bluuebunny/crossref_metadata_2025 huggingface dataset:
Development Model Of Factors Influencing The Adoption Of Online Education Platforms For Promoting Educational Equity In Chinese Higher Education Institutions
Authors: Zhu. Hao , Pongtornkulpanich Anan , Chankoson Thitinan
Published: April 2024

In the era of digital education, fostering online education for sustainable development emerges as a critical challenge, particularly in bridging the digital divide that hinders equitable access to digital education technologies. This study aims to uncovers the impact of the digital divide on higher education students' engagement with online education platforms aimed at education equality. Additionally, it seeks to assess the mediating roles of equity in resource allocation and educational process fairness. Leveraging online surveys, data were amassed from students across Tsinghua University, Peking University, Fudan University, Nanjing University, and SouthWest JiaoTong University, encompassing a diverse cohort of 449 individuals with varying degrees and experiences in utilizing online education platforms for learning about sustainable development. Employing structural equation modeling, the analysis revealed that the digital divide adversely impacts both the equity of resource distribution and the fairness of the educational process, thereby deterring the adoption of online education platforms for education equality. Conversely, equitable resource distribution and a fair educational process were found to positively influence platform adoption. Importantly, equity in resource distribution and educational process fairness were identified as critical mediators between the digital divide and the utilization of online education platforms for education equality. These findings underscore the necessity of enhancing equity in resource distribution and the educational process to mitigate the digital divide's negative effects, thereby fostering greater engagement with online education platforms among higher education students for sustainable development.
Environmental conditions, mobility and history of contact as determinants of dengue haemorrhagic fever in Denpasar, 2012
Authors: Subagia Kenyem , Sawitri Anak Agung Sagung , Wirawan Dewa Nyoman
Published: April 2024

Bali Province is endemic for Dengue Hemorrhagic Fever (DHF). Denpasar is reported to have the highest cases with incidence rates of 143.2 per 100.000 persons in 2011. Vaccine has not been available until recently and efforts to control the endemic are only achieved modest result. This case control study was aimed to identify risk factors for high incidence rate of DHF in Denpasar. Total cases were 80 and controls were 160 persons. The variables explored were characteristics of the respondents, indoor and outdoor environtment, respondent mobility, history of contact with the DHF patients and larvae presence in public places with a maximum radius of 100 m from respondent’s residence. The data were collected from documents, interviews and observations. The instruments used were questionnaires and check lists. Data analysis was carried out using univariate, bivariate (chi-square) and multivariate (logistic regression) analysis. Bivariate analysis showed several factors which increase the risk of dengue incidence in Denpasar: age OR=1.88 [95%CI: 1.09-3.23], indoor condition OR=8.27 [95%CI: 2.63-26.07], mobility OR=2.78 [95%CI: 1.57-4.92] and contact history OR=2.85 [95%CI: 1.62-5.03]. After multivariate analysis, the variables that contributed to increase the risk of DHF incidence in Denpasar were age OR=1.09 [95%CI: 1.06-1.11], indoor environment condition OR=10.74 [95%CI: 2.94-39.32], respondent mobility OR=3.12 [95%CI: 1.55-6.28] and history of contact OR=2.4 [95%CI: 1.21-4.79]. Health promotion need to be improved to prevent DHF by increasing indoor environmental quality including intervention to refregerator drainage and residual water tapping at dispenser
Group breathing-based exercise to improve cardiopulmonory fitness of aged care patients in Werdha Wana Seraya Denpasar
Authors: Parwati Ni Made , Karmaya I Nyoman Mangku , Sutjana Dewa Putu
Published: April 2024

The aging process greatly impacts upon individual’s physical, mental, psychosocial and spiritual health. Those aged 30 years and over experience an annual 1% decline in cardiopulmonary fitness every year. Based on this, it is estimated that oxygen consumption capacity by cardiopulmonary fitness of someone aged 60 years will eventually decline to 35%. This study assessed the positive impact of breathing-based exercise on cardiopulmonary fitness of the aged patients of Werdha Wana Seraya in Denpasar. The aims of this study were to identify and to analyze differences of mean cardiopulmonary fitness among aged care patients before and after carrying out breathing-based exercise. Study design used one group pretest and posttest based on sample of 15 individuals using a purposive sampling. The cardiopulmonary fitness is measured using the Rockport method. The independent variable was breathing-based exercise and cardiopulmonary fitness was the dependent variable. Breathing-based exercise was held three times a week over a period of eight weeks during which time data on the impact on cardiopulmonary fitness were collected. Data were analysed using a paired sample t test. The study found that breathing-based exercise can improve cardiopulmonary fitness from 21 ml/kg/min up to 21.87 ml/kg/min [p=0.0001]. To conclude, conducting breathing-based exercise with aged cared patients can have a positive impact on their cardiopulmonary fitness and such activities should be supported.
Correlation between perceptions with the occurence of dental decay among cruise employee candidates who visited dental clinics in Denpasar year 2012
Authors: Pratiwi Putu Eka , Sawitri Anak Agung Sagung , Adiputra I Nyoman
Published: April 2024

