Buletin Penelitian Sistem Kesehatan

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

329-335

Authors: Indirawati Tjahja Notohartojo and Lusianawaty Tana

Background: Pulmonary TB is an infectious disease of the respiratory tract caused by bacteria. Dental health professionals such as dentists and dental nurses are in charge of health personnel to prevent, treat, cure, teeth the mouth, so as not to arise or aggravate toothache. In doing their job as dental health workers is expected to use gloves or masks, and always wash their hands to avoid the transmission of pulmonary TB disease Methods: A cross sectional study was conducted involving 78 dental health professionals in 50 primary health centers that were chosen in six districts in three provinces of Banten, South Kalimantan and Gorontalo. Data were obtained by interviews and processed using SPSS Results: More than 90% dental health workers in work wore masks gloves and washed their hands after work. There was a signifi cant relationship between exercise with dental health professionals with a p value of 0.007, which means a signifi cant. Conclusion: In performing their duties, dental health workers have already used personal protective equipment such as masks, gloves, and washed their hands and did enough exercise. Recommendation: need to increase knowledge about pulmonary TB in dental health professionals.

347-354

Authors: Agung Dwi Laksono and Khoirul Faizin

Background: Muyu Tribes have an open mind toward modernization, while still holding fast to some beliefs that often collide with each other, not to mentional so the case in the original Muyu health workers. For health workers who came from the tribe Muyu, in daily life, it seems as if stuck on the pull two poles of different beliefs, and even sometimes the opposite. Medical concepts are studied and are believed to be a health worker was overlap and collide with the belief in the concept as part of the cultural tradition of his tribe. This study was conducted to explore in depth the pull of tradition surrounding the Muyu health workers. Methods: This research is a case study carried out in depth on indigenous health workers Muyu tribe. This ethnography research was conducted in Mindiptana, District Digoel. Data collection was performed by means of participant observation, in-depth interviews and document searches. Result: The research results showed the influence of western and migrants in some ways helped change the mindset or perspective of health workers to be able to receive the pattern rationalistic offered. But within certain limits if health workers are stuck in the old tradition of Muyu who tend to be irrational and mystical. Conclusion: Empirical fact that their tradition Muyu Tribe (indigenous health workers Tribe Muyu) believe, they often receive repetitive, making them not to circumvent these beliefs. Although, rationalistic culture completely different they have learned indifferent practice. Recommendation: Appropriate supervision can be a task that should be done by health personnel.

365-375

Authors: Rukmini and Ristrini

Background: In an effort to reduce maternal mortality rate required an effective referral system, especially for cases of complications. One of the fundamental aspects of primary health care is a good relationship among levels especially with above level that refl ects as an effective referral system. Method: An observational study with cross sectional design carried out in Tambakrejo and Tanah Kali Kedinding health centers Surabaya in 2013. Respondent were head of the health center and the midwives’ coordinator. Collecting data with in depth interviews, structured questionnaires and study documents of maternity referral cases period of 2010 - June 2013. Data were analyzed descriptively. Result: The implementation of maternity referral cases in Tambakrejo and Tanah Kali Kedinding health centers consisted of clinical and administrative procedures. Clinical procedures have been implemented well, on the other hand, there were some administrative procedures that had not been implemented yet, these were 1) record for patients in register books; 2) giving a referral feedback letter to health facility and worker that refer the patient; 3) There is no procedure of receiving back referred. Coordination for maternal referral among health facilities has been implemented with limitations. Implementation of maternity referral cases and childbirth cases’ handling are in accordance with medical indication primary health care authority. Conclusion: Maternity referral cases in Tambakrejo and Tanah Kali Kedinding health centers has been implementing well enough with limitations, i.e. there is no referral back from hospital to primary health care facility. Recommendation: To implement the policy of back referral, the hospital should make a written standard procedures for the return of referrals. In addition, public health centers have to make standard procedures for receiving back referred patient from hospital and returning back them to other primary health care, sub health centers or midwife.

