bluuebunny/crossref_metadata_2025 huggingface dataset:
Faktor Risiko Sepsis Neonatorum di Ruang Perinatologi Rumah Sakit Umum Pusat Sanglah Denpasar
Authors: Widayati Kurniasih , Kurniati Desak Putu Yuli , Windiani Gusti Ayu Trisna
Published: April 2019

Latar belakang dan tujuan: Angka Kematian Bayi (AKB) secara nasional tahun 2012 sebesar 32/1000 KH dan untuk Provinsi Bali sebesar 29/1000 KH. Angka ini masih lebih tinggi dari target Millenium Development Goals (MDGs) tahun 2015 sebesar 23/1000 KH. Salah satu dari banyak faktor yang meningkatkan risiko kematian bayi adalah sepsis neonatorum. Penelitian tentang sepsis neonatorum pernah dilakukan di RSUP Sanglah namun hanya penelitian deskriptif. Penelitian ini dilakukan untuk mengetahui faktor sosiodemografi, klinis, lingkungan dan tindakan invasif yang berhubungan dengan sepsis neonatorum di RSUP Sanglah.Metode: Rancangan penelitian adalah kasus kontrol dengan jumlah sampel 30 kasus (pasien yang didiagnosa sepsis neonatorum) dan 30 kontrol (pasien bukan sepsis neonatorum) dipilih secara acak dan matching berdasarkan bulan kelahiran bayi dari buku register 1 Januari-31 Desember 2014 di ruang perinatologi RSUP Sanglah. Data dikumpulkan dari rekam medis pasien dengan formulir ekstraksi data. Analisis secara bivariat untuk mengetahui crude OR dan multivariat dengan metode regresi logistikÂ  untuk mengetahui adjusted OR.Hasil: Analisis bivariat menunjukkan bahwa faktor yang meningkatkan risiko sepsis neonatorum adalah ibu yang tidak bekerja dan bekerja sebagai buruh dengan OR=3,5 (95%CI: 1,1-11,7), bayi berat lahir rendah (BBLR) dengan OR=6,6 (95%CI: 1,9-24,2), perawatan bayi dalam inkubator dengan OR=4,1 (95%CI: 1,2-14,3), pemberian infus dengan OR=9,3 (95%CI: 1,7-92,1) dan pemberian oksigen dengan OR=7,0 (95%CI: 1,9-29,7). Analisis multivariat menunjukkan bahwa satu-satunya variabel yang bermakna meningkatkan risiko sepsis neonatorum adalah BBLR dengan OR=20,2 (95%CI: 1,4-289,7).Simpulan: BBLR merupakanÂ  faktor risiko sepsis neonatorum di ruang perinatologi RSUP Sanglah Denpasar.
Hubungan Penggunaan Pestisida dan Alat Pelindung Diri dengan Keluhan Kesehatan pada Petani Hortikultura di Buleleng, Bali
Authors: Minaka Ida Ayu Dwi Astuti , Sawitri Anak Agung Sagung , Wirawan Dewa Nyoman
Published: April 2019

Latar belakang dan tujuan: Penggunaan pestisida highly toxic banyak terjadi di negara berkembang termasuk Indonesia. Petani Desa Pancasari di Bali merupakan pengguna pestisida aktif, sehingga ada potensi keracunan pestisida. Saat ini belum banyak diketahui perilaku penggunaan pestisida serta alat pelindung diri (APD) dan hubungannyaÂ  dengan keluhan kesehatan petani di wilayah tersebut.Metode: Survei cross sectional dilakukan pada 87 petani hortikultura. Pengumpulan data dilakukan dengan wawancara dan observasi. Data dianalisis secara bivariat dengan chi square test dan multivariat dengan regresi logistik untuk mengetahui hubungan antara keluhan kesehatan spesifik terkait pestisida (sakit kepala, gatal-gatal, kelelahan meningkat dan mual) dengan karakteristik sosiodemografi, pengetahuan dan perilaku penggunaan pestisida serta penggunaan APD.Hasil: Mayoritas petani berumur â‰¥ 30 tahun (94,3%), laki-laki (81,6%) dengan pendidikan menengah kebawah (78,2%). Sebanyak 54,1% petani memiliki pengetahuan cukup baik tentang pestisida dan APD, namun perilakunya masih buruk. Sebanyak 60,9% petani memiliki keluhan kesehatan spesifik. Keluhan kesehatan dijumpai berhubungan dengan penggunaan pestisida golongan organophosfat (AOR=3,74; 95%CI: 1,33-10,48), lama hari pemakaian baju kerja sebelum dicuci (AOR=1,37; 95%CI: 1,08-1,75), tidak menggunakan baju panjang pada saat pencampuran (AOR=0,25; 95%CI: 0,09-0,76) dan tidak memakai masker pada saat penyemprotan (AOR=0,18; 95%CI: 0,05-0,69).Simpulan: Keluhan kesehatan spesifik pada petani berhubungan dengan penggunaan pestisida golongan organophosfat, perilaku pemakaian baju kerja dan penggunaan APD yang tidak tepat.
Penerimaan Pelayanan Alat Kontrasepsi dalam Rahim Pasca Plasenta di Kota Denpasar
Authors: Widiastuti Ni Made Rai , Suariyani Ni Luh Putu , Karmaya I Nyoman Mangku
Published: April 2019

