Buletin Penelitian Sistem Kesehatan

219-225

Authors: Indirawati Tjahja Notohartojo, Made Ayu Lely Suratri

If dental and oral hygiene are not maintained properly, the balance of bacteria plaque will be disrupted. By brushing teeth properly after breakfast and before sleep at night, the dental and oral hygiene are well preserved. Physical activity is important can increase blood circulation throughout the body. Periodontal tissues are supporting teeth consisting of gums, periodontal ligament, cementum and alveolar bone. The study aimed to determine association of tooth brushing, eating fruits and vegetables, physical activity and Diabetes Mellitus to Periodontal tissues. It was a further analysis of Riskesdas 2013. The Riskesdas was a survey of observational and with a cross sectional design. It was carried out in 33 provinces and 497 districts year 2013. The population were all Indonesians. Samples were household members aged 15 years and above and of a total 722 329 people. Variable dependent was periodontal tissue health, whereas the independent variables were brush teeth properly, eat fruits and vegetables, physical activity, Diabetes Mellitus. Data were analyzed bivariately x2 test. Brushing teeth properly was signifi cantly associated to periodontal tissues health, as well as enough physical activity. Meanwhile, eat fruits and vegetables (p = 0.117) and also diabetes mellitus (p = 0.647) were not signifi cantly associated to periodontal tissues health. Diabetes mellitus did not infl uence the periodontal tissues health possibly because it was assessed by interview and was not followed by blood examination. It suggests to maintain dental and oral hygiene by brushing teeth properly twice a day after breakfast and before sleep. Besides, it needs to promote enough physical activity associated with healthy periodontal tissues.

236-242

Authors: Juhairiyah, Lenie Marlinae

In order to provide legal certainty and legal protection against HIV/AIDS prevention and control in districts, the Tanah Bumbu District government has issued district regulation Number 7 year 2013 on HIV/AIDS prevention and control. By the district regulation, increasing of HIV/AIDS epidemic in Tanah Bumbu District could be minimezed but HIV cases ranked the highest and AIDS cases ranked the second highest among all districts in South Kalimantan Province. So, the study aimed to implementation the policies of HIV/AIDS control in Tanah Bumbu District. It was an observational study with acros sectional design. Data were collected by in-depth interviews to policy actors and also collection of secondairy data of policy documents on HIV/AIDS prevention and control, data of HIV/AIDS cases from KPA Tanah Bumbu. The highest HIV/AIDS cases in Tanah Bumbu district were among direct sex workers. Policy analysis by gap analysis on implementation the HIV/AIDS control in Tanah Bumbu District. Data were analyzed descriptively. The implementation of the HIV/AIDS control was not optimal, including promotive and preventive efforts that were still not maximal as lck of coordination and facilitation. Tanah Bumbu District Hospital as a people living with HIV (ODHA) hospital referral was not optimum, to provide services of counseling and voluntary testing, health care, treatment and support for people living with HIV. It needs coordinationon on HIV/AIDS control program among related institutions and Non Government Organization so that did not conduct the program individually.

250-257

Authors: Asep Kusnali, Turniani Laksmiarti, Diyan Ermawan Effendi

The Healthcare BPJS (BPJS-Kesehatan) is one of the Financial Services Institutions that is supervised by the Financial Services Authority (OJK). According to the OJK Regulation No. 1/POJK.07/2014 on Alternative Dispute Resolution Institution in Financial Services Sector, Financial Services Institution must be a member of the Alternative Dispute Resolution Institution in the fi nancial services sector. However, there is a difference in the dispute resolution mechanism in the National Health Insurance (JKN) program. The difference is related to the existence of the government’s role or intervention as the organizer of JKN. The method of the study was normative juridical with qualitative data analysis. The potential disputes in JKN from the complaints basis are caused by the existence of direct connections between the members (patients) and the BPJS-Kesehatan as well as connection between the members (patients) and the Health Facilities. Meanwhile, the disputes that are originated from the basis other than complaints occur because of the connection between Health Facilities and BPJS-Kesehatan as well as the connection between Health Facilities Association and BPJS-Kesehatan. This varied pattern of relationships needs to be accommodated in an independent institution to oversee the implementation of JKN in the fi eld such as the late payment on claims, diagnosis coding, independent participants who could not ascend the treatment class, cooperation agreement with BPJS-Kesehatan, and other issues. The existence of independent institutions is essential as a form of alternative dispute resolution system strengthening and minimizing the infl ux of the disputes to the court. The establishment of an independent institution that also functions as an arbiter in the JKN disputes needs to be reorganized to facilitate the government’s regulatory and supervisory functions.

