Buletin Penelitian Sistem Kesehatan

327–336

Authors: Supriyantoro, Harimat Hendarwan, Youth Savithri

Background: The variation of benefit packages implemented by some local social health insurance schemes(Jamkesda) become an important issue in the effort to integrating them into National Health Insurance (JKN). This study aims to describe implementation of Jamkesda’s benefit packages as a basic consideration in integration to JKN. Methods: Design of this study is case study with qualitative and quantitative aproaches,conducted 2013–2014 in all of districts/cities which already have Jamkesda. Primary and secondary data was collected. Primary data has been collected by focus group discussion,interview, observation, and self administered questioner. Secondary data collected from many sources such as articles, journal, official document, statistics data, and others. Results:Of this study show there is no significant relationship between fiscal capacity group and benefit packages (continuity correction, p value = 0.065).But,districts/cities with high fiscal capacity (high and very high) seem likely to have probability 1,920 bigger than lower capacity districts/cities in giving equal or more benefit than existing national social health insurance (Jamkesmas) (Mantel-Haenszel, Common Odds Ratio Estimates = 1.920; Confidence Interval 95% =1.008–3.658; asymp. Sig 2 sided = 0.047). There is variation of benefit packages between each Jamkesda.Qualitative results show there are many obstacles faced in giving benefit health services, such as limited community accessibility to health facilities, the absence of health workforce, and lack of health infrastructure and equipment. Recomendation: This study recommends to set a national minimum benefit packages and equalizing percetion of local decission maker.

345–352

Authors: Ainun Sajidah, Wimpie I. Pangkahila, J. Alex Pangkahila

Background:Disharmonious sexual life often create many problems. When the sexual function of the wives is not optimum, the sexual satisfaction of the husbands, or both husband and wife, will be disturbed. These will lead husbands to do sexual intercourses with FSW without condoms. Such intercourse may cause of STIs. The aims of this study were to identify the frequency of sexual intercourse without condom with FSW related to the level of sexual satisfaction of the husband and the risk of STIs. Methods:The study applied observational analytic with cross sectional design. The accidental sampling technique, the 196 samples, comprise of husband with the following criteria: having non-menopause legal wives, regularly having sex with wives without condoms within 6 months, having sex with FSW without condom at least once in 6 months, in the family stage II standard, healthy and willing to be respondents. Data on the level of sexual satisfaction and frequency of sexual intercourse without condom was collected through interviews, data on the risk of STIs was collected with physical and laboratory check-up by medical staff. The laboratory check-up for gonorrhea was done with the Gram’s coloring, syphilis with T. Pallidum Hemagglutination Assay (TPHA) and Veneral Disease Research Laboratory (VDRL), genital herpes and acuminate condyloma with clinical symptoms. The result was analysed descriptively and data normality was tested with Kolmogorov-Smirnov test and the correlaton test was done with the Spearman’s rho and Chi-Square tests. Results:The result showed there was the frequency of sexual intercourse without condom with FSW the most 1 time/week 57 persons (29.10%), with STIs 10 persons (5,10%) the level of sexual satisfaction that was quite satisfied 97 persons(49.50%), and the STIs 41 persons (20,90%). The frequency of sexual intercourse without condom with FSW not related to the level of sexual satisfaction of the husbands p = 0.146 (p > 0.05). The frequency of sexual intercourse without condom with FSW related to the risk STIs p = 0.001 (p < 0.01). Conclusions:The frequency of sexual intercourse without condom with FSW was not related to the level sexual satisfaction of the husband, but related to the risk of STIs. The study was expected to be used as the base of further study to know other factors the frequency of sexual intercourse without condom with FSW.

363–370

Authors: Anggi Septia Irawan , Aryani Pujiyanti , Wiwik Trapsilowati

Background: Malaria was becoming a re-emerging disease in central java, especially for Kebumen Regency, it has been hit by malaria outbreak with the increasing case. A study was conducted in rural area of sub district Rowokele, Kebumen, Central java to identify local knowledge and practice of the community that has been becoming one of the important factors for vector borne disease control, including malaria control. Methods: This research was conducted between June 2011 and November 2011, applying qualitative method with ethnoscience approach. Data were retrieved from in-depth interviews and focus-group. Qualitative thematic content analysis was applied to understanding sharpening of the social and cultural aspect of malaria disease. Results:Qualitative method using in-depth interview able to explain several findings, such as the result of a local term of malaria, called “udug-udug” in rowokele sub-district. It shows the insufficient understanding of malaria signs and symptoms in the sub of villages, it leads to delay for illness recognition and its treatment. Conclution: Misperceptions on the preventive activities, as well as confusion of malaria with dengue fever, were identified. This study detected risk group of malaria infection in community practices such as a farmer who works in the forest and seasonal migration. Recommendation: Promotion intensification and health education on vector, prevention and therapy are important to be introduced.

