Gambaran Konsumsi Sumber Vitamin Dan Mineral, Status Gizi, dan Kejadian Dismenorea Pada Remaja Putri Di SMP Shafiyyatul Amaliyyah Tahun 2015

Lampiran 2. Kuesioner Skrining Kejadian Dismenorea di SMPShafiyyatul Amaliyyah

KUESIONER PENELITIAN HUBUNGAN KONSUMSI SUMBER VITAMIN DAN MINERAL, DAN STATUS GIZI DENGAN KEJADIAN

DISMENOREA PADA REMAJA PUTRI DI SMP SHAFIYYATUL AMALIYYAH TAHUN 2015

I. Data Responden

No. :

Nama :

Umur :

Kelas :

No. Hp :

BeratBadan (BB) : TinggiBadan (TB) :

II. Kuesioner Nyeri Haid

Pilihlah jawaban yang PALING SESUAI denganAnda!

1.Apakah kamu sudah menstruasi (haid)?

a. Ya b. Tidak

Jika ya, lanjut ke pertanyaan berikutnya!

2. Apakah kamu merasakan nyeri di perut bawah ketika haid (datangbulan)?

a. Ya b. Tidak

Jika ya, lanjut ke pertanyaan berikutnya!

3. Bila kamu merasakan nyeri diperut bawah ketika haid, seberapa sering? a. Selalu b. Kadang-kadang

4.Apakah nyeri tersebut membuat kamu tidak mampu melakukan aktivitas sehari hari termasuk sekolah?

a. Ya b. Tidak

5. Selain di perut bagian bawah, nyeriketika dating bulan juga terasa di... a. Pinggang dan paha b. Tangan, kaki

c.Tempat lain, sebutkan_____________

6. Selain nyeri di perut bagian bawah kamu juga memiliki keluhan… a.Payudara terasa nyeri c. Kembung

Lampiran 4.Universal Pain Assessment Tool

Tingkat Nyeri Dismenorea

Silahkan gunakan salah satu dari skala di bawah ini untuk menunjukkan rata-rata tingkat nyeri yang Anda alami.

Jawaban :

a. 0 - 1 : Tidak nyeri ( tidak sakit )

b. 1 – 3 : Nyeri ringan ( dapat diabaikan ) c. 3 – 5 : Nyeri sedang ( mengganggu tugas ) d. 5 – 7 : Nyeri sedang ( mengganggu konsentrasi ) e. 7 – 9 : Nyeri berat ( mengganggu aktivitas )

Lampiran 5. Formulir Food Recall 24 Jam FORMULIR FOOD RECALL 24 JAM

Hari/ Tanggal : Hari ke- :

Waktu Nama Masakan

Bahan Makanan Banyaknya

Jenis URT gr

Pagi/ Jam

Siang/Jam

Lampiran 6. Formulir Food Frequency

FORMULIR FOOD FREQUENCY

Nama :

