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As a tropical country, Indonesia continues to grapple with the prevalence of tuberculosis. This study conducted by the Department of Public Health and Preventive Medicine at Universitas Airlangga, Surabaya, Indonesia, presented a novel approach to prevent tuberculosis through measures tailored to the socio-cultural context of the population. Specifically, this study assessed how effective the use of tuberculosis comics is as an educational tool to inform junior high school students about tuberculosis. This research was quasi-experimental, with a one-group pre-test-post-test design. Seventy junior high school students in Dukun District, Gresik, Indonesia participated in this study. Each participant received a questionnaire consisting of ten questions about tuberculosis. Afterward, tuberculosis education was shared through comics. The post-test was carried out using the same questions as the pre-test. The data were analyzed using the R Program for Windows, version 4.1.3 (Auckland University, New Zealand). The analysis revealed a significant difference between the pre-test and post-test results (p < 0.0001). As indicated by the data, comics proved to be an effective method of educating people about infectious diseases, specifically tuberculosis. Here, we introduce an educational tool designed to revitalize the educational method for disseminating knowledge about infectious diseases. Ultimately, comics can increase students' interest in learning about tuberculosis, including its etiology, prevention, and treatment strategies. [ABSTRACT FROM AUTHOR]

Etawah crossbreed and Senduro goats as superior local goats and biological genetic resources that must be preserved in Indonesia. Melanocortin receptor type 4 (MC4R) is the primary gene that regulates food intake and energy balance which can be used as a candidate marker for livestock selection genes. This study aimed to analyze the comparison of cement quality and detect the profile of the MC4R gene in Etawah crossbreed and Senduro goat semen. The samples of this study were Etawah crossbreed and Senduro goat semen. Macroscopic examination of cement includes the evaluation of volume, consistency, odor, color, and pH. Microscopic examination of semen includes motility, abnormalities, and spermatozoa concentration. Examination of motility was performed in the condition of fresh semen, after the addition of diluents, and post-thawing of frozen straw. The polymerase chain reaction (PCR) method was performed to amplify specific fragments of the MC4R gene. There was a decrease in spermatozoa motility before freezing and post-thawing frozen semen compared to fresh semen. The quality of frozen straw post-thawing Etawah crossbreed and Senduro goat was still worth using for artificial insemination and in vitro embryo production. The MC4R gene can be detected in liquid and frozen semen from Etawah crossbreed and Senduro goats using a PCR test in the form of a single band along 642 bp. [ABSTRACT FROM AUTHOR]

Background: Although there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning. Methods: A mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying "dimensions" of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants. Results: Indonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent "dimensions" of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings. Conclusions: Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward. Plain English Summary: Despite global recognition of the importance of involving men in family planning and women's health matters, this matter has received insufficient the attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify correlates of male involvement, and assess the implications of varying levels of male participation for family planning outcomes. The study used a mixed methods research design. The main source of quantitative data was a 2017 Indonesian Demographic Health Survey (IDHS) data set of 8,380 married couples. Factor analyses were undertaken to identify the underlying dimensions of male involvement. The correlates of male involvement were assessed via comparisons across the four underlying dimensions of male involvement group identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants. The study found that male involvement as family planning clients remains limited, with only 8% of men using contraceptive methods themselves. However, Indonesian men are involved in other ways such via approval of family planning and active communications that contribute to lower female unmet need for family planning. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher versus lower levels of involvement. The most important contribution of males to realizing couple-level desires to limit or space births is via the approval of family planning, which empowers females take action to avoid unwanted pregnancies. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males are highlighted in the quantitative findings. In the way of an overall conclusion, Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward. [ABSTRACT FROM AUTHOR]