379–384

Authors: Roy G.A. Massie , Indra Domili, Joy Rattu

Background:The maternal mortality rate (MMR) in Indonesia is still high with 90% occured during labor and after delivery. In 2007–2009 MMR in the District of North Gorontalo is higher than the national. Efforts in order to decrease maternal mortality, especially in the antenatal phase had been formally conducted by health professionals in the form of promotion. There is effort that can be done traditionally by local cultural approach particularly in Gorontalo Province known as the ceremomial Molontalo. Molontalo is a statement from the husband’s family that first pregnancy is fulfilled expectations will be a continuation derived from legal marriage. The purpose of the research was to increase the hulango (village shaman) and hatibi’s (village priest) knowledge of MCH as community and religious leaders through traditional ceremonies Molontalo so the pregnant women can visit the health care workers and facilities. Methods:Operational research, which begins with the intervention, data collection, analyzed the objects, the situation that described descriptively. Results:Pre-test of the hatibi and hulango knowledge on MCH programs were low, but there was improvement in post-test. Furthermore, the hulango and hatibi, in terms of delivery MCH messages to the pregnant women could be maintained by the health workers, so they could involved in the health sector, especially for MCH program. The performanced of the hulango for delivering MCH message was good and the hatibi as well. However, there were need to be regularly improved the MCH program related to any Molontalo ceremonial activities. Conclusion:This ceremony may facilitate the delivery of MCH program especially in promotion stage. This activity was expected to decrease the maternal mortality rate. Recommendation:Evaluation needs to be done for the communities’ understanding of Molontalo ceremony in order to recognize the level of understanding of the MCH program. Each ceremony is expected to be conducted continuously and consistently in order to deliver the MCH program messages.

395–405

Authors: Niniek Lely Pratiwi, Agus Suprapto, Agung D Laksono, Betty R , Rukmini, Gurendro , Ristrini , Wahyu D Astuti, Oktarina, Mugeni S

Background: Health Policy Regulation Number 494/Menkes/SK/IV/2010 on the distribution of BOK funds to local government is one of the government’s responsibility for the development of public health in improving health promotion and prevention efforts in order to accelerate the achievement of MDGs in Health. The purpose of the study is to provide policy recommendations regarding to BOK in achieving the goals of maternal and child health programs. Methods: Secondary data review of the district health profile in 2009-2011 and analysis on the primary data collected from focus group discussion (FGD) with invited technical implementor from district health office and health centers as well as some of the staffs of the local government that handle BOK. Results: The decline in maternal and infant mortality rates are still slow and cases of malnutrition increased from the three profile data review Sampang, Gresik and Sidoarjo. Local governments pay little commitment in developing priority strategies of maternal and child health programs in the form of a local action and innovation plan. BOK preventive promotive activities are lacking of monitoring and accountability controls, especially in health centers located far from the district center. Financial accountability is less precise to the programs and targetes, having seen the data of maternal and child health outcomes KN1-KN4 coverage which rose in 2010, but then fell back in 2011. Conclusion: Evaluation and monitoring are needed on the utilization of BOK funds,supervising the activities by the district/city health office, as well as by local community leaders. Prioritise monitoring the health centers in the area with high MMR and IMR. Suggestion: Needed routine and periodic mentoring and coaching in the form of technical assistance related to the utilization of BOK

415–424

Authors: Riswati , Ni Ketut Aryastami, Meda Permana , Ratna Widyasari , Qomariah Alwi