173-182

Authors: N.A. Ma’ruf, Dwi Hapsari, Ika Dharmayanti

Economic development in Indonesia has improved a lot, but in community there are still many problems related to poverty which in turn have an impact on heath. One of the health problems that associated with poverty are malnutrition. The research aimed to determine roles of the various fields of development to nutritional status. The analysis used Riskesdas 2013 (Balitbangkes), PSE and IPM (BPS) data. They were analyzed using linear regression to examine the relationship of variables and the nutritional status. It showed that number of poor people, income per capita, literacy rates, adequacy of doctor and posyandu, ownership of health insurance, and knowledge of the availability of health facilities were correlated with malnutrition status of children under five. Where as, number of midwives did not influence malnutrition status of children under five. The higher percentage of poor people influenced higher malnutrition status of children under five. Meanwhile higher percentage of income per capita, literacy rates, adequacy of doctors and Posyandu, ownership of health insurance and knowledge of the availability of health facilities influenced lower malnutrition status of children under five. The development on the field of socio-economic was through additional employment, education through compulsory education, as well as the health sector by improving health services. It needs a sustained effort and long-term strategy in each area for the improvement of nutritional status of under five.

190-199

Authors: Roy G.A. Massie

In Indonesia, there is HIV/AIDS epidemics with a prevalence of 0.2% among adults. It needs assessment on integrity to improve reliability and effectiveness the program implementation for understanding public policy, transparency, accountability, active community participation and ethics considerations of HIV/AIDS based on Government Regulation No. 75/2006. The study aimed to understand integrity of HIV/AIDS on public health institutions, and related private sectors in Manado City. It was an observational study with a cross sectional design. Data were collected by in-depth interviews to policy makers in the public sector, Head of Health Offices and the programmers, Provincial AIDS Committee, Province hospital, health centers, NGOs and private clinics. Standards and regulations of HIV/AIDS management activities refer to the international, national, provincial and municipal. There were transparencies but financial aspects and recording reporting of cases are still un opened. The accountability and effectiveness of procedure management could not be as a whole because lacked of adequate resources, including budget availability. There were not availabity of etics based standard services. There were not policy on human resources capacity building that caused in balance the quality and quantity of staffs. The prevention and management are still lack in high-risk and vulnerable populations. There were lack of concept understanding and practical integrity of health workers on management level and health care providers. It needed financial transparency. Monitoring and evaluation to health facilities should be regularly; there should be policies for handling public complaints, training of standards management for health workers; training concept of integrity to related sectors. The active community participation should be enhanced.

211-217

Authors: Luh Putu Febryana Larasanty, Ni Luh Putu Dian Wulandari, Raden Ayu Dwi Puspita Sari