387-397

Authors: Noor Edi Widya Sukoco, Joko Pambudi, Maria Holly Herawati

Background: Indonesia is one of 117 countries which has three crucial nutritional problems in children under fives,such as stunting, wasting and overweight. This study is important because nutritional status of children under five years old was closely related with economic factors. While economic conditions of families depend on the work of both parents. Methods: The study design was cross sectional based on health research “Riskesdas 2007 and 2013”. Type of research was quantitative and qualitative methods. Samples consisted of children under fives years old of whom their parents were still alive and have completed the information for the questionnaires. The informants of the qualitative research came from caregivers, district nutrition officer, sub-district nutrition officer, district labor office, and parliament at district. Quantitative data was processed and analyzed by SPSS version 15 under the licensed of NIHRD MOH RI. While primary data was explored by indepth interview and analyzed using content analyses. Result: There was no relationship between parents who were both working with the nutritional status of children under fi ves based on indicators: weight/age p= 0,77 2007), p = 0,92 (2013); height/age p = 0,58 (2007), p = 0,71 (2013); weight/height p = 0,77 (2007), p =,33(2013). These qualitative results were confi rmed by informants’ opinions that the nutritional status of children under fives years were not differ between those whose parents are working and not working. Conclusion: The analysis whether quantitative or qualitative found there was no significant relationship between the nutritional status of children under fives to those both of the parents working. Recommendation: Nutritional problems should be solved inter - sectoraly, it does not guarantee that only the economic capacity to bring about positive impacts the nutritional status of children under five.

407-419

Authors: Marwansyah and Hidayad Heny Sholikhah

Background: Pulmonary tuberculosis healing takes a long time. These were any problems that often occurs in the care and treatment of pulmonary tuberculosis in Indonesia. Family members should be empowered to be able to carry out the duties of health, to avoid mistakes in patient care at home. Methods: This study aims to analyze the influence of family empowerment Pulmonary TB sufferers of the ability of the family in carrying out the tasks of family health. The study design was Quasy-experiment research Nonequivalent control group design. Each group of interventing and control consist of 16 people. The family empowerment activities were conducted 3 times a week for visits at interval of one day. Data were analyzed by Wilcoxon Singed Ranks Test and Mann-Whitney Test. Results: Intervention results showed that the ability to carry out family health tasks which includes most of the known health problems (87.5%) category of good, take the right decisions most of the action (62.5%) categories of good, giving care to sick family (100%) categories of good, maintaining physical environments that support health home (100%) categories of good, using the majority of health facilities (93.8%) categories of good. Statistical test results obtained family empowerment pulmonary TB patients can improve the ability of family task of family health (p=0.001). Conclusion: Family empowerment affect the family ability to carry out family health tasks to prevent, to care and to cure pulmonary tuberculosis, which includes the known health problems, take the right decisions, giving care to sick family, maintaining physical environments that support health home, using the majority of health facilities. Recommendation: Health workers are expected to increase health education, especially for newly diagnosed patients with positive pulmonary TB.

431-435

Authors: Erna Luciasari and Liestiana Indriyati

Background: Gayo Lues is a regency in Aceh Province having the second place of the lowest PHDI (Public Health Development Index) grade in Indonesia. Gayo Lues get low scores in almost all of PHDI absolute indicator, such as imunization coverage and child weighing. Gayo Lues have high percentage of poverty more than national average and the low percentage of village midwife number, made Gayo Lues categorized as MUD (Mentoring of Underdeveloped District). The research goal to identify the change of inovation or new breakthrough to increase the IPKM grade. Method: Observation, foccus group discussion and structured interviews using questionnaire to midwife and housewife using posyandu (Maternal and Child center) also indepth interview for directur and staf of health institutions. Result: The sweeping of child weighing is one of programme handling by midwife to increase the child weighing coverage, so in the end of 2012, the coverage have been going almost 100% until 100%. Conclusion: The result it can be concluded that The Goverment of Gayo Lues have been made some breakthrough for the increasing of IPHDI grade. Recommendation: Breakthrough and movements that teach people about the importance of monitoring the health of children by weighing needs to be improved, among others, could empower community leaders.