Latar belakang dan tujuan: Hasil Survei Demografi Kesehatan Indonesia Tahun 2012 menunjukkan bahwa prevalensi pemakaian kontrasepsi di Provinsi Bali mengalami penurunan dibandingkan Tahun 2007. Selain itu proporsi pemakaian alat kontrasepsi dalam rahim (AKDR) juga terus menurun. Salah satu upaya yang ditempuh untuk meningkatkan akseptor AKDR adalah meningkatkan promosi pemakaian AKDR pasca plasenta, namun penerimaannya masih rendah. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan penerimaan pelayanan kontrasepsi AKDR pasca plasenta di Kota Denpasar. Metode: Penelitian survei cross sectional dilakukan pada ibu pasca persalinan dengan jumlah sebanyak 100 ibu dan dipilih secara consecutive sampling yang melahirkan sejak Januari-Februari 2016 di Rumah Sakit Umum Daerah Wangaya, Puskesmas Pembantu Dauh Puri, Puskesmas I Denpasar Timur dan Puskesmas IV Denpasar Selatan. Data dikumpulkan dengan wawancara menggunakan kuesioner di tempat ibu melahirkan. Analisis data dilakukan secara bivariat (dengan chi square test) dan multivariat dengan regresi logistik.Hasil: Hasil penelitian menunjukkan proporsi penerimaan pemakaian AKDR pasca plasenta sebesar 35% dari semua ibu yang diberikan konseling tentang pemakaian AKDR pasca plasenta. Hasil analisis multivariat menunjukkan bahwa penerimaan AKDR pasca plasenta berhubungan dengan persepsi manfaat AKDR (AOR=10,39; 95%CI: 2,792-38,56), persepsi efek samping yang rendah (AOR=5,288; 95%CI: 1,085-25,761), peran petugas kesehatan (AOR=7,1; 95%CI: 1,781-28,60), dan dukungan suami (AOR=12,020; 95%CI: 2,888-50,01).Simpulan: Variabel persepsi efek samping yang rendah, persepsi manfaat terhadap AKDR, peran petugas kesehatan dan dukungan suami berhubungan dengan penerimaan kontrasepsi AKDR pasca plasenta.
Hubungan Kepemimpinan, Motivasi dan Kompensasi dengan Kepuasan Kerja Pegawai Puskesmas di Kota Denpasar
Authors: Wirajaya Made Karma Maha , Nopiyani Ni Made Sri , Wijaya I Putu Ganda
Published: April 2019

Latar belakang dan tujuan: Kepuasan kerja dapat meningkatkan kinerja pegawai dalam bekerja sehingga mampu menciptakan suatu keadaan positif di lingkungan organisasi. Penelitian sebelumnya mendapatkan bahwa kepemimpinan, motivasi dan kompensasi berhubungan dengan kepuasan kerja pegawai puskesmas namun belum dapat menjelaskan hubungan kepemimpinan, motivasi dan kompensasi secara bersama sama dengan kepuasan kerja pegawai puskesmas. Penelitian ini dilakukan untuk mengetahui hubungan kepemimpinan, motivasi dan kompensasi dengan kepuasan kerja pegawai puskesmas di Kota Denpasar.Metode: Rancangan penelitian ini adalah survei cross sectional pada semua pegawai puskesmas yakni sebanyak 39 pegawai di Puskesmas II Denpasar Selatan dan 36 pegawai di Puskesmas III Denpasar Utara. Data dikumpulkan melalui wawancara dengan menggunakan kuesioner dan dianalisis dengan regresi logistik untuk melihat hubungan kepemimpinan, motivasi dan kompensasi dengan kepuasan kerja pegawai puskesmas.Hasil: Pegawai puskesmas yang mempersepsikan kepemimpinan kepala puskesmas kurang baik sebanyak 52,00%, pegawai puskesmas yang memiliki motivasi tinggi dalam bekerja hanya 56,00%, pegawai puskesmas yang mempersepsikan kompensasi yang diterima memadai 60,00% dan pegawai yang merasa puas dalam bekerja hanya 52%. Analisis multivariat menunjukkan bahwa faktor kepemimpinan dengan OR=7,28 (95%CI: 2,17-24,46) dan motivasi dengan OR=4,31 (95%CI: 1,29- 14,39) berhubungan positif dengan kepuasan kerja pegawai puskesmas.Simpulan: Kepemimpinan dan motivasi berhubungan bermakna dengan kepuasan kerja pegawai puskesmas. Aspek perilaku pemimpin dalam memotivasi pegawai dan motivasi ekstrinsik terutama pada kondisi kerja masih perlu ditingkatkan untuk menciptakan kepuasan kerja pegawai.
Faktor-faktor yang Berhubungan dengan Pemberian ASI Ekslusif pada Ibu Beraktivitas dalam Rumah di Kabupaten Tabanan
Authors: Subratha Hesteria Friska Armynia , Putra I Wayan Gede Artawan Eka , Duarsa Dyah Pradnyaparamita
Published: April 2019

Latar belakang dan tujuan: Beberapa penelitian menunjukkan bahwa ibu yang bekerja dan meninggalkan bayinya di rumah lebih dari delapan jam sehari banyak yang tidak memberikan ASI eksklusif. Penelitian ini bertujuan untuk mengetahui proporsi pemberian ASI ekslusif pada ibu yang beraktivitas dalam rumah dan faktor-faktor yang mempengaruhinya.Metode: Penelitian survei cross sectional dilakukan pada ibu yang memiliki bayi berumur 6-12 bulan dengan sampel sebanyak 132 orang yang dipilih secara convenience di wilayah kerja Puskesmas Marga I Tabanan. Pengumpulan data dilakukan Bulan Maret-April 2016 dengan wawancara di rumah responden tentang: karakteristik sosial-demografi, pengetahuan, persepsi, konseling selama kehamilan dan persalinan, inisiasi menyusu dini (IMD), dukungan keluarga, dukungan tenaga kesehatan dan pemberian ASI eksklusif. Data dianalisis dengan STATA 12.1 secara univariat, bivariat (dengan chi square test) dan multivariat menggunakan regresi poisson.Hasil: Sebanyak 66,67% responden memberikan ASI eksklusifÂ  secara penuh dalam waktu 6 bulan. Alasan yang dikemukankan oleh responden tidak memberikan ASI eksklusif 6 bulan adalah ASI tidak mencukupi (32,58%), ASI tidak keluar (13,64%), nasehat keluarga (8,33%), bayi tidak mau disusui (6,06%), nasehat tenaga kesehatan (2,27%) dan agar payudara tidak berubah bentuk (1,52%). Hasil analisis multivariat menunjukkan bahwa variabel yang berhubungan dengan pemberian ASI eksklusifÂ  adalah paritas <3 (adjusted PR=1,50; 95%CI: 1,01-2,15), memberikan IMD (APR=1,80; 95%CI: 1,13-2,90) dan dukungan keluarga (APR=1,4; 95%CI: 1,10-1,76).Simpulan: Faktor yang secara signifikan berhubungan dengan pemberian ASI eksklusif adalah paritas <3, IMD dan dukungan keluarga yang baik.Â
Hubungan Pengetahuan dan Sikap Bidan dengan Pelaksanaan Inisiasi Menyusu Dini di Kabupaten Badung
Authors: Sudemi Luh , Adhi Kadek Tresna , Duarsa Dyah Pradnyaparamita
Published: April 2019