Background:Jampersal program was launched in Indonesia in January of 2011 by Permenkes No.631/Menkes/PER/III/2011. The aim was to improve the coverage of antenatal care, delivery, postpartum care, postnatal, and family planning by health professionals free of charge. After over a year Jampersal program runs, The ANC figures of Jampersal utilization were still very low. Methods:Quantitative and qualitative research on socio- cultural factors in relation to the selection of health personnel by utilizing Jampersal conducted in 2012 which was then followed by a round table discussion to review the policy options related to the Jampersal utilization of the 6 rural districts. Results:Policy options suggested in Jampersal socialization activities need Intersectoral Commitment:The Ministry of Home Affairs, Ministry of Religious Affairs, and BKKBN, followed by a clear and decisive political commitment. They need active partnerships of the midwives, TBAs and cadres in Jampersal socialization. Midwives in the health center level should be prohibited from private practice, but the total amount of compensation of midwife in helping delivery should be adjusted. Regulations are required and procedures should be set for Jamkesnas, Jamkesda, and Jampersal; They need regulation on cooperation between the health centers staffs and village chiefs to further reinforce ID requirement;The transportation cost to refferal unit; TBAs services (division of task and cost); Financial restrictions to cover by Jampersal on second or third delivery. Additionally need a regulation of reward and punishment for midwives,TBAs and cadres involvement in serving pregnancy and delivery. In village level, they need to establish regulation, that TbaS AND Cadres should write the pregnat women data at the board office of village chiefts. Lastly, MoU between head of district health center and midwife assosiation related to midwife understanding of cultural approaches and on the job training for midewife should be established. Conclusion:Culture-Based Approach has important role to improve Delivery By Health WorkersIn Rural Areas. Recommendation:Shorterm and longterm priority of policy should be set up.

215-225

Authors: Ristrini and Oktarina

Background:MCH book is a tool for early detection for vulnerable gravida. Meanwhile, the utilization of MCH book was still low. The target achieved for early detection was 12% out of 20% from 2011 to 2012. Based on SDKI 2012, the average maternal mortality rate reached 359 per 100.000 live births,increased significantly from the data of SDKI 2007 which reached 228 per 100.000 live births. Methods: This study was observational with cross sectional design. Both quantitative and qualitative data were collected. Secondary data were collected by the availability of MCH book, midwives training, supervisions, and complete fulfillment of MCH book. Populations in Puskesmas Kedundung and Puskesmas Geger Bangkalan District. The samples were midwives with more than one year working and graduated from DIII (diploma). The complete fulfillment of MCH book was identified from family identity, delivery preparation, gravida medical record, antenatal medical record, postnatal medical record, KMS (Booklet to Infant Nutritional Status Detection), Neonatus medical record, infant medical record, vitamin A supplementary. Result: The complete fulfillments were in Puskesmas Geger 0.66 (category: good 0.51–1.00) and Puskesmas Kedundung 0.35 (category: low 0.00–0.50). Midwives’ Motivations were low (50.0%) and midwives workload were high (66.7%) at Puskesmas Geger. Midwives were highly motivated (66.7%) and their workloads are fair. Recomendation: make group of work and allocate the job description properly to assist midwives workload. In addition, health office of Bangkalan should give reward to those who do the work excellently.

233-239

Authors: Laurentia Mihardja, Delima, Qomariah Alwi, Lannywati Ghani, Olwin Nainggolan and Raflizar

Background: Impaired glucose tolerance (IGT) or pre diabetes is not categorized as diabetes yet but blood glucose level is more than normal. IGT is the risk factor for diabetes mellitus, coronary disease and stroke. Methods: In 2009, a cross-sectional study was conducted in DKI Jakarta to follow up 78 subjects identified as IGT in Basic Health Survey(Riskesdas) 2007. It aimed to assess the hyperglycemia status of the IGT subjects, whether developing into diabetes mellitus or becoming normal glucose tolerance or just remained IGT. Results: We found over two years for IGT subjects, 7.2% progressed to diabetes mellitus, 47.8% remained impaired glucose tolerance, 4.3% changed to impaired fasting glucose and 40.7% reverted to normal glucose tolerance. Life style and biological factors of the subjects, like body mass index, central obesity, dyslipidemia had no significant difference in year 2009 compared with 2007. In analysis we found waist circumference increased but not significantly difference and Homa-IR(insulin resistance) was higher (p < 0.05) in IGT conversed to Diabetes compared to other groups. Recomendations: Stakeholder should make an intervention program for IGT group in order to prevent them becoming diabetes or getting degenerative disease complications.