Drug information service is one of competencies that pharmacist should have to increase patient compliance on treatment. It needs a good learning method to improve pharmacy student the ability in applying their theoretical knowledge to clinical practice in community later. The study aims to determine effect of problem based learning method on drug information systems course for the ability of drug information service by pharmacy students. The assessment is on aspects of theoretical knowledge, competence of the learning material and case solving abilities. It is a single-blind, case-control study. The study was carried out in 19 months, in January 2014 to July 2015 at the Department of Pharmacy, Udayana University. The case group are pharmacy students who receive problem-based learning method, while control group are students who receive conventional teaching methods. A total 79 students are selected, consisting of 38 students in the control group and 41 students in the case group (PBL), respectively. The score of theoretical competence among students in the control group is significantly higher than the case group (p = 0.047). Whereas, the competency of learning material and problem solving ability in the case group are significantly higher than the case group (p = 0.000). The application of problem based learning method can improve the competencies of learning material and problem solving on drug information service by pharmacy students who take drug information systems course. The application of problem based learning method is good to be used at the pharmacy department in general to improve students soft skills, especially in applied subjects relating to clinical practice competencie among pharmacists in the community.

119-125

Authors: Eva Sulistiowati, Dina Bisara Lolong, Lamria Pangaribuan

Background: Cancer is the third leading cause of deaths in the world and the incidence increases each year. In fulfilling the statistics cause of deaths, it is necessary to record causes of deaths that meets international standard and describing the community data. Methods: The Formulir Keterangan Penyebab Kematian (FKPK) is an instrument for recording causes of deaths with criteria of the International Classification of Diseases-10 (ICD-10) as recommended by World Health Organization (WHO). Data collection were done by filling the FKPK since January 1st to December 31th, 2011 in 15 districts/municipalitiess in Indonesia. Underlying causes of deaths is determined based on rules of the mortality statistics. Results: Cancer cause of deaths in 15 districts/municialities which occurred in 2011 were 2433 cases. The proportion of deaths due to cancer was higher among (53.3%) women than (46.7%) men and the deaths at homes were higher than in hospitals (62.2%, 37.8%). The highest proportion of cancer cause of death in men was(17.5%) liver and intrahepatic bile duct, whereas in women was (26.0%) breast cancer. The proportion cancer among children aged ≤ 18 years mostly was (44.05%) leukemia. Conclusion: The incidence of cancer in Indonesia is quite high. Cancer can be prevented, so it needs promotive and preventive efforts to prevent cancer by performing the Clean and Healthy Behaviors and CERDIK.

135-140

Authors: Siti Sugih Hartiningsih, Suryani Soepardan, Yeti Hernawati, Weny Lestari

Background: A healthy pregnancy is more likely to increase the childbirth safety. Usik Wiwitan from West Java is a traditional practice which is purported to maintain physical and psychological health of pregnant women. This practice consists of two forms of activity, bodywork and breathwork (ngajurus) and meditation-like (tumekung). Both of these activities performed are accompanied by praying. Through government’s program of pregnancy exercise combined with the Usik Wiwitan is expected to reach physical and psychological health of pregnant women until the baby’s delivery. Objectives: This study investigated the effect of pregnancy exercise combined with Usik Wiwitan to maintain the health of pregnant women. Methods: This study design is quasi experimental. A total of 41 participants were in their third trimester of pregnancy who have no serious illnesses. They were selected from anarea of Puskesmas Ibrahim Adjie Bandung. Selection of the intervention group and the control was done randomly. The intervention was pregnancy exercise combined with Usik Wiwitan. This was performed for 16 sessions in 8 weeks, while the control group only did pregnancy exercise alone in the same time. The measured parameter are the physical condition (blood pressure, urine protein and oedema conditions) and anxiety level by using a State-Trait Anxiety Inventory (STAI). Results: There is a significant difference between the control and the intervention group and between pre and post test within the intervention group. The intervention group showed more significant decrease of blood level, urine protein and anxiety level in 8 week and 16 week compared to control group. Conclusions: Usik Wiwitan have shown a positive influence on the physical and psychological health conditions of third trimester pregnant women. Recommendation: The art of Usik Wiwitan can be used as a model of intervention program for health promotion during pregnancy and for safe delivery