221-228

Authors: Mardiatun, Lalu Ahmad Yani, Dewi Purnamawati, Zulkifli, Ristrini

Background: The state of malnutrition occurs because the body lacks of one or several types of nutrients needed. Some things that can cause the body to nutritional defi ciencies among others: the amount of nutrients which consumed was less , low quality of nutrients or both of them. Since 1970, Departement of health of the Republic of Indonesia has implemented a prevention programme through the distribution of iron tablets free of charge to pregnant women but the impact caused due to iron defi ciency is still a problem. The aims of this study is to explain the relationship between the history of ante natal care and the level of iron consumption with incidence of malnutrition of pregnant women. Methods: The method used in this study was an observational analytic with cross sectional approach use Riskesdas data 2013 and the measurement of variable was performed at the same time. Data were analized using bivariate test with chi square test. Result: the results obtainedp value 0.000 < 0.005 which means there is a relationship between the history of the ANC with malnutrition events in NTB and DIJ. While the consumption level of Fe obtained P value 0.000 <0.005 which means there is a relationship between the level of consumption of Fe with malnutrion events in NTB and DIJ. Conclusions: mothers should be emphasized the importance of consuming Fe tablet at least 90 tablets during pregnancy and do the ANC at least 4 times during pregnancy with an emphasis on quality than on quantity. Recommendation: consumption of the should be follow up by concelling during ANC visit.

239-246

Authors: Ahmad Erlan

Background: District Parigi Moutong, Central Sulawesi Province is one of the Regional District Health Problems. Ranking Public Health Development Index Parigi Moutong to the level of Central Sulawesi was ranked 6 out of 9 districts/cities, while at the national level comes out to 320 of 440 districts/cities in Indonesia. The purpose of this study is to provide a picture of the health problems in Parigi Moutong. In more detail the objectives are observed after the implementation of such interventions and Booster Kalakarya prevention efforts in the area of health problems. Methods: The study is qualitative observational study of participatory design. Samples were taken by using purposive sampling to conduct in-depth interviews and document searches. Results: The results of in-depth interviews obtained information of some constraints in the implementation of health programs, ie no actions/movements that were signifi cant in the response to the problem. Infant mortality in 2012, registered 7 cases. Substitution head of the health center too fast. This happens because the head of the health center has held PTT doctor working period of one year, which resulted in problems in sustainability programs in health centers. Internal monthly meeting at the Department of Health and the District Health Offi ce with the entire health center no. Effort or movement to address the problems associated Regional Health Problems has not be percieved. Conclusions: Implementation of Regional Booster Kalakarya and Health Troubled make changes to the head of health policy by forming groups Conscious Movement IHC and revitalization partnership TBA and midwives who are increasing numbers toddlers weighing scope and aid delivery by health personnel.

257-266

Authors: Murlan, Ruwiah, Santi Suardi, Weny Lestari, Niniek L. Pratiwi

Backgroud: Buton District was had the highest case on children under fi ve years’ malnutritions in South East Sulawesi Province. Butonesse have culture of making Virgin Coconut Oil which made from coconut untill now. Side product of VCO was a coconut residue (blondo) which has not been used by the community. Blondo VCO contains a lot of protein clumps of coconut which is similar to the formula that can be used for food additives, especially in children because it is easily to absorb. The aim of this study was to determine increasing of knowledge, changing behavior and attitudes on mothers of children under fi ve years about the use of blondo VCO for additional nutritional improvement of local food. Methods: this study used intervention on nutritions’ knowledge based on the use of lokal ingredient. Training and practice about children’s local food processing with blondo VCO were held. Results: The results showed that there was an improvement in knowledge, attitude and practice of mothers after they had been given the intervention with counseling and training of local food with blondo VCO ingredients. There were variations of local food made by mothers more than before. Conclusions: It showed that the presence of counseling and training on the use of blondo VCO can increase knowledge, attitudes and behavior towards mothers who have children under fi ve. Recomendation: Suggestions of this study was processed of blondo VCO could be used as ingredient of local food with high nutritional value for society in general and for children in particular.

