HUBUNGAN KARAKTERISTIK DAN PERILAKU IBU DENGAN STATUS PERSALINAN DI WILAYAH PESISIR KECAMATAN TALLO MAKASSAR

WHO tahun 2008 sebanyak 358.000 ibu meninggal selama kehamilan dan persalinan. Penelitian ini bertujuan untuk mengetahui hubungan antara karakteristik dan perilaku ibu dengan status persalinan. Jenis penelitian yang digunakan adalah observasional dengan rancangan cross sectional study. Populasi adalah seluruh ibu bersalin tahun 2013 berjumlah 199 orang di dua kelurahan yakni Buloa dan Tallo. Sampel berjumlah 132 ibu bersalin dan penarikan sampel menggunakan simple random sampling. Analisis data yang dilakukan adalah univariat dan bivariat dengan uji chi square p < 0,05. Hasil penelitian diperoleh variabel yang berhubungan dengan status persalinan adalah umur (p=0,004), tingkat pendidikan (p=0,009), status pekerjaan (p=0,003), pendapatan (p=0,043). Variabel yang tidak berhubungan dengan status persalinan adalah paritas (p=0,072), kelengkapan pemeriksaan antenatal (p=0,629), jarak ke fasilitas kesehatan (p=0,418), dukungan suami/keluarga/kerabat (p=0,146). Kesimpulan dari penelitian ini bahwa ada hubungan antara umur, tingkat pendidikan, status pekerjaan, dan pendapatan dengan status persalinan di wilayah pesisir kecamatan Tallo Makassar. Disarankan agar ibu hamil pada umur berisiko, tingkat pendidikan rendah dan ibu yang bekerja, serta berpendapatan rendah agar lebih memperhatikan masa kehamilan untuk persalinannya sehingga dapat mengurangi risiko pada saat persalinan, juga bagi peneliti lain agar dapat menggali informasi lebih penyebab ibu mengalami persalinan tidak normal

HUBUNGAN QUALITY OF WORK LIFE (QWL) TERHADAP KINERJA DOKTER DI RSUD SYEKH YUSUF KABUPATEN GOWA

Quality or Work Life (QWL) adalah persepsi karyawan terhadap kehidupan kerja yang dapat mempengaruhikinerja individu baik secara langsung maupun tidak langsung. Penelitian ini bertujuan untuk menganalisishubungan QWL beserta dimensinya terhadap kinerja dokter di RSUD Syekh Yusuf Kabupaten Gowa. Penelitiandilaksanakan di RSUD Syekh Yusuf Kabupaten Gowa. Jenis penelitian yang digunakan adalah cross sectionaldengan menggunakan mixed method (metode kualitatif dan kuantitatif). Pengambilan sampel pada penelitian inidilakukan menggunakan metode total sampling terhadap 44 dokter dan dokter gigi yang bertugas. Analisis yangdigunakan adalah Fisher dan regresi logistik. Hasil penelitian menggunanakan analisis bivariat menunjukanbahwa variabel yang memiliki hubungan signifikan dengan kinerja adalah quality of work life (p=0,000),kompensasi yang seimbang (0,001), rasa aman terhadap pekerjaan (p=0,032), keselamatan lingkungan kerja(p=0,027) dan rasa bangga terhadap institusi (p=0,048). Sedangkan variabel keterlibatan dokter, pengembangankarir (p=0,247), fasilitas yang tersedia (p=0,161), penyelesaian masalah (p=0,175), dan komunikasi (p=0,105)tidak memiliki hubungan signifikan terhadap kinerja dokter. Selanjutnya, dari seluruh komponen QWL,kompensasi merupakan variabel yang paling berpengaruh terhadap kinerja dokter (B=3,133 p=0,009). Suasanaideal yang dapat meningkatkan kinerja dokter ialah harus didukung dengan sarana dan prasana yang baik,dijembatani dengan komunikasi yang baik dan kebijakan-kebijakan yang paten serta tersosialisasi dengan baik

Spatial Analysis Risk Factors of Pneumonia Incidence in Toddlers Gowa Regency

Background: Pneumonia is one of the highest causes of death in children under five years old in the world. Globally, the number of under-five deaths due to pneumonia is estimated to reach up to 700,000 cases per year. Objectives: This study aimed to spatially analyze the risk factors for pneumonia incidence among under-fives in Gowa Regency in 2021-2023. Methods: This study used an analytic observational with an ecological study design. The population in this study was all cases of pneumonia among under-fives in Gowa Regency in 2021-2023, totaling 1,634 cases. The sample size in this study was 18 subdistricts with the sample selection technique using the exhaustive sampling method. Results: There was a relationship between population density (r=0.470 p=0.000), poor population (r=0.422 p=0.001) and incomplete immunization status (r=0.457 p=0.000) with the incidence of pneumonia among under-fives in Gowa Regency in 2021-2023. Meanwhile, there was no association between undernutrition status (r=0.250 p=0.068) with the incidence of pneumonia among under-fives in Gowa Regency in 2021-2023. Conclusion: Although undernutrition status did not show a statistically significant association in this study, it remains an important risk factor in the susceptibility of under-fives to pneumonia and other infections. Children with undernutrition status have a weak immune system, making them susceptible to disease complications. Therefore, nutritional interventions such as the provision of supplementary food, increasing exclusive breastfeeding coverage, and nutrition education to parents still need to be developed in a sustainable manner

The Relationship Between The Physical Environment and Quality of Life for Patients With Type 2 Diabetes Mellitus

Background: Diabetes Mellitus (DM) is a chronic disease with a high mortality rate and can affect a person's quality of life. One of the factors determining the quality of life is the physical environment, such as temperature, humidity, lighting, noise, and PM2,5. Objective: To determine the relationship between the physical environment and the quality of life of type 2 DM patients at the Barombong Community Health Center, Makassar City. Materials and Methods: This research uses a study design case-control&nbsp;with purposive&nbsp;sampling. Interviews were conducted with the WHOQol questionnaire and measuring the physical environment in 138 patients with type 2 diabetes then analyzed with the odd ratio test and logistic regression on the Stata application. Results: The results obtained showed a non-significant relationship for the variables humidity, lighting and PM2,5 on the quality of life of type 2 DM patients due to value-p &gt; 0.05 while the variables related to the quality of life of type 2 DM patients are house temperature (OR=4.833; 95% CI: 2.121-11.481) and noise (OR=4.723; 95% CI: 2.075-10.895) with a probability of type 2 DM with unqualified temperature and noise having a poor quality of life of 73.9%. Conclusion: The most significant factor that affects the quality of life of people with type 2 diabetes mellitus is their home temperature

The readiness of public primary health care (PUSKESMAS) for cardiovascular services in Makasar city, Indonesia

Backgrounds: The increasing burden of cardiovascular disease (CVD) has become a major challenge globally, including in Indonesia. Understanding the readiness of primary health care facilities is necessary to confront the challenge of providing access to quality CVD health care services. Our study aimed to provide information regarding readiness to deliver CVD health services in public primary health care namely Puskesmas. Methods: The study questionnaire was adapted from the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA), modified based on the package of essentials for non-communicable disease (PEN) and the Indonesian Ministry of health regulation. Data were collected from all Puskesmas facilities (N = 47) located in Makassar city. We analysed relevant data following the WHO-SARA manual to assess the readiness of Puskesmas to deliver CVD services. Human resources, diagnostic capacity, supporting equipment, essential medication, infrastructure and guidelines, and ambulatory services domain were assessed based on the availability of each tracer item in a particular domain. The mean domain score was calculated based on the availability of tracer items within each domain. Furthermore, the means of all domains’ scores are expressed as an overall readiness index. Higher scores indicate greater readiness of Puskesmas to deliver CVD-related health care. Results: Puskesmas delivers health promotion, disease prevention, and prompt diagnosis for cardiovascular-related diseases, including hypertension, diabetes, coronary heart disease (CHD), and stroke. Meanwhile, basic treatments were observed in the majority of the Puskesmas. Long-term care for hypertension and diabetes patients and rehabilitation for CHD and stroke were only observed in a few Puskesmas. The readiness score of Puskesmas to deliver CVD health care ranged from 60 to 86 for. Furthermore, there were 11 Puskesmas (23.4%) with a score below 75, indicating a sub-optimal readiness for delivering CVD health services. A shortage of essential medicines and a low capacity for diagnostic testing were the most noticeable shortcomings leading to suboptimal readiness for high-quality CVD health services. Conclusion: Close cooperation with the government and other related stakeholders is required to tackle the identified shortcomings, especially the continuous monitoring of adequate supplies of medicines and diagnostic tools to achieve better CVD care for patients in Indonesia

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Modifiable risk factors in adults with and without prior cardiovascular disease: findings from the Indonesian National Basic Health Research

Backgrounds: The majority of risk factors for cardiovascular diseases (CVDs) are modifiable. Continuous monitoring and control of these factors could significantly reduce the risk of CVDs-related morbidity and mortality. This study estimated the prevalence of modifiable risk factors in Indonesia and its co-occurence of multiple risk factors stratified by prior CVDs diagnosis status and sex. Methods: Adult participants (> 15 years, N = 36,329, 57% women) with median age of 40 years were selected from a nationwide Indonesian cross-sectional study called Basic Health Research or Riset Kesehatan Dasar (Riskesdas) conducted in 2018. Thirteen risk factors were identified from the study, including smoking, a high-risk diet, inadequate fruit and vegetable consumption, a low physical activity level, the presence of mental-emotional disorders, obesity, a high waist circumference (WC), a high waist-to-height ratio (WtHR), hypertension, diabetes, a high total cholesterol level, a high low-density lipoprotein (LDL) cholesterol level, and a low high-density lipoprotein (HDL) cholesterol level. Age-adjusted prevalence ratios stratified by CVDs status and sex were calculated using Poisson regression with the robust covariance estimator. Results: CVDs were found in 3% of the study population. Risk factor prevalence in the overall population ranged from 5.7 to 96.5% for diabetes and inadequate fruit and vegetable consumption respectively. Smoking, a high-risk food diet, and a low HDL cholesterol level were more prevalent in men, whereas a low physical activity level, the presence of mental-emotional disorders, obesity, a high WC, a high WtHR, hypertension, diabetes, a high total cholesterol level, and a high LDL cholesterol level were more prevalent in women. Approximately 22% of men and 18% of women had at least 4 risk factors, and these proportions were higher in participants with prior CVDs diagnosis. Conclusions: There is a high prevalence of modifiable risk factors in the Indonesian adult population. Sex, age, and the presence of CVD are major determinants of the variations in risk factors. The presence of multiple risk factors, which are often inter-related, requires a comprehensive approach through health promotion, lifestyle modification and patient education

Mental Health Problems Among Indonesian Adolescents: Findings of a Cross-Sectional Study Utilising Validated Scales and Innovative Sampling Methods

Purpose This study aimed to estimate the prevalence of mental health problems and identify potential risk and protective exposures for adolescents in Indonesia. Methods An innovative sampling approach was applied to simultaneously recruit school- and community-based adolescents aged 16–18 years old from Jakarta (urban megacity) and South Sulawesi (remote province). We used multistage cluster sampling for in-school (N = 1,337) and respondent driven sampling for out-of-school (N = 824) adolescents. Mental health was measured using two validated scales: Kessler-10 and Center for Epidemiologic Studies Depression Scale-Revised . Psychiatric interviews were conducted in a subsample (N = 196) of students from Jakarta to validate the self-report scales. Results The estimated population prevalence of psychological distress and depression were 24.3% (95% CI = 21.5–27.2) and 12.6% (10.5–14.4) for in-school and 23.7% (20.7–26.7) and 23.5% (20.4–26.5) for out-of-school adolescents, respectively. In participants who completed a psychiatric interview, common psychiatric morbidities were social anxiety, depression, and suicidality. Compared to in-school females, male in-school adolescents reported a lower prevalence of psychological distress (16.9% (13.1–20.7) vs. 30.4% (26.4–34.4)) and depression (10.1% (7.2–13.1) vs. 14.6 (11.4–17.8)). By contrast, for out-of-school adolescents, males reported a higher prevalence of psychological distress (25.2% (21.6–28.9) vs. 20.2% (15.1–25.3)) and depression (26.3% (22.5–30.1) vs. 16.9% (11.8–21.9)). In-school adolescents who did not seek healthcare despite a perceived need were more likely to report psychological distress and depression. Discussion Adolescent mental health problems are highly prevalent in Indonesia, with substantial variation by gender, geography, and school enrolment. This study and its approach to sampling and measurement may serve as a model to improving mental health surveillance across other settings

Foregone health care in adolescents from school and community settings in Indonesia: a cross-sectional study

Background Adolescence is a development period marked by the onset of a new set of health needs. The present study sought to quantify the prevalence of foregone care (not seeking medical care when needed) and identify which adolescents are at greater risk of having unmet healthcare needs. Methods A multi-stage random sampling strategy was used to recruit school participants (grade 10–12) in two provinces in Indonesia. Respondent driven sampling was used to recruit out-of-school adolescents in the community. All participants completed a self-reported questionnaire which measured healthcare seeking behaviours, psychosocial wellbeing, use of healthcare services, and perceived barriers to accessing healthcare. Multivariable regression analysis was performed to examine factors associated with foregone care. Findings A total of 2161 adolescents participated in the present study and nearly one in four adolescents reported foregone care in the past year. Experiences of poly-victimisation and seeking care for mental health needs increased the risk of foregone care. In-school adolescents who reported psychological distress [adjusted risk ratio (aRR) = 1.88, 95%CI = 1.48–2.38] or had high body mass index (aRR = 1.25, 95%CI = 1.00–1.57) were at greater risk of foregone care. The leading reason for foregone care was lack of knowledge of available services. In-school adolescents predominantly reported non-access barriers to care (e.g., perception of the health concern or anxiety about accessing care) whereas most out-of-school adolescents reported access barriers (e.g., did not know where to get care or could not pay). Interpretation Foregone care is common among Indonesian adolescents, especially in adolescents with mental and physical health risks. Differences between in-school and out-of-school adolescents suggest that interventions to promote appropriate healthcare use will need tailoring. Further research is needed to determine causal relationships around barriers in access to healthcare

Low Attainment of Treatment Targets for Cardiovascular Risk Factors in Indonesian Adults With Established Coronary Artery Disease

Rationale: Established coronary artery disease (CAD) patients are at increased risk for recurrence of cardiovascular events and mortality due to non-attainment of recommended risk factor control targets. Objective: We aimed to evaluate the attainment of treatment targets for risk factor control among CAD patients as recommended in the Indonesian CVD prevention guidelines. Methods: Patients were consecutively recruited from the Makassar Cardiac Center at Wahidin Sudirohusodo Hospital, Indonesia. Targets for systolic blood pressure (SBP < 140 mmHg), low-density lipoprotein-cholesterol (LDL-C < 1.8 mmol/L), body mass index (BMI: 20–25 kg/m2), non-smoking status and antithrombotic use were assessed according to the national guideline. Attainment levels were evaluated in CAD population subgroups using logistic regression to identify patients who required more intensive monitoring. Results: A total of 395 CAD patients (median age: 57 years (IQR: 49–65), 63.8% men) were recruited between February and June 2021. We observed that 1.8% of the CAD patients met all risk factor treatment targets. LDL-C had the lowest attainment level (5.1%), followed by BMI (59.7%), SBP (62.8%), antithrombotic usage (76.7%) and non-smoking status (94.4%). Apart from lower attainment of SBP control in the 50+ years age group (aOR: 0.57, 95% CI: 0.35–0.94) and women (aOR: 0.53, 95% CI: 0.34–0.83), the attainment levels of other risk factors were consistently low across age, sex, marital status and educational subgroups. Conclusion: These findings emphasize the urgent need for effective management and heightened awareness, particularly for controlling LDL-C in the CAD population. Action to address this issue is crucial for mitigating the CVD burden, particularly in low- and middle-income countries such as Indonesia