149-156

Authors: Mugeni Sugiharto, Ristrini

Background: Infants in their golden period are particularly vulnerable to infectious diseases, such as neonatal tetanus. Bangkalan District Government supports policy on Elimination Maternal Neonatal Tetanus (EMNT) to save infants from neonatal tetanus infection. The study aims to identify profiles of tetanus cases among infants for support the policy on EMNT in Bangkalan District, East Java Province year 2012–2014. Methods: The study used secondary data on Tetanus Toxoid immmunization and tetanus neonatorum from Bangkalan District Health Office. In Depth interview on the policy on EMNT for the Programmer of immunization. Result: Every year there were tetanus neonatorum cases in Bangkalan District that caused deats because their mothers were not immunized by TT during pregnancies, deliveries assisted by traditional birth attendants, unhygienic cord care such as unsterile scissors and using traditional herbs for curing. To prevent tetanus neonatorum, Bangkalan District issued policy on EMNT as in the operational strategies that must conducted by all related staffs. Implementation of the EMNT policy is not as expected because there were still TN cases are each year, TT coverage tended lower as 61.7% in 2012 to 59.18% in 2014. In accordance, DPT for infants were from 92.8% to 88.0% during the same. Conclusion: Bangkalan District are prone to tetanus, including tetanus neonatorum, due to declining coverages of TT immunization among pregnant women and DPT immunization among infants each year. The policy of tetanus neonatorum elimination was appropriate to increase immunization coverage and prevents TN among infants in Bangkalan. Suggestion: Programmer immunization should be more active to disseminate TT immunization through the ANC among pregnant women and DPT for infants to prevent tetanus cases.

165-171

Authors: Pramita Andarwati, Syarifah Nuraini, Arief Priyo Nugroho

Background: Motivation of a medical doctor in the career preference has been developed during study, in which type of career determine is as to support health development. The study aimed to provide basic data describing medical students’ career preference and their based motivation. Methods: It was an observational study conducted during March to September 2014. Samples were all final-year medical students at Airlangga University period 2009. Data were collected by questionnaires and focus group discussions. Respondents were asked about career preference and motivation in choosing career path. The data were analyzed by chi-square and thematic content analysis. Results: The response rate was 95.2% (n = 180). Career as a clinician was preferred by the majority of respondents (62.2%), with the highest interest in internal medicine specialization (20.4%). Social background of students (the origin, parental education and profession, the source of funds), academic ability (IPK), experience during clinical rotation are not related to career choices (clinicians and non-clinicians). They expressed the balance of career and family lives, interest at particular field study and salary were reasons to choose a specialist. Conclusion: The main motivation in choosing career path is the balance of work and family life; interest in a particular field study and the salary. Recommendation: Academic institution, Medicine Faculty the University of Airlangga are expected to be able to motivate their students by improving the teaching methods and create an academic environment that supports the growth of interest in studying both the nonclinical and clinical medicine field study

1-9

Authors: Joko Irianto and Suharjo

Backgroud: The health problems can be described on the number of Maternal Mortality (MMR), the higher of MMR to indication of so many health problems. Maternal mortality is closely related to access of quality health care. Quality access will provide opportunities for mothers to get prenatal care, aid delivery, and good treatment. Public health care is health facilities early referral of maternal care in villages, and then Public health care will be referred to a PONEK hospital if necessary. Objective: To knows the difference that maternal health services are carried out in PONED and non PONED Public health centers. Methods: To combine datas of Village Potential 2011, Maternal Mortality Follow-Up Study of Population Census 2012 and Research Health Facilities 2011 for analysis. Field confi rmation in two health centers and two hospitals in Bekasi and Bogor cities for cases maternal death of during pregnancy, during childbirth, miscarriage, and after birth (postnatal). Results: The hospitals can prevent maternal death during pregnancy or during childbirth. At public health care, the risk for maternal death during childbirth is higher than postnatal OR = 1.9 (CI: 1.22 to 3.0), maternal death during pregnancy and miscarriage in PONED is higher than Non PONED but not signifi cant (p > 0.05). At public health care not PONED, birth attendants is a factor in the recommendation to referral (p < 0.05). Conclution: The hospital facilities are able to PONEK the best services for mothers who need obstetric treatment. The midwives are important to reducing maternal mortality, they should be closer access to birth attendants and to perform appropriate referrals. Recommendation: The hospitals are need to be reinforced services capable PONEK and within easy reach from public health centers.

