali
especially North Denpasar
2) To study the pattern of drug use in pregnant women in Bali especially
North Denpasar
3) To study the knowledge of pregnant women in Bali especially North
Denpasar about drugs used in pregnancy
1.4. Benefit
1.4.1. Benefit for Science
Hopefully this study will be useful for giving scientific information
regarding drug use during pregnancy especially in Bali. It might provide basic
information for subsequent study related to our study.
5
1.4.2. Benefit for Health and Community
Since the pharmaco-epidemiology study about drugs used during
pregnancy in Indonesia especially Bali is limited, this descriptive study can
provide basic information needed to develop a preventive strategy in order to
diminish the risk of drug exposure in pregnant women.