Buletin Penelitian Sistem Kesehatan

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.