21-31

Authors: Aryo Ginanjar, Arih Diyaning Intiasari, and A. R Siswanto Budi Wiyoto

Background: Implementation of Puskesmas function as the center of society empowerment was done through the development of UKBM in work region of Puskesmas. This research aims to know the role of Puskesmas leader in Purbalingga District, Central Java Province in the implementation of Puskesmas function as the the center of society empowerment through development of UKBM. Role of Puskesmas leader that were analyzed in this research were role of motivation, communication, leadership, guidance, observation and supervision. Methods: The mainsubject of this research were 7 leaders of Puskesmas in Purbalingga District. The supporting subject were 7 people worked as Health Promotor in 7 Puskesmas and 1 person worked as Head of Society Empowerment and Health Promotion Divition Purbalingga District. Research type is descriptive with qualitative approach. Results of indepth interview, observation, and document analysis showed that the knowledgeof the Puskesmas leader in Purbalingga District concerning Puskesmas function as the center of society empowrement represent the Health Paradigm through facilities in the form of UKBM as the active participation from society to increase health degree of Indonesian society. Results: The role of Puskesmas leader in aspects of motivation, communication, guidance, supervise, and development of UKBM had been done well. The leadership role was applied by the combination of Democratic and Autoritary style of leadership. The difference of the role between Puskesmas leaders from medical background and nonmedical background was found insupervision aspect. Conclusion: Department of Health needs to undertake human resource development in the health center which has a dual leadership with the workload so that the role of supervision has not run optimally.

41-53

Authors: Muhammad Agus Mikrajab and Tety Rachmawati

Backgrounds: Integrated antenatal care as one of key program in screening maternal and child health services is started antenatal to puerperium phase and it is essential to protect complications during both antenatal and postnatal phases. Access to antenatal care (fi rst ANC to fourth ANC) has became providers key strategies in order to decrease missed opportunities of pregnant women that it can be implicated toward services quality and caused by increasing MMR and IMR in Blitar City. The purpose of this study was to analize of policy implementation for Integrated Antenatal Care services at Sananwetan, Kepanjen kidul, and Sukorejo Public Health Centers. Methods: A qualitative study with purposive design. Method for policy analysis used “a health policy triangle framework” (Walt & Gilson, 1994). Results: Lack of the role of policy actors in fi elds to bridge among integrated antenatal care services program, midwives, lab analyst and provider. Integrated Antenatal care Services are concerned with physical examinations conducted by Midwives and are concerned with laboratorium test both routine and medical indications conducted by laboratory analyst. Lack of technical training for midwives and lab analyst. Conclusion: Inter Sectoral partnership for policy actors in implementing integrated antenatal care of Health Centers were lack and ranning partially. Lack of availability of laboratory facilities and USG to exam pregnant womens. Local Government Regulation regarding general services retributions are concerned routine lab and medical indications examinations is not yet for the poor peoples. Recommendation: The masive role of policy actors in Blitar City through inter sectoral partnership involving policy review, monitoring, and evaluation of integrated antenatal care for health centers are sustainable. Budgetting in APBD and other sources to enhance laboratorium facilities and USG at three Health Centers based on types of laboratory and medical devices. Integrated antenatal care strengthening through technicals training are especially midwives and laborium analysts in developing midwives in obstetrics and medical examination competencies. We need a limited revision of regulation clauses. It is clauses of routine lab examination and medical indications free for every poor womens that conduct lab examinations.