Latar belakang dan tujuan: Angka Kematian Bayi (AKB) di Bali dan juga di Indonesia masih tinggi sementara proporsi pemberian air susu ibu (ASI) eksklusif selama enam bulan penuh masih sangat rendah. Salah satu upaya untuk meningkatkan pemberian ASI eksklusif adalah dengan inisiasi menyusu dini (IMD) yaitu pemberian ASI pada bayi segera setelah lahir. Penelitian ini dilakukan untuk mengetahui penerapan IMD oleh bidan dan faktor-faktor yang mempengaruhinya.Metode: Rancangan penelitian adalah survei cross-sectional pada 61 bidan praktek mandiri sebagai responden di Kabupaten Badung. Responden adalah semua bidan praktek mandiri di tiga kecamatan yang dipilih secara purposive dari enam kecamatan yang ada di Kabupaten Badung. Data dikumpulkan menggunakan kuesioner yang diisi sendiri oleh bidan dan dianalisis secara bivariat dengan uji chi-square dan multivariat dengan poisson regression.Hasil: Pelaksanaan IMD diterapkan oleh 62,3% responden. Pada kelompok bidan yang menolong persalinan >4 pasien per bulan secara bermakna lebih banyak menerapkan IMD dibandingkan dengan bidan yang menolong persalinan â‰¤4 per bulan yaitu 83,3% vs 57,1% (p=0,008). Penerapan IMD dijumpai berbeda secara bermakna pada bidan dengan pengetahuan yang lebih tinggi yaitu 84,6% vs 45,7% (p=0,002), sikap yang positif yaitu 79,1% vs 22,2% (p=<0,001) dan bidan yang pernah mendapat supervisi yaitu 77,5% vs 33,3% (p=0,001). Analisis multivariat menunjukkan bahwa faktor yang mempengaruhi pelaksanaan IMD adalah pengetahuan dengan APR=1,48 (95%CI: 1,03-2,13) dan sikap dengan APR=2,62 (95%CI: 1,10-6,24). Simpulan: Pengetahuan dan sikap berhubungan secara signifikan dengan pelaksanaan IMD oleh bidan
Faktor Risiko Kehamilan Usia Remaja di Bali: Penelitian Case Control
Authors: Meriyani Dewi Aprelia , Kurniati Desak Putu Yuli , Januraga Pande Putu
Published: April 2019

Latar belakang dan tujuan: Kehamilan usia remaja merupakan masalah kesehatan masyarakat di Indonesia. Data Survei Demografi dan KesehatanÂ  Indonesia 2012 menunjukkan bahwa 9,5% wanita usia 15-19 tahun sudah melahirkan atau hamil anak pertama. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kehamilan remaja.Metode: Penelitian dilakukan di Kecamatan Kintamani, Bangli, Provinsi Bali. Â Rancangan penelitian adalah kasus kontrol dengan responden sebanyak 96 orang. Kelompok kasus adalah remaja yang hamil usia <20 tahun, sebanyak 32 orang dan kontrol adalah remaja usia <20 tahun yang tidak hamil dan belum menikah sebanyak 64 orang. Kasus diambil dari semua remaja hamil usia <20 tahun yang tercatat di register ibu hamil Puskesmas Kintamani I dan VI. Kontrol diambil secara acak dari daftar remaja putri yang ada di kelompok muda mudi wilayah kerja kedua puskesmas. Pengumpulan data dilakukan dengan wawancara di rumah masing-masing responden. Data dianalisis secara bivariat (uji chi square) dan multivariat menggunakan regresi logistik.Hasil: Faktor risiko yang dijumpai berhubungan dengan kehamilan usia remaja adalah pergaulan dengan teman sebaya yang negatif dengan adjusted OR (AOR)=71,6 (95%CI: 9,4-545,2); remaja yang memiliki kesempatan untuk melakukan hubungan seksual (AOR=17,7; 95%CI: 3,2-98,2); pengetahuan remaja yang kurang tentang kesehatan reproduksi dan kehamilan usia remaja (AOR=12,8; 95%CI: 2,5-66,5) dan penghasilan keluarga yang lebih tinggi (AOR=5,8; 95%CI: 1,3-26,6). Pendidikan responden dan paparan pornografi dijumpai tidak berhubungan dengan kehamilan usia remaja.Simpulan: Pergaulan dengan teman sebaya yang negatif, kesempatan untuk melakukan hubungan seksual, pengetahuan yang kurang dan penghasilan keluarga yang lebih tinggi dijumpai sebagai faktor risiko kehamilan usia remaja.
Analisis Kinerja RSUD Karangasem Berbasis Balanced Scorecard
Authors: Yulianti Putu , Sutarsa I Nyoman , Wijaya I Putu Ganda
Published: April 2019