249-256

Authors: Ruben Wadu Willa and Majematang Mading

Background: West Manggarai district in period January until July 2012. Infant mortality rate were 34 cases, stillbirths were 33 cases and maternal mortality rate was 9 cases. Methods:This research is qualitative study using Focus Group Discussion (FGD) desain, cooperation with head of public health center, midwife, nutrition program manager, and public health at health department. Results:Maternal and infant mortality in Labuan Bajo public health center caused by maternal nutritional deficiency, infectious diseases such as malaria and typhoid fever, mother less attention to the baby when the baby’s ill and difficult access to health services. The problem solution is pregnant women should be regularly having antenathal care, using of mosquito nets. Need to be provided cheaper sea transport. Causes of malnutrition and under-nourishment is knowledge, parenting skill and infectious diseases such as diarrhea and malaria. To overcome this problem midwife should be proactive giving counseling to families with malnutrition children under five. Maternal and infant mortality in Winekang public health center caused by not availability of hospital at district, pregnant women still seeking treatment to traditional healers, the implementation of government regulations are less strict and families often late in taking decision to be referred. The solution is health officers must always giving counseling to pregnant women and cross-sector approach to monitoring. Whereas the main cause nutritional problems is parenting behavior, infectious diseases, and not enough healthy food. Conclusion:Maternal and infant mortality caused by difficult access to health services, there are pregnant womens who go to traditional healers, not availability of hospitals in the district, also infectious diseases likes malaria and diarrhea. The solution is the midwife must active involving the village and subdistrict heads in monitoring pregnant women, need to provide a boat and build district hospital

267-274

Authors: Suharmiati, Lestari Handayani and Herti Maryani

Background: Many private clinics in the Province of Bali service tourists. It should be the responsibility of the government. On the other hand the feasibility of health centers (HC) based on the availability of coastal tourism facilities and infrastructure, including human resources available to the health service is not clear. This study compared the feasibility of health centers shore excursions and non touristic beach health centers in Bali Province. Methods:Secondary data Healthcare Research Facility (Rifaskes 2011) all health centers in the Province of Bali. The number of samples are 114 health centers. Variabels consisted of facilities, infrastructure, human resources and health programs. The analysis is done by giving the value (weight) of each variabel, then performed the scoring of each variabel both in Beach Tourist and Non Tourist Health Centers. Distribution of of the multiplication of the value with a score used to determine the feasibility of each variabel by calculating the mean (x) and standart deviation (SD).Comparison of eligibility of Health Centers by differentiating the mean (x) of each health center using different test (t test). Result: There is no difference in viability between Tourist and Non Tourist Beach the shore excursions based on the availability of facilities, infrastructure, human resources and health services (p > 0.05).Recomendation: Suggested health centers increase the completeness and appropriate management to be a Health Centers for Tourist, and cooperation with private clinics, the has to monitor the services and the due to cases HC responsibility.

285-296

Authors: Andi Leny Susyanty, Sudibyo Supardi, Max Joseph Herman and Heny Lestary

Background: In the Decree of the Minister of Health on the National Immunisation Movement Acceleration Universal Child Immunization 2010–2014 (GAIN UCI 2010–2014) stated that the general problems of decline in immunization coverage and quality of service were caused by several things, one of which is the lack of quantity, quality and distribution of human resources. Methods: A cross-sectional mix-method study to investigate human resources in vaccine management had been conducted in two provinces in 2012. Primary data were collected by interviewing stakeholders thoroughly, secondary data collection and observation were also carried out. Analysis was done by scoring for data concerning education, length of employment, training experience and knowledge. Result:The number of Vaccine management officers are still lacking. While the immunization guidelines required minimal two officers for each health centers. Officers’ knowledge in primary health centers is still inadequate, especially in terms of the vaccine and Coldchain (Ice Lined Refrigerators). Officers at Provincial Health Office had been trained in vaccine management, but not all officers at District Health Office and Primary Health Centers had received training yet. Suggestion: This study suggests the addition of the quantity and quality of human resources in vaccine management, because the officers can affect the quality of the vaccines, because vaccines need a special handling to maintain the quality to provide immunity and prevent the occurrence of diseases that can be prevented by immunization (PD3I).