63-73

Authors: Made Asri B and Setia Pranata

Background: Islamic boarding school system has long story in indonesia, they covered as much 14.798 student who are teenager between 9–15 year old. Problems encountered with adolescent sexuality and reproductive health. Methods: An explorative research implemented in 3 provinces ie East Java, Nusa Tenggara Barat (NTB), East Kalimantan and six Islamic boarding schools. Data were collected through questionnaires about reproductive health. Results: It showed 48,5% of respondents didn’t have enough knowledge, attitudes and behavior about reproductive health, 40% of respondents knew very little about puberty, menstruation and wet dream, 71% of respondents had little knowledge about the risk of pregnancy; 49% of respondents had not enough knowledge about sexually transmited diseases. 88% respondents said that they had fall in love, 76% of respondents had positive courtship behavior. Conclusion: The information about reproductive health in islamic boarding school for adolescents is still in adequate and only refer to yellow book. Health worker did not provide adequqte information. We still found student who have sex while when they were engaged still datting. Suggestion: The need of additional and up to date reproductive health information and the risks of sexual intercourse marriage it maybe delivery on interesting media, such as one social networking. A health reproductive modules consist of scientic material and some knowledge has to be developed and should be delivery health worker. Reproductive health syllabus and training for trainers for teachers of boarding school is needed.

83-90

Authors: Siti Isfandari

Background: The 2007 National Health Report, Riskesdas 2007 showed that female leads male almost in all morbidity of chronic diseases. Differences in health and illness patterns of men and women are not primarily technical or medical in nature, but also attributable to social factors such as powerlessness, access to resources, and constrained roles. Using the latest data of Riskesdas 2013, this analysis intends to use gender approach analyzing and interpreting health status difference between female and male to get inputs for the appropriate measures to reduce the gap between female and male morbidity on NCD. Methods: Riskesdas 2013 data was analyzed using gender framework which stressed the importance of socio economic factors on health status defi ned as prevalence of chronic diseases. Results: With the exception of younger age, women have higher prevalence of non communicable/chronic diseases. High education appears to benefi t only middle age women to achieve equal health status with men. Conclusion: Education, access to information is important factors to reduce the gap of female and male health status, however biological factor remains as primary factor. Recommendation: Since improving health status of women needs comprehensive approach, government policy should facilitate access to education and economic resources to women. Gender approach should be implemented for analysing health data.

99-107

Authors: Yurika Fauzia Wardhani and Astridya Paramita

Background: Health is a state of body, soul, and socially to enable more people to live socially and economically productive. In 2007 and 2013 Research and Development of the Ministry of Health conducted research which includes basic health morbidity, disability, mental health and lifestyle. This study aims to get an overview of community disability that affects their ability to perform economic and social measures. We hope this research may result in a recommendation for decision makers about mental kesehatan services. Methods: This study is a further analysis of secondary data from the Riskesdas 2007 and 2013. Data were analyzed by descriptive and analytical / comparative. The population in this analysis are all household members in Indonesia, with large and sampling techniques follow Riskesdas samples which household members aged > 15 years. Results: There is a percentage increase (5.8%) of respondents mental health status category of ’Healthy’ (no emotional mental disorder) and the percentage decrease in all categories of mental disorders around 50.0 percent in 2013. The highest severe emotional Mental Disorders in 2007 and 2013 were in women, who have divorced marital status dead / alive, residing in rural areas, or the end of the adult age group (> 60 years). Data processing results also show that: 1) the higher the degree of disability and, 2) the more unfavorable lifestyle, the more severe mental disorders experienced emotional. This is supported by the results of tests Kendalls tau-b that there is a signifi cant association between disability and mental disorder (α = 0.000 < 0.5) and lifestyle with mental disorders (α = 0.000 < 0.5).Conclusion: Public mental health status in the year 2013 has been better than in 2007. There has been an increase in mental health status, and there is a relationship between disability, lifestyle, mental health status. Recommendation: Promotion of mental disorders and persons with disabilities should be further improved and include the wider community, not only in cities but to remote perdesaan. Perlu provision of primary health care (health centers ODGJ care and disabilities and actively invites the public to maintain a healthy lifestyle through preventive-promotive activities