Latar belakang dan tujuan: Rumah Sakit Umum Daerah (RSUD) Karangasem telah mengadopsi metode balanced scorecard dalam penyusunan rencana strategisnya. Selama ini evaluasi kinerja yang dilakukan setiap tahun hanya pada perspektif keuangan dan belum pernah dilakukan evaluasi terhadap tiga perspektif lainnya. Penelitian ini dilakukan untuk mengetahui kinerja RSUD Karangasem dari empat perspektif tersebut.Metode: Rancangan penelitian adalah survei cross-sectional pada 110 pasien rawat inap dan 95 karyawan yang dipilih secara convenience. Data dikumpulkan dengan wawancara menggunakan kuesioner. Data dianalisis diagram kartesius untuk mengetahui sub item kepuasan pasien dan karyawan yang perlu diprioritaskan. Analisis data sekunder dilakukan untuk mengetahui kecenderungan empat perspektif tersebut.Hasil: Kinerja rumah sakit dalam empat perspektif secara keseluruhan termasuk kategori cukup dengan skor 44,7%. Bila dilihat untuk masing-masing perspektif dijumpai bahwaÂ  perspektif keuangan, pelanggan, dan proses bisnis internal termasuk dalam kategori cukup yaitu masing-masing dengan skor: 16,65%, 12,5% dan 15,62%. Sedangkan perspektif pertumbuhan/pembelajaran termasuk kategori tidak baik (0).Â  Analisis diagram kartesius menunjukkan duaÂ  sub-item yang perlu diperbaiki pada kepuasan pasien yaitu: prosedur dan kecepatan pelayanan, sedangkan pada kepuasan karyawan terdapat lima sub item yang perlu perbaikan yaitu: respon cepat, dukungan manajemen, perhatian dan kerapian tempat kerja.Simpulan: Kinerja RSUD Karangasem berbasis balanced scorecard berada pada kategori cukup dan kepuasan pasien/karyawan masih perlu diperbaiki pada sub item tertentu
Implementation of quality function deployment to identify priority needs of customers and health providers of child-friendly community health centre
Authors: Ariani Ni Nyoman , Nopiyani Ni Made Sri , Wijaya I Putu Ganda
Published: April 2019

Background and purpose: The efforts to increase quality of service is critical in public services. Service providers should be able to identify customer needs and expectations. As one of health providers, community health centre are required to develop mechanisms for identifying needs of customers and staff. Needs assessment of clients and staff at Blahbatuh II Health Centre is never been conducted. This study aims to identify priority needs of customer and staff to improve the quality of service at Blahbatuh II Health Centre.Methods: A quantitative study was conducted at Blahbatuh II Health Centre. Data was collected through interviews guided by a structured questionnaire. A total of 97 customers were consecutively selected and were interviewed. Eight staff of child-friendly community health centres were purposively recruited. Data was analysed using quality function deployment method and presented in the House of Quality (HoQ) matrix.Results: There were 16 and 13 expectations from customers and staff respectively. The house of quality matrix showed that respondents ranked several expectations as the most important that include friendly staff, quick and on-time services, and effective treatment. Health staff on the other hand expected the centre to implement performance-based reward system, to provide training program and to follow the standard operating procedures.Conclusions: Expectations from customers and health staff are different. In order to meet these expectations, health centre should design and implement a quality improvement program to address these diverse quality issues.
Cervical cancer screening among reproductive-aged women: a crossectional survey in Tabanan Regency
Authors: Apriani Desak Gede Yenny , Suaryani Ni Luh Putu , Karmaya I Nyoman Mangku
Published: April 2019

Background and purpose: Cervical and breast cancers are the most common malignancies among women in Indonesia. The prevalence of cervical cancer in Bali was 0.6% in 2013. Screening coverage for cervical cancer in Tabanan district varies from 37% to 67%. This study aims to determine factors associated to cervical cancer screening uptake among reproductive-aged women.Methods: A cross-sectional survey was conducted at Baturiti Subdistrict, Tabanan Regency, Bali Province. This study involved 188 reproductive-aged women. Samples were randomly selected from all reproductive-aged women from two villages of Baturiti and Angseri. Data were collected using home interviews by a standardised questionnaire. Multivariate analysis was conducted using poisson regression model to determine factors associated to cervical cancer screening uptake.Results: This study showed that the proportion of cervical cancer screening was 38.83%. Variables associated to the uptake of cervical cancer screening were comprehensive knowledge about cervical cancer (APR=10.16; 95%CI: 4.33-24.76), insurance holder (APR=2.95; 95%CI: 1.38-6.64) and aged of â‰¥40 years (APR=1.26; 95%CI: 1.01-1.59). Education level, employment status and perceived benefits were not associated with the screening uptake among reproductive-aged women.Conclusions: Level of knowledge about cervical cancer, insurance ownership and aged over 40 years increase the cervical screening uptake among reproductive-aged women.
Risk factors of pulmonary tuberculosis among diabetes mellitus patients in Denpasar City
Authors: Dewi Desak Putu Risna , Putra I Wayan  Gede Artawan Eka , Sawitri Anak Agung Sagung , Duarsa Dyah Pradnyaparamita
Published: April 2019

Background and Purpose: Tuberculosis (TB) is more common in developing countries, including Indonesia. Denpasar City contributes the most on the total number of TB patients in Bali Province. There is evidence on increased burden of diabetes mellitus (DM) patients with TB comorbidity. This study aims to examine risk factors of TB among DM patients.Method: A case control study was conducted in Denpasar City. A total of 135 samples, 45 cases and 90 controls, were recruited to participate in the study. Cases were DM patients with TB comorbidity and were taken from patients register between 2013 to 2015. Controls were DM patients without TB comorbidity and were taken from Bali Province screening operational study. Data were collected using interviews, observations, measurements and document review. Data were analysed using bivariate analysis and multivariate with logistic regression model.Results: Demographic characteristics between cases and controls were comparable in sex and family income but not comparable in age groups, education, domicile, and employment. Risk factors of TB among DM patients were house density (AOR=36.11; 95%CI: 5.0-259.9), undernutrition (AOR=24.76; 95%CI: 3.7-162.3), inadequate glycemic control (AOR=12.64; 95%CI: 2.4-66.2), and being employed (AOR=10.55; 95%CI: 1.2-92.7). TB infection among DM patients was associated with aged<60 years (AOR=7.47; 95%CI: 1.2-44.3) and being male (AOR=5.42 ;95%CI: 1.2-24.0). TB co-infection among DM patients was also associated with low education level (AOR=6.96; 95%CI: 1.0-48.6), contact with TB patients (AOR=5.84; 95%CI: 0.7-46.6) and inadequate house ventilation (AOR=2.92; 95%CI: 0.6-13.1).Conclusion: Socio-demographic characteristics, physical environments of the house and clinical conditions are risk factors of TB among DM patiens.
Barriers for people who inject drug (PWID) to access voluntary counselling and testing (VCT) at the health centres in East Lombok
Authors: Karmila Dany , Januraga Pande Putu , Septarini Ni Wayan
Published: April 2019