277-284

Authors: Betty Roosihermiatie, Niniek Lely Pratiwi, Rukmini, Widodo JP

Background: As a tropic country Indonesia still faces malaria problems. In Asean, indonesia is one of three countries with the highest malaria morbidity. In 2007, 396 (80%) of 495 districts/municipalities in indonesia are malaria. In 2009 the government issued a decree of the minister of health No 293 on malaria elimination. The study aimed to analyze the implementation decree of Ministry of Health No. 293/2009 on malaria elimination. Methods: It was a descriptive study. The study was conducted in 4 provinces, and 4 districts based on malaria elimination stages as in Bali province and Karangasem district, Riau islands province and Bintan district, West Nusa Tenggara province and west Lombok district, and Maluku province and South Halmahera district. The stakeholders were Heads and malaria programmers at province/district Health Offices and the related programs. Data were collected by focus group discussion and secondary data were taken. Data were collected by focus group discussion and secondary data. Analysis for Ministry of Health decree No.293 year 2009 on 1) Comphrehend, 2) Implementation, and, 3) Comittment, 4) Innovation intervension to support malaria elimination, 5) Sustainability of activity community empowerment, 6) Proportion of budget. Results: showed there was district that had not issued local policy on malaria elimination, the implementation with comittment especially that health centers in areas under study corfi rm diagnose by laboratory examination and malaria treatment by Artemisin Combined Therapy (ACT), although there were still treatment to clinical malaria, innovation activities were of bersifat local spesifi c, and reward for Juru Malaria Desa or malaria cadre to increase malaria suspect case detection, and with district budget for malaria program ranged 0,95-5,6% of the total budget. Recomendations: It suggested to advocate all malaria endemic areas to issue local policy on malaria elimination, decide intervension of the priority program with target and time schedule, enhance surveillance especially data analysis for malaria stability, and advocate local government to commit on malaria budgetting, distribution health workers, enhance health infrastructures, and also enhance health system for malaria program activities.

293-300

Authors: Turniani Laksmiarti, Asep Kusnali, Diyan Ermawan Effendi

Background: According to Article 22 of Law No. 32 of 2004 and the decision of the Court granting judicial review on Law No. 40 of 2004, local governments also have the authority and obligation to organize a social security system for its people, including health insurance. One of the problems faced by the local governments is in synchronizing the implementation of the local health insurance system (Jamkesda) with the National Health Insurance System (JKN). This study aimed at analyzing the synchronization of implementation of the health insurance system at central and regional levels. Methods: This study was using qualitative data analysis. The data were retrieved from literary data and the results of in-depth interviews with the parties that are considered to have in-depth knowledge related to the research topic. Results: Local Government of Nganjuk has developed social security system in health sector through the free of retribution policy in health services through the Regional Health Insurance System (SJKD). This health insurance system is operated by the District Health Insurance Agency (BPJKD) under the East Java Provincial Government. Since the implementation of JKN, Nganjuk Local Government has already begun to integrate this policy with JKN, but constrained by the scope of membership and dues obligations for the region. Conclusion: Nganjuk Government has conducted social service functions through a free retribution in health services policy with some restrictions and along with East Java Provincial Government held SJKD. Synchronization of health insurance in Nganjuk could be begun with the process of integration of free retribution health services policy to SJKD and continue the health policy to cost sharing with the East Java Provincial Government to facilitate the process of integration to JKN. Recommendation: Nganjuk district in efforts to achieve universal health coverage is necessary to re-collecting and validating the data of jamkesmas participants, impoverished letter and the participants who can afford to pay the dues.

311-320

Authors: Revi Rosavika Kinansi and Ika Martiningsih

Background: controlling of dengue haemorrhagic was still a complicated problems, because it has not found a cure. The best way to prevent dengue fever was to control mosquito larvae Dengue Hemorrhagic Fever (DHF). The existence of Aedes aegypti larvae in an area is an indicator of the presence of populations of Ae. aegypti in that area. In an effort to determine the interventions on the incidence of dengue in the city of Batam through mosquito larvae control, need to know how much infl uence the larvae of Ae. aegypti free house to dengue cases. The purpose of this discussion is to know what variables affect the dengue cases in the city of Batam. Methods: analysis of data using linear regression analysis. Signifi cance values provide information on the variables that signifi cantly affect the number of dengue cases in the city of Batam, so the government can seek for each house is required to be free of larvae. Results: results of the analysis provides information that the value of a statistical p-value indicates the number 0,017 on variables healthy home. Conclution: there is a signifi cant infl uence between the variables of a healthy home for the presence of dengue cases in the city of Batam. Recomendation: This suggests that a healthy home include sanitation, adequate ventilation, good lighting, good management of water access and other problems causing the lack of space used as breeding places of Ae. aegypti. Many factors affect the presence of dengue among others to note is altitude, ecology and bionomik, eggs, larvae and pupae, adult mosquitoes, the habit of perching, fl ying range, as well as the life span of transovarial transmission.