Hari/ Tanggal : Nama Bahan

Makanan

Frekuensi Konsumsi

Keterangan Tidak Pernah 1-3x/hari 4-6x/mgg 1-3x/mgg 1x/bulan

1. Makanan Pokok a. Nasi

2. Lauk Hewani a. Telur

b. Daging Ayam c. Daging Sapi d. Ikan

e. Udang f. Kerang g. Kepiting h. Tiram i. Hati 3. Lauk Nabati

a. Tempe b. Tahu

c. Kacang tanah d. Kacang merah e. Kacang hijau 4. Sayuran

a. Bayam b. Kangkung c. Buncis d. Daun Ubi e. Tauge f. Sawi 5. Lain-lain

Lampiran 7. Output Data

No Nama Umur

(th) Tingkat Nyeri Status gizi Asupan

B6 akg % E akg % Ca akg % Zn akg %

1 Tasya

Nabila 13 4 0,22 1 1.2 83.333 2.3 15 15.333 71.6 1200 5.9667 11.2 16 70

2 Cut Alya 13 2 1,92 0.8 1.2 66.667 3.4 15 22.667 954 1200 79.5 6.1 16 38.125

3 Diva

Marisa 13 3 0,82 0.7 1.2 58.333 8.4 15 56 553.5 1200 46.125 5.9 16 36.875

4 Anggi

Pratiwi 14 2 -1,43 0.6 1.2 50 3.2 15 21.333 89.6 1200 7.4667 6.3 16 39.375

5 Khairisa

F 13 3 0,22 0.8 1.2 66.667 4.3 15 28.667 514.9 1200 42.908 5.6 16 35

6 Kesya

Aurelya 12 2 -0,49 0.9 1.2 75 5.8 15 38.667 911.6 1200 75.967 10.7 14 76.429

7 Devi

Dayanti 13 2 -1,61 0.6 1.2 50 1.8 15 12 419.4 1200 34.95 4.7 16 29.375

8 Khansa 14 3 1,53 0.3 1.2 25 1.2 15 8 43.5 1200 3.625 2.4 16 15

9 Rania

Andira 13 2 -1,83 0.5 1.2 41.667 0.7 15 4.6667 476.4 1200 39.7 2.9 16 18.125

10 Widya

Yustika 13 2 0,13 0.5 1.2 41.667 2.4 15 16 97.9 1200 8.1583 3.1 16 19.375

11 Wan

Annisa 13 3 -0,62 0.7 1.2 58.333 5.1 15 34 391.3 1200 32.608 4.2 16 26.25

12 Sisi

Tazmi 13 4 2,66 0.4 1.2 33.333 5.4 15 36 343.5 1200 28.625 2.9 16 18.125

13 Amira

Salsabila 14 2 2,01 0.4 1.2 33.333 2 15 13.333 143.9 1200 11.992 2.7 16 16.875

14 Elsa

Laura 14 2 -1,64 0.5 1.2 41.667 3.7 15 24.667 534.6 1200 44.55 5.3 16 33.125

15 Dalva

Dalton 14 5 1,80 0.7 1.2 58.333 3.4 15 22.667 85.5 1200 7.125 7.2 16 45

16 Adzra

Shafwa 13 4 0,07 0.9 1.2 75 1.4 15 9.3333 103.4 1200 8.6167 4.9 16 30.625

17 Meuthia

A 13 2 -0,50 0.8 1.2 66.667 6 15 40 109.4 1200 9.1167 4.4 16 27.5

18 Shana

Asyila 13 2 -0,77 1 1.2 83.333 5.7 15 38

1235.

1 1200 102.93 10.4 16 65

19 Dwita

Oktavani 13 3 0,04 0.5 1.2 41.667 9.4 15 62.667 353.2 1200 29.433 4.5 16 28.125

20 Nafisah

Syahda 12 2 0,95 0.9 1.2 75 4 15 26.667

1031.

