KARYA PERTAMA

JUDUL : Bisrula (Seaweed Biskuit): Latest Innovation of Seaweed Marketing in Hypertension Prevention Program on Pregnant Woman in Makassar City

LOMBA : FKS RESEARCH AWARDS

JUARA : Finalis

 

BISRULA (SEAWEED BISKUIT): LATEST INNOVATION OF SEAWEED MARKETING IN HYPERTENSION PREVENTION PROGRAM ON PREGNANT WOMAN IN MAKASSAR CITY

Anis Ammar Mihdar1, Andi Moh. Roem Askari1, Muh. Haedar1, Yasmin Syauki2

  1. Program Studi Pendidikan Dokter, Fakultas Kedokteran, Universitas Hasanuddin, Makassar
  2. Dokter Spesialis Gizi Klinik – Departemen Gizi Fakultas kedokteran Universitas Hasanuddin

 

Pre-eclampsia is a major cause of maternal and child morbidity and mortality worldwide, especially in developing countries such as Indonesia. In pregnant women with insufficient iodine can cause hypothyroidism at risk for pregnancy complications such as preeclampsia, and other hypertensive disease.  Seaweed contains essential Iodine for pregnant women and can be an alternative prevention of pre-eclampsia in pregnant women. This study aimed to test the effectiveness of the management and development of seaweed biscuits in the effort of prevention of hypertension in pregnant women in Makassar City. This research used experimental type and used  analytical research design which in this case was developed with pretest – posttest control group design. Samples were chosen based on purposive sampling method with the study population were all pregnant women in Makassar City, especially in Tamalanrea sub district and obtained 14 samples. The results showed that the effectiveness of management and provision of BISRULA in pregnant women has not been too significant to lower blood pressure in pregnant women, this is evidenced by viewing the presentation of changes in the condition of the study samples that showed a meaningless value in which all the test against the variable yields p> 0 , 05 This is due mainly to the samples were  used very little because of the difficulty of finding the appropriate sample criteria and also because of the shortness of the research time so it is difficult to prove the effectiveness of BISRULA as well as the measuring instruments  had not used a more detailed measurement standard to see any changes occurring in samples so that these can be suggestions for conducting further research related to this study.

Keywords: Preeclampsia, iodine deficiency, hypertension, seaweed

 

INTRODUCTION

Background

Maternal death is one of the major global health problems, and generally occurs mainly in developing countries. Compared to some countries in the Asean region, MMR (Maternal Mortality Ratio) in Indonesia is higher than Thailand, Myanmar, Malaysia, Philippines although still lower than Camboja and Laos (UNICEF, 2012). According to the Indonesian Demographic and Health Survey (SDKI) 2012 survey, the maternal mortality rate jumped significantly from 228 per 100,000 live births in 2007 to 359 per 100,000 live births.

The result of analysis of PWS report of KIA in South Sulawesi shows that there is a change of pattern of cause of maternal death during the last six years that is from bleeding to eclampsia. This has caused the government to adapt to reduce maternal mortality rate in South Sulawesi and prevent the death of pregnant women due to eclampsia or hypertension disease in pregnant women. Many things can cause hypertension, one of the iodine deficiency. In pregnant women with insufficient iodine can lead to hypothyroidism at risk for complications of pregnancy such as preeclampsia, and other hypertensive diseases. (Krasses et al, 2010).

Seaweed as one of the highest export commodities of South Sulawesi should also be utilized in this condition by making innovation in Makassar City, not only exporting but also can be utilized for the benefit of Makassar itself. Seaweed has an excellent iodine content for maternal and infant pregnancies. Iodine as a micronutrient type of mineral is very crucial and essential for maternal and fetal nutrition. Monitoring iodine levels in pregnant women is very influential on baby’s growth and mother’s own health. Iodine deficiency can lead to poor outcomes such as mental disorders, spontaneous abortion and even death. (TK maharani dkk, 2013).

The purpose of this research proposal preparation is to test the effectiveness of management and development of seaweed biscuits in an effort to prevent hypertension in pregnant women in the city of Makassar.

The results of this study is expected to be a reference for the government and the community about the effectiveness of the management and development of seaweed biscuits in the prevention of hypertension in pregnant women in Makassar.

Literature review

Seaweed

Understanding & Habitat Seaweed.