111–119

Authors: Yunita Fitrianti and Tri Juni Angkasawati

Background: Gayo is an ethnic who lived in Gayo Lues, Province of Aceh. Traditional medicine is still popular convalescence for puerperal mother. Of course, there are a lot of factors which influenced traditional medicine utilization. This article will describe how they use traditional medicine for puerperal mother, what the utility of the medicine is, and how the policy will accommodate the traditional medicine. Method: The research used ethnography method. Result: The result of research illustrates that there are two types of Gayo traditional medicine system for puerperal mother which are external medicine and internal medicine. For external medication they use fumigation as a herb beside their back and smear certain spices on their bodies. Meanwhile, for internal medicine they drink treated certain spices. On their perspective, utililizing traditional medicine is to cure puerperal mother after parturition, to prevent them from disease and illness, and to heal them in order that they can work in the field strongly, and they believe that traditional medication is better than modern medicine by medical doctors. Conclusion: traditional treatment of gayo survive because of perceived benefits in accordance with the expectations of society gayo. Recommendation: it needs traditional medicine development by pharmacological perspectif in order that can be used in the community according to standart. So that, policy for medication of puerperal mother based on local wisdom, family planning, and community might be formulizied. Key words: traditional medicine; puerperal woman; Gayo ethnic

131–139

Authors: Syarifah Nuraini and Aan Kurniawan

Background:Riskesdas 2010 illustrates that birth deliveries by health workers in low-income community reached 69.3%; while deliveries were conducted health workers at health facilities only reached 55.4%. This illustrates that the health facility or program that has given local or central government has not run optimally. Methods:This study aims to determine antenatal care and birth delivery preferences in the community and what factors underlie the preference. The location of research is precisely in the area of Puskesmas Kassi-kassi, Makassar City. Results showed that the mother already has the knowledge, attitudes and behavior quite well in maintaining health. Society does not always take advantage of government facilities. Antinatal care is mostly done in the doctor or midwife in private practice for reasons of convenience and prestige; while health centers for labor is still the main choice for the cheapest. Conclusion: Urban community in Kassi Health Center area have many option other than health center the quality only type of services is factor related to costumer choice because they are able to finance the cost. Recommendation: Government need to involve the private sector and do not ignore the social economic and culture condition for the successful of program.

151-160

Authors: Anna Maria Sirait, Eva Sulistiowati, Marice Sihombing, Aria Kusuma, Sri Idayani

Background: Diabetes mellitus (DM) is a chronic progressive disease that can lead to various complications in other organs and becoming a serious public health problem. This analysis aimed to determine the incidence of diabetes, prediabetes and risk factors that influence the occurrence of DM. Methods: Respondents who did not have DM at baseline Cohort Study of Non-Communicable Diseases in 2011 were followed until 2013. They were interviewed with questionnaires, had physical examination (measuring height, weight, waist circumference, blood pressure) and laboratory tests (fasting blood glucose, cholesterol, HDL, LDL and triglycerides) in accordance with procedures. Respondents were said to suffer from diabetes if the fasting blood glucose levels ≥ 126 mg/dL or blood glucose levels after loading 75 g glucose ≥ 200 mg/dL and was diagnosed diabetes by health professionals. Pre diabetes categorized into impaired fasting glucose (IFG) when fasting blood glucose levels (100–125 mg/dl) and impared glucose tolerance (IGT) when plasma glucose levels two hours after loading 75 g glucose 140–199 mg/dl. Result: Beseline respondents in 2011, was not suffering from diabetes and underwent a complete laboratory examination to follow-up in 2013 amounted to 1313 people. The incidence of diabetes is 3.5% and pre diabetes 18.4%. Multivariate logistic regression analysis demonstrated that central obesity (RR = 3.98; 95% CI: 1.86 to 8.55), Impaired Glucose Tolerance (RR = 3.49; 95% CI: 1.82 to 6.68), fasting blood sugar (RR = 3.35; 95% CI: 1.59 to 7.07), history of parental diabetes (RR = 2.41; 95% CI: 1.06 to 5.50), hypertension (RR = 1.88; 95% CI: 1.0 to 3.55) were risk factors that have a significant relationship with the occurrence of DM. Respondents with IFG and IGT has been changes into DM respectively by 13.5%; 10.4% after 2 years. Conclusion: the factor that most contribute to diabetes and IGT are central obesity, tasting blood glucose level, history of diabetes and hypertension. Recommendation: Prevention & promotion of diabetes risk should be done in the form of healthy behavior & wight loss