Background and purpose: Utilisation of voluntary counselling and testing (VCT) by people who inject drug (PWID) in East Lombok is low. This study aims to explore barriers for PWID to access VCT service from community health centres in East Lombok, West Nusa Tenggara.Methods: A qualitative study was conducted in East Lombok. Data were collected using in-depth interviews. Nine participats were purposively selected consisted of five HIV negative PWID who repeatedly tested for HIV, one non-governmental organization official, one field worker, one VCT counsellor and one medical doctor. Data were inductively analysed.Â Results: This study found that PWID preferred to use mobile VCT rather than VCT at health centres because of scared of getting caught by police. They also felt uncomfortable of using VCT service at the health centres due to stigma and discrimination. In addition, lack of human resources at the health centre was also found to be a significant barrier. This led to increased workload thus limited attention was given to quality of VCT service.Conclusions: Barriers to access VCT service at the health centre include high stigma and discrimination from health provider and living arrangements of PWID. To improve VCT access for PWID, effective collaboration between health centres, private health institutions and village cadres are required.
Evaluation of HIV screening at antenatal care settings in Denpasar City
Authors: Yuliyatni Putu Cintya Denny , Pujana Wayan , Indriani Citra
Published: April 2019

Background and purpose: National strategy to increase the coverage of prevention of mother to child transmission (PMTCT) program in Indonesia is integrating the service into public health centres (puskesmas). In Bali, the integration has been started since 2014. After one year of program implementation, an evaluation was conducted in order to provide input and feedback for program improvement.Methods: Secondary data analysis and indepth interview with 13 key informants in Denpasar City were conducted to assess input, process and output of the integration implementation.Â Results: Of the 11,719 pregnant women targeted within the program, 43% were offered to undergo HIV testing and 98% of these agreed to have HIV test with 17 were found HIV positive. Interviews with key informants found that there were adequate resources both in terms of manpower, funds and equipment. Obstacles found in the implementation include different site of ANC and HIV testing facility. The other barrier was high number of pregnant mother who conducted ANC at private obstetrician which not yet included in the program.Conclusions: Integration of PMTCT into ANC services at public health centre (PHC) is an effective way to improve the uptake of HIV screening among pregnant women. However, there is a need of effective of referral systems from private midwives and PHC satellite services. The expansion of networks into private midwives and obstetrician will be instrumental in improving performance outcomes.
Risk factors for low birth weight infants in East Nusa Tenggara
Authors: Owa Khrispina , Putra I Wayan Gede Artawan Eka , Windiani I Gusti Ayu Trisna
Published: April 2019

Background and purpose: Low birth weight (LBW) is a major cause of neonatal and infant mortality. The Indonesian Demographic and Health Survey indicated that neonatal mortality rate in East Nusa Tenggara was 26 per 1000 live births, 15% of which were caused by low birth weight. This study aims to understand the relationship between age of mother, birth spacing, chronic energy deficiency, presence of concomitant diseases, employment status, anemia, quality of antenatal care and traditional dietary restrictions on the incidence of LBW in Ende District, East Nusa Tenggara.Methods: A case control study was conducted at Ende District in 2015, with a total of 156 respondents. Cases were mothers giving birth to LBW infant (<2500 gram) and controls were mothers giving birth to normal weight infant (â‰¥2500 gram). Case and control ratio was 1:1. Data were obtained from antenatal care records and interviews. Data were analysed using bivariate analysis and multivariate with logistic regression.Results: This study found that risk factors of LBW include age of mother <20 or â‰¥35 years (AOR=6.8; 95%CI: 1.87-25.0), traditional dietary restrictions (AOR=6.7; 95%CI: 1.71-26.8), birth spacing <2 years (AOR=6.5; 95%CI: 1.78-24.2), chronic energy deficiency (AOR=5.3; 95%CI: 1.38-21.0), being employe (AOR=4.6; 95%CI: 1.44-14.9), anemia (AOR=4.2; 95%CI: 1.37-13.1), malaria infection (AOR=3.9; 95%CI: 1.21-12.7) and low quality of antenatal care (AOR=3.5; 95%CI: 1.11-11.3).Conclusions: Age of mother <20 or â‰¥35 years, traditional dietary restrictions, birth spacing <2 years, chronic energy deficiency, maternal occupation, anemia, malaria infection and low quality of antenatal care are risk factors for LBW in the District of Ende.
Readiness of girls aged 10-12 years for an early menarche: a transtheoretical model of behavioural change analysis
Authors: Diaris Ni Made , Listyowati Rina , Januraga Pande Putu
Published: April 2019