Background Skin areas that are no longer pigmented due to the loss of melanocytes characterize the inherited skin condition known as vitiligo. Patients with vitiligo may experience a decline in self-esteem and quality of life due to the condition's cosmetic effects. A particular instrument is needed to measure the quality of life in vitiligo patients in Indonesia, as the Dermatology Life Quality Index (DLQI) is a generic questionnaire for assessing the well-being of dermatology patients across the board. This study aimed to examine the relationship between the Vitiligo Area Scoring Index (VASI) and patients' self-esteem and quality of life, as measured by the Rosenberg Self-Esteem Scale (RSES) and the Dermatology Life Quality Index (DLQI). Methods The VitiQol was initially cross-culturally adapted to the Indonesian language. The Indonesian version of the VitiQol was distributed to 39 vitiligo patients and the dermatology life quality index (DLQI) and Rosenberg Self Esteem Scale (RSES) at Dr. Soetomo General Hospital Surabaya in December 2021-January 2022. This study was conducted by cross-sectional analytic observation. Sociodemographic data and patient characteristics with VASI, DLQI, VitiQol, and self-esteem were analyzed. Results There is a correlation between VASI with DLQI (p=0.001) and VitiQol (p=0.001), but no correlation between VASI and self-esteem (p= 0.174). There was a significant correlation between marital status and self-esteem (p=0.002), vitiligo type with VASI score (p=0.000), vitiligo type with VitiQol score (p=0.022), vitiligo location with DLQI (p=0.009), and vitiligo location with VitiQol score (p=0.001). Conclusion There is a significant correlation between the increase in VASI and the effect of vitiligo on the patients as assessed by the DLQI and VitiQol questionnaires, and there is no effect of vitiligo on self-esteem as assessed by the Rosenberg Self Esteem Scale (RSES) questionnaire. [ABSTRACT FROM AUTHOR]

Background: The unmet need for family planning in Indonesia has been stagnant since the early 2000s in the 10%-12% range with substantial socioeconomic and geographic disparities. This study sought to better understand the factors underlying the nonuse of contraceptives among women with an apparent need for family planning so that evidence-based corrective actions can be taken. Methods: Three sources of quantitative data were used in the study--the 2017 Indonesia Demographic Health Survey, the 2018 Village Potential Survey, and the National Population and Family Planning Board service statistics. Further insights were obtained from online focus group discussions and in-depth interviews with participants in 12 districts/cities in seven provinces. Results: The analyses indicated that health concerns, service delivery-related factors, and opposition to family planning all contribute to the unmet need for family planning in Indonesia. Importantly, the salience of these factors varied significantly across different subgroups of women and geographic areas. Conclusions: Successful efforts to reduce the unmet need for family planning are complex in that they must contend with the interplay between local sociocultural contexts, individual beliefs/aspirations/preferences, and the supply environment of family planning services. Differentiated interventions for different population subgroups and geographic areas will be needed. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) mechanism includes vasoconstriction and vascular remodeling. In Indonesia, sildenafil as a vasodilator is the only standard treatment for PAH. Research on pomegranate extract showed its potential as an anti-inflammatory and anti-proliferative agent that could work synergically with sildenafil in reducing pulmonary arterial pressure (PAP) Objective: To investigate the effect of pomegranate supplementation in the clinical manifestation of PAH in children with acyanotic CHD. Methods: This study was a randomized controlled clinical trial that compared the clinical manifestation of PAH in children with acyanotic CHD who received standard therapy for PAH and pomegranate extract supplementation with the placebo group. Observations were carried out over three months, and pre-and post-test evaluations were conducted to assess changes in PAP, functional classification of PAH, body weight, systolic blood pressure, heart rate, respiratory rate, and oxygen saturation in both groups. Statistical analysis was undertaken using the Wilcoxon, Mann-Whitney, and Spearman correlation tests. Results: There was no significant difference in PAP reduction between the pomegranate and placebo groups (p = .44) and no significant difference in the functional classification of PAH in the placebo and pomegranate groups (p = .55). There was a considerable reduction in the respiratory rate in the pomegranate group (p = .017). Respiratory rate was positively correlated with the functional classification of PAH (p = .011). Conclusion: There was a significant reduction in the respiratory rate in the pomegranate group that correlated with the functional classification of PAH. [ABSTRACT FROM AUTHOR]