309-318

Authors: Rukmini and Zainul Nantabah

Background: Drug warehouse at health centres is one of pharmacy service that should be paid attention to store medication and ensure the quality. The study aimed to analyze the availability and eligibility of drug warehouse at health centres in Indonesia based on geographic location and topography of the health centers. Methods:It is a further analysis on secondary data from Health Facility Research year 2011 which conducted in 33 provinces of Indonesia. Results: There were more than 90% of health centres available drug warehouses in Indonesia based on the geography and topography conditions, except in very remote area just 89.7%. The highest component of warehouse facilities on reporting and drugs storage facilities were logistick and distribution in 2010, meanwhile the lowest was supporting facilities as narcotics/psychotropic cabinet. The availability of that facilities is lower in remote, borderline and islands area. The eligibility of warehouse at health centers in Indonesia showed the majority were classified as eligible but in the remote, bordeline and islands areas are lower. The statistical analysis (Mann Whitney and Spearman correlation) were significant associations between eligibility warehouse by geographic and topographic of island and remote areas. Conclusion: The availability and eligibility of warehouse at health center in Indonesia the majority were classified as eligible but in the remote, bordeline and islands areas are lower. Recommendation: Central and local governments should assure increase facilities and infrastructure of drug warehouses by increasing health budget to ensure appropriate and standardized drug storages.

107-114

Authors: khadijah azhar , ika dharmayanti and athena anwar

background: Poor and inadequate drinking water supply are the cause of the high occurrence of water-borne diseases, such as diarrhea and typhoid. These diseases often caused an outbreak among the citizens. This article was a further analysis of data obtained from Basic Health Research (Riskesdas) in 2007 with the aim to figure out the influence of drinking water access against the occurrence of diarrhea and typhoid. Methods: the used samples were taken from all samples of the 2007 Riskesdas, which had complete data about drinking water supply. The dependent variables were diarrhea and typhoid, and the independent variables were total water usage, physical quality of the water, the water access, type of facilities, type of sanitation facilities, hygiene behavior (e. g. hand washing with soap before having and preparing meals, hand washing with soap after defecation, the use of latrine), and characteristic of respondents (educational background, occupation, age, and gender). Analysis was performed by using bivariate and multivariate logistic regression. results: showed that diarrhea and typhoid were influenced by the difficulty of the access to get water from sources, difficulty level for obtaining the water, non physical-standards water, low educational background, behavior of hand washing and latrine usage. conclusion: was water-borne diseases occured if the access of water was limited, inadequate water’s physical quality and unhigienic behavior.

125-134

Authors: Yuyun Yuniar, M. Syaripuddin and Bryan Mario Isakh

background:The escalation of HIV-AIDS epidemic needs a comprehensive control efforts including the treatment stage. ARV is inevitably needed to control the development of HIV-AIDS infection. The availability and accessibility of ARV is crucial to reach the successful treatment. Objective:To identify the implementation of logistic management process in the central level.Methods:Conducting in depth interviews with informants from AIDS and Infectious Disease sub division of the Directorate General of Disease Prevention and Control-MoH, Directorate General Pharmacy and Medical Devices, GF-ATM, and PT. Kimia Farma as the manufacturer of ARV in Indonesia. Data was collected in Jakarta during May-August 2011. result:Source of fund procurement of ARV drugs in Indonesia comes from the national budget and Global Fund. Kimia Farma is the only national manufacture of 5-drugs firts line of ARV, while second line ARV is import include raw materials of ARVs. Logistics management consists of planning, procurement and storage, and distribution. conclusion: Logistic management of ARV in the central level has run in accordance to drug logistic cycle. Unfortunately, most raw active materials and final second line of ARVs product were still being imported. The government has planned an exit strategy to reduce the dependency on the donor funding. The report and coordination process among the government, PT. Kimia Farma and end user (hospitals) has not worked well and synchronized. recommendation:The government have to encourage the local pharmaceutical industries to be able to produce ARV, especially the second line. All related stakeholders should enhance good coordination through periodic monitoring and evaluation in ARV distribution process and human resources capability in reporting mechanism.