Based on Basic Health Research (Riskesdas) in 2007, the prevalence of dental decay in Bali Province was 22.5%. The proportion of dental decay among the cruise employee candidates who visited a dental clinic was 96.2%. The behavior to prevent decay influences the occurrence of decay, in which perception affects the behavior. This case control study aims to examine the correlations between perception of susceptibility, seriousness, barriers, benefits, trigger factors and knowledge on dental decay with the occurence of dental decay at the cruise employee candidates.  The study conducted between June-October 2012. The case in this study was the cruise employee candidates who were diagnosed of having dental decay and the control was them who are not. Risk factors explored include perception of susceptibility, seriousness, barriers, benefits and trigger factors that correlated with dental decay using structured questionaire. Education and age are the control variables. Data were analysed using univariate, bivariate and multivariate. The crude OR indicates that perception of seriousness [OR=4.38; 95%CI: 2.13-8.99], benefits [OR=3.08; 95%CI: 1.51-6.28] and knowledge [OR=4.85; 95%CI: 2.32-10.11] can increase risk of dental decay. The adjusted OR shows that perception of seriousness [OR=10.5; 95%CI: 3.73-29.97], benefits [OR=3.3; 95%CI: 1.41-8.19], barriers [OR=3.3; 95%CI: 1.2-9.35] and knowledge [OR=6.4; 95%CI: 2.59-16.19] increased risk of dental decay. Efforts to improve perception of seriousness, benefit, barrier and knowledge on dental decay for cruise employee candidates need to be conducted in a sustainable manner.
Long-term trends in Neisseria gonorrhoeae and Chlamydia trachomatis prevalence among brothel-based female sex workers in Denpasar, Bali, Indonesia
Authors: Wirawan Dewa Nyoman , Rowe Emily , Silfanus Fonny , Pidari Putri , Satriani Gusti Ayu , Suyetna Dewa
Published: April 2024

The objective of this study is to analyze the long-term trends of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections and risk factors among female sex workers (FSW) in Denpasar, Bali, Indonesia. In order to understand the long-term trends, secondary data was examined from the years 1997-1999, 2004, 2007, 2009 and 2010; to analyze associated factors, data from 2010 was used.  Analysis indicates an overall decrease of NG prevalence in Bali from 60.5% (95%CI: 56.6-64.5) in 1997 to 22% (95%CI: 16.8-27.1) in 2010. CT prevalence has also experienced a long term decline but not to the same degree as NG. Findings from analysis of surveys in 2004 and 2010 indicate that there is a strong relationship between condom use in the last sexual transaction with NG infection (p=0.02), duration of sex work (p=0.02), number of clients in the last week (p=0.01), clinic visit intervals and clinic visit frequency. CT prevalence was associated with the number of clients (p=0.04) and clinic visit frequency. Unfortunately, these were the only variables collected therefore a multivariate analysis was not possible. High prevalence of both NG and CT is associated with the high mobility of FSW and low condom use. There is a significant long-term decrease of NG prevalence from 60.5% to 22%. However, CT experienced an insignificant long term decrease from 41.3% to 35%.
The 2011 health analysis in Mataram City: application of the Bryant Method
Authors: Khulaila Aini , Utama Made , Sawitri Anak Agung Sagung
Published: April 2024

The budget for health program of Mataram City is only allocated IDR 39,868,095,387 or 3.9% of the total annual city budget. It is lower than minimum 5% proportion as required by the government regulation. This study involved assessing the priority areas in health according to implicated stakeholders from the health office (head of communicable diseases control, family health, living environments, immunisations and surveillance staff). Data was collected through the months of January-July 2012 through self administered questionnaire using the Bryant Method. Secondary data (census, economic, socio-cultural and health records as well as population income levels) was obtained through government records. Data was analysed and interpreted in order to gain insight into perceived priority areas. Cross checking of respondent input was conducted to validate data. Results indicated that the priority health issues are: dengue fever, HIV/AIDS, TB, respiratory infections, hypertension, diarrhea and traffic accidents. Obstacles experienced during fieldwork included time restraints from respondents and inconsistencies within secondary data. The absence of the key persons in several discussions and unavailability of written data and reports are the main challenges during investigation. Improving the quality of program data findings and taking the beneficiary of the data source are suggested. Future recommendations include further more qualitative research into the issue, increased collaboration and cooperation between implicated stakeholders as well as more conscientious keeping of public records.
Analysis of factors associated with the presence of Aedes aegypti larvae in working area of Community Health Centre III, South Denpasar
Authors: Ekaputra Ida Bagus , Ani Luh Seri , Suastika Ketut
Published: April 2024