Background and purpose: Studies have revealed that girls are now having menarche much younger. An early menarche put young girls at higher risk for physical and psychological problems. This study aims to explore stages of readiness of girls aged 10-12 years for an early menarche.Method: A qualitative study was conducted in Denpasar City. A total of 20 students both from primary school and junior high school aged between 10 and 12 years were purposively selected to participate in the study. Ten students had menarche while the other 10 were yet to have menarche. Data were collected through in-depth interviews at the schools after approval from parents was obtained. Data were analysed using a thematic approach.Results: All informants have conceded the pre-contemplation and contemplation stages. Most of them were at the preparation stage. Some children were at the action stage though some were just entered the action stage. In-depth interviews revealed that the majority of informants understood the basic knowledge of menstruation. Their mother provided information and supports after they had menarche. However, some informants stated that they were panic, ashamed, and anxious during their menarche. They also believed that several activities including washing hair, drinking icy beverages, and eating sweets were forbidden.Conclusion: Some girls are not fully at the action stage leading to fear and shame when they had menarche. This suggests that a more comprehensive education program and psychological supports especially from mother should target younger girls to prepare them for an early menarche.
Needs for sexual and reproductive health education for students with hearing impairment in Buleleng District, Bali Province
Authors: Ariantini Nyoman Sri , Kurniati Desak Putu Yuli , Duarsa Dyah Pradnyaparamita
Published: April 2019

Background and purpose: Adolescents with hearing impairment face a number of exclusion due to their limitation, including lack of access to information on reproductive health. This study aims to explore needs for sexual and reproductive health education for students with hearing impairment at Singaraja. Â Methods: A qualitative study was conducted at Buleleng District. Data were collected through in-depth interviews to 19 informants. Informants were purposively selected based on their specific roles. Our informants included students with hearing impairment, head of school, teachers and parents or carers. Data were analysed using a thematic approach.Results: The majority of students with hearing impairment had low level of knowledge associated to sexual and reproductive health. However, sexual and reproductive health practices between adolescents with and without hearing impairment were generally comparable. Needs for sexual and reproductive health education must cover several elements: (1) education material must be tailored based on age, (2) learning methods should be tailored based on their intellectual ability, and (3) learning methods must use contextual and real model approach to allow better transfer of information. Teachers faced difficulty to provide sexual and reproductive health education for students with hearing impairment even though some modules are already available.Conclusions: The provision of sexual and reproductive health education for students with hearing impairment requires tailored material, simple and attractive learning methods, and visual media. Further analysis of the existing reproductive health education curricula for students with hearing impairment is required in order to ensure fulfilment of reproductive rights of adolescent with special needs.
Willingness of private general practitioners to refer suspected tuberculosis patients in Badung District
Authors: Dewi Ni Putu Eka Purnama , Sawitri Anak Agung Sagung , Utami Ni Wayan Arya
Published: April 2019

Background and purpose: The national tuberculosis (TB) prevalence study showed that between 2013 and 2014 there was significant proportion of pulmonary TB patients received treatment from private healthcare facilities. Data from Bali Province and Badung District Health Offices revealed that of all suspected TB patients only a few were referred by their private general practitioner. A reward system was created in 2012 by providing credit points to every referral made by the private general practitioner. This study aims to examine association between the reward system, national health insurance scheme and willingness to refer suspected TB patients.Methods: A cross-sectional study was conducted from February to April 2017. A total of 111 private general practitioners who practice at Badung District were interviewed. In addition, medical record from these private general practitioners were also examined.Results: Our study found that as many as 55 (45.95%) of private general practitioners had ever referred suspected TB patients over the last year. The total suspected TB patient being reffered in the last year was 132 cases. A cross checking with the laboratory data revealed that only 47 cases (35.61%) presented at referral laboratory facilities. Multivariate analysis showed that the willingness of private general practitioners to refer suspected TB patient was associated to reward system (AOR=4.62; 95%CI: 1.23-17.32) and supervision from TB officials (AOR=13.07; 95%CI: 3.78-45.13). The enrollment of private general practitioners as a primary healthcare facility under the national insurance scheme was not associated with the willingness to refer suspected TB patients.Conclusions: About half of the private general practitioners have ever referred a suspected TB patient. Supervision from TB officials and a reward system in terms of credit points were associated with the willingness to refer suspected TB patients. Ongoing supervision, providing credit points, and improving referral systems are required to improve case findings and referral of suspected TB patients by private general practitioners.
Risk factors of pre-eclampsia in Dompu District, West Nusa Tenggara Province
Authors: Ulfah Maria , Suaryani Luh Putu , Duarsa Dyah Pradnyaparamita
Published: April 2019

Background and purpose: Pre-eclampsia is a major contributing factor of maternal mortality. Dompu District has a high rate of maternal mortality relative to the rest of districts in West Nusa Tenggara Province. Pre-eclampsia is the major cause of maternal mortality in Dompu District. This study aims to examine risk factors of pre-eclampsia among pregnant women.Methods: A case control study was conducted in five public health centres in Dompu District. A total of 104 women who gave birth and have diagnosed with pre-eclampsia during the pregnancy were recruited as cases. A total of 104 women who gave girth and did not have pre-eclampsia were selected as controls. All cases and controls were selected using a systematic random sampling technique from the 2016 pregnant women cohort at five public health centres. Data were collected through interview and extraction from the maternal and child health book. Data were analysed using bivariate and multivariate techniques.Results: Our multivariate analysis found that pre-eclampsia was associated with parity of 1 or >3 (AOR=3.64; 95%CI: 1.85-7.17), body mass index of >27.0 kg/m2 (AOR=3.01; 95%CI: 1.39-6.48), history of chronic diseases (AOR=16.43; 95%CI: 3.32-81.22) and smoke exposure (AOR=3.71; 95%CI: 1.95-7.05).Conclusions: Parity of 1 and >3, BMI of >27.0 kg/m2, history of chronic illnesses and smoke exposure are risk factors for pre-eclampsia in Dompu District, West Nusa Tenggara.
Perceptions of patients and providers on the use of acupressure services at Public Health Centres, Tabanan District, Bali
Authors: Sukawinaca I Made , Sari Komang Ayu Kartika , Wirawan I Made Ady
Published: April 2019