143-150

Authors: Oktarina, Lulut Sasmito and Sri Rahayu

background: The introduction of health post (Posyandu) activities for children from an early age through the Early age Childhood Institutions (PAUD) or Kindergarden is very important, because it can enter into a health program without omitting the principles of learning by playing. This study aims to modify the dance Memengan Ayo Nyang Posyandu, packaged in the form of a video for intervention materials to children under five (early childhood/kindergarten). Methods: Seven (7) children under five years in the early childhood institutions and kindergartens, 2 teachers, 18 gamelan players (panjak), and a student as sinden were the purposively sample. Research location in the sub village Kradjan Mangir Rogojampi–Banyuwangi District during 10 months in the year of 2012.results: The study showed modification of Memengan Dance “Ayo Nyang Posyandu” by the kids early childhood/kindergarten can be filled messages of invitation to come to Posyandu. Memengan dance contains Mother and Child program of Banyuwangi “Anak Tokcer” (Children’s Optimal Growth, Quality and Smart), that are weighing the babies regularly, providing breastfeed from birth to age 6 months, consuming various foods, adding Iodine salt in foods consumed, taking sufficient nutritious supplement. This dance is accompanied by gamelan music, direct dialogue between Panjak, Children and Sinden. Dances recorded in the form of video, duration of 6 minutes 18 seconds and it can be accepted by stakeholders. conclusions: Dance Memengan can be used as a media campaign of posyandu activities. recommendation: Needs further research to determinent the impact of change of community’s interest and participants who visit Posyandu.

157-166

Authors: Weny Lestari and Yurika Fauzia Wardhani

background:Mental disorders remain serious mental health problems in Indonesia. In 2007 there were 0,46 percent of the total population in Indonesia had high risk of schizophrenia. There are many people with severe mental disorders who do not receive medical treatment or dropped out from medical treatment and then put in physical restraint. Methods: The analysis was based on previous study on the elimination program for physical restraints in 2011. The methods were by collecting news, research results and reviews about stigma and management on people with severe mental disorders. results showed that suspect mental disorders people who had physical restraints by their families was the last alternative of mental disorders management after all medical treatment seek by the families. But the families and communities unknowing early detection and post-treatment management at the Mental Health Hospital causes the patient did not treated properly. People with mental disorders frequently also stigmatized on their neighbourhood. The stigma attached to the patient themselves and their families. Health and socio-cultural’s consequences of stigma in people with mental disorders were as not treated optimally, dropout from the treatment, had physical restraint and incorrect understanding about people with mental disorders. conclutions: The conclusions are that it needs to socialize about early detection of mental disorders sympton to community to prevent delays on early phase treatment that could be cured. Besides empowering people is needed to improve knowledge about mental disorders and emotional disturbance at certain levels in order to avoid the stigma against people with mental disorders.

177-184

Authors: Ernawaty and Nuzulul Kusuma Putri

background:Poverty in urban area triggered new problem related with their access to health care services. Heavy burden of life in urban makes health, especially reproductive health, never become first priority for urban poor community. This study is aimed to analyzed equity of urban poor community when accessing the reproductive health care. Methods: This is descriptive study with cross sectional design applied. There were 78 women residents of Penjaringansari II Flats in Surabaya selected by simple random sampling (α=10%) as respondents.Penjaringansari II Flats was choosen because it is a slum area that residence by unskilled labours and odd employees. The need fulfillment of respondents in reproductive health care was analyzed by spider web analysis. result:Most of respondents (55.1%) were first married before 20 years old. There were 60.5% of them gave birth before 20 years old also, so it belongs to high risk pregnant women. Spider web area for health care of under age married was less than ideal age married which means that under age married urban poor experienced inequity for ANC health services. Approximately 10.3% of respondents had never use contraceptives because they fear of side effects and inhibiton of their husband. conclutions:Better equity shown in the prevention of cervical cancer. Being perceived as the poor who need assistance, free pap smear was often held by Penjaringansari II residents. Poor conditions experienced by a group not only can promote health care inequity, but also promote health care equity. recomendation:Health care equity for urban poor can be pursued through both aid schemes provided by the community or the government.

193-202

Authors: Vita Kartika Mahirawati

background:Pregnant woman who suffered Chronic Energy Deficiency (CED) has delivered babies with low birth weight and increased the risk for mortality. The objective of this research was to analyze the related factors of CED at pregnant woman. Method:A Cross sectional design was used. A random sample of pregnant women who registered in kohort. has taken 104 people as the samples. Collecting data using questionnaires (quantitative) and secondary data obtain through kohort register during 2012–2013 and profile of Dinkes 2012, conducted during 6 (six) months 2013 in Puskesmas Kamoning and Tambelangan. The data were analyzed descriptively and statistically using Chi Square test. result: The socio-economic factors: 35.5% mother’s education mostly elementary school graduates. 29.4 % didn’t graduate from elementary school. The majority of their husband (39.2%) work as farm worker with income less than 1 million rupiah per month. The maternal factors: the average age between 21 until 34 years old (70.6%). The age of marriage mostly under 17 years old (41.1%) and most of them (31.4%) have their first pregnancy in the age between 18 until 21 years old. The most pregnant women (54.9%) ate 3 times/day. 70.6% pregnant women with CED suffered from anemia; 66.7% of them took irow tablets every day. conclusion:economic factors social conditions associated with the incidence of maternal CED husband is education and maternal work status, whereas maternal factors are gestational age, hemoglobin levels in the blood and consumption of iron pills. recommendation:Areas programme and sectorce, should be involved to reduce the CED prevalence.