7 1200 85.975 8 14 57.143

21 Sabrina

Mutiara 13 3 2.13 0.6 1.2 50 5.8 15 38.667 52.5 1200 4.375 6 16 37.5

22 Alfdira

Husna 12 2 2,18 1.1 1.2 91.667 4.2 15 28 570.2 1200 47.517 7.4 14 52.857

23 Nadya

Putri 13 4 0,29 0.8 1.2 66.667 4.3 15 28.667 951 1200 79.25 6.5 16 40.625

24 Nadira

Azzahra 14 3 1,40 0.5 1.2 41.667 2.6 15 17.333 124.6 1200 10.383 3.6 16 22.5

Sartika 26 Nabila

Risqi 12 2 1,25 0.9 1.2 75 4.1 15 27.333 965 1200 80.417 8.2 14 58.571

27 Cut

Balqis 14 5 0,42 0.8 1.2 66.667 5.9 15 39.333 105.7 1200 8.8083 4.5 16 28.125

28 Nabila

Febrina 12 3 0,28 1.2 1.2 100 3.2 15 21.333 2064 1200 172 12.7 14 90.714

29 S.

Reinnata 13 2 -0,47 1.2 1.2 100 3 15 20 1435 1200 119.58 10.9 16 68.125

30 Zahra

Afifah 12 4 1,49 0.4 1.2 33.333 2.2 15 14.667 55.6 1200 4.6333 3.5 14 25

31 Siti Alya

Putri 11 4 2,30 0.5 1.2 41.667 1.7 15 11.333 87 1200 7.25 4.5 14 32.143

32 Farah

Naurah 13 5 -1,06 0.5 1.2 41.667 2.5 15 16.667 500.8 1200 41.733 4.8 16 30

33 Khalisa

Nabila 12 2 -0,03 0.8 1.2 66.667 3.2 15 21.333 585.2 1200 48.767 5.9 14 42.143

34 Aisha C 13 4 1,12 1.6 1.2 133.33 2.8 15 18.667 2905.

5 1200 242.13 17 16 106.25

35 Natasya

Patricia 14 3 2,59 0.3 1.2 25 1.4 15 9.3333 326.9 1200 27.242 4.1 16 25.625

36 Annisya

Azzahra 12 2 0,59 1.1 1.2 91.667 7.5 15 50 860.8 1200 71.733 9.2 14 65.714

37 Fidelia 13 3 -0,30 0.2 1.2 16.667 2.9 15 19.333 17.7 1200 1.475 2.1 16 13.125

38 Lailan

noor 12 5 1,27 1.3 1.2 108.33 5.3 15 35.333 380.5 1200 31.708 8.1 14 57.857

39 Nabila

Fisya 12 2 -0,14 0.9 1.2 75 1.7 15 11.333 157.5 1200 13.125 5.9 14 42.143

40 Balqis

Salsabila 12 4 1,95 0.7 1.2 58.333 4.7 15 31.333 152.3 1200 12.692 9.2 14 65.714 41 Nadya

Adlin 12 2 1,07 0.8 1.2 66.667 1.1 15 7.3333 68 1200 5.6667 2.8 14 20

42 Akifah

Najla 12 3 2,67 0.9 1.2 75 4.1 15 27.333 162.9 1200 13.575 5.5 14 39.286

43 Nadya

Fithrie 12 3 0,06 1.4 1.2 116.67 3.2 15 21.333 415.3 1200 34.608 9.7 14 69.286

Data Kategorik

No Nama Umur

(th) Tingkat Nyeri Status gizi Jumlah Asupan

Vit. B6 Vit. E Kalsium Zink

1 Tasya

Nabila 13 3 1 2 1 1 2

2 Cut Alya 13 2 4 1 1 2 1

3 Diva Marisa 13 3 1 1 1 1 1

4 Anggi

Pratiwi 14 2 1 1 1 1 1

5 Khairisa F 13 3 1 1 1 1 1

6 Kesya

Aurelya 12 2 1 1 1 1 1

7 Devi

Dayanti 13 2 1 1 1 1 1

8 Khansa 14 3 4 1 1 1 1

9 Rania

Andira 13 2 1 1 1 1 1

10 Widya

Yustika 13 2 1 1 1 1 1

11 Wan Annisa 13 3 1 1 1 1 1

12 Sisi Tazmi 13 3 5 1 1 1 1

13 Amira

Salsabila 14 2 5 1 1 1 1

14 Elsa Laura 14 2 1 1 1 1 1

15 Dalva

Dalton 14 4 4 1 1 1 1

16 Adzra

Shafwa 13 3 1 1 1 1 1

17 Meuthia A 13 2 1 1 1 1 1

18 Shana

Asyila 13 2 1 2 1 2 1

19 Dwita

Oktavani 13 3 1 1 1 1 1

20 Nafisah

Syahda 12 2 1 1 1 2 1

21 Sabrina

Mutiara 13 3 5 1 1 1 1

22 Alfdira

Husna 12 2 5 2 1 1 1

24 Nadira

Azzahra 14 3 4 1 1 1 1

25 Sarah

Sartika 11 2 4 1 1 1 1

26 Nabila

Risqi 12 2 4 1 1 2 1

27 Cut Balqis 14 4 1 1 1 1 1

28 Nabila

Febrina 12 3 1 2 1 2 2

29 S. Reinnata 13 2 1 2 1 2 1

30 Zahra

Afifah 12 3 4 1 1 1 1

31 Siti Alya

Putri 11 3 5 1 1 1 1

32 Farah

Naurah 13 4 1 1 1 1 1

33 Khalisa

Nabila 12 2 1 1 1 1 1

34 Aisha C 13 3 4 2 1 2 2

35 Natasya

Patricia 14 3 5 1 1 1 1

36 Annisya

Azzahra 12 2 1 2 1 1 1

37 Fidelia 13 3 1 1 1 1 1

38 Lailan noor 12 4 4 2 1 1 1

39 Nabila

Fisya 12 2 1 1 1 1 1

40 Balqis

Salsabila 12 3 4 1 1 1 1

41 Namira

Yasmine 12 2 4 1 1 1 1

42 Akifah

Najla 12 3 5 1 1 1 1

43 Nadya

Fithrie 12 3 1 2 1 1 1

Analisis Univariat 1. Usia

Usia

Frequency Percent Valid Percent

Cumulative Percent

Valid 11 2 4.5 4.5 4.5

12 15 34.1 34.1 38.6

13 19 43.2 43.2 81.8

14 8 18.2 18.2 100.0

Total 44 100.0 100.0

2. Tingkat Nyeri

Tingkat Nyeri

Frequency Percent Valid Percent

Cumulative Percent

Valid nyeri ringan 19 43.2 43.2 43.2

nyeri sedang 21 47.7 47.7 90.9

nyeri berat 4 9.1 9.1 100.0

Total 44 100.0 100.0

3. Status Gizi

Status Gizi

Frequency Percent Valid Percent

Cumulative Percent

Valid normal 26 59.1 59.1 59.1

risiko gemuk 11 25.0 25.0 84.1

gemuk 7 15.9 15.9 100.0

4. Vitamin B6

Vitamin B6

Frequency Percent Valid Percent

Cumulative Percent

Valid kurang 34 77.3 77.3 77.3

cukup 10 22.7 22.7 100.0

Total 44 100.0 100.0

5. Vitamin E

Vitamin E

Frequency Percent Valid Percent

Cumulative Percent

Valid kurang 44 100.0 100.0 100.0

6. Kalsium

Kalsium

Frequency Percent Valid Percent

Cumulative Percent

Valid kurang 36 81.8 81.8 81.8

cukup 8 18.2 18.2 100.0

Total 44 100.0 100.0

7. Zink

Zink

Frequency Percent Valid Percent

Cumulative Percent

Valid kurang 40 90.9 90.9 90.9

cukup 4 9.1 9.1 100.0

Tabulasi Silang

1. Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Vitamin dan Mineral

1.1 Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Vitamin B6

Vitamin B6 * Tingkat Nyeri Crosstabulation

Tingkat Nyeri

Total nyeri ringan nyeri sedang nyeri berat

Vitamin B6 kurang Count 15 16 3 34

% within Vitamin B6

44.1% 47.1% 8.8% 100.0%

Cukup Count 4 5 1 10

% within Vitamin B6

40.0% 50.0% 10.0% 100.0%

Total Count 19 21 4 44

% within Vitamin B6

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Point Probability

Pearson Chi-Square .056a 2 .972 1.000

Likelihood Ratio .056 2 .972 1.000

Fisher's Exact Test .337 1.000

Linear-by-Linear Association

.052b 1 .820 1.000 .513 .211

N of Valid Cases 44

a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .91. b. The standardized statistic is .228.

1.2 Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Vitamin E Vitamin E * Tingkat Nyeri Crosstabulation

Tingkat Nyeri

Total nyeri ringan nyeri sedang nyeri berat

Vitamin E kurang Count 19 21 4 44

% within Vitamin E

43.2% 47.7% 9.1% 100.0%

Total Count 19 21 4 44

% within Vitamin E

43.2% 47.7% 9.1% 100.0%

Test Statistics

Tingkat Nyeri

Chi-Square 11.773a

Df 2

Asymp. Sig. .003

a. 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 14.7.

1.3 Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Kalsium Kalsium * Tingkat Nyeri Crosstabulation

Tingkat Nyeri

Total nyeri ringan nyeri sedang nyeri berat

Kalsium kurang Count 14 18 4 36

% within Kalsium

38.9% 50.0% 11.1% 100.0%

cukup Count 5 3 0 8

% within Kalsium

62.5% 37.5% .0% 100.0%

Total Count 19 21 4 44

% within Kalsium

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig.

(2-sided)

Exact Sig. (2-sided)

Exact Sig. (1-sided)

Point Probability

Pearson Chi-Square 1.948a 2 .378 .432

Likelihood Ratio 2.599 2 .273 .333

Fisher's Exact Test 1.422 .511

Linear-by-Linear Association

1.897b 1 .168 .230 .140 .100

N of Valid Cases 44

a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .73. b. The standardized statistic is -1.377.

1.4 Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Zink Zink * Tingkat Nyeri Crosstabulation

Tingkat Nyeri

Total nyeri ringan nyeri sedang nyeri berat

Zink kurang Count 19 17 4 40

% within Zink

47.5% 42.5% 10.0% 100.0%

cukup Count 0 4 0 4

% within Zink

.0% 100.0% .0% 100.0%

Total Count 19 21 4 44

% within Zink

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Point Probability Pearson Chi-Square

4.819a 2 .090 .108

Likelihood Ratio 6.358 2 .042 .091

Fisher's Exact Test 3.963 .176

Linear-by-Linear Association

1.229b 1 .268 .415 .237 .169

N of Valid Cases 44

a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .36.

2. Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Status Gizi Remaja Putri

Status Gizi * Tingkat Nyeri Crosstabulation

Tingkat Nyeri Total nyeri ringan nyeri sedang nyeri berat Status Gizi

normal Count 13 11 2 26

% within Status Gizi

50.0% 42.3% 7.7% 100.0%

risiko gemuk

Count 4 5 2 11

% within Status Gizi

36.4% 45.5% 18.2% 100.0%

gemuk Count 2 5 0 7

% within Status Gizi

28.6% 71.4% .0% 100.0%

Total Count 19 21 4 44

% within Status Gizi

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Point Probability Pearson Chi-Square

3.432a 4 .488 .484

Likelihood Ratio 3.782 4 .436 .539

Fisher's Exact Test 3.002 .550

Linear-by-Linear Association

.878b 1 .349 .376 .196 .036

N of Valid Cases 44

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .64.

Chi-Square Tests

Value Df

Asymp. Sig.

(2-sided)

Exact Sig. (2-sided)

Exact Sig. (1-sided)

Point Probability Pearson

Chi-Square

3.432a 4 .488 .484

Likelihood Ratio 3.782 4 .436 .539

Fisher's Exact Test 3.002 .550

Linear-by-Linear Association

.878b 1 .349 .376 .196 .036

N of Valid Cases 44

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .64.

Lampiran 8. Dokumentasi Penelitian

Gambar 1. Penimbangan Berat Badan Remaja Putri

Gambar 3. Wawancara Food Recall dengan Remaja Putri

1.4 Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Konsumsi Zink Zink * Tingkat Nyeri Crosstabulation

Tingkat Nyeri

Total nyeri ringan nyeri sedang nyeri berat

Zink kurang Count 19 17 4 40

% within Zink

47.5% 42.5% 10.0% 100.0%

cukup Count 0 4 0 4

% within Zink

.0% 100.0% .0% 100.0%

Total Count 19 21 4 44

% within Zink

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Point Probability Pearson Chi-Square

4.819a 2 .090 .108

Likelihood Ratio 6.358 2 .042 .091

Fisher's Exact Test 3.963 .176

Linear-by-Linear Association

1.229b 1 .268 .415 .237 .169

N of Valid Cases 44

a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .36.

2. Kejadian Dismenorea (Tingkat Nyeri) Berdasarkan Status Gizi Remaja Putri

Status Gizi * Tingkat Nyeri Crosstabulation Tingkat Nyeri Total nyeri ringan nyeri sedang nyeri berat Status Gizi

normal Count 13 11 2 26

% within Status Gizi

50.0% 42.3% 7.7% 100.0% risiko

gemuk

Count 4 5 2 11

% within Status Gizi

36.4% 45.5% 18.2% 100.0%

gemuk Count 2 5 0 7

% within Status Gizi

28.6% 71.4% .0% 100.0%

Total Count 19 21 4 44

% within Status Gizi

43.2% 47.7% 9.1% 100.0%

Chi-Square Tests

Value Df

Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Point Probability Pearson Chi-Square

3.432a 4 .488 .484

Likelihood Ratio 3.782 4 .436 .539

Fisher's Exact Test 3.002 .550

Linear-by-Linear Association

.878b 1 .349 .376 .196 .036

N of Valid Cases 44

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .64.

Chi-Square Tests

Value Df

Asymp. Sig.

(2-sided)

Exact Sig. (2-sided)

Exact Sig. (1-sided)

Point Probability Pearson

Chi-Square

3.432a 4 .488 .484

Likelihood Ratio 3.782 4 .436 .539

Fisher's Exact Test 3.002 .550

Linear-by-Linear Association

.878b 1 .349 .376 .196 .036

N of Valid Cases 44

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .64.

Lampiran 8. Dokumentasi Penelitian

Gambar 1. Penimbangan Berat Badan Remaja Putri

Gambar 3. Wawancara Food Recall dengan Remaja Putri