Background and purpose: Acupressure services are available at some public health centres (PHCs) in Bali, but the service utilisation remains low. The purpose of this study is to explore the perception of patients and service providers on the use of acupressure services at PHC in Tabanan.Methods: This study used a qualitative design based on observation and in-depth interviews with 13 informants consisting of patients, health service practitioners, head of PHC and programÂ  manager at Tabanan Health Office. The informants were chosen purposively and the data were analysed thematically.Results: There were different perceptions regarding the benefits of acupressure services between patients utilising the services and those who had not. Patients who had undergone acupressure demonstrated positive perception of the service. Acupressure services are considered to be effective in dealing with patient complaints, have no side effects, and patients reported being satisfied with the services provided by the PHC. Patients who did not utilise acupressure services, view acupressure as an ineffective therapy with potential side effects that may endanger their health. These patients experienced trauma from similar massage techniques. Service providers lamented the absence of government support in the form of local regulations that would enable them to access funding, increase human resources and facilitate promotion of the services.Conclusions: Patient perceptions of acupressure services still vary, with some contraints in the implementation that consist of local regulation, operational fund and human resources. Acupressure services still require synergy between central and local government policies to support its implementation.
The provision of promotive and preventative healthcare services by private primary care physicians in the era of the national health insurance program
Authors: Artha Ketut Ary Diana , Suarjana Ketut , Januraga Pande Putu
Published: April 2019

Background and purpose: In addition to their duties in addressing the curative and rehabilitative needs of the community, private primary care physicians (PCP) play an important role in providing promotive and preventative healthcare services. This study aims to determine the behaviours, enabling and inhibiting factors involved with the provision of promotive and preventative services by PCP in the era of national health insurance (JKN) implementation.Methods: This research is a mix method study using a combination of quantitative and qualitative approaches. Quantitative surveys were conducted with all PCPs already in working collaboration with the Social Security Administering Agency (BPJS) in the Denpasar City area (61 people). Data analysis techniques used descriptive techniques in order to explore the kinds of promotion and preventative services provided by PCPs. Qualitative research was conducted through in-depth interviews of 8 informants selected by purposive sampling and analyzed thematically to discover the enabling and inhibiting factors of the provision of promotive and preventative services by PCPs.Results: The results showed that 91.8% of PCPs did perform promotive and preventative services in their practice site. PCPs who did not carry out promotive and preventative services demonstrate perceptions, beliefs and motivations categorized as low and weak as well as attitudes that do not support the implementation of such services. Enabling factors of promotion and preventative services by PCPs, include among others, quality of facilities and infrastructure, the receipt of awards from BPJS and capitation systems that benefit physicians financially. Inhibiting factors include a low willingness of the patient to carry out doctor's advice, limitations in the PCPs work time and limited funds to perform preventative/promotive services.Conclusions: Promotive and preventative services are not being optimally carried out by PCPs in Denpasar. This is due to the low willingness of the patients, the limited time of the doctor, and the limited allocated funds for promotive and preventative services and low capitation.
Risk factors for hepatitis B virus infections among pregnant women in East Lombok District
Authors: Faizaturrahmi Eka , Ani Luh Seri , Sari Komang Ayu Kartika
Published: April 2019

Background and objectives: The World Health Organization has set a target of 90% reduction in new Hepatitis B infections by 2030. The program includes prevention of new infections, and increases testing uptake and treatment. In order to effectively foster prevention, it is necessary to understand the risk factors for transmission. This study aims to determine the risk factors of Hepatitis B infection in pregnant women.Method: A case control study was carried out among 52 pregnant women with HBsAg (+) as cases and 104 pregnant women with HBsAg (-) as controls. The source of cases and controls was the register of pregnant women at the Pringgasela Public Health Center from January 2016 to October 2017. Cases were selected using systematic random sampling from 67 HBsAg (+) pregnant women and controls were selected in the same way from 1644 pregnant women with HBsAg (-). Cases and controls were matched by domicile. The data collected were age, age of first marriage, education, family income, parity, history of miscarriage, maternal or husbandâ€™s history of working abroad, frequency of marriage, history of injection, surgery, blood transfusion and dental care. Data collection was carried out with a pre-tested questionnaire in April-May 2018 through interviews at the home of each respondent. Multivariate analysis with logistic regression was carried out to determine the adjusted odds ratio of each risk factor.Results: Case and control characteristics were found to be similar in terms of age, domicile, education and income. Significant risk factors were the history of husband working abroad (AOR=4,115; 95%CI: 1,657-11,075), age of first marriage <20 years (AOR=2,420; 95%CI: 1,157-5,481) and frequency of husband's marriage more than one time (AOR=3,081; 95%CI: 1,345-7,080).Conclusion: Husbands with history of working abroad, age of first marriage <20 years and frequency of husband's marriage more than one time were found to be the risk factors for Hepatitis B infection in pregnant women. These factors require public health attention in order to reduce the transmission of Hepatitis B.
Anemia as a risk factor of postpartum hemorrhage at dr. R. Soedjono Hospital, Selong, East Lombok
Authors: Ernawati Ernawati , Sari Komang Ayu Kartika , Budiana I Nyoman Gede , Ani Luh Seri
Published: April 2019