1 - 7

Authors: Muhammad Kazwaini and Wahyu Pudji Nugraheni

Background: District Sumbawa is one of the underdeveloped district (DBK), the ratings are based on indicators that include the concerns of pregnant women, infants and toddlers, from the existing data gaps in other words surveillance system implemented may not produce outputs that have high leverage the prevention of health problems. The purpose of this study is to identify issues and priorities the strengthening of the surveillance system of pregnant women, infants and toddlers in Sumbawa, Provinsi NTB. Methods:research conducted at PHC Unit I, PHC Moyo Hulu and Sumbawa District Health Office. Data were collected by observing to see the weaknesses or lacks of a surveillance system, then make alternative reinforcement through the Focus Group Discussion to get the most ideal reinforcement priorities to be implemented. Results: There is a difference between health districts profile data, Health Center profile data and the program data. The difference begins from the data source occurs pregnant women infants and toddlers: which at the time of data collection, at the time of recording and reporting, and at the time of publishing information. Strengthening alternative system that has been identified is building a database, simple data analysis, increased monitoring and evaluation, formation and repair forums verivication of the data storage system. The calculation of priority the strengthening of the surveillance system was decided the a simple data analysis is the most likely alternative. Conclusion: Problems surveillance of pregnant women, infants and toddlers is a process and output activities. Priority strengthening surveillance systems of pregnant women, infants and toddlers are most likely to be implemented is a simple data analysis to interpret the resulting figures.

17-26

Authors: Mugeni Sugiharto and Oktarina

Introduction: Environmental health program is preventive in activities to improve environmental health quality hence it is useful to improve life quality and human health and is in accord with Kepmenkes RI No 1428/2006 and this environmental health program is mandatory to perform in Puskesmas. Objective: The study was to elaboratie the difference of environmental health program implementation between urban Public Health Care (PHC) and rural PHC, difference of environmental health program performance output based on environmental health staff and availability and feedback giving among PHCs. Methods: Comparative analysis through descriptive method is in form of Rifaskes 2011 table and graphic from secondary data. Population was PHC in Tuban District and it was used as total sample and PHC as analysis unit.Result: PHC in Tuban Regency had not been optimum in performing all environmental health programs. Difference between urban and rural PHCs were the urban PHC didn’t perform all kesling program while the rural PHC performed all environmental health program albeit non maximum. There was difference between sanitarian staff availability between PHCs including in reaching output and there was difference between PHCs that perform performance assessment by obtaining feedback only 9 (27%) PHCs, and feedback benefit had not been influencing environmental health program performance improvement. Less than 50% PHC obtained performance “good” category on public places assessment and other environmental health program was still categorized “poor.” Conclusion: There was difference of environmental health program implementation among PHCs and sanitary staff availability that still lack and feedback benefit had not been effecting environmental health program performance improvement.

35-44

Authors: Mochamad Setyo Pramono , Herti Maryani and Sri Pingit Wulandari

Background: Indonesia is a tropical disease endemic areas, one of which is the disease elephantiasis(filariasis). Filariasis is filarial worm infectionand transmitted by mosquito bites. Baseline Health Survey (Riskesdas) 2007 showed that the percentage of patients with filariasis in the province of Nanggroe Aceh Darussalam (NAD) was the largest in Indonesia. Methods: Secondary data analysis from Riskesdas 2007. The unit of analysis is the individual in NAD Province. Research focused on the relationship between patients with filariasi sfactors in NAD Province. The method usedis the Poisson and ZIP regression. Results: Probability of 10,000 house hold to softer from filariasisis are as many as 72 house hold and 10,000 people may be affected by filariasis are as many as 25 people. Individuals who do not use the bed nets exposed to filariasis risk is 1.60 compared to the use of bed nets. While individuals whose homes without sewer have risk to suffer filariasis 3.47 times compare to them with sewer. Conclusion: Variables that affect the incidence of filariasis in NAD is the average distance to the neares thealth care, the average distance to the water source and the percentage of households

