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Abstract Background Public health surveillance is crucial in monitoring the progress of maternal, newborn, and children under-five health outcomes (MNCH). Consequently, mapping the existing surveillance system from countries with different income and development levels is needed to learn and compare the effectiveness of surveillance. However, the current COVID-19 pandemic has disrupted the health system, including the healthcare services for pregnant women, neonates, infants, and children under five, as well as the recording, reporting, and surveillance system. The need to adapt to the new normal during the pandemic has stimulated innovation while incorporating new COVID-19-related indicators into the existing public health system. Therefore, this review aims to describe the existing implementation and the COVID-19 pandemic’s influence on the MNCH surveillance system. Methods We will search published literature (from MEDLINE, Embase, and Portal Garuda), manually search from all reference lists of included studies, and conduct a targeted search of relevant gray literature. This review will include studies of surveillance systems or describe COVID-19 surveillance or routine reports involving MNCH (morbidity and mortality). The studies included will be in English or Indonesian language, observational study designs, and published or documented from 2010 to 2023. Two investigators will independently screen the title and abstract, including each full article to determine the eligibility of studies. The data will be assessed using a narrative approach. Data will be reported in simple descriptive tables. Discussion Our findings are expected to map the existing implementation of MNCH surveillance systems before and during the pandemic, including the influence of the COVID-19 pandemic on MNCH surveillance across countries with different income levels. This may contribute to existing knowledge on the MNCH health surveillance system that could be integrated into the surveillance of emerging diseases, such as COVID-19. Systematic review registration The protocol has been registered on the Open Science Framework ( https://osf.io/bc6t4 ).

IntroductionTransitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience.MethodsA pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week.ResultsCompared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P

Many studies show the impact of adolescent mothers on child development. To prevent the impact of adolescent pregnancy, nurturing care is needed to support optimal children's development. This study aims to identify comprehensive nurturing care among adolescent mothers. This study used secondary data in the integration of the 2018 National Socioeconomic Survey and Basic Health Survey. To measure nurturing care, 5 components were used: health, adequate nutrition, security and safety, responsive caregiving, and opportunities for early learning with latent class analysis. The results of the analysis showed that 62% of adolescent mothers provided uncompleted nurturing care. About 21% of adolescent mothers need assistance in improving nurturing care related to adequate nutrition and learning opportunities, and 17% need assistance to improve health, nutrition, responsive caregiving, and opportunities for early learning. Adolescent mothers are in need of comprehensive nurturing care for their children. Practice is needed in order to enhance nurturing care initiatives, particularly for teenage mothers.

Maternal Mortality Rate (MMR) is one of the national health indicators to achieve the success of maternal health efforts where the number of MMR in Indonesia reached 305 per 100,000 live births. Family planning services including Post Partum Family Planning/Keluarga Berencana Pascapersalinan (KBPP) can effectively reduce maternal mortality by reducing births and reducing high risk. The high number of KBPP users in DKI Jakarta can be caused by many things such as local government support, level of service by health workers, and others. Therefore, this study aims to analyze and find out the special causes that cause the number of KBPP participants in DKI Jakarta and as a lesson learned for other local governments. This research is a descriptive study to see the variety of data on the number of KBPP participants in DKI Jakarta. Univariate analysis was used to describe the number of KBPP participants and bivariate analysis to explain the characteristics of the variables studied based on time, namely in the form of a run chart. Based on four tests that have been carried out on the data on the number of KBPP participants in DKI Jakarta, it can be said that there is one test that meets the requirements as a variation of system data so that there is a special cause that causes the number of KBPP participants in 2019-2020. The existence of policy support from the DKI Jakarta Provincial Government, and various stakeholders has resulted in high coverage of the use of postpartum family planning.

Indonesia has its emergency patient management system regulated in Public Safety Center (PSC) 119 as stated in Indonesia’s Health Ministry Regulation No. 19 (2016). An evaluation to assess the ongoing management of this system is a must to ensure its continuous development. This study assessed the ongoing emergency patient management system using instrument indicator questionnaires developed by the authors. The questionnaire consists of 28 indicators from 8 assessment aspects including: policy, planning, program implementation, communication, transportation, referral, management reviews, and emergency services. Questionnaires were distributed and completed questionnaires were received from 88 respondents from 21 provinces of Indonesia. Validity test results counted the coefficient correlation of all indicators above r value table (0.2096) and all Alpha Cronbach’s indicators value above 0,80. The value indicator is considered poor if its average score is below the average score of the overall indicators and is considered good if it is above the average overall indicator score. The assessment result there is twelve indicators from this study shows a below average value (66) . Data acquired in this study can be used as a preliminary reference for continuous improvement of Indonesia’s emergency management system operated by the PSC.

Background: Complete basic immunization for infants in Indonesia is an obligation in an effort to protect infant health. It is one of the important indicators in determining the quality of health services in a certain area. However, the coverage of complete basic immunization in Indonesia in 2017 and 2018 has not been achieved nationally with National Strategic Planning and it has not been achieved the targets of 80% of districts/cities in 2019. Objective: This study aims to analyze the factors correlated to the complete basic immunization coverage of infants in Indonesia in 2017-2019. Methods: Ecological analysis was carried out using secondary data from the report of the Ministry of Health of the Republic of Indonesia in 2017-2019. Univariate analysis was conducted using descriptive statistics and one sample Kolmogorov Smirnov. Bivariate analysis was conducted by correlation test (Pearson and Spearman) and scatter plot. Results: Complete basic immunization for infants had a significant correlation with the adequacy of midwives at the primary health care in 2017 (r = -0.337). There was significant correlation between poverty and complete basic immunization in 2017 and 2018 (r = -0.362 and r = -0.535). In 2019, active Integrated Service Post (Posyandu) was correlated to the complete basic immunization (r = 0.444). The first neonatal visit was correlated to the complete basic immunization of infants for three consecutive years (2017-2019). Conclusion: Efforts that can be made to increase the coverage of complete basic immunization in Indonesia are increasing the distribution of midwives in Indonesia, increasing the coverage of the first neonatal visit by paying attention to Posyandu cadres, especially in provinces with high poverty rates.

Introduction. Unsteady gait, instability, and lower extremity muscle weakness are some of the risk factors for falls. Reduced balance is a further precursor of falls, and injuries adversely affect the instability. In doing an activity without losing their balance, confidence among older adults is also crucial because it will influence their mobility. Objectives. The objective of this study is to examine the association between activity balance confidence and functional mobility, including gait, balance, and strength, among older adults. Methods. A cross-sectional study was conducted among older adults living in long-term care facilities and community dwellings. A total of 326 older adults (>60 years old) participated in this study from three provinces in Java Island, Indonesia. The inclusion criteria were older adults living independently and without obstacles in communication, who have no hearing loss, and who agreed to be respondents. The activity-specific balance confidence (ABC) scale determines the level of confidence. The participants were asked about their balance confidence not to lose their balance while doing 16 activities. The dependent variable is the mobility test, including a gait test using TUG (times up and go) to see how the subjects stand, walk, and turn around; a balance test (four stages); and a strength test (30-second chair stand). Results. The results of the ABC scale showed the respondents felt the most confidence not to lose their balance when they walk around the house (82.01%) and the less confidence when they stepped onto or off an escalator while holding onto a railing (37.7%). The gait, balance, and strength test revealed that 51.2% of the respondents showed an unsteady gait, 63.8% showed instability that felt awkward and unusual when standing on one leg, and 60.1% of the participants showed muscle weakness. The bivariate analysis significantly correlated the ABC scale test and all mobility tests. The older adult participants who are not confident will have 12.03 times higher the unstable result of the gait test, 8.4 times higher the unstable result of the balance test, and 7.47 times higher the less strength result of the strength test who are confident. Conclusion. Older adults who lack balance confidence showed significantly poorer results in mobility tests.

Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. Methods: Tis cross-sectional study was conducted July–August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. Tey responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. Results: In the year immediately preceding the study, 29.0% of participants had sufered a fall. Approximately one-third of women (31.1%) and one-ffth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. Te overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratifed analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identifed for the population overall and for specifc populations in the home care and community setting that could help in designing fall-prevention strategies.

Diabetic foot ulcers are a common complication that occurs in approximately 15 percent of patients with diabetes mellitus. Over 60% of diabetic foot ulcers are caused by underlying neuropathy. Former studies on diabetic animals with foot wounds found that vibration platforms significantly accelerate wound healing by catalyzing epithelization, promoting angiogenesis, and enhancing muscle bulk. This result suggests that there is evidence that vibrations may accelerate diabetic neuropathic ulcer healing in human patients. However, to the best of our knowledge, the effect of vibration on the enhancements of diabetic foot ulcer healing in human patients is rarely investigated. Hence, in this work, we conducted an experimental study with human subjects to investigate whether vibration therapy, as a complement to the standard wound treatment, can accelerate the wound healing rate of diabetic neuropathic foot ulcers. In this prospective experimental study, 80 participants diagnosed with Wagner grades I–III diabetic neuropathic foot ulcers were randomly distributed to experimental (n = 40) and control groups (n = 40). Patients in the intervention group received standard wound treatment and vibration wound therapy (VWT), whereas patients in the control group retrieved only standard wound treatment. The results (p = 0.024, α = 0.05) show notable differences in the median healing rate between the intervention group (25 days, 95% CI: 20.3–29.7) and control group (33 days, 95% CI: 25.6–40.4), with the effect-size r, Cohen’s d, Glass’s Δ, and Hedges’ g, respectively, being 0.810, 2.764, 2.311, and 2.772. Moreover, the nitric oxide (NO) level, wound closure area, and wound healing score after intervention significantly differed between the two groups (p < 0.05), putting the intervention group on a higher level than the control group. Furthermore, positive associations were found between the NO level and wound healing closure rates. These findings suggested that VWT enhances diabetic neuropathic foot ulcer healing in terms of healing rate, wound closure area, healing score, and elevated NO level. Considering that no clinically adverse effects were found in the patients induced with vibration intervention, VWT can be regarded as a complementary therapy to the existing ones to accelerate the healing of DFUs.

Introduction: One of the causes of disability among elderly is falling. The ability to predict the risk of falls among this group is important so that the appropriate treatment can be provided to reduce the risk. The objective of this study was to compare the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative from the Centers for Disease Control and Prevention (CDC) and The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) from the Johns Hopkins University. Methods: This study used the STEADI tool, JHFRAT, Activities-Specific Balance Confidence Scale (ABC), and The Geriatric Depression Scale (GDS). The study areas were in community and elderly home in both public and private sectors and the samples were 427 after cleaning. Results: The results for the STEADI and JHFRAT tools were similar where the respondents at highest risk of falling among women (STEADI: 49%; JHFRAT: 3.4%), in Bandung area (63.5%; 5.4%), in private homes (63.3%; 4.4%), non-schools (54.6%; 6.2%), aged 80 or older (64.8%; 6.7%) and not working (48.9%;3.3%). The regression analysis indicated that there was a significant relationship between the risk factors for falls in the elderly determined by the JHFRAT and STEADI tools: namely, region, type of home, age, disease history, total GDS and ABC averages. Conclusion: Despite the similarity in the risk factors obtained through these assessments, there was a significant difference between the results for the STEADI tool and the JHFRAT. The test strength was 43%. However, STEADI is more sensitive to detect fall risk smong elderly than JHFRAT Keywords: Activities-Specific Balance Confidence scale, elderly, fall risk, The Johns Hopkins Fall Risk Assessment Tool, the Stopping Elderly Accidents, Deaths, & Injuries

Postpartum family planning coverage in Central Java is below the national standard, or it only reached 26.8%. Postpartum mothers are at risk of getting pregnant if they do not use contraception. Modern contraceptives prevent 3.2 million of 5.6 million under-five deaths and 109,000 of 155,000 (70%) maternal deaths. Continuity of Midwifery Care during the extended postpartum period encourages mothers to use modern contraception to manage the pregnancy gap. This study aimed to explore midwifery services for Family Planning Postpartum from the perspective of providers and clients in three health facilities: hospitals (RS), Public Health Centers, and Independent Midwifery Practice (PMB). The research was implemented through a qualitative descriptive, a case study approach design in 2021. informants were ten postpartum mothers, nine midwives, two heads of Puskesmas, head division of Family Planning, Women and Children Empowerment (KBPPA) conducted an in-depth interview. The interviews were digitally recorded, transcribed, and analyzed using the Miles and Huberman method. Providers and clients identified several benefits of Postpartum Family Planning (KBPP). Midwives stated several obstacles in providing services, such as limited counseling time during labor and lack of support from hospital management. The competence of midwives constrained KBPP services at the Puskesmas. There were still few midwives at the Puskesmas certified to provide Long Term Contraception Method services. Midwives were also overloaded with work during the pandemic. Obstacles in the Independent Midwifery Practice were the lack of IMP with clinical networks and the limited authority of the midwife. Meanwhile, postpartum mothers' barriers included lack of knowledge about fertility and KBPP, worry about side effects, and the husband's lack of support. Therefore, optimizing the referral mechanism for long-term contraception in advanced health facilities is necessary. Continuity of care midwives and integration of services will increase coverage of postpartum contraception.

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia.Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability).Results: The content validity test produced positive results with an I-CVI scores of 0.7–1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521.Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable.

Background: Tuberculosis (TB) is an infectious disease that is a major problem in Indonesia, placing Indonesia among the three major countries with the highest TB cases in the world. In addition, reporting of TB data from health service facilities, especially hospitals, is still weak. Since the implementation of Directly Observed Treatment Shortcourse (DOTS) in hospitals in 1995, the number of new TB case reports from hospitals is still low. In order to increase hospital participation in TB control, the government has made a breakthrough strategy, which is the integration of the DOTS strategy in hospital accreditation. Design and methods: This study conducted a literature review and document analysis related TB control standards in hospital accreditation and the implication for the involvement of hospitals in national TB program. This study analyzed regulations, policies, and procedures, including hospital accreditation instruments and annual reports of TB. Results: Accreditation standards related to TB control include: i) Hospital must implement a tuberculosis control program in the hospital, including monitoring and evaluation through activities such as health promotion, tuberculosis surveillance, controlling risk factors, detection and treatment of tuberculosis cases, providing immunity and preventive drugs; ii) Hospital prepares resources for service delivery and tuberculosis control; iii) hospital provides facilities and infrastructures for tuberculosis services in accordance with regulations; and iv) hospital conducts tuberculosis services and efforts to control tuberculosis risk factors in accordance with regulations. Conclusions: Standards and elements of the assessment of TB control components in accreditation are adjusted to the national TB control guidelines.

Background: Inequalities in health represent a major problem in many countries, including Indonesia. Addressing health inequality is a central component of the Sustainable Development Goals and a priority of the World Health Organization (WHO). WHO provides technical support for health inequality monitoring among its member states. Following a capacity-building workshop in the WHO South-East Asia Region in 2014, Indonesia expressed interest in incorporating health-inequality monitoring into its national health information system. Objectives: This article details the capacity-building process for national health inequality monitoring in Indonesia, discusses successes and challenges, and how this process may be adapted and implemented in other countries/settings. Methods: We outline key capacity-building activities undertaken between April 2016 and December 2017 in Indonesia and present the four key outcomes of this process. Results: The capacity-building process entailed a series of workshops, meetings, activities, and processes undertaken between April 2016 and December 2017. At each stage, a range of stakeholders with access to the relevant data and capacity for data analysis, interpretation and reporting was engaged with, under the stewardship of state agencies. Key steps to strengthening health inequality monitoring included capacity building in (1) identification of the health topics/areas of interest, (2) mapping data sources and identifying gaps, (3) conducting equity analyses using raw datasets, and (4) interpreting and reporting inequality results. As a result, Indonesia developed its first national report on the state of health inequality. A number of peer-reviewed manuscripts on various aspects of health inequality in Indonesia have also been developed. Conclusions: The capacity-building process undertaken in Indonesia is designed to be adaptable to other contexts. Capacity building for health inequality monitoring among countries is a critical step for strengthening equity-oriented national health information systems and eventually tackling health inequities.

Objectives: This study has aimed at identifying the nature of preconception care delivered by healthcare practitioners toward prospective brides and grooms at primary healthcare in Jakarta. Materials and methods: This study used a qualitative design with descriptive analysis. The participants of this study are nine health practitioners, who deliver preconception care to prospective brides and grooms at primary healthcare in Jakarta, involving doctors, nurses, midwives, health analysts, and psychologists. The criteria of the participant were healthcare practitioners who were in charge of delivering healthcare service to prospects from primary healthcare, at least having a year experience at primary healthcare, having at least an associate degree. Participants have selected through purposive sampling in which characteristics suitable to the research objectives. The trustworthiness of the data has met through principles of credibility, conformability, dependability, and transferability. Results: The study identified four themes, which include participants’ perspective on prospects preparation, implementation of preconception care to prospects at primary healthcare, obstacles faced during the delivery, and participants’ needs for preconception care services. Conclusion: Healthcare practitioners need specialized training and interagency cooperation to enhance professional skill-mix in preconception care to achieve goals for maternal and child health.

Falls are one of the common problems among older adults; it is estimated that 684,000 fatal cases of falls occur every year. Furthermore, falls constitute one of the leading causes of mortality due to accidental injury. This study aims to identify the risk factors for falls in the older adults who live in the community, according to the dimensions of the living area: in urban and rural. The proportional sampling method was used to identify the rural and urban areas in West Java Prefecture; meanwhile, the incidence of fall in the last 12 months was selected as the outcome variable. Furthermore, sociodemographic background, chronic medical condition, fear of falling, visual and hearing impairments, Activity of Daily Living (ADL), Barthel index, physical performance (Short Performance Physical Battery (SPPB)), and living environment were analyzed to identify the risk factors that contribute to the incidence of falls. A total of 611 older adults participated in this study: 62% of them are living in rural area and 38% of them are living urban areas. More than 70% of study participants were aged 60–69 years, while 73% were females. There is no significant difference in fall prevalence in rural (16.5%) and urban (10.7%) areas (p value = 0.228). Furthermore, the multiple logistic regression analysis showed that the male gender (OR = 0.29, 95%CI [0.09–0.88]), chronic illness (OR = 3.25, 95%CI [1.24–8.53]), and visual impairment (OR = 3.6, 95%CI [1.52–8.54]) were associated with fall among older adults in urban areas. Meanwhile, visual impairment (OR = 1.81, 95%CI [1.03–3.18]) and living environment (OR = 3.36, 95% CI [1.14–9.93]) were significantly associated with falls in rural areas. Based on the associated risk factors identified in this study, a different approach is needed to reduce the falling risk among older adults in urban and rural areas in Indonesia.

OBJECTIVES The global prevalence of preterm labor is approximately 11.1% of live births. However, preterm labor contributes to 75-80% of neonatal morbidity and mortality. The morbidity experienced by preterm infants may continue to influence their subsequent development, imposing physical, psychological, and economic burdens. Premature rupture of membranes (PROM) is a causal factor that may affect preterm birth. Previous studies have shown an association between PROM and preterm labor, but this association should be investigated in more diverse populations. Therefore, this study was conducted in Cilegon, Indonesia to determine the magnitude of the risk of preterm labor associated with PROM at Cilegon Hospital from July 2014 to December 2015. METHODS This case-control study used data from patients’ medical records. The cases were all mothers who delivered at less than 37 weeks of gestation, while the control population comprised all mothers who delivered at greater or equal to 37 weeks. The data were analyzed using logistic regression. RESULTS The bivariate analysis yielded an odds ratio (OR) of 2.97 (95% confidence interval [CI], 1.92 to 4.59) before controlling for covariates. The model derived through multiple regression analysis after controlling for education, history of preterm labor, and anemia resulted in an OR of 2.58 (95% CI, 1.68 to 3.98). CONCLUSIONS Mothers who experience PROM during pregnancy were at a 2.58 times higher risk of preterm labor after controlling for education, history of preterm labor, and anemia.

Introduction: School-age children in Indonesia are at risk of health problems due to food insecurity. Parents have a very important role in preparing safe food, both at home and for lunch at school. The aim of this study was to determine the effect of a collaboration model of teachers, students, and their families (KOGUSIGA) towards the parents’ knowledge and skills on the food safety of elementary school students. Methods: This study applied a quasi-experiment design pre- and post-test with a control group. The subject sample used was the total sampling method, involving 206 parents. The study was conducted for over 10 weeks, supported with modules for nurses and parents, textbooks for the students and their families, and a student workbook. Results: The results showed that the KOGUSIGA model is associated significantly with greater knowledge (p-value = 0.000; with a mean difference of 20.23) and the parent’s skills (p-value = 0.000; with a mean difference of 12.3) to do with food insecurity. Conclusions: The KOGUSIGA model tends to improve the knowledge and skills parents significantly, in relation to the food safety of the students. It is expected that the KOGUSIGA model will be applied under the community health nursing/school health nurses’ supervision.

Abstrak Masalah kesehatan akibat makanan yang tidak aman di Indonesia masih sering terjadi, terutama pada kelompok anak usia sekolah untuk itu dikembangkan sebuah model yang melibatkan pihak sekolah, orang tua dan siswa. Penelitian ini merupakan bagian dari sebuah penelitian besar. Tujuan penelitian ini adalah menguji pengaruh model kolaborasi guru, siswa, dan keluarga (KOGUSIGA) terhadap peningkatan pengetahuan dan keterampilan guru tentang keamanan makanan pada siswa Sekolah Dasar (SD). Penelitian ini menggunakan desain eksperimen semu dengan pre-post test dengan menggunakan kelompok kontrol. Subjek sampel penelitian menggunakan total sampling sebanyak 28 responden guru. Kelompok intervensi diberi perlakuan berupa proses kelompok yang dilakukan selama 10 minggu sebagai implementasi model KOGUSIGA dengan kelengkapan modul untuk guru. Hasil penelitian menunjukkan model KOGUSIGA berpengaruh secara signifikan terhadap peningkatan pengetahuan (p= 0,003) dan keterampilan (p= 0,015) guru tentang keamanan makanan pada anak usia sekolah. Model KOGUSIGA diharapkan dapat menjadi program intervensi dalam Usaha Kesehatan Sekolah (UKS) dan disarankan perawat kesehatan sekolah menjadi koordinatornya. Kata kunci: Anak usia sekolah, guru, keamanan makanan, kolaborasi, perawat UKS Abstract Improvement of Knowledge and Skills Related to Food Safety for School Age Children Through Teacher, Student and Family Collaboration (KOGUSIGA) Model. Food insecurity, especially in school-age children often caused health problems. The purpose of this study was to determine the effect of collaboration model for teachers, students, and families (KOGUSIGA) toward knowledge and skills of teachers about food safety in elementary school students (SD). This study applied quasi–experiment design pre–posttest with a control group. The total sampling included 28 teachers. Intervention was provided over 10 weeks and supported by modules for the teachers. The results showed that KOGUSIGA mode significantly affected on knowledge (p= 0.003 and the teachers’ skills (p= 0.015) about food insecurity. It is concluded that KOGUSIGA model tends to promote food safety for students. It is expected that KOGUSIGA model applied under school health nurses’ supervision. Keywords: School age children, teachers, food safety, collaboration, school nurse

Maternal mortality rate and infant mortality rate in Indonesia are currently high. One of factors causing the high risk of maternal and infant mortality is too short birth intervals. This study aimed to learn determinants of birth intervals among multiparous women in Indonesia. This study used data from the Indonesia Demographic and Health Survey 2012 with 9,945 multiparous women. The data was analyzed using Mann Whitney, Kruskal Wallis and logistic regression tests. Median of birth intervals was 62 months and 22.8% women had birth interval less than three years. Results showed that determinants of birth intervals included maternal education, the last age of childbirth, ideal family size, the use of contraception, infant mortality records and survival of preceding child (p value < 0.05). The age of childbirth was a major risk factor of too short birth intervals. It needs the improvement of communication, information and education regarding maturation of age for marriage, ideal number of children as well as the increase of contraception use in order to increase optimum birth intervals. Abstrak Angka kematian ibu dan angka kematian bayi di Indonesia masih tinggi. Salah satu faktor yang menyebabkan tingginya risiko kematian pada ibu dan bayi adalah kelahiran terlalu dekat. Penelitian ini bertujuan untuk mempelajari determinan jarak antarkelahiran pada perempuan multipara di Indonesia. Penelitian ini menggunakan data Survei Demografi Kesehatan Indonesia tahun 2012 pada 9.945 perempuan multipara. Analisis data menggunakan uji Mann Whitney, Kruskal Wallis, dan regresi logistik. Median jarak antarkelahiran sebesar 62 bulan dan 22,8% perempuan memiliki jarak antarkelahiran kurang dari tiga tahun. Hasil menunjukkan determinan jarak antarkelahiran pendek meliputi pendidikan ibu, usia terakhir melahirkan, ukuran ideal keluarga, pemakaian kontrasepsi, riwayat kematian anak, dan kelangsungan hidup anak sebelumnya (nilai p < 0,05). Usia melahirkan merupakan faktor yang paling berisiko terhadap jarak kelahiran terlalu dekat. Diperlukan peningkatan komunikasi, informasi, dan edukasi mengenai pendewasaan usia pernikahan, jumlah anak ideal serta peningkatan pemakaian kontrasepsi dalam upaya meningkatkan jarak antarkelahiran optimum.

The relaive risk for Coronary Heart Disease (CHD) death in type 2 diabetics was 1.9-3.3 times higher, when compared to non-diabetics. Pathological studies have demonstrated a strong correlation between the presence of coronary calcium and CHD. Previous studies reported that the accumulation of dental plaque and dental calculus, and the severity of periodontal disease in type 2 diabetics were widely varied. A cross-sectional study on periodontal and CHD status of 36 non smoker type 2 diabetics was performed. The periodontal status was determined using Plaque Index of Sillness and Löe, Calculus Index of lingual anterior teeth, Papillary bleeding Index of Muleman, Periodontal Index of Russell, and dental panoramic rontgenogram. The CHD was determined by using standard ECG recording. Statistical analysis was using Fisher's exact test with the significant level of p2) was not found in positive CHD diabetics, but found in 925 (36%) of negative CHD diabetics; a slight to moderate dental plaque accumulation was found in 11/11 (100%) of positive CHD diabetics, and 16/25 (64%) of negative CHD diabetics (p=.03). A heavy lingual calculus accumulaiton (score>2) was found in 11/11 (100%) of positive CHD diabetics and 10/25 (40%) of negative CHD diabetics (p=0.006). A severe generalized gingival bleeding (score>2) was not found in positive CHD diabetics, but found in 8/25 (32%) of negative CHD diabetics; a mild to moderate gingival bleeding was found in 11/11 (100%) of positive CHD diabetics and 17/25 (68%) of negative CHD diabetics (p=0.7). A severe generalized periodontal disease (score>5) was not found in positive CHD diabetics, but found in 9/25 (36%) of positive CHD diabetics; a mild to moderate periodontal disease (score

Untuk melaksanakan penelitian di Indonesia yang dapat mewakili 33 provinsi, sampling bertahap banyak dilakukan, dan tahap awalnya adalah memilih provinsi. Pada penelitian bidang kesehatan, agar provinsi terpilih mewakili kondisi kesehatan penduduk Indonesia, seyogyanya provinsi dikelompokkan berdasarkan variabel terkait kesehatan. Untuk itu, secara statistik dapat dilakukan analisis gugus (cluster analysis) memakai data dari berbagai sumber, dengan 27 variabel mencakup prevalensi beberapa penyakit infeksi dan status gizi, akses ke pelayanan kesehatan, status demografi, indeks pembangunan manusia, dan aspek keuangan. Hasil akhir menunjukkan bahwa ada 4 gugus provinsi di Indonesia, pada masing-masing gugus terdapat sebanyak 4, 8, 7, dan 14 provinsi. Proses penggugusan dengan analisis gugus semacam ini dapat diterapkan dengan memakai data yang diperbaharui dan hasilnya dapat dimanfaatkan sebagai salah satu pertimbangan untuk sampling provinsi di Indonesia. Amultistage sampling procedure is often used in conducting a research that represents all 33 provinces in Indonesia, and the first step for the procedure is the sample selection of provinces. In the area of health research, it is recommended that the province selection is based on the stratification of provinces using health related variables. Cluster analysis is a statistical technique possibly employed utilizing data from many sources. In this particular application, it involves 27 important health variables which reflect important communicable diseases and nutritional status, access to health services, demographic situation, human development index, and financial factor. This cluster analysis produces four clusters of province, with each of them comprising of 4, 8, 7, and 14 provinces. This statistical clustering technique of provinces can be implemented and considered in the sampling process of provinces in Indonesia using the updated data.

Background: In the last two decades, unmet need for family planning in Indonesia remains stagnant, and contraceptive discontinuation has increased. These two indicators describe the risk of unwanted pregnancy in a population. Therefore, this study aims to develop an accurate calculation of the unmet need for family planning in Indonesia. Method: The study uses 2017 IDHS data to compare unmet need at survey-time and five years preceding the survey, measured by contraceptive calendar data that measured history of contraceptive use within five years preceding the survey. Unmet need at five years preceding the survey is measured by calculating the proportion of months not using contraceptive to the duration of months exposed to pregnancy in a period of 69 months. The study population is married women in Indonesia, with a sample size of 35,681. Results: Unmet need with contraceptive calendar calculation is higher than unmet need at survey-time. A difference of 3% concerns an additional of nearly 1.6 million unwanted pregnancies. This study proves that the high number of contraceptive discontinuations is directly proportional to higher unmet need with contraceptive calendar calculation. Conclusion: In Indonesia, with a relatively high contraceptive discontinuation rate, the calculation of unmet need using the calendar method is more precise than at survey-time method. The study results suggest the use of unmet need calendar for countries with high contraceptive discontinuation rate and provision of primary health care that is responsive to a potential unwanted pregnancy.