The Public Health Center (PHC) III of South Denpasar is one of the endemic areas of Dengue Hemorrhagic Fever (DHF) in Denpasar, Bali Province. Dengue morbidity rate was high (>55 per 100,000 population), while the Percentage of Larvae Free Rate (PLFR) was low (<95%). This study aims at discovering the relationship between community's knowledge, attitude, behavior of Aedes aegypti (Ae. aegypti) larvae eradication and environmental health with the existence of Ae. aegypti larvae in the working area of PHC III of South Denpasar. A cross-sectional study was conducted with 147 households using systematic random sampling from a total of 5781 households. The respondents were the head of the family unit. The independent variables were knowledge, attitude, behavior and environmental health, while the dependent variable was the presence of Ae. aegypti mosquito larvae. The data were collected by using interview and observation in the respondent's house using instruments of questionnaire. The data were then analysed in stages covering the univariate, bivariate and multivariate analysis. Results indicated the PLFR was 87.1%. The variables related to the existence of larva were behavior (PR=17.89; 95%CI: 4.99-64.11) and environmental health (PR=7,08; 95%CI: 2.48-20.23). Multivariate analysis revealed that dominant variable was the behavior (PR=11,60, 95%CI: 2,98-45,13). Meanwhile, knowledge and attitude were not statistically associated with the existence of larvae. It can be concluded that the behavioral changes efforts that support of Ae. aegypti larvae eradication is still needed. It was recommended that the PHC needs to upscale health promotion efforts addressing the severity of DHF and prevention methods, cross-sector coordination, and involvement from healthcare providers as well as specially employed field workers in developing societies to eradicate mosquito breeding in order to increase the community's behavior of mosquito-larva eradication in order to increase the PLFR and to reduce the incidence rate of DHF.
Relationship between Education, Knowledge, Attitude, Behavior and Family Support with Antenatal Care (ANC) Visit Frequency among Expectant Mothers in the Ermera District Timor Leste, 2013
Authors: Carvalho Honoria D.F.P. , Suryadhi Nyoman Tigeh , Wulandari Luh Putu Lila
Published: April 2024

Background and purpose: Regional government recommendations require that 80% of all pregnant mothers visit an antenatal care clinic, however, Ermera District has yet to fulfil this target (34.5%). Low levels of access to antenatal care clinic services impacts negatively on maternal and infant mortality. This study aims to determine the relationship between education, knowledge, attitudes, behaviors and family support with ANC clinic access among pregnat mothers in Ermera District, Timor Leste.

Methods: A cross-sectional design was adopted with a sample of 87 pregnant mothers, drawn by the method of multistage cluster random sampling of 9.886 population. The dependent variable was the ANC clinic, while maternal education, knowledge, attitude, behavior and family support were independent variables. Data were collected through self-administered questionnaires, however for the illiterate, researcher assisted completion of the instrument. Data analysis was conducted in stages included univariate, bivariate (chi-squared test) and multivariate (logistic regression) analysis.

Results: The results of bivariate analysis indicated there was significant association between knowledge (p=0.002), attitude (p=0.012), behavior (p=0.030), and family support (p=0.015) with the ANC in pregnant women. Multivariate analysis indicated that there was an association between maternal knowledge and ANC visit frequency. Analysis showed that maternal knowledge was the only variable associated with the ANC visits (p=0.046).

Conclusion: Only maternal knowledge is associated with the ANC visit among pregnant mothers in Ermera District, Timor Leste
The Utilization of Reproductive Health Services for Adolescents in Tegallalang I Health Centre
Authors: Witari Deni , Suariyani Ni Luh Putu , Karmaya I Nyoman Mangku
Published: April 2024

Background and purpose: Adolescence is one of the most crucial periods of a human’s life cycle, and therefore, there is an unquestionable need for services that directly address adolescent reproductive health issues. The number of adolescents who utilized reproductive health services at Tegallalang I Health Centre is only 119 out of 708 targeted adolescents. This study investigate the correlation between knowledge, attitude, adolescent needs, access, family acceptability, and the utilization of reproductive health services in Tegallalang I Health Centre.

Methods: The design was a cross sectional analytic. From the population of 4725 adolescents in the Tegallalang I Health Centre work area, 84 were selected through systematic random sampling. The independent variables were knowledge, attitude, adolescent needs, access and family acceptability while the dependent variable was the utilization of adolescent reproductive health service. Data was collected through structured interviews and analysed using univariate, bivariate (chi-squared test), and multivariate (logistic regression) analysis.

Results: The results of this study showed that most respondents have high level of knowledge (54.8%), negative attitudes (69.0%)), perceived need (59.5%), ease of access (52.4%), negative family acceptability (60.7%)), and (62.0%) do not take advantage of services. Based on the bivariate analysis it is evident that there is a relationship between knowledge (p=0.043), attitude (p=0.047), access (p=0.08), family acceptability (p=0.042) and the utilization of reproduction health service. Based on multivariate analysis, it is evident that access has a positive influence on the utilization of reproductive health service with OR=3.481 (95%CI: 1,21-10,24).

Conclusion: Access has a positive influence on the utilisation of reproductive health service in Tegalalang I Health Centre.
Barriers to Encourage Motivation in Relation to Work Performance of Nurses in Buleleng District Hospital
Authors: Budiastri  , Indrayathi Ayu , Wijaya I Putu Ganda
Published: April 2024

Background and purpose: Nurses at hospitals regularly receives criticism from the general public, negatively commenting on their lack of patient care, lack of professionalism and diminished quality of service. Survey findings on patient satisifaction at Buleleng Public Hospital from 2011 indicate that 2.03% of patients remained unsatisfied with staff workplace attitudes and 6.39% felt that nursing service overall was unsatisifactory. Preliminary interviews with ward nurses on 24 November 2012 exposed a number of issues: a lack of career support and development for nurses, including opportunities to expand their skills, and a lack of workplace satisifaction from patient supplementary income. Weakness regarding technical support and motivation from ward supervisors evidently also has an impact on nurses workplace motivation and therefore quality of service. This research investigates the influence of supervision, career development, supplementary income support, and administrational records on the workplace attitude of nursing staff.

Methods: Research was formulated using qualitative and phenomenology methods. Informants were purposively selected. Data was collected through in-depth interviews and administration documentation study and analysed using thematic analysis.

Results and conclusion: Findings indicated that little monitoring and evaluation of nurse workplace attitudes, a lack of support and motivational direction from supervisors, administrational documentation issues, minimun supplementary income support, as well as career development had a large impact on nurse quality of care. Most dominant variables included supervision, career development and supplementary income support.
Prostitution Legislation Reforms in Western Australia: What Indonesia Can Learn
Authors: Sari Komang Ayu Kartika
Published: April 2024

The proposed approach in prostitution in WA needs to be redirected to decriminalisation system with the implementation of harm reduction to achieve the effective public health efforts. Intensive health promotion efforts, including accurate information for HIV positive sex workers and health policies to reduce stigma and discrimination for all sex workers are needed to provide supportive environment for sex workers, which will enable their health and safety issues to be addressed. These approaches should be applied in the Indonesian context as well, where sex workers are still illegal and mostly criminalised. Decriminalisation system is needed even when there is no idea of legalising prostitution yet in Indonesia. In addition, as brothel-based sex workers are more organised and easier to reach, they have higher potential to participate in the health promotion efforts. The established brothels in Indonesia therefore should be well managed in terms of health and safety in the premises, without any human rights violation and criminalisation.
Workload Analysis of Doctors at Puskesmas Using Workload Indicators of Staffing Need in Denpasar
Authors: Dharmayuda Anak Agung Ngurah Gede , Wulandari Luh Putu Lila , Wirawan Dewa Nyoman
Published: April 2024

Background and purpose: Ratio of health staff instead of workload have been used to determine quota of staff at primary health centers. There is no study assessing workload of functional medical doctors (general practitioners) at primary health centers in Bali. The objectives of this study were to describe functional medical doctors workload, the number and distribution which is needed in primary health centers in Denpasar.
Methods: Descriptive cross-sectional study was conducted among functional medical doctors at 11 primary health centers across Denpasar. Data were collected by interview and participatory observation to the study participants. Data was analyzed using WISN English Version 1.1.132.0 software.
Results: Among 34 study participants, majority were female (73.5%), aged 35-44 years (61.8%), working as a government employee (97.1%), with tenure of 6-10 years (55.9%) and almost all of them (95.6%) had additional duties besides providing medical care to patients. Results indicated that workload of functional medical doctors at primary health centers was high with WISN ratio 0.5-0.9 compared to the ideal ratio=1. Based on workload analysis, shortages of functional medical doctors was found in all primary health centers in Denpasar.
Conclusion: When using the ratio of functional medical doctors per population, the number was sufficient. However, when using workload analysis indicated shortage.
Risk Factors of Attention Deficit Hyperactivity Disorder (ADHD) among Children in Denpasar
Authors: Adiputra I Made Sudarma , Sutarga I Made , Pinatih Gede Ngurah Indraguna
Published: April 2024

