Buletin Penelitian Sistem Kesehatan

109–116

Authors: Suharmiati, Agung Dwi Laksono and Wahyu Dwi Astuti

Background: To improve coverage and equity of health services, plans and development plans is formulated. The Ministry of Health 2010, one of strategy almost is to increase to qualited health care. Methods: policy research on health centers in remote border areas, also conducted document review/policy, literature review, and the review of primary and secondary data. The purpose of the policy review of health centers in remote areas of the border is to acquire strategies and policy options related to health services in remote areas of the border. Results: Policy issues: Remote, Border and Islands (DTPK) has an extreme topography; The role of infrastructure is one of the important physical components of the border region. Therefore, there is a significant correlation between the condition of the infrastructure with the pulse of social and economic activities of society, and also the welfare of the people at the border;Availability of health services and support facilities in the Rural Sector, Border and Islands (DTPK) are still low. Policy options: Fulfillment of the availability of facilities and basic health services in accordance with Border topography; Compliance with the availability of transport for referral in accordance Border topography; Development of infrastructure in a systematic, consistent and targeted, will lead to improved well-being of border communities. Conclusion:The availability of infrastructure and the health services and health center network in the border areas is not optimal, clinic staf especially doctors and paramedics have not received an appropriate reward. Recommendation:Meeting the health care facilities and health centers and their networks in border areas and patterns of prime services at least equal to the neighboring state of health services, the nearest health center personnel exchanges between countries on a regular basis to follow up the International Health Regulations (IHR), and Availability transport for referral in DTPK

128–133

Authors: Lusianawaty Tana and Lannywati Ghani

Background:Backpain can cause temporary or permanent limitation of mobility to workers until they need sick leave and treatment. Back pain is also known as the second leading cause of sick leave. The objective of this study was to analyze back pain impact to work attendance among paramedics working at 3 hospitals in Jakarta. Methods: A cross sectional study was conducted in three hospitals in Jakarta. The subject inclusion criteria were paramedics working in care unit, had back pain in the last 1 year, aged 20–45 years old, and had worked more than 1 year. There were 109 subjects eligible. Results: Back pain occurred first in workplace was 2 times higher than outside workplace. A total of 16.5% paramedics took sick leave and the highest length of sick leave was 1–3 days and 7–14 days consecutively. Most of the subjects experienced back pain recurrence more than once in a year. The sick leave was significantly associated with the back pain scale: higher in subjects with back pain scale of 6–10 than 1–5 (p = 0.006 OR 4.5 95% CI 1.5–3.2). Conclusions:Back pain can be recurrent and has an impact on work attendance of paramedics in the hospital.

143–153

Authors: Alfridsyah, Ichsan and Ampera Miko

Background:In 2003, WHO formulates multicenter growth references study (MGRS) concept, conducted in 6 countries, with 8440 samples of children living in a healthy environment that allows, then grow in accordance with their genetic potency. Primary health research (Riskesdas) in 2007 were conducted simultaneously in 33 provinces and the assessment of children under-five nutritional status has referred to WHO 2006. Overall NAD Province was inducted within the top 10 provinces with nutritional problem. This research aims to determine the effectiveness of the use of the new standard anthropometric 2006 to increase knowledge and assessment of nutritional status on Nutrition Implementation Force in Banda Aceh in 2009. Methods:The design of this study is exploratory analytical method with Quasi-Experimental Design approach, carried out at 70 TPG and divided into two groups. Data collected included primary and secondary. Analysis of the data was applied the Independent T-Test and Dependent T-Test at 95%. Results:The results of the Independent T-Test analysis shows that there is a significant difference between knowledge (p = 0.000), attitude (p = 0.004), behavior (p = 0.005) and an increase in PSG (p = 0.031) between the post-test on the lecture with discussion and lectures with practice. While the results of analysis Dependent T-Test showed a significant increase from the pre-test to post-test for both groups at TGP in the working area of Banda Aceh. The results of the Independent T-Test analysis shows that there is a significant difference between knowledge (p=0.000), attitude (p = 0.004), behavior (p = 0.005) and an increase of PSG (p=0.031) between the post-test on the lecture with discussion and lectures with practice. While the results of analysis Dependent T-Test Showed a significant increase of from the pre-test to post-test for both groups at TGP in the working area of Banda Aceh. Recommendation:It’s suggested that by improving equity Nutritional Status Assessment Program (PSG) means to improve the health and nutritional status of children to be more optimal, while involving profession nutritionist in the implementation of nutrition program PSG, and use the lecture method with practice in providing education/counseling to TPG and then to cadres-cadres who are working each region, as this can increase the knowledge, attitude and behavior of executive power of nutrition in improving the nutritional status assessment.

168–175

Authors: Indirawati Tjahja Notohartojo and Lelly Andayasari

Background:The common cause of periodontal disease is poor oral hygiene, so it lead to make plaque accumulation containing various bacteria. Methods: The study used Cross Sectional study design and conducted in selected sub district primary health centers in DKI Jakarta. The amount of people were 950 persons conducted both gender with 20–55 years age and ever lived in Jakarta. Research goal is to get how much value oral hygiene industry employees Pulogadung in Jakarta. Data analyses were using Chi Square and Logistic Regression by SPSS version 15.Results: The result of this study showed related significant between variable education and variable age with the OHIS (Oral Hygiene Indeks Simplified).By analyse Logistic Regression only variable age was significant (p < 0.001). Conclusion:Worker oral hygiene indeks in the industrial area in Pulo Gadung Jakarta most still low. Recommendation: Recommended brushing teeth 2 times a day after breakfast and before bedtime to maintain oral hygiene.

185–193

Authors: Merryana Adriani and Vita Kartika

Background:According to UNICEF, is direct cause of children under five are malnutrition toddler food consumption is not balanced and the presence of infectious diseases, while indirect factors such as parenting toddlers. Methods:The research was conducted over ten months in 2011, in three provinces of East Java, Central Java and Central Kalimantan. The design of the research done crossectional. Quantitative data collection through interviews using a structured questionare on maternal nutriton status of children under five with malnutrition. Sampling was conducted under five are malnourished purposively in each study site. Results:Most of which 33.3% have children under five maternal education level of primary school and 26.7% graduated from high school. In this district there is a 45.8% Sumenep toddler educated mothers completed primary school, while the toddler’s mother graduated from high school in the city of Semarang and counties Gn. Mas respectively 38% and 35.1%. Malnourished children under five who have fathers with education level did not complete as much as 16.7% of schools in the district Sumenep. Malnourished children under five who have fathers with education level did not complete as much as 16.7% of schools in the district Sumenep, while in Semarang and counties Gn Mas most educated toddler’s father graduated from high school is as many as 44.8% and 35.1%. Type of disease that often affects children under five are malnourished in the three study sites was 68.9% as fever, cough and colds was 15.6%, and diarrhea 8.9%. A diet that is given in addition to breast milk in children aged 0–6 months include honey, water, starch, milk formula, baby biscuits, bananas are softened, milk porridge, soft food, rice, vegetables, fish, eggs, beef, snacks with reason that children want to eat and not cry. Conclusion:Inappropriate diet for toddlers makes early breastfeeding initiation and exclusive breast feeding can not be implemented properly.

203–216

Authors: Muhammad Agus Mikrajab and Syahrianti

Background: Implementing the Childbirth Planning and Complications Prevention Program that has released by Ministry of Health in 2007 for Pregnant women Services at Posyandu still tackles concern maternal health services particularly pregnant women that will be affected in achieving Fourth and Five MDGs Goals targets.Objectives: This study aimed to describe characteristics of pregnant women and to assess utiliziation of pregnant women services through integrating Childbirth Planning and Complications Prevention Program and Antenatal Care at Integrated Health Sevices Post.Methods: A cross sectional design with explorative approach through interview using structured questionn arias of pregnant women. Sample Size in this study was 69 pregnants women. Data were analyzed descriptively with STATA 11SE licensed©. This study was conducted in two health centers in Mojokerto City, Provincial East Java. Results: According to the observation shows that Posyandu services was conducted routinely by midwives, physician, nurses and health cadres involves counseling on imunization (92.8%) and family planning (85.5%), basic imunization services for maternal and neonatal (84.1%), allocating supplementary foods (82.6%), and maternal and neonatal services (81.2%) whereas Posyandu services was not conducted involves development and training for cadres (56.5%), receive referrals from traditional birth attendants (TBAs) and cadres (44.9%), referral for pregnant women to health center/hospital (34.8%), examining fundus utery (33.3%), examining fetal heart rate (31.9%), examining fetus position (27.5%), examining breastfeeding and postpartum mothers (26.1%), Screening(early detection of pregnant women at high risk (23.2%), examining tension and family planning (20.3%). Conclusions: P4K and ANC Services focused on high risk groups for pregnancies and delivery problems were 18–25 years and 34–41years. Most of households head were work in private sector. Most of pregnant women were not referred to health facilities by family when they suffer complications. According to the medical views that pregnant women parity for Grande Para category has a serious health problems particularly maternal and neonatal death. Furthermore, availability of maternal and neonatal cohorts was still low as it cannot be obtained adequate information concerns progress/mother health problems. Integrating P4K and ANC services have founded that services routine coverage of pregnant women at Integrated Health Services Post that conducted by midwives was still low. Recommendations: Increasing role of pregnant women through pregnant women class and more broadly socialization concern important of referral system and health services facilities availability for pregnant women and health examination only to health professions. Building partnership with traditional birth attendants in referring as pregnant women examination coverage to traditional birth attendants can be decreased. Conducting pregnant women counseling is concerned with pregnant women risk and number children that fulfill health requirements. It also, policy of local government to implement recording system for maternal and neonatal cohorts, information system based local area monitoring and its application particularly midwives and other health professions.

1-9

Authors: Endi Ridwan

Background:High-dose vitamin A supplementation twice a year to children 6–59 months old in vitamin A deficient areas has been studied to reduce under-five mortality by 23%. Vitamin A deficiency increases the risk of death associated with infectious diseases due to lower immune system of the body. Vitamin A supplementation program has been implemented in Indonesia with varying coverage. Many factors of residence, family characteristics, and family access to health services are expected to have association with high coverage of vitamin A supplementation. Objective:To assess the varying coverage of vitamin A supplementation in children 12–59 months old in association with child residence, family characteristics, and family access to health services in Indonesia. Methods:The study used secondary data of Baseline Health Research 2010. A cross-sectional nationwide health study includes information on whether children received vitamin A capsules in the last six months was conducted in 2010 in all-over Indonesia. A total of 16,955 children aged 12–59 months we included nationwide using probability proportional to size (PPS) sampling technique. A multivariate logistic regression was used to measure the risk of receiving vitamin A capsule associated with residence, family characteristics and access to health services. Results:Vitamin A supplementation coverage among children was 70.5% varies among provinces, higher in urban (75.3%) than in rural areas (65.6%). Most of the vitamin A supplementation coverage was achieved through Posyandu (Community Health Post). Multivariate logistic regression analysis reveals that the risk of children not receiving high-dose vitamin A capsules in the last six months are significantly associated (CI ± 95%) with children living in rural areas (AOR = 1.353), household head of woman (AOR = 0.799), head education of household junior high school or less (AOR = 1.262), do not know the location of community health center (AOR = 1.260), private service of physician (AOR = 1.233), private service of midwife (AOR = 1.258), posyandu (AOR = 1.267), and does not attend monthly posyandu activities (AOR = 1.735). The Marital status, age, and occupation of household head were not significant to simultaneously. Conclusion:High coverage of vitamin A supplementation was achieved through Posyandu (Community Heath Post). Multivariate logistic regression analysis reveals that the risk of children not receiving high-dose vitamin A are not associated with marital status, age, and occupation of household head.

21-28

Authors: Selma Siahaan, Siti Isfandari and Rini Sasanti H

Background:The use of contraceptive methods by reproductive age women in Indonesia is influenced by their socioeconomic status. The ability to pay of these women needs` to be considered to ensure the success of the national family planning program. Methods: This study used data of Basic Health Research (Riskesdas) 2010. The aims of the study is to determine the cost of contraceptive methods paid by married women between 10–59 years old based on their economic status. Data were analyzed descriptively using chi-square statistical tests. Results: The most favorable contraceptive methods for reproductive age women (WUS) with low, middle and higher status is injection while condom is mostly used by WUS with the higher economic status. Approximately 50% of reproductive age WUS with low economic status should pay 10,000 up to 15,000 rupiah for there contraception, meanwhile those with higher economic status ussually paid more than 20,000 rupiah. There is a correlation between contraceptive methods in family planning with service costs and economic status. Conclusion:Injection contraception is still the most preferred method for WUS in Indonesia and the method selection of family planning is related to the WUS economic status. Therefore health promotion in Family planning program should be intensively enhanced, particularly the utilization of IUD, so it can be better known and acceptable to society. Furthermore policy in family planning for the WUS with low economic status should be covered by government, free of charge or at an affordable cost.

38-47

Authors: Moch. Setyo Pramono and Suharmiati

Background: One of the efforts of North Central Timor regency in Improving Maternal and Child Health is a MCH revolution in the save community. This research focus on organizing network on alert system particularly at the level of villages and naketi traditions in Noeltoko and Noelpesu village. Methods: The study was conducted in August-November 2012 in Noeltoko and Noepesu village, Eban health centers in the region. Types of non interventional studies with exploratory design. Information was obtained through in-depth interviews and direct observations. As informants are community leaders, midwives and members of the networks. Results: There are six major networks in the study villages notification, transportation, family planning, funding, exclusive breastfeeding and blood donor. In the Village Noeltoko again that there is a network of disaster preparedness. Regular monthly meeting conducted the meeting initiator and network with a collective agreement since the creation of idle village. There is the usual tradition Naketi at between 7–9 months of gestation, the wife to the husband recantation face to face followed by recantation couple to a large family (parents). Conclusion: Community-based alert system through idle villagers networking proved effective enough to increase public awareness of health villagers. Indicators of success, logging all pregnant women and birth mothers through their networks by themselves, not by health personnel. All the efforts of labor is no longer in the house but in a health facility with a commitment involving all networks. Another indicator is the discussion and the dialogue is quite intensive in the sufficiently describes the networking meeting in high spirits for the improvement of health in their village. Naketi tradition as a form of local wisdom that is positive for minimal preparation for the delivery of maternal psychological side.

58-65

Authors: Wasis Budiarto and Mugeni Sugiharto

Background:The implementation of INA-CBGs system on hospital financing of catastropic diseases (heart, cancer, stroke) to Jamkesmas members at inpatient hospital, giving consequences catastropic diseases represent threat to more expense of Jamkesmas financing period of coming, while other side hospital feel that INA-CBGs claim that lower of hospital tariff. The purpose of this research is to conduct expense of medication of catastropic disease anf comparison of INA CBGs claim with real expense based on hospital tariff. Methods: Research type is observational with research cross sectional layout is according to hospital perspective. Data taken by using retrospective method taken away by medical record document. The research subjects are lodging patient at 10 Ministry of Health hospital within periode January–March 2012. Data analysis conducted descriptively. Results:The result of this strudy indicate that inpatient hospital of Jamkesmas members by catastropic disease is heart disease 37.11%, cancer 23.54% and stroke 39.35%. Conclusion: The average real expense inpatient hospital in A class much more compared to class of B and special hospital. Expense of INA CBGs claim much more of A class hospital compared to B class and special hospital. Component of many expense is accomodation cost, room action, laboratory, non surgical operation for the heart, surgical operation for cancer and the medicine expense. Expense of disease catastropic pursuant to compared to bigger claim based on INA-CBGs of real expense to hospital tariff, so that for hospital catastropic disease not lose. So, the policy of ladder refferal to Jamkesmas participant have to observe tightly so that health services to poor community become more well quality guaranted, exepense and sustainability

73-82

Authors: Sunarti and Elvia Maryani

Background: Coronary heart disease (CHD) is the leading cause of death in Indonesia. Central obesity is one of the risk factors that is often found in patients with CHD. Body mass index(BMI) of waist and hip circumference is commonly used to measure the central obesity in individuals. And now, this method is considered as the anthropometric measurement which is more sensitive, cheaper and easier to assess central obesity.This study aims to determine the relationship between hip and waist circumference ratio with the incidence of coronary heart disease in Sukoharjo district hospital. Methods: This study is an analytic study using cross-sectional study design. Blood pressure and blood sugar levels in this study serve as a controlling variable. 109 study subjects were taken through simple random sampling. The subjects were those who came to the emergency room for ECG assesment conducted between May and September 2009. Result: Based on chi-square test, the results show the relationship between hip and waist circumference ratio with the occurence of CHD with a value of RP = 1.760; CI 95% = 1.115 < RP < 2.778 and p-value = 0.007. Relationship between blood pressure and the CHD incident is at the value of RP = 1.533; 95% CI = 1.041 to 2.256 and the p-value = 0.022, while the relationship of blood sugar levels with CHD is at a value of PR = 1.148; 95% CI = 0.779 to 1.691 and the p-value = 0.317. Based on logistic regretion result show the relation between hip and circumference ratio with the occurence of CHD with value of p-value 0.028. There are no relation blood pressure and blood sugar levels with CHD, with value of p-value 0.083 and 0.782. Conclusion: The relationship between the ratio of waist and hips with the incidence of CHD is confirmed in the patients of Sukoharjo District Hospital.

88-98

Authors: Max Joseph Herman, Sudibyo Supardi and Yuyun Yuniar

Background: Government Regulation Number 51 of 2009 on Pharmacy Practice states that pharmacy staff is those who practice pharmacy, namely pharmacists and technical pharmacy staff. According to chapter 2, dispensing of prescription drugs, among others in primary health center (PHC), must be done by a pharmacist. The availability of pharmacy staff relating to PHC characteristics and pharmacy practice is still unclear. Methods: This study is a follow-up study through an analysis of secondary data of National Health Facility Research of 2011 which was done cross-sectionally on PHCs in districts/cities, regarding the availability of pharmacy staff in PHC and has been conducted in August and September 2012. The objectives of this study are to obtain information on the availability of pharmacy staff in PHC, the availability of pharmacy staff based on the characteristics of PHC and pharmacy practices based on the availability of pharmacy staff in PHC. Data confirmation was done through in-depth interviews with HRD staff of Bekasi and Bogor City Health Office and pharmacy staff in two PHCs in each city. Data was analyzed by comparing the availability of pharmacy staff based on the characteristics of PHC and pharmacy practice based on the availability of pharmacy staff in PHC. Statistical analysis was conducted using frequency distribution; Mann-Whitney, Kruskal-Wallis and Kendalls tau b tests. Results: Results of the study showed that only 17.5% of PHCs in Indonesia nationally had pharmacist and there were 32.2% PHCs with no pharmacy staff at all. There was statistically siginificant difference in the availability of pharmacy staff among PHCs based on their locus, sort of PHC, rural/urban area and employment status of pharmacy staff. Pharmacist performed better in pharmacy practice, drug management and complete LP-LPO reporting than who was also consecutively better than non-parmacy staff.