169-177

Authors: Dicky Andiarsa, Yuniarti Suryatinah, Liestiana Indriyati, Budi Hairani, Gusti Meliyanie

Background: Malaria remains health problem that not decrease it rate yet. Outcome that clearly follows malaria is disability that made 60 thousand Dollars lost from Indonesian people who live in endemic areas due to this disease. This article need to analyzed Riskesdas data to define malaria influences to disability, what malaria that impact larger to disability, outcome disability caused by malaria could make patient’s productive day lost and socio-economic loss and to find out the differences of malaria burden between western and eastern Indonesia. Method: Analysis used Riskesdas data by cross sectional design. Scopes of analysis include malaria and disability data that confounded with other disease that may induce disability. Data analyzed with scoring according to WHODAS 2.0 and logistic regression, also people’s economic loss consideration due to malaria that reduce productive day. Result: The result showed that malaria trigger disability 1,6 fold, and western Indonesia 1,2 fold more risky to disability. Malaria tropica (Plasmodium falciparum) and tertiana (P. vivax) did not significantly different to cause disability. Productive day loss, western Indonesia slightly larger than eastern Indonesia. Malaria could inflict a financial loss of the malaria suffere in the amount of Rp. 390.620.016 from one day loss of work due to malaria. Conclusion: There’s a significant correlation between malaria and disability, however there was no significant difference of productive day loss between eastern and western Indonesia. Recommendation: Need for enhance effort to eliminate malaria, upgrade health and medical attendance for malaria patient, increase health service access for free particularly for poor community.

187-195

Authors: Khoiron dan Dewi Rokhmah

Backgroud: Jember government had conducted several programs to improve sanitation service in Jember area. One of them was Silo District, it was quite big of coffee plantation area. One of Silo district sanitation access, especially, healthy toilet was low (45,3%). One of the coffee plantation village in Silo district was Sidomulyo village. Methods: This research was quantitative and qualitative research by using Participation Rural Apraisal (PRA) method. The data was collected by interview, observation, and Focus Group Discussion (FGD). The research was aimed to identify role and the potential of environment sanitation people in the coffee plantation of Sidomulyo Village, Silo District, Jember regency. Results: The research results showed respondent’s sanitation knowledge are low 36%, intermediate 46%. The respondent’s attitude are bad 14%, and intermediate are 72%. The respondent’s behaviour; intermediate 55% and bad 31%. Mostly, respondents used spring as source of MCK are 79%, drinking water 58%. Most of the respondent did not have well as many as 85%. 67% did not have toilet and 60% did not have bathroom. 50% of the respondents did not have toilet, they used river and coffee garden as toilet. The bad house condition was 62%. According to FGD result, the people had motivation to increase management of environment sanitation. Some of people did arisan activity, karang taruna and gentlemens’ religiuos meeting as used media to increase peoples’ awareness in the management of environment sanitation in coffee plantation area. Conclusions: The research results showed that a large of respondents had knowledge, attitude, and behaviour about environment sanitation was intermediate. There was still respondents that had poor behaviour in environment sanitation. It was showed by most of the respondent did not have well, toilet and bathroom in their house. A half of respondent which did not have toilet, used river and coffee garden as toilet. Recommendation: The using of social institution to increas the sanitation behaviour of the society.

203-210

Authors: Susilo Wirawan, Fifi Luthfiyah, Mardiansyah, dan Ristrini

Background: Pregnant women who suffer Energy Chronic Defisiensi (KEK) have a greater risk of morbidity, especially in comparison to normal pregnant women. As a result, the risk for having a baby with low birth weight increased. KEK pregnant women in North Lombok region increased from year to year. Researchers are making efforts to prevent it. Researchers gave “Opak” Typical North Lombok has innovated by adding Moringa leaf powder and Ikan ekor kuning. The purpose of research creates opaque products enriched nutrients Opak Kelor Ikan (OKI), knowing acceptance of pregnant women against product, reviewing and analyzing the ease of getting the product to the target product sustainability of provision. Methods: Pre-experimental research methods for the design of the product, then the organoleptic tests, selected the best products, test and product proximate ready to be given to the respondent. OKI was given for 30 days. Results: Design making panelists preferred OIC is the use of fish and moringa ratio 1:2. The content of nutrients best OKI 2.64% protein, 4.07% fat, carbohydrates 83.9%, and 2.34% ash. Meeting the needs of nutrients from the OKI to snack pregnant women is about 3–4 pieces (65 grams). Samples were feeling good (61.7%), slightly bitter at 58.3%, 96.7% said crunchy. Ease of getting OKI, easy (91.7%). How to get, walking (86.7%). Access to get in the shop (83.3%). Sustainability of the OKI shows like only 32.53%, but the majority of respondents willing to continue with the 73%. depth interview in pregnant women happy diberikan OKI because these foods commonly consumed much less nutritious for babies. The midwife stated OKI very helpful in disseminating knowledge about nutritious food for pregnant women. Stakeholders from religious leaders expressed readiness to support and dissemination of information in any religious lectures delivered so that people become more familiar with the OKI. Conclusion: OKI can be given to pregnant women and can be KEK traditional nutritious snack. OKI to be sustainable. Recommendation: Storability test needs to be done to determine the expired date.

1–10

Authors: Mochamad Setyo Pramono, Astridya Paramita

Background: Low Birth Weight (LBW) is associated with neonatal mortality and morbidity, impaired growth and cognitive development, and chronic diseases later in life. LBW can also seriously affect the quality of future generations because it can slow the growth and development of children, and therefore contributes to a decrease of intelligence. Methods: This study is a secondary data analysis, the data source is the result of National Basic Health Research (Riskesdas) in 2013 with coverage of all provinces in Indonesia. The unit of analysis is the baby. The data were processed using descriptive analysis and logistic regression. Results: The percentage of low birth weight is 6.37% nationwide. Conclusion:Incidence of low birth weight is influenced by many factors the number of children, the occurrence of complications during pregnancy, low economic status and the baby girl. The most impact variable is the risk of complication during pregnancy reaches 2.74 times. Recommendation: It is needed improved efforts in handling Infants with low birth weight so that it will not result in death or impaired physical and mental growth and development of infants that affect on the quality of state human resources and increase the state burden.

19–28

Authors: Nana Noviana, Sri Setyati and Said

Background: The phenomenon of increase in poverty in South Kalimantan becomes a concern in an effort to reduce morbidity in poor communities. Efforts to reduce morbidity in poor communities to ensure the health needs of the poor/Underprivileged then held a health insurance program. A health insurance program is expected to lower the maternal mortality rate, infant and under five mortality rate as well as the birth rate besides the underserved of health for the poor in general. This study aims to analyze the implementation of health insurance program that can provide information and consideration in making policy in an effort to improve health care for the poor/underprivileged in South Kalimantan. Methods: This study presented a qualitative approach with descriptive exploratory that focuses the location in 5 cities in the province of South Kalimantan. The cities were chosen by geographical area category, HDI and poverty. The study was carried out in 6 months. The study instrument was questionnaire, in-depth interviews were conducted to the various informants who are competent. The field data were taken by direct observation as well as document review. Result: The results showed that the health insurance program in South Kalimantan is not optimimum in its implementation so that still needs to be evaluated. So that it could ensure the fulfillness of health needs of the poor and reduce the morbidity and mortality in poor communities. Conclusion: The implementation of health insurance program in South Kalimantan has been following the guidelines. However, it is still not optimum in case of the membership, quality of services, facilities and infrastructure, even the reporting system and organizing the health insurance program. Recommendation: Required human resources better in the implementation of such program conducted training for program managers as well as the need for SK to Tim so clear in their duties. Need more actively monitoring program for the implementation of the program can be run in line with expectations.

37–46

Authors: Eva Sulistiowati, Dina Bisara Lolong, Lamria Pangaribuan and Sri Mardikani N

Background:Cause of death statistics is one of the key indicators to describe the health status of a population and it is important for health planners or policy makers of a country. Cause of Death Information Form we called FKPK is an instrument for recording causes of death using the criteria of the International Classification of Diseases-10 (ICD-10) which can be used directly by the examining or a treating physician deceased before dying and recommended by WHO. The purpose of writing this article to see the pattern of causes of death in Ambon during 2010–2012 and saw the cause of the trend pattern of deaths each year. Methods:The methods is a descriptive research using cause of death (COD) data collected in Ambon 2010-2012 using tools FKPK collected from 22 health centers and 9 hospitals. The population was residents who died in Ambon at 2010–2012. The research sample included all deaths that occurred in the population of Ambon in 2010–2012. Results:the pattern of causes of death in Ambon City is dominated by non-communicable diseases(NCD) and the highest infectious diseases death is pulmonary tuberculosis. The high non-communicable occurs in many early age and the elderly, so it is necessary to establish posbindu elderly or posbindu NCD in Ambon city, as well as the need to increase the emphasis on health promotion Clean and Healthy Behavior.

57–64

Authors: Kristina, Lamria Pangaribuan, Dina Bisara and Oster Suriani

Background:Research of mortality was essential to provide basic information on the status of population health. Indonesia does not have a standart role for recording and reporting cause of death for every case that occurs in hospital or at home. Objective: determinan cause of death in MCCD in Gowa regency in 2011. Methods: Training and socialitation to medical doctors in every hospital how to fill the Information and Cause of Death Form ICD-10. The source information to fill MCCD was medical record and autopsi verbal questionnaire. Autopsi verbal was collected by nurse and paramedics then the doctors was resumed and cause of death code in MCCD. The analyses data was underlying causes of death based on ICD 10. Results: There are 2.813 mortality in Gowa regency in 2011 year. The place of mortality most at home (87,6%) and 12,4% only in health facility. The mortality was rised by increasing of age. The most of mortality by age group is + 65 years (47,2%). The main of base on 6 groups cause of death in Gowa regency is non communicable deseases (54,1%). There are transition of epidemiology cause of death in Gowa regency from communicable disease to non communicable disease. The main casue of death is stroke (13,6%). Conclusions: Recording and reporting system on UCoD in Gowa regency is developed but not optimal, because the result was still underestimate of mortality rate. The most mortality by sex is man and by place of death is at home. The main cause of death in Gowa regency is stroke.Recommendations: need to increase non-communicable disease control programs,especially stroke to reduce deaths from stroke

77–86

Authors: Zainul Khaqiqi Nantabah, Agung Dwi Laksono and Tumaji

Background:Female circumcision is still in debate. Some people consider that female circumcision may harmful to health. Meanwhile others consider female circumcision as a thing that taught by the religion. Objective:To analyze female circumcision and factors that influence parents to circumcise their daughter in Indonesia. Methods:This study is non-intervention analysis research by using data of 2013 Riskesdas. The data are contained of 14.859 parents who have daughter with age of 0 until 11 years old. The data are analyzed based on socio demographic and Girl’s circumcision behavior by using univariate, bivariate and multivariate analyzes method. Result: From the total respondent are found about 33.2% circumcise their daughter. The interesting fact is that 51.8% respondent are living in urban areas. Considering the age of the girls that have circumcised shows 71.8% are done in the age of 1 until 3 month after birth. Around 51.7% are having their daughters circumcised in the midwives. Factors that influence parents to circumcise their daughters are age, education, occupation, quintile of ownership index, and area of residence. Conclusion:Female circumcision in Indonesia is relatively high. Female circumcision done when the child was aged 1–3 years and are mostly done by midwives. Suggestion: It needs to spread correct information about female circumcision, especially for parents who willing to circumcise their daughters. The circumcision should be performed by medical practioners in order to avoid illegal practices which may be detrimental to the health of the children.

95–103

Authors: Wiwik Trapsilowati, Sugeng Juwono Mardihusodo , Yayi Suryo Prabandari, and Totok Mardikanto

Background: Dengue hemorrhagic fever (DHF) prevention required active participation from community. Thus in addition, empowerment methods need to be developed for increasing the community participation for DHF vector control. Methods: The study was conducted in Semarang. The design of this study was participatory action research (PAR). The intervension of this study was empowerment methods from PRA, PLA and COMBI modification which was difined as Community Empowerment in Dengue Vector Control (PMPV-DBD). Data was collected by structured interview and observation/larvae monitoring. Results: There was a positive significantly difference (p < 0.05) in knowledge and attitudes of community after the application of PMPV-DBD method in intervention area, although there was no significant difference in community practice before and after intervention. In control area, there was no difference (p > 0.05) in knowledge, attitude and practice in community before and after intervention. Conclusion: Indicator of entomology (larvae free index/ABJ) showed an increasing trend, while House index (HI), Container index (CI) and Breteau Index (BI) tended to decrease. Recommendation: The PMPV-DBD method application could be adapted by health sector according to Permenkes No.65 Tahun 2013 for sustained program and could be applicated to the larger area.