Background and purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder that often occurs in children characterized by low concentration and hyperactivity. Comprehensive efforts required to prevent and to understand risk factor of ADHD. Aim of this study was to understand risk factors that may increase the occurrence of ADHD among children in Denpasar.
Methods: The study design was a matched case-control. Number of samples was 38 cases and 38 controls, who were matched by age, sex and residence. Cases was obtained from the Service Center of Psychology and Children with Special Needs Pradnyagama Denpasar. Controls were selected from the residence close to cases. Data analysis was performed with the McNemar test and conditional (fixed-effects) logistic regression.
Results: The study found that there were two factors significantly increase risk of ADHD namely low birth weight (adjusted OR=220.9; 95%CI: 6.9-6991,3) and genetic (adjusted OR=45.5; 95% CI: 3.3-620.9).
Conclusions: Low birth weight and genetic were found as risk factorsof ADHD.
Barriers to Integrating Antiretroviral Therapy Services Into Community Health Centre: A Qualitative Study in Badung Regency
Authors: Sugiana Made , Sutarsa I Nyoman , Duarsa Dyah Pradnyaparamita
Published: April 2024

Background and purpose: Increasing of HIV+ cases resulted in the increasing demand for antiretroviral (ARV) and access to ART services. This study aims to explore barriers of integrating ART services into primary health centres in Badung District.
Methods: Explorative interviews were conducted with CST officers at Badung District Hospital, puskesmas (health centres), NGOs, policy makers, community leaders and PLWHA. Data were collected by conducting indepth interviews, focus group discussion and observation. Data were thematically analysed.
Results: The study found that there were variations in internal barriers across different puskesmas in Badung District to be a satellite site. The main internal barriers perceived by health officers particularly in relation to issues around the availability of human resources, lack of competencies and increase of workload. Internal capacity of puskesmas which also perceived as barriers including the availability of laboratory facilities, absent of operational procedures, limited information system and source of funds that predominantly still from donor agencies. External barriers perceived by respondent were stigma and discrimination.
Conclusions: Barriers to integrate ART services into puskesmas consist of structural barriers from internal puskesmas as well as external barriers such as stigma and discrimination towards PLWHA.
Risk Factors of Poor Glycaemic Control among Patients with Type 2 Diabetes Mellitus at the Primary Health Center of Kembiritan Banyuwangi Regency
Authors: Purwitaningtyas Rizki Yulia , Putra I Wayan Gede Artawan Eka , Wirawan Dewa Nyoman
Published: April 2024

Background and purpose: Number of patients with type 2 diabetes mellitus in Kembiritan Primary Health Center has increased as many as 160 in 2013 to 215 in 2014. This study was conducted to determine risk factors of poor glycaemic control among patients with type 2 diabetes mellitus in the Primary Health Center of Kembiritan Banyuwangi.
Methods: The research design was a case control study of 55 patients with poor glycaemic control of diabetes mellitus as cases and 55 patients with good glycaemic control of diabetes mellitus as controls (1:1), who were randomly selected from the registers of patients with diabetes mellitus at the primary health center during 2014. Data was collected through interviews at the primary health center during March-May 2015 using questionnaires. Data was analyzed by univariate, bivariate (chi square test) and multivariate using logistic regression.
Results: Bivariate analysis showed that duration of disease and nutritional status significantly increase risks of poor glycaemic control respectively with OR=2.9 (95%CI: 1.20-7.54) and OR=5.7 (95%CI: 1.82-21.04). Multivariate analysis showed four factors that increase the risk of poor glycaemic control, namely duration of disease with adjusted OR=3.8 (95% CI: 1.37 to 10.59), medication adherence, with adjusted OR=3.7 (95% CI : 1.30 to 10.59), nutritional status, with adjusted OR=6.6 (95%CI: 2.01-21.44) and distance of health facilities, with adjusted OR=3.1 (95%CI: 1.19-7.95).
Conclusion: Risk factors for poor glycaemic control among patients with type 2 diabetes mellitus were disease duration, adherence of medication, nutritional status and distance to health facilities.
Analysis of Inpatients Food Leftover at Sanglah Hospital Bali Province
Authors: Wirasamadi Ni Luh Partiwi , Adhi Kadek Tresna , Weta I Wayan
Published: April 2024

Background and purpose: Foods leftover is still very common in many hospitals in Indonesia. Minimum standard of hospitals require that foods leftover of patient is not more than 20%. The aim of this study was to determine the number and cost wasted due to the foods leftover of patient.
Methods: The study was cross-sectional involving 68 inpatient subjects in the 1st, 2nd and 3rd ward class and hospitalized up to 10 days and had regular food with a 10-day menu cycle. Data of foods leftover were obtained by three methods: observation, medical records and interview. Foods leftover were measured by Visual Comstock method with the scale of 6 points. Age, sex, length of stay, ward classes, and types of patients’ diseases were obtained from medical records. Patient’s perception of food appearance and taste were gained through interviews. Data were analyzed by independent sample t-test and one-way ANOVA.
Results: Average number of patients’ food leftover amounted to 14.79%. Patients who left foods were mostly women, aged 50-64 years, hospitalized in the class 2nd and 3rd with a length of stay ≤5 days. Those who had good perception on appearance and taste of the food tended to leave less food leftovers. The average cost of meal wasted a day was Rp 2,939 per patient. There were significant different leftover foods according to gender, age group, length of stay, ward classes, and the patient’s perception (p<0,05), whereas there were no significant different leftover foods according to the type of diseases and the menu cycles (p>0,05).
Conclusion: Average number of patients’ food leftover at Sanglah Hospital Denpasar has satisfied hospital minimum standard (less than 20%) with an average daily cost of meal wasted was Rp 2,939 per patient.
Hygiene, Sanitation and Potential Existence of Virulent Genes of E.coli in Lawar in Kuta: The Challenge for Tourism and Safe Food Provision in Bali
Authors: Trisdayanti Ni Putu Eka , Sawitri Anak Agung Sagung , Sujaya I Nengah
Published: April 2024

Background and purpose: The reoccurrence of food-borne parasitic outbreaks may be related to contamination by pathogenic strains of E.coli. As lawar (Balinese food) is a favorite of locals and tourists, there needs to be an examination into the presence of pathogenic strains of E.coli in lawar and its relation to hygiene and sanitation standards at food stalls in Kuta.
Methods: Cross-sectional analytical study was conducted on 43 stalls that selling white lawar in North Kuta, Kuta and South Kuta. Observations and interviews to sellers were conducted to assess the personal hygiene practices, equipment/stall sanitation and sanitary facilities. Lawar samples were tested in the laboratory. Indicators of the food quality was the number of bacterial colonies with Total Plate Count (TPC), the presence of E.coli with fertilization techniques and the detection of E.coli virulence genes by PCR. Data were analyzed using univariate, bivariate and multivariate analysis.
Results: As many as 44.2% of lawar contained bacterial colony >106 CFU/g; 46.5% of lawar positively contained E.coli, and 20% of those positive E.coli had the similar size band of Shiga Like Toxin Type I (SLT-I). The sellers with poor hygiene had higher risks of the presence of E.coli in the lawar compared with those having higher hygiene standards (adjusted OR=7.29; 95% CI 1.473-36.088).
Conclusion: Lawar quality in Kuta was poor, as were hygiene practices and seller/stall sanitation.
Factors Associated with the Behavior of Food Handlers in the Application of Good Manufacturing Practice (GMP) in the Household Food Industry (HFI) in Karangasem Regency
Authors: Handayani Ni Made Astini , Adhi Kadek Tresna , Duarsa Dyah Pradnyaparamita
Published: April 2024

Backgrounds and purpose: Indonesia is considered of the countries in Southeast Asia with low food quality. The poor behaviors of food handlers in applying good manufacturing practice may bring about a decline in food quality which can lead to the risk of health conditions such as diarrhea, worm infection or food poisoning. This study aims to determine the factors associated with the behaviors of food handlers in the application of good manufacturing practice at the household food industry level.
Methods: Cross-sectional survey was conducted among 79 food handlers, working at the household food industry in Karangasem. Data were collected through interviews and observations and analyzed using poisson regression to understand the association of knowledge, attitudes and managerial support with behavior of food handlers.
Results: The knowledge and attitude of food handlers were relatively poor at respectively 48.10% and 53.16%. The behavior of food handlers classified as good was 49.37%. Behavior of food handlers was significantly associated with knowledge (PR=1.48; 95%CI: 1.01-2.15), attitude (PR=2.13; 95%CI: 1.47-3.08) and managerial support (PR=3.01; 95%CI: 1.77-5.13).
Conclusion: The behavior of food handlers in the application of good manufacturing practice at the household food industry remains low and was associated with knowledge, attitude and level of managerial support.
The Partnership between Traditional Birth Attendance (TBA) and Midwives in Childbirth Assistance: A Qualitative Study in East Manggarai Regency
Authors: Nanur Fransiska Nova , Widarini Ni Putu , Karmaya I Nyoman Mangku
Published: April 2024

Background and purpose: Partnership between traditional birth attendance (TBA) and midwives is one of the strategies to increase the coverage of childbirth assistance by the health personnel. This partnership seems to be ineffective as there were still TBA performed childbirth assistance. The study aims to find out about the overview and obstacles in the implementation of the partnership between TBA and midwives in the East Manggarai Regency.
Methods: The qualitative research with in-depth interviews using open interview guide was conducted among 15 participants who were selected purposively, consisted of two village midwives, five TBAs who partnered with midwives, three TBAs who are not partnered with a midwife, and two participants of community leaders, the religious leaders, the two puerperal women and one policy maker. Data were analyzed by using thematic analysis approach.
Results: The results showed that the facilities and supporting infrastructure of partnership were inadequate, funds provided were not enough to finance the implementation of the partnership, there were no regular meetings between the midwives and the traditional healers, coordination was done merely incidental. The division of roles in the treatment of childbirth was clear, but many obstacles were found, namely transportation barriers, economic problems and there were traditional healers who did not want to partner.
Conclusion: The overview of partnership between the traditional healers and midwives in childbirth assistance has not gone well and there were still many obstacles found both internally and externally. To optimize this program, sufficient funds should be allocated, transportation should be improved and counseling should be provided to the community to raise awareness of the importance of childbirth assistance by the health personnel.
Masalah Demam Berdarah Dengue (DBD) dan Ketersediaan Vaksin
Authors: Wirawan Dewa Nyoman
Published: April 2024

Untuk menurunkan morbiditas DBD sebanyak 25% dan mortalitas sebanyak 50%, WHO merekomendasikan perlunya kombinasi berbagai upaya terutama penanggulangan vektor dan program vaksinasi.1,2 Program vaksinasi direkomendasikan pada daerah-daerah endemis terutama daerah dengan persentase penduduk yang sero-positif dengue di atas 50%.2 Mengingat tingginya kasus DBD di Indonesia, untuk mengetahui efektivitas vaksin di masyarakat diperlukan uji coba pada daerah-daerah dengan tingkat endemisitas yang tinggi dan sekalian untuk mengetahui besaran biaya yang diperlukan untuk mencegah kasus DBD dalam kawasan yang lebih luas atau secara nasional.
The Consumption of Tuak Increases Risk of Central Obesity among Adult Males at Karangasem, Bali
Authors: Sudiana I Ketut , Putra I Wayan Gede Artawan Eka , Januraga Pande Putu
Published: April 2024

Background and purpose: Traditional alcohol beverage known as risk factor of central obesity. The prevalence of central obesity in adult males in Karangasem is high and 40% of the population have drink habits of traditional palm wine (locally called tuak) with high sucrose and glucose. This study aims to determine the relationship between the consumption of tuak with the prevalence of central obesity among adult males.
Methods: The study is cross-sectional with samples consisted of 220 men aged 18-65 years selected by probability proportional to size. The data were collected by the researcher using structured interview and direct measurement. Data were analyzed using STATA 12.1 by univariate, bivariate (chi-square test) and multivariate using logistic regression.
Results: The study found that the prevalence of central obesity among adult males in Karangasem was 8.18% and respondents who consumed tuak was 53.18%, consumed alkohol of non tuak was 4.09% and 42.73% did not consume any alcohol. Multivariate analysis showed that variables associated with the prevalence of central obesity were heavy drinker of tuak (AOR=6.55; 95%CI: 1.45- 29.65), the quantity of tuak consumption (AOR=1.14; 95%CI: 1.03- 1.25), duration of tuak consumption (AOR=1.12; 95%CI: 1.04-1.20), consumption of other local wine (called arak) (AOR=3.86; 95%CI: 1.36-10.95. Education was found to reduce risk of obesity (AOR=0.32; 95%CI: 0.11-0.96).
Conclusion: The consumption of tuak increases risk of central obesity among adult males in Karangasem Bali.
Consumption and Distribution of Iodized Salt in Subamia Village Tabanan District 2014
Authors: Dewi Manik Ulan , Adhi Kadek Tresna , Duarsa Dyah Pradnyaparamita
Published: April 2024

Background and purpose: Consumption of iodized salt is essential to prevent iodine deficiency disorders. One of the key success of iodized salt program is the distribution. This study explored the consumption and logistical distribution patterns of iodized salt among housewives in Subamia Village Tabanan District.
Methods: The study was a qualitative with data collection using two focus group discussions (FGD) of 6 active and 6 inactive cadres. Indepth interviews were conducted with two health staffs, two community leaders, one staff of Trade/Industrial Office at Tabanan District and one salt seller. Data was analysed using thematic method.
Results: Respondents preferred uniodized salt because of several reasons including less bitter, tastier and cheaper than iodized salt. Moreover, the distribution of iodized salt regulated by the government was reported to be impeded the salt distribution, this resulted in the difficulty of villagers to access the iodized salt
Conclusion: Appetizing flavor, access and no local regulations on distribution of iodized salt is the cause of low consumption of iodized salt in Subamia Village Tabanan District.
Predictors to Achieve Normal Nutrition Status: Longitudinal Study among HIV Children on Antiretroviral Treatment in Bali
Authors: Haryadi  , Sawitri Anak Agung Sagung , Wati Ketut Dewi Kumara , Putra I Wayan Gede Artawan Eka , Merati Ketut Tuti Parwati
Published: April 2024

Background and purpose: Malnutrition is common in children with HIV/AIDS. Antiretroviral therapy (ART) improves the nutritional status; however, information about predictors affecting the changes of nutritional status is limited and inconsistent.
Methods: The retrospective survival study analyzed secondary data of 84 undernourished children receiving ART in Sanglah Central Hospital in 2010 to 2015. Demographic, clinical and socio-economic characteristics at ART initiation were linked to the achievement of normal nutritional status (z-score ≥ -2 SD). Kaplan Meier analysis was used to obtain the incidence rate and median time and cox proportional hazards models to identify its predictors.
Results: Of the 73.81% of children achieved a normal nutrition status with the incidence of children achieving normal nutritional was 19 per 100 child months, and a median time of 4 months 10 days. Children with birth weight ≥2500 gr (AHR=5.41; 95%CI: 1.76-16.61), without candidiasis (AHR=3.72; 95%CI: 1.27-10.93), Clinical WHO Stage III (AHR=1.6; 95%CI: 1.08-4.24), Clinical WHO Stage II (AHR=4.49; 95%CI: 1.95-10.79) and early ART intiation (AHR=0.91; 95%CI: 0.83-0.98) were predictors to achieve normal nutritional status.
Conclusion: Clinical characteristics of children are predictors of achieving a normal nutritional status.
Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali
Authors: Astiti Cok Istri Sri Dharma , Sawitri Anak Agung Sagung , Merati Ketut Tuti Parwati
Published: April 2024

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.
Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.
Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI: 1.65-7.13) and being widow/widower (AOR=4.85; 95%CI: 1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI: 0.14-0.70).
Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.
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 2024

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 (≥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 ≥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 ≥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.
Where do we go with HIV pre-exposure prophylaxis in Indonesia?
Authors: Sutarsa I Nyoman
Published: April 2024

PrEP is an effective additional prevention strategy at trial settings. Decision to adopt PrEP as a public health intervention must be made based on the need and capacity of current systems. Instead of allocating substantial resources for PrEP, the limited resources could be wisely allocated to scale-up the existing prevention strategies including access to ART, as well as to ensure equality of access of people to full-range of HIV prevention and treatment measures.
Electronic prescribing reduces prescription errors in Sanglah General Hospital Denpasar
Authors: Nurhaeni Ni Luh Putu , Suarjana I Ketut , Wirawan I  Made Ady
Published: April 2024

Background and purpose: Medication error is any preventable event that may lead to inappropriate medication use or patient harm. Prescription error, one component of medication error, at Sanglah General Hospital Denpasar is high. An electronic prescribing has been piloted at Angsoka Ward, Sanglah General Hospital Denpasar to reduce prescription errors. However, the evaluation of such implementation is never been conducted. This study aims to evaluate the effect of electronic prescribing on prescription errors at Sanglah General Hospital Denpasar.

Methods: An evaluation study was conducted by adopting pre and post control design at Sanglah General Hospital Denpasar. Prescription errors at Angsoka Ward where the electronic prescribing is implemented, were compared to Kamboja Ward that uses manual prescribing. Heterogeneity of patients in these two wards was comparable. Prescription samples were selected using a simple random sampling. Prescription samples prior to implementation of electronic prescribing were taken from June and July 2016, while samples after implementation were taken from March and April 2017. Prescription samples from the control group were also taken from the same periods. A total of 96 prescriptions were taken from each arm – leading to 384 prescription samples in total. Prescription error was evaluated using three requirements namely: administrative (9 components), pharmacy (5 components) and clinical (3 components).

Results: Our study found that there was a significant difference of prescription errors between pre and post implementation of electronic prescribing at Angsoka Ward (p<0.05). The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [3] vs. 0 [0] (p<0.001); based on pharmacy requirements were 1 [2] vs. 0 [0] (p<0.001); based on clinical requirements were 1 [2] vs 0 [0] (p<0,001). In contrast, prescription error based on administrative and pharmacy requirements in Kamboja Ward was insignificantly reduced. The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [2] vs. 2 [2] (p=0.505) and based on pharmacy requirements were 1 [2] vs. 1 [1] (p=0.295). There was a significant difference of prescription errors (p<0.05) based on clinical requirements with median values [IQR] of 1 [1] vs. 1 [1]. Implementation of electronic prescribing reduced the proportion of prescription errors by 67.8%. After implementation of electronic prescribing, some errors were still apparent related to drug administration and order duplication.

Conclusions: Implementation of electronic prescribing reduces prescription errors. Scaling-up of electronic prescribing followed by training on standardised prescribing practices are warranted.