55-62

Authors: Lely Indrawati

Background: Trends of prevalence contraceptive rates is increasing in the last few years. However, the discontinuation of contraceptives prevalence is still stagnant. Goals: To obtain factors influencing discontinuation of contraceptives in couples of childbearing age 10–49 years. Methods: Population this research are women of childbearing age 10–49 years who are married. Sample in this research are all couples of childbearing age of 10–49 years who had ever used contraception and using contraception. The data was analysed using statistic test of logistic regression multivariate use SPSS version 15nd STATA version 10. The analysed used primary sampling unit and weight to adjust based on survey design. Result: Proportion of discontinuation of contraceptives in women of childbearing age 10–49 years is 32%. In comparison between regions, the highest prevalence of discontinuation of contraceptives is on outer Jawa Bali II (33.6%) than outer Jawa Bali I (32.9%) and Jawa Bali (30.5%). The most frequent reason of discontinuation of contraceptives are do not need contraceptives (31%), want to have child (26%), fear of side effects (14%) and do not want anymore (10%). Based on the multivariate analysis show odds ratio of discontinuation of contraceptives is twice as higher among married women age above 35 years compare to the younger group (OR adjusted 2.150; 95% CI = 2.041–2.265). The odds ratio of discontinuation of contraceptives is also higher among couples who have less children (0-1 child) compare to those who has 3 or more children (OR adjusted 1.486; 95% CI = 1.373–1.568). Couples who have children in the same sex have higher discontinuation of contraceptives than couples who have both male and female children (OR adjusted 1.398; 95% CI = 1.333–.466). Conclution: The main contributing factors of discontinuation of contraceptives are age of wife, number of children and sex composition of children with the control variables education of husband and wife, living area, household expenditure per capita, wife’s menstrual history, and wife and husband’s knowledge in health.

71-79

Authors: Juliana Sandrawati, Stefanus Supriyanto and Thinni Nurul R

Background: Surgical Safety Checklist has been adopted in surgery room as a tool to improve safe surgery. Its implementation during 2012 was low (33.9%) so was the completeness of filling it (57.3%). Objective: To increase the implementation of Surgical Safety Checklist (SSC) through analyzing the effect of policy, procedures, patient safety culture, and individual factors on compliance SSC implementation in the surgery room. Methods: Cross-sectional study with descriptive observational approach was done to find influencing factors of health care personnels’ compliance to fill SSC. Sample consisted of all surgery room nurses (45 nurses), 10 surgeons and 4 anesthesists. Data collection was made use of questionnaires, surgical medical records and SSC form. Results:The compliance to fill SSC in April 2013 was still low (55.9%). Written policy on patient safety was absent and awareness of respondents about the procedure was low. Respondents’ assessment showed that patient safety culture in surgery room was good, except management and stress recognition dimensions. Likewise, the respondents’knowledge about SSC was low (61.0%). Conclusion: The study conclude that influencing factors of compliance implementation SSC is absence of the written policy in patient safety, lack of socialization of Standar Prosedur Operasional to health care personnels, lack of knowledge about SSC, lack awareness about the importance of SSC, shortage of surgery room nurses, and innappropriate perception about filling SSC as workload. Recomendation: The study will be making of written policy in patient safety and SSC, followed by socialization to health care personnels, training about SSC implementation, empowering and advocating surgery room nurses and use of reminders.

89-95

Authors: Julianty Pradono and Ning Sulistyowati

Background:Health status is one reflection of human resources, an important capital in the development of a nation. Quality of human resources influenced by several factors, such as the level of education, lifestyle, environmental, and health. The purpose of this study is to analyze the association between three important factors that are affecting quality of human resources (the level of education, knowledge about environmental health and healthy living behavior) with one’s health status. Methods: The study was conducted towards adolescents, male and female, ages 10–24 years old. The sample size consists of 300 respondents from five districts in ten selected neighborhoods in Central Jakarta. Sample selection used was simple random sampling; data was collected using questionnaire, and analysis was correlation analysis method. Results: There are significant positive relationships between health statuses with knowledge about environmental health (51.6%), healthy living behavior (48.2%), and education level (47.1%). The association of these three variables together may contribute about 55% to one’s health status.