Seaweed is a low-grade, thalus-shaped plant of the Thalophyta division (leafless body structure). In general, seaweed lives in the depths of the sea that can still be achieved by the sun. This seaweed is generally living as phytophosos living creatures that attachs itself to the substrate of mud, sand, shells, dead coral fragments, stones, wood and other hard objects. some are attached to other plants specifically. (Wibowo et al, 2014)

Contents.of Seaweed

Seaweed is a major source of iodine, so seafood in the form of fish, shrimp and shellfish and seaweed is a good source of iodine, as well as plants that grow in coastal areas (Astuti & Sumartini, 2014). In addition to high iodine, seaweed is also high in fiber. Seaweed Gracilaria sp. Contains  iodine 29.94 ppm (% bk) and dietary fiber 9.76% (% bb) (Chaidir, 2007).

Potential Seaweed Indonesia-Makassar

According to FAO (2008) data, Indonesia is one of the largest seawater producer countries (table 1) and even 2013 Indonesia is ranked 2nd after China (Wibowo et al, 2014). If measured in terms of export volume, Indonesia is in the first position as a seaweed exporter by contributing 95,588 tons of seaweed. (Warinangin et al, 2013). South Sulawesi province gets a budget allocation of Rp 30 billion in 2016, about 10 percent of the total budget of Rp300 billion for the development of seaweed. Makassar City Government itself continues to improve the welfare of its people through its marine potential, especially Makassar has many small islands and the expanse of the sea (Antara News, 2016).

The role of iodine for pregnant women

Iodine is one of the essential micronutrients needed for neural development and thyroid hormone production (Wei et al, 2015). After conception, thyroid hormone production of pregnant women increased by about 50% due to increased use by the fetus, 30-50% due to increased renal iodine clearance, and increased association with thyroid binding globulin (TBG) (Obican et al., 2012). In pregnant women with insufficient iodine can lead to hypothyroidism at risk for complications of pregnancy such as preeclampsia, placental absorption, abortion, premature infants, and low birth weight. (Casey et al, 2005; Krasses et al, 2010; Negro & Mestman, 2011). To prevent harmful effects on the fetus, maternal iodine deficiency must be corrected before conception (Astuti & Sumartini, 2014). The American Thyroid Association (ATA) recommends 250 micrograms per day of iodine intake for pregnant and lactating women. The only food intake is the source of iodine, which is essential for the synthesis of thyroid hormones. Iodine is found in several food sources including iodized salt, dairy products, seaweed, and fish. To achieve this goal, it is strongly recommended that all pregnant and lactating women take a daily iodine supplement of 150 micrograms (Obican et al, 2012).

 Pre-eclampsia

Understanding Pre-eclampsia

Preeclampsia is hypertension (140/90 mmHg) and proteinuria (> 300 mg / 24 hours of urine) occurring after 20 weeks of pregnancy in previously normotensive women. Treatment of non-pharmacologic hypertension depends on the clinical state, the severity of hypertension, gestational age and the risk of the mother and fetus. The form of treatment can be strict supervision, physical activity restrictions, resting on the left side. Under these circumstances a normal diet is recommended without salt restriction (Suhardjono, 2014).

Prevalence of Pre-eclampsia in Indonesia-Makassar

Maternal mortality in Indonesia is still dominated by three main causes of death: haemorrhage, hypertension in pregnancy (HDK), and infection. But the proportions have changed, where bleeding and infection tend to decrease while HDK proportion is increasing. More than 25% of maternal deaths in Indonesia in 2013 are due to HDK (Ministry of Health RI, 2015)

METHOD

This research uses experimental type and uses analytical research design, which in this case developed with pretest – posttest control group design. The researcher conducts treatment and interviews to the sample in the data collection phase.

The study population was all pregnant women in Makassar City, especially in sub district Tamalanrea then selected based on purposive sampling method to serve as research sample. The samples obtained were 14 people with criteria, ie pregnant women who were in the 2nd or 3rd trimester of pregnancy, suffering from hypertension (minimum blood pressure 140/90 mmHg) and willing to be a research sample.

The research data is the primary data obtained directly from the sample by using patient medical record data including the profile of pregnant women’s patients. The data obtained then analyzed by statistical test Paired T test and Independence T test presented in the form of tables and narrations to see the relationship between variables studied.

The operational definition of the variable is as follows:

Iodine intake in pregnant women (independent variable)

Iodine intake in pregnant women referred to in this research is iodine level which will be given to sample (pregnant mother) to be packed in the form of biscuits processed with seaweed material that will be taken from seaweed factory KIMA (Industrial Area of Makassar) and named BISRULA (Seaweed Biscuits)

Maternal blood pressure (dependent variable)

Maternal blood pressure in this study is blood pressure in the sample (pregnant women) to be examined before and after administration of BISRULA (Seaweed Biscuit) to see the presence of hypertension in pregnancy or not.

Consumption of pregnant women’s nutrients (confounding variables)

Maternal nutrient consumption in this study is the nutrient content of food consumed by the sample (pregnant women) during the period of pregnancy, especially during the implementation of the study.

RESULTS

Based on the research, 14 samples were obtained from the target of 20 samples to be used as research samples. Of the 14 samples, there were 4 samples included in the dropout criteria to be excluded from the study and the remaining sample amounted to 10 samples used until the end of the study.

 

Table 1. Characteristics of Research Sample

No Name Control/intervention Trimester Body Mass Index Pulsation Temperature Blood Pressure 0 Blood Pressure 1 Blood Pressure 2
1. Arianty Control 3 29.5 92 37.0 130/80 130/90 130/80
2. Linda Control 3 19.5 90 37.5 100/90 120/70 120/70
3. Febriyanti Control 2 27.3 90 37.0 132/90 130/80 130/90
4. Riska Puspitasari Control 3 25.1 96 37.1 110/90 110/80 110/80
5. Nurhayati Control 2 24.3 90 37.0 130/70 120/80 120/70
6. Jumiati Intervention 2 20.8 78 37.2 120/90 110/70 110/80
7. Hasmiati Intervention 2 19.4 90 37.0 120/90 120/70 110/70
8. Dian Anggraeni Intervention 2 21.4 90 37.0 140/90 120/70 120/70
9. Risnawati Intervention 3 26.5 88 36.7 110/90 120/90 110/70
10. Wiwi Rawanda Intervention 2 23.0 68 36.7 110/90 110/70 120/70

 

Based on table 1, it is known that the number of samples is 10 samples from 5 samples as control and 5 samples as the intervention where each sample is at the age of 2nd and 3rd trimester. Then it is obtained that for 5 samples that serve as the control is not found any change blood pressure is significant, that remains in the pre-hypertensive state for samples 1 and 3 and normotensi for samples 2, 4, and 5. As for the sample given intervention, in this case given the consumption of BISRULA there are variations of results obtained, that is to samples 6, 7, 8, and 10 contained a blood pressure decrease from pre-hypertensive conditions to normotensi in terms of both systolic and diastolic pressure states in the first and second weeks after treatment, the increase in blood pressure return for sample 9 was due to the sample compliance had forgotten to consume BISRULA in a day.

 

Table 2. Changes in Systolic and Diastolic Blood Pressure on Control Samples

SYSTOLIC CONTROL
No SC 0 SC 1 P Value SC 0 SC 2 P Value SC 1 SC 2 P Value
1. 130.00 130.00 0.906 130.00 130.00 0.906 130.00 130.00 SE = 0
2. 110.00 120.00 110.00 120.00 120.00 120.00
3. 132.00 130.00 132.00 130.00 130.00 130.00
4. 110.00 110.00 110.00 110.00 110.00 110.00
5. 130.00 120.00 130.00 120.00 120.00 120.00
Mean 122,4 122 122,4 122 122 122
                   
DIASTOLIC CONTROL
No DC 0 DC 1 P Value DC 0 DC 2 P Value DC 1 DC 2 P Value
1. 80.00 90.00 0.541 80.00 80.00 0.208 90.00 80.00 0.621
2. 90.00 70.00 90.00 70.00 70.00 70.00
3. 90.00 80.00 90.00 90.00 80.00 90.00
4. 90.00 80.00 90.00 80.00 80.00 80.00
5. 70.00 80.00 70.00 70.00 80.00 70.00
Mean 84 80 84 78 80 78

 

*Information :

Using Paired T Test

SC 0 = Systolic Control before Treatment

SC 1 = Systolic Control after the first week of treatment

SC 2 = Systolic Control after the second week of treatment

DC 0 = Diastolic Control before Treatment

DC 1 = Diastolic Control after the first week of treatment

DC 2 = Diastolic Control after second week treatment

Based on table 2, the overall p value of each variable has not significant significance where the p value of variable relationship SC 0 with SC 1, SC 0 with SC 2, SC 1 with SC 2, DC 0 with DC 1, DC 0 with DC 2 and DC 1 with DC 2 respectively are 0.906, 0.906, SE = 0, 0.541, 0.208, 0.621. This shows that changes in systolic and diastolic blood pressure in control samples are not very significant. As for the relationship variable DC 1 with DC 2 get the error value because there is no change at all in systolic blood pressure control samples.

 

Table 3. Changes in Systolic and Diastolic Blood Pressure on Intervention Samples

SYSTOLIC INTERVENTION
No SI 0 SI 1 P Value SI 0 SI 2 P Value SI 1 SI 2 P Value
1. 110.00 110.00 1 110.00 110.00 0.778 110.00 110.00 0.621
2. 120.00 120.00 120.00 110.00 120.00 110.00
3. 140.00 120.00 140.00 120.00 120.00 120.00
4. 110.00 120.00 110.00 110.00 120.00 110.00
5. 100.00 110.00 100.00 120.00 110.00 120.00
Mean 116 116 116 114 116 114
                   
DIASTOLIC INTERVENTION
No DI 0 DI 1 P Value DI 0 DI 2 P Value DI 1 DI 2 P Value
1. 80.00 70.00 0.242 80.00 80.00 0.089 70.00 80.00 0.704
2. 90.00 70.00 90.00 70.00 70.00 70.00
3. 90.00 70.00 90.00 70.00 70.00 70.00
4. 80.00 90.00 80.00 70.00 90.00 70.00
5. 70.00 70.00 70.00 70.00 70.00 70.00
Mean 82 74 82 72 74 72

 

 

*Information :

Using Paired T Test

SI 0 = Systolic Intervention before Treatment

SI 1 = Systolic Intervention after the first week of treatment

SI 2 = Systolic Intervention after the second week of treatment

DI 0 = Diastolic Intervention before Treatment

DI 1 = Diastolic Intervention after the first week of treatment

DI 2 = Diastolic Intervention after second week treatment

Based on table 3, the overall p value of each variable has not significant significance where the p value of the variable relationship SI 0 with SI 1, SI 0 with SI 2, SI 1 with SI 2, DI 0 with DI 1, DI 0 with DI 2 and DI 1 with DI 2 respectively are 1, 0.778, 0.621, 0.242, 0.089, 0.704. This shows that changes in systolic and diastolic blood pressure in the intervention sample have not been significant. As for the relationship variable DI 0 with DI 2 that get p value near p <0.05 indicates that still need improvement of research procedure to get significant result significantly.

Table 4. Comparison of Systolic and Diastolic Blood Pressure on Control and Intervention Samples

Variable C/I Mean P Value
Systolic 0 Control 122.4 0.756
Intervension 120
Diastolic 0 Control 84 0.172
Intervension 90
Systolic 1 Control 122 0.217
Intervension 116
Diastolic 1 Control 80 0.273
Intervension 74
Systolic 2 Control 122 0.111
Intervension 114
Diastolic 2 Control 78 0.195
Intervension 72

 

* Description: Using Independence T Test Test

 

According to Table 4, the overall p value of each variable was not significantly significant where the p value of the control variable comparison with systolic 0, diastolic 0, systolic 1, diastolic 1, systolic 2 and diastolic 2 intervention were 0.756, 0.172 , 0.217, 0.273, 0.111, and 0.195. This suggests that the ratio of changes in blood pressure in the dick and intervention variables is still not significant.

This study is a recent innovation in terms of seaweed intervention in pregnancy, there has been no related research that discusses this so that no research results can be used as a comparison of this study.

CONCLUSION

Based on the research that has been done, it can be concluded that the effectiveness of management and provision of BISRULA in pregnant women has not been too significant to lower blood pressure in pregnant women, this is evidenced by viewing the presentation of changes in conditions in the study sample.

SUGGESTION

For further research, it is advisable to measure iodine levels first in pregnant women before and after giving treatment to the sample in order to obtain more accurate results. Then for the sample problem used is very difficult to obtain so it is advisable to use the more easily obtained sample criteria. And for the problem of time of research should do research in a longer time that is at least about 2 months of research to see effectiveness of iodine delivery through BISRULA because of short research time is difficult to prove the effectiveness of BISRULA and measuring instrument used should have more detailed measurement standard to see existence changes that occur in the sample.