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PROGRAM PENANGGULANGAN ANEMIA

PROGRAM PENANGGULANGAN ANEMIA. OLEH : SRI SUMARMI. PROGRAM PENANGGULANGAN ANEMIA. Nilai ambang batas Hb utk kategori anemia. Derajat keparahan anemia. JENIS ANEMIA. ANEMIA. ANEMIA GIZI. ANEMIA PENYAKIT. ANEMIA GENETIK. I.D.A. ANEMIA APLASTIK. THALASEMIA. SIKLE CELL.

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PROGRAM PENANGGULANGAN ANEMIA

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  1. PROGRAM PENANGGULANGAN ANEMIA OLEH : SRI SUMARMI

  2. PROGRAM PENANGGULANGAN ANEMIA

  3. Nilai ambang batas Hb utk kategori anemia Derajat keparahan anemia

  4. JENIS ANEMIA ANEMIA ANEMIA GIZI ANEMIA PENYAKIT ANEMIA GENETIK I.D.A ANEMIA APLASTIK THALASEMIA SIKLE CELL MEGALOBLASTIK PENYAKIT INFEKSI & PENY LAIN PERNISIOSA ANEMIA HEMOLITIK IDA = IRON DEFICIENY ANEMIA

  5. PARADIGMA LAMA MASALAH ANEMIA DI INDONESIA ANEMIA KURANG FOLAT, VIT. B12 KURANG ZAT BESI (90%) Perdarahan, Infeksi, parasit Faktor Makanan (>50%) Kuantitas rendah Kualitas rendah (high inhibitor, low enhancer

  6. ANEMIA IS A PROBLEM WITH MULTIFACTOR CAUSES

  7. F A K T O R P A N G A N Fe PROTEIN VIT B KOMPLEKS VIT B12 INHIBITOR VIT A Cu Zn SIMPANAN TDK DIGUNAKAN PENYERAPAN TRANSFERIN HEME SYNTHESIS ERYTROPOISIS A N E M I A GAGAL GINJAL GENETIK PERDARAHAN INF PARASIT F A K T O R N O N P A N G A N

  8. LUAS MASALAH • PREVALENSI ANEMIA DI INDONESIA - BAYI : >70% - IBU HAMIL : 43% - WUS : 29% Sumber : UNICEF (2006)

  9. Prevalensi Anemia di Indonesia(SKRT 2001)

  10. PREVALENSI ANEMIA PADA BALITA Sumber : SKRT 2001

  11. PREVALENSI ANEMIARISKESDAS 2007

  12. KRITERIA Perempuan : • Anemia Mikrositik : MCV <96 fl (fitoliter) • Anemia Normositik : MCV = 96 – 108 fl • Anemia Makrositik : MCV >108 fl Laki-laki : • Anemia Mikrositik : MCV <96 fl (fitoliter) • Anemia Normositik : MCV = 96 – 108 fl • Anemia Makrositik : MCV >108 fl Perempuan dan laki-laki : • Anemia Hipokromik : MCHC <33 % • Anemia Normokromik : MCHC = 33 – 36% • Anemia Hiperkromik : MCHC >36 %

  13. MASALAH • SCREENING KASUS Belum ada mekanisme pemeriksaan hemoglobin secara rutin., bahkan pada ibu hamil belum semua ibu hamil diperiksa • MELEKAT DENGAN PROGRAM DI KIA - Tergantung cakupan K1 - Tergantung keahlian bidan

  14. PROGRAM • SUPLEMENTASI • FORTIFIKASI • MODIFIKASI MENU • PENGENDALIAN PENYAKIT PARASIT

  15. SUPLEMENTASI • SUPLEMENTASI ZAT BESI : FERO SULFAT - BENTUK SULFAT DIPILIH KARENA BIOAVAILABILITY TINGGI - EFISIEN • BENTUK : - TABLET : AUS, BUMIL, BUTEKI, REMAJA - SIRUP : BAYI DAN BALITA

  16. DOSIS SUPLEMENTASI

  17. MASALAH DALAM PROG. SUPLEMNETASI Fe Kel. Penduduk defisiensi. Fe Biaya Logistik Pengadaan tablet besi Akses thd Yankes Pemanfaatan Yankes Penyimpanan Faktor tng kes sembuh Masuk dlm cakupan program Follow up Minum tablet besi Faktor kepatuhan Drop Out Enhancer & inhibitor Penyerapan zat besi Pengeluaran Fe Kadar Hb meningkat

  18. WHAT’S THE OTHER PROBLEMS? • DELAYED APPERANCE OF BENEFITS OF IRON SUPPLEMENTATION EFFECT OF SUPPLEMENTATION DURING PREGNANCY OR INFANCY MAY NOT SHOW UP UNTIL LATER IN LIFE 2. SUPPLEMENTATION PROGRAM MUST TARGET WOMEN PRIOR TO, NOT JUST DURING PREGNANCY PROVIDING IRON SUPPLEMENTATION DURING THE SECOND AND THIRD TRIMESTER OF PREGNANCY IS NOT ENOUGH TO MEET THE REQUIREMENT 3. DAILY Vs WEEKLY SUPPLEMENTATION COMPARABLE EFFECTIVENESS OF WEEKLY TO DAILY SUPPLEMENTATION

  19. LIFE CYCLE APPROACH FOR Fe SUPPLEMENTATION INFANCY Intervention Fe syrup in selected area PRE SCHOOL CHILDREN Intervention : school feeding SCHOOL CHILDREN Intervention among senior High school students ADOLESCENCE Strategic Entry point To make body iron store prior to pregnancy PRIMIPARA ..? PRE PREGNANCY ..? MULTIPARA PREGNANCY Daily Fe supplementation

  20. DAILY IRON SUPPLEMENTATION > 30 mg, SHOULD BE ADDED WITH ZINC SUPPLEMENTATION • IRON : ZINC RATIO SHOULD NOT BE MORE THAN 2 : 1 TO AVOID IMPAIRING ZINC ABSORPTION • VITAMIN A SUPPLEMENTATION SHOULD BE GIVEN BEFORE SUPPLEMENTTAION OF IRON AND ZINC WERE STARTED

  21. PILOT PROJECT • MULTIPLE MICRONUTRIENT (MMN) SUPPLEMENTATION FOR PREGNANT WOMEN IN DEVELOPING COUNTRIES (INDONESIA : LOMBOK TENGAH, SIKA, BELU) (OTHER COUNTRIES : NEPAL, MEXICO, zimbaque) • MMN CONTAINT DAILY DOSE OF 15 VITAMINS & MINERALS

  22. HASIL…? DI INDONESIA • PREVALENSI ANEMIA BUMIL TM III TIDAK ADA BEDA ANTARA YG MINUM MMN (61%) DAN IFA (iron folid acid)(59%) • AKB LEBH TINGGI PADA IFA (43/1000) DIBANDINGKAN MMN (35/1000) (Lancet 2008; 371:215-27) DI MEXICO • ANEMIA LEBIH TINGGI PADA WUS YANG MINUM MMN DIBANDING YG MINUM IFA (Am J ClinNutr 2004;80:1308 –11) DI ZIMBAQUE • MMN MENINGKATKAN LAMA HAMIL, BERAT LAHIR, DAN LINGKAR KEPALA BAYI • (Am J ClinNutr 2004;80:178–84)

  23. FORTIFIKASI • FORTIFIKASI ZAT BESI DI INDONESIA DIPILIH TERIGU SEBAGAI VEHICLE DENGAN PERTIMBANGAN : - ADA TREND KENAIKAN KONSUMSI TERIGU SEJAK TAHUN 1990AN - KONSUMSI MI PADA SEMUA KELOMPOK UMUR - PERAN INDUSTRI • BENTUK FORTIFIKAN : Fe SULFAT - BIOAVAILABILITY TINGGI - BIAYA RENDAH

  24. COST EFFECTIVENESS OF NUTRITION INTERVENTION

  25. MODIFIKASI MENU PRINSIP : • MENINGKATKAN KONSUMSI MAKANAN SUMEBR ZAT BESI • MENINGKATKAN MAKANAN SEBAGAI ENHANCER PENYERAPAN ZAT BESI • MENGURANGI MAKANAN SUMBER INHIBITOR PENYERAPAN ZAT BESI PENDIDIKAN GIZI

  26. PENGENDALIAN PENYAKIT PARASIT INFESTASI CACING : MEMUTUS RANTAI TRANSMISI KEBIASAAN HIDUP SEHAT SANITASI LINGKUNGAN MALARIA : PENGENDALIAN BREEDING PLACE

  27. Persentase ibu hamil yang pernah minum tablet Fe dan cakupan K4 menurut provinsi, Susenas 2004 Target SPM 2005 = 70 % Cakupan K4 Target SPM 2005=78%

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