AbstractBackground and purpose: Globally, maternal mortality rate due to labor complications remains high, with postpartum hemorrhage as the most common cause. Studies on the risk factors of postpartum hemorrhage have been widely published, however, its association with maternal anemia is inconsistent. This study aims to explore anemia as a risk factor for postpartum hemorrhage.Methods: A case control study was carried out with 69 women who experienced postpartum hemorrhage as cases and 207 women who had given birth but did not experience hemorrhage as controls. Cases and controls were taken from medical records at the Dr. R. Soedjono Hospital, Selong, East Lombok District, West Nusa Tenggara. Cases were selected by systematic random sampling from 147 mothers who experienced postpartum hemorrhage during 2017. Controls were selected in the same way from 2,855 mothers who did not experience postpartum hemorrhage. Cases and controls were matched for birth weight of infants and maternal employment. Data were obtained by medical record extraction in May 2018 consisting of information on hemoglobin concentration, parity, age at pregnancy, birthing method, gestational age, birth spacing and length of labor. Data analysis was performed using logistic regression to determine the adjusted odds ratio (AOR) of anemia.Results: Characteristics of cases and controls were found to be similar in terms of infant birth weight, maternal occupation, parity, gestational age and length of delivery but statistically different by maternal age at pregnancy and birth spacing. Analysis with logistic regression showed that anemia during pregnancy with hemoglobin concentration â‰¤10 gr/dL was a significant risk factor for postpartum hemorrhage with AOR=16.32 (95% CI: 7.69-34.64). Delivery through caesarean section (SC) or oxytocin drip was also found to significantly reduce the risk of postpartum hemorrhage (AOR=0.03; 95%CI: 0.01-0.13).Conclusion: Anemia during pregnancy with hemoglobin concentration â‰¤10 gr/dL was found to be a risk factor for postpartum hemorrhage. Prevention and control of anemia in pregnant women need to be enhanced to prevent postpartum hemorrhage
Association between handwashing practices and quality of toilets with diarrhea among under-five years children
Authors: Zulfiana Yesvi , Ani Luh Seri , Utami Ni Wayan Arya
Published: April 2019

Background and purpose: The incidence of diarrhea among under-five years children in Indonesia is considerably high. Studies exploring risk factors of diarrhea have been extensively conducted in Indonesia. However, the association between handwashing practices of the mother and quality of toilets with diarrhea among under-five years children are still inconsistent across studies. This study aims to examine the association between handwashing practices of the mother, quality of toilets and the episodes of diarrhea among under-five years children.Methods: A cross-sectional survey was conducted involving 104 under-five years children in Selagalas Village. Samples were selected using systematic random sampling. Data were collected in July 2017 by observation and face-to-face interviews using questionnaires. Bivariate analysis and logistic regression were conducted to examine the association between hand washing practices, quality of toilets and diarrhea among under-five years children.Results: We found more than half of under-five years children (64.42%) had experienced at least one episode of diarrhea over the last three months. We found a significant association between diarrhea with unhygienic toilets with an adjusted odds ratio (AOR) of 2.84 and poor hand washing practices of the mother with AOR of 2.46, however, both have a lower limit of AOR confidence interval that close to one, namely 95%CI: 1.05-5.97 and 95%CI: 1.03-5.87.Conclusion: Poor hand washing practices and unhygienic toilets are associated with the episodes of diarrhea among under-five years children, however, both have a low programmatic importance. Further study should be carried out to understand the association between hand washing practices and quality of toilets with diarrhea. Despite of the low programmatic importance, good hand washing practice should be promoted and access to toilets that meet the health standard must be enhanced.
Engaging the private sector to improve antimicrobial use in the community
Authors: Wulandari Luh Putu Lila , Wiseman Virginia
Published: April 2019

Antimicrobial resistance (AMR) is one of the worldâ€™s most pressing public health threats. It increases the cost of health care through longer duration of illness and hospital stays,Â additional tests,Â and the need for more expensive drugs.AMR refers to the ability of a microorganism to stop an antimicrobial (such as an antibiotic, antiviral or antimalarial) from working against it. As a consequence of AMR, standard treatments become ineffective, and infections persist and may spread to others. The impact of AMR is far-reaching and equates to the situation before the discovery of antibiotics, when even small infections were difficult, or very often impossible to treat, and medical procedures too risky to perform due to the potential of untreatable infection.
Factors affecting the use of electronic cigarettes in Udayana University students
Authors: Pitriyanti Luh , Wirawan Dewa Nyoman , Sari Komang Ayu Kartika , Kurniati Desak Putu Yuli , Duana I Made Kerta , Wirawan I Made Ady
Published: April 2019

AbstractBackground and purpose: Electronic cigarettes have been available globally since 2003 and first became for sale in Indonesia in 2010. Users tend to be predominately young people. The purpose of this study is to determine the proportion, characteristics and factors that influence the use of electronic cigarette among university students.Method: This research used a cross sectional survey with 351 undergraduate students from a variety of disciplines at Udayana University chosen by multistage sampling. In the first phase, 10 study programs were chosen randomly from 47 courses at Udayana University. The selection of respondents was influenced by the convenience of data collection, that is, questionnaire via the Survey Monkey application. Analysis with logistic regression was used to determine the factors influencing electronic cigarette usage based on several variables.Results: The proportion of students who used tobacco cigarettes was 14.53%. Respondents who reported using electronic cigarettes numbered 61 (17.38%, 95%CI: 13.46%-21.3%), and 40.98% of them were still current smokers. As many as 88.52% of respondents who had ever used electronic cigarette are male students, and 11.48% female students. Students who had ever used electronic cigarettes in the campus area totaled 22 people (36.07%). The reasons provided for using electronic cigarettes included a desire to stop using tobacco cigarettes (29.51%), the fact that electronic cigarettes are considered safer (26.23%), are considered â€œcoolâ€ (22.95%), experimental reasons, and other (26.23%). Multivariate analysis showed that the variables found to be associated with the use of electronic cigarettes were gender (AOR=14.72; 95%CI: 4.34-49.87), a history of smoking tobacco cigarettes (AOR=42.16; 95%CI: 13.56-131.08), had a history of consuming alcoholic beverages (AOR=5.72; 95%CI: 2.04-16.04) as well as coming from a smoking household (AOR=3.87; 95%CI: 1.33 - 11.21).Conclusion: The proportion of students who have ever used electronic cigarettes was found to be higher than cigarette tobacco users. In addition, use was found to be greater among male students than in female students. Influencing factors associated with the use of electronic cigarettes are gender, a history of tobacco smoking, a history of consuming alcoholic beverages as well as coming from a smoking household. There is a need for prevention efforts including education and regulations to reduce the use of electronic cigarettes among students and the general public.