Faktor Pendukung dan Penghambat Pemberian Program Tablet Tambah Darah Remaja Putri di Wilayah Puskesmas Kabupaten Kuningan

Abstract

Anemia menjadi masalah gizi dan kesehatan yang utama khususnya terjadi pada remaja putri, wanita usia subur, wanita hamil dan anak-anak. Anemia merupakan suatu kondisi tubuh memiliki konsentrasi hemoglobin berada dibawah normal. Sebagian besar jenis anemia yang sering terjadi pada remaja putri di dunia adalah anemia defisiensi besi. Remaja yang mengalami anemia berisiko mengalami anemia saat hamil dan berdampak negatif bagi perkembangan janin, seperti melahirkan bayi dengan berat bayi lahir rendah (BBLR), bayi prematur, bayi stunting bahkan dapat menyebabkan kematian pada ibu dan janin. Upaya untuk mencegah dan menanggulangi anemia pada remaja putri salah satunya dengan suplementasi zat besi. Program suplementasi zat besi dan asam folat bertujuan untuk mencapai Global Nutrition Target dalam mengurangi 50% anemia pada wanita usia subur tahun 2025 dan sebagai intervensi spesifik pencegahan stunting di Indonesia. Indikator keberhasilan program pemberian tablet tambah darah pada remaja putri dapat diidentifikasi dengan evaluasi faktor pendukung dan penghambat program tablet tambah darah. Salah satu yang memengaruhi cakupan program suplementasi tablet tambah darah adalah kepatuhan. Faktor-faktor yang memengaruhi kepatuhan konsumsi tablet tambah darah diantaranya dipengaruhi oleh faktor predisposisi seperti pengetahuan dan sikap, faktor pendorong seperti dukungan dari luar yaitu guru, teman sebaya dan orang tua dan faktor pemungkin seperti ketersediaan edukasi/konseling, sarana dan prasarana. Penelitian ini bertujuan menganalisis faktor pendukung dan penghambat program tablet tambah darah di wilayah Puskesmas Kabupaten Kuningan. Penelitian ini menggunakan metode penelitian campuran (mix method) kuantitatif dan kualitatif dengan jenis penelitian mix method yang digunakan adalah concurrent triangulation. Metode kuantitatif dilakukan menggunakan desain cross sectional dan metode kualitatif menggunakan pendekatan deskriptif. Penelitian dilakukan pada bulan Maret-Mei 2025 dengan melibatkan dua puskesmas yaitu Puskesmas Lamepayung dan Puskesmas Ciawigebang dan dua sekolah tingkat SMA/sederajat yaitu SMA Negeri 3 Kuningan dan SMK Negeri 5 Kuningan. Pemilihan tempat penelitian dilakukan menggunakan teknik simple random sampling. Subjek kuantitatif adalah remaja putri kelas X berjumlah 105 siswi, yang dipilih menggunakan proportionate stratified random sampling. Subjek kualitatif dalam penelitian ini meliputi 1) tenaga pelaksana gizi, 2) tenaga bagian anak usia sekolah dan remaja, 3) kepala puskesmas, 4) wakil kepala sekolah, 5) guru penanggungjawab program tablet tambah darah, 6) enam remaja putri kelas X. Penelitian ini menggunakan data primer meliputi pengisian kuesioner (kuantitatif), hasil wawancara dan focus group discussion (kualitatif). Data sekunder meliputi data remaja putri kelas X. Data kuantitatif dianalisis secara statistik menggunakan uji univariat, bivariat dan multivariat. Analisis bivariat menggunakan uji Chi Square untuk uji hubungan karakteristik remaja putri, pengetahuan, sikap, dukungan guru, dukungan teman sebaya, ketersediaan edukasi dan konseling gizi dengan kepatuhan konsumsi tablet tambah darah. Analisis multivariat menggunakan uji regresi logistik biner berganda untuk mengetahui variabel independen yang berpengaruh pada variabel dependen. Data kualitatif dianalisis dengan analisis tematik. Evaluasi program tablet tambah darah berdasarkan indikator masukan sebagian besar sudah tersedia cukup. Pada indikator proses sebagian besar belum dilaksanakan dengan optimal baik di tingkat puskesmas maupun pelaksanaan di sekolah. Beberapa kendalanya diantaranya komunikasi yang kurang efektif antara pihak puskesmas dengan pihak sekolah karena kesibukan masing-masing, sering adanya pergantian guru penanggungjawab program yang tidak konfirmasi, belum ada guru Pembina Usaha Kesehatan Sekolah (UKS) dan kurangnya pelatihan guru Usaha Kesehatan Sekolah (UKS). Indikator luaran sudah cukup baik, menurut data menunjukkan bahwa jumlah tablet tambah darah yang didistribusikan dari puskesmas telah sesuai rekomendasi (52 tablet setiap 1 tahun) dan cakupan program tablet tambah darah sudah tercapai. Penelitian menunjukkan bahwa terdapat hubungan antara pendidikan ayah, pengetahuan, sikap, dukungan guru, dukungan teman sebaya, ketersediaan edukasi atau konseling gizi dengan kepatuhan konsumsi tablet tambah darah. Faktor yang berpengaruh pada kepatuhan konsumsi tablet tambah darah diantaranya pendidikan ayah, pengetahuan, dukungan teman sebaya dan ketersediaan edukasi atau konseling gizi. Faktor yang sudah mendukung program Tablet Tambah Darah pada remaja putri diantaranya adalah ketersediaan sumber daya manusia yang terlibat sebagai petugas program Tablet Tambah Darah, ketersediaan Tablet Tambah Darah, sarana dan prasarana (buku pedoman Tablet Tambah Darah dan tempat penyimpanan Tablet Tambah Darah), alokasi dana, perencanaan program dari puskesmas, pencatatan dan pelaporan oleh Tenaga Pelaksana Gizi, jumlah Tablet Tambah Darah terdistribusi dan target program yang sudah tercapai. Selain itu, pengetahuan dan sikap remaja putri mayoritas pada kategori baik. Faktor yang masih menjadi hambatan program Tablet Tambah Darah pada remaja putri diantaranya belum tersedianya kartu monitoring, keterbaruan dan ketersediaan media edukasi, komunikasi yang kurang efektif antara pihak puskesmas dengan pihak sekolah, kurangnya pengawasan oleh tenaga kesehatan dan guru, tidak tersedianya pelatihan bagi guru Usaha Kesehatan Sekolah (UKS), pelaksanaan program tablet tambah darah di sekolah belum sesuai baik waktu maupun jumlah Tablet Tambah Darah yang dibagikan, kurangnya edukasi dari guru, kurangnya kerja sama dan komunikasi antar stakeholder di sekolah, pencatatan dan pelaporan dari sekolah belum optimal, kurangnya dukungan guru dan teman sebaya yang berkaitan dengan pelaksanaan program tablet tambah darah. Berdasarkan hasil penelitian ini, perlunya kerja sama dan komitmen bersama antara sektor kesehatan dan lintas sektor untuk melaksanakan program tablet tambah darah lebih konsisten lagi dan masih diperlukan studi lanjutan mengenai faktor pendukung dan penghambat dari semua pihak yang terlibat.

Anemia is a major nutritional and health problem, particularly among adolescent girls, women of childbearing age, pregnant women and children. Anemia is a condition in which the body has a haemoglobin concentration below normal. The most common type of anemia among adolescent girls worldwide is iron deficiency anemia. Anemia that occurs during adolescence increases the risk of anemia during pregnancy and has negative effects on fetal development, such as giving birth to babies with low birth weight, premature babies, stunted babies, and can even lead to the death of the mother and fetus. One of the efforts to prevent and address anemia in adolescent girls is iron supplementation. The iron and folic acid supplementation program aims to achieve the Global Nutrition Target of reducing anemia by 50% in women of childbearing age by 2025 and as a specific intervention to prevent stunting in Indonesia. The success of the iron tablet supplementation program for adolescent girls can be identified by evaluating the factors that support and barrier the iron tablet supplementation program. One factor influencing the coverage of the iron tablet supplementation program is compliance. Factors affecting compliance with iron tablet consumption include predisposing factors such as knowledge and attitude, enabling factors such as external support from teachers, peers and parents and facilitating factors such as the availability of education/counselling nutrition or health, facilities and infrastructure. This study aims to analyze the supporting and inhibiting factors of the iron tablet program at Health Center areas in Kuningan Regency. This study used a mixed method of quantitative and qualitative research, with the type of mixed method used being concurrent triangulation. The quantitative method used a cross-sectional design, while the qualitative method used a descriptive approach. The research was conducted from March to May 2025, involving two community health centers (Puskesmas), namely Puskesmas Lamepayung and Puskesmas Ciawigebang, and two senior high schools (SMA/equivalent), namely SMA Negeri 3 Kuningan and SMK Negeri 5 Kuningan. The selection of research locations used simple random sampling techniques, with the cluster units being the community health centers and schools. The quantitative subjects were 105 female students in grade X, selected using proportionate stratified random sampling. The qualitative subjects in this study include 1) nutrition staff, 2) staff responsible for school-age children and adolescents, 3) health center directors, 4) school vice principals, 5) teachers responsible for the iron tablet program, and 6) six female students in the 10th grade. This study used primary data, including questionnaire completion (quantitative), interview results and focus group discussions (qualitative). Secondary data included data on female students in the 10th grade. The quantitative data were analyzed statistically using univariate, bivariate, and multivariate tests. The bivariate analysis used the Chi-Square test to examine the relationship between characteristics of adolescent girls, knowledge, attitudes, teacher support, peer support, availability of nutrition education and counselling and compliance with tablet consumption. The multivariate analysis using multiple binary logistic regression tests to determine the independent variables that influence the dependent variables. Qualitative analysis using thematic analysis. The evaluation of the iron tablet program based on input indicators showed that most of the indicators are sufficiently available. However, most of the process indicators have not been implemented optimally, both at the community health center level and in schools. Some of the obstacles include ineffective communication between community health centers and schools due to their respective busy schedules and frequent changes in program-in-charge teachers who do not confirm their availability, the absence of School Health Unit (UKS) supervising teachers, and a lack of training for School Health Unit (UKS) teachers. Output indicators are already quite good. According to the data, the number of iron tablets distributed from health centers is in line with recommendations (52 tablets in a year), and the coverage of the iron tablet program has been achieved. This research showed that there is a relationship between father’s education, knowledge, attitude, teacher support, peer support, availability of nutrition education or counselling, and compliance with iron supplement consumption. These results are evidenced by p-values for each variable <0.05. Factors that influence compliance with iron supplement consumption are father’s education, knowledge, peer support and availability of nutrition education or counselling. The factors that have supported the Iron Supplement Tablet (TTD) program among adolescent girls include the availability of human resources involved as Iron Supplement Tablet (TTD) program officers, the availability of Iron Supplement Tablet (TTD), facilities and infrastructure (Iron Supplement Tablet manuals and Iron Supplement Tablet storage facilities), funding allocation, program planning by health centers, recording and reporting by Nutrition Implementation Staff, the number of Iron Supplement Tablet (TTD) distributed, and program targets that have been achieved. In addition, the knowledge and attitudes of adolescent girls are mostly good. Factors that still hinder the iron tablet program for adolescent girls include the unavailability of monitoring cards, outdated and unavailable educational media, ineffective communication between staff of community health centers and schools, lack of supervision by health workers and teachers and the unavailability of training for School Health Unit (UKS) teachers. The implementation of the iron tablet program in schools is not yet optimal in terms of timing and the number of iron tablets distributed, insufficient education from teachers, lack of cooperation and communication among stakeholders in schools, inadequate recording and reporting from schools, and insufficient support from teachers and peers related to the iron tablet program. Based on the results of this study, there is a need for collaboration and shared commitment between the health sector and cross-sectoral stakeholders to implement the iron tablet program more consistently and further studies are still needed regarding the supporting and inhibiting factors from all parties involved.