Retinoblastoma is a rare neoplasm disease that occurs in children, generally under the age of two. Retinoblastoma is more prevalent in developing countries and is often associated with a late diagnosis. Such delays can lead to a poor prognosis. The time from the appearance of symptoms of retinoblastoma (onset) to the time of diagnosis is called lag time. Early diagnosis of retinoblastoma by paying attention to factors such as age, clinical symptoms, and laterality can help improve retinoblastoma survival rates, especially in developing countries. The purpose of this study was to analyze the relationship between the lag time to the stage of retinoblastoma patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This study was a retrospective analytical observational study using secondary data from retinoblastoma patients at the Ophthalmology Outpatient Unit at Dr. Soetomo General Academic Hospital, Surabaya, from January 2014 to December 2018. The data were analyzed using Kendall's tau-C test. No significant correlation was found between lag time and stage (p = 0.339). Patients with International Retinoblastoma Staging System (IRSS) I stage had the longest lag time (on average 28 months), and patients with stage IVB had the shortest lag time (on average four months). There was no correlation between lag time and retinoblastoma stage. However, there was a trend of patients with early stages delaying hospital visits, while patients with advanced stages in earlier to the hospital. [ABSTRACT FROM AUTHOR]

Accommodating the needs of Indonesia's rapidly growing urban population is essential to reaching national reproductive health goals and international commitments. As in other rapidly urbanizing low- and middle-income countries, satisfying the needs of Indonesia's urban poor is both a high priority and a significant challenge. In this study, we assessed both how being from urban poor or near-poor households affects the quantity and quality of family planning and maternal health services received and the extent to which differentials had narrowed during the 2012-2017 period. This time interval is significant due to the introduction of a national social health insurance scheme in 2014, establishing the foundation for universal health care in the country. Data from the 2012 and 2017 Indonesian Demographic and Health Surveys were analyzed using logistic and multinomial logit regression. Poverty status was measured in terms of urban household wealth quintiles. For family planning, although urban poor and near-poor women made different method choices than non-poor women, no substantial 2017 differences in contraceptive prevalence, unmet need for family planning or informed choice were observed. However, urban poor women and to a lesser extent nearpoor women systematically lagged non-poor urban women in both the quantity and quality of maternal health services received in connection with recent pregnancies. Significant maternal health service gains were observed for all urban women during the study reference period, with gains for poor and near poor urban women exceeding those for non-poor on several indicators. While the deployment of pro-poor interventions such as the national social health insurance scheme is likely to have contributed to these results, evidence suggesting that the scheme may not be influencing consumer health-seeking behaviors as had been anticipated along with continued limitations in public health sector supply-side readiness resulting in service quality issues suggest that more will have to be done. [ABSTRACT FROM AUTHOR]

Health-risk behaviors (smoking, alcohol consumption, and premarital sex) among Indonesian students are important issues. Understanding the association of these health-risk behaviors and adolescents' social contexts (family, peers, and neighborhood characteristics) to illicit drug use is required to develop strategies in preventing illicit drug use in Indonesia. The study used a multi-stage cluster random sampling method to collect data from the 2016 National Narcotics Survey of Indonesian students. The sample included 31,439 students. The result shows that the illicit drug use pattern was different from previous studies: the most prevalent was at the senior high school level. Multiple logistic regression analyses showed that smoking, alcohol consumption, premarital sex, peers, sex, family, and neighborhood were associated with illicit drug use. The study highlighted the importance of health-risk behaviors, social contexts of adolescents, and the illicit drug use pattern as considering factors in developing strategies to reduce illicit drug use prevalence. [ABSTRACT FROM AUTHOR]

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents' abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration. Methods: We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS). Results: A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% confidence interval [CI], 2.90--6.37] vs. 2.55 [95% CI, 2.19--2.90] vs. 3.82 [95% CI, 2.41--5.22], P=0.047; GRS: 10.00 [95% CI, 7.01--12.99] vs. 5.18 [95% CI, 3.99--6.38] vs. 7.18 [95% CI, 6.11--8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88--8.46]; GRS: 12.83 [95% CI, 8.61--17.05] vs. OSATS: 3.40 [95% CI, 0.83--5.97]; GRS: 5.67 [95% CI, 2.80--8.54]). Conclusion: Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Obstetric anal sphincter injury is one of the most common complications during delivery. Simulation models with manikins can be used as an effective medical learning method to improve students' abilities before encountering patients. The present study aimed to describe the development of an anal sphincter injury model and to assess residents' satisfaction and self-confidence after a perineal repair workshop with an anal sphincter injury simulator in Indonesia. Methods: This was a cross-sectional study with evaluation of outcomes before and after the workshop. We created a silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and used it as a simulation model for the workshop. We asked residents about their satisfaction with repairing anal sphincter injuries using a simulation model and residents' self-confidence when practicing anal sphincter injury repair. Results: All residents felt the simulation-based workshop was valuable (100%). Most of the scores for the similarity of the simulation model were good (about 8 out of maximum 10). The self-assessment of confidence was measured before and after the workshop. Overall self-confidence increased significantly after the workshop in identifying the external sphincter ani (EAS) (P=0.031), suturing the anal mucosa (P=0.001), suturing the internal sphincter ani (P=0.001), suturing the EAS (P<0.001), and evaluating the sphincter ani tone (P=0.016). Conclusion: The anal sphincter injury simulator improved residents' self-confidence in identifying the EAS, suturing the anal mucosa, suturing the internal sphincter ani, suturing the EAS, and evaluating sphincter ani tone. [ABSTRACT FROM AUTHOR]

Mental fatigue among coal mining operators was related to driving activities that require high concentration. This study aimed to determine factors that contributed to mental fatigue among coal mine operators in Indonesia, specifically in Kalimantan and Sumatra, after a one-year COVID-19 pandemic. This crosssectional study was conducted among 480 operators from two companies and seven sites. A self-administrated questionnaire in the Google Form was used to measure mental fatigue, the non-work-related factors (age, education, marital status, residence, and stress level), and work-related factors (working periods, shift pattern, type of shift, and work area in mining). The data analyzed using Chi-square and binomial logistic regression showed that the prevalence of mental fatigue was 32.3%. Operators with moderate stress and working in the pit area demonstrated a significant association with mental fatigue (p-va - lue<0.001). Multivariable analysis showed that medium stress (AOR = 2.11; 95% CI = 1.41-3.15) and working in the pit (AOR = 2.27; 95% CI: 1.45-3.57) had a positive association with mental fatigue. Thus, the pit condition and stress levels were the dominant factors influencing mental fatigue and became points to manage mental fatigue in coal mining operators in Kalimantan and Sumatra. [ABSTRACT FROM AUTHOR]

Background: Prior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood. Methods: Data from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions. Results: Higher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality. Conclusions: Community contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010–2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal. [ABSTRACT FROM AUTHOR]

Background: Although efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal. Methods: The study takes advantage of data from long series of population censuses and large-scale surveys that are available in few other low- and middle-income countries. We use the decomposition method suggested by (Matern Child Health J, 16:456–463, 2012) and regression-based policy simulations to estimate the number of maternal deaths averted during 1970–2017 due to contraceptive use and project potential future contributions to the year 2030. Results: It is estimated that between 523,885 and 663,146 maternal deaths were averted from 1970 to 2017 due to contraceptive use, a 37.5–43.1% reduction. If the contraceptive prevalence rate (CPR) were to rise from 63% in 2017 to 70% in 2030 and unmet need for family planning were to fall to from 10 to 7%, an additional 34,621–37,186 maternal deaths would be averted, an 18.9–20.0% reduction. A 2030 CPR of 75% and unmet need for family planning of 5% would result in 51,971–54,536 maternal deaths being averted, a 28.4–29.4% reduction. However, the CPR growth rate would have to nearly double the 2000–2017 rate to reach 70% CPR by 2030 and more than triple to reach 75%. Achieving the most ambitious target would still leave the maternal mortality ratio at 125 in 2030 without corresponding improvements in maternal health services. Conclusions: Although substantial reductions in maternal mortality between 1970 and 2017 can be attributed to contraceptive use and further contributions to the year 2030 are probable, smaller contributions are likely due to the already relatively high CPR and the challenges that must be overcome to move the CPR significantly higher. The ability of Indonesia to reach the 2030 SDG maternal mortality target of 70 maternal deaths per 100,000 live births will depend primarily upon health system effectiveness in addressing health risks to women once they are pregnant. [ABSTRACT FROM AUTHOR]

In Indonesia, access to services for the prevention of mother-to-child transmission (PMTCT) is quite low. The objective of this study was to design and implement a model to improve access to PMTCT services. This study was a quasi-experimental design involving 770 pregnant women in 2 districts (intervention and control district; n = 385 each). The implementation model had four stages: exploration, installation, initial implementation, and full implementation. The key activities included the provision of health education, an offering HIV testing, and the implementation of HIV tests for pregnant women in the community. The success of the model was assessed using three indicators: 1) the increase in the proportion of health facilities offering PMTCT services, 2) increase in the proportion of pregnant women who were offered HIV testing, and 3) increase in the proportion of pregnant women underwent HIV testing. The effectiveness of the model was assessed using multiple logistic regression analysis. In the intervention district, the number of facilities that offered PMTCT services increased from 6% to 34%, and the number of pregnant women who underwent HIV tests increased from 4.7% to 85.5%. Pregnant women in the intervention district showed greater access to PMTCT after controlling by the education of pregnant women, the role of decision making in the family, education and knowledge of the husband (odds ratio = 63.6; 95% confidence interval: 38.9–103.8; p = 0.000). The implementation model effectively improved access to PMTCT services. A multi-phased approach implemented in this study was able to overcome the barriers to access PMTCT services. [ABSTRACT FROM AUTHOR]

The article discusses a study on the application of the standard Abortion Incidence Complications Method (AICM) and the modified AICM to estimate the incidence of induced abortion (IA) in Java, Indonesia in 2018. The bases that were used to evaluate each method include data quality and the sexual and reproductive health indicators related to abortion. Results include the percentage distribution of IA reported, and the difference between reports of abortions from women and those from informants.

Objectives: The information about the return of fertility was important for women use contraceptives for delaying and spacing. The objective of this study was to analyze time to pregnancy following contraceptive discontinuation among reproductive women in Indonesia. Material and Method: Data on the return of fertility after discontinuation of various reversible contraceptive method were collected through a calendar contraceptive history among currently married women taking part in the Indonesia Demographic and Health Survey (IDHS) 2017. There were 3,887 women who discontinued using injectables, 1,641 women who discontinued using oral contraceptives, 228 women who removed their IUDs and 233 women who removed their implants for planning a pregnancy, who were followed up in this study to assess the return of fertility after discontinuation of their respective reversible contraceptives. Findings: This study found that there is a delay in conception or pregnancy following discontinuation of a reversible contraceptive, but there is no permanent infertility among women after discontinuation of reversible contraceptives. The cumulative pregnancy rate for a-year is 75% for discontinuers of oral contraceptive users, 72% for discontinuers of IUD users, 75% discontinuers of implant users and 64% for discontinuers of injectable users. Conclusions: The study found that contraceptive method significantly influenced the length time to become pregnant after discontinuation of reversible contraceptive method. However, the duration of contraceptive use has no relationship to time to pregnancy. To conclude, there is no impaired fertility after contraceptive discontinuation. Implication of this study is important for counseling process. [ABSTRACT FROM AUTHOR]

Background: The contraceptive prevalence in Indonesia was still dominated by short-acting method. Recently, the use of traditional contraceptives in Indonesia show an upward trend which is high risk of unintended pregnancy and sexual transmitted disease. This study aims to examine the determinants of contraceptive use in Indonesia and find the differences in characteristics of users. Material and Method: Data used were from the IDHS 2007, IDHS 2012 and IDHS 2017. Contraceptive method mix was used as dependent variables. Chi-square test and binary logistic regression were applied to find the significant factors. Findings: The findings indicated that contraception in Indonesia was mostly used for fertility limiting. About 90% of contraceptive method mix in Indonesia are contributed by modern contraceptive method. Modern contraceptive method are frequently used by women who live in rural areas. Compared to modern contraceptive users, traditional users in Indonesia were more likely have good education and occupation and live in urban areas. Conclusion: Women who used traditional method should be encouraged to switch into the more effective modern contraceptive method. Strategy to promote the use of Long-Acting Reversible and Permanent Method needs to be strengthened. [ABSTRACT FROM AUTHOR]

Objectives: Nicotine narrows uterine blood vessels reducing the flow of oxygen and nutrients to the developing fetus. This study examined the effects of fetal exposure to secondhand smoke on neonatal anthropometry. Methods: This cross sectional study recruited 128 pregnant women in the third trimester of single pregnancies who had no chronic illness, were not active or ex-smokers, and who were willing to participate in the study. Pregnant women who were exposed to secondhand smoke had umbilical cord blood nicotine concentrations of = 1 ng/mL. Neonatal anthropometry was assessed according to the newborn birth weight and length. The independent t-test was used to determine the neonatal difference in mean birth weight and length between the women who were exposed to secondhand smoke, and those who were not exposed. A multiple linear regression analysis was employed to assess the effect of secondhand smoke exposure on birth weight and birth length, controlling for potential confounding variables (weight gain during pregnancy, body mass index, parity, maternal age, and maternal hemoglobin). Results: There were 35 women exposed to secondhand smoke (nicotine = 1 ng/mL). Neonate birth weight and birth length were lower among mothers who were exposed to secondhand smoke. However, only neonate birth weight was significantly reduced by exposure to secondhand smoke (p = 0.005). The mean birth weight of these neonates was 2,916.5 g ± 327.3 g which was 205.6 g less than in unexposed fetuses. Conclusion: Exposure of mothers to secondhand smoke during pregnancy reduces fetal development and neonatal weight. [ABSTRACT FROM AUTHOR]

Background: Maternal and neonatal mortality in Indonesia are still high compared to countries with the same economic level. The cause of death of both the most common causes were delayed getting medical services. This study aims to understanding the delayed factors to reducing maternal and neonatal mortality in Indonesia. Method: Data were derived from two cross-sectional studies, the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Statistics. The study population was women of reproductive age (15-49 years) who lived in the households located within the 40,750 census blocks of the 2015 SUPAS. There were 652,000 households. Information of all maternal and neonatal deaths (singleton live births) that occurred between 2010 and 2015. The unit analysis was a census block, and each census block consisted of 16 households. The analysis used equalized block census level of socio-economic and health program factors on the natural log of unadjusted measures of maternal and neonatal mortality. Results: Risk of mortality were women of low education (lower than secondary high school), poor household, longer average distance to hospital, a large number of traditional birth attendants and residing in out Jawa Bali, Use of contraceptives, delivery attended by trained health workers are significantly associated with lower maternal and neonatal mortality. Conclusion: socio-economic and geographic differentials contribute to delayed of health services and causes high maternal and neonatal mortality in Indonesia. [ABSTRACT FROM AUTHOR]

Indonesia is seeking to expand its cocoa production to meet the increased international demand. However, this effort faces economies of scale and ecological challenges. This research aims at evaluating environmental performance of cocoa production from cocoa monoculture and cocoa-agroforestry by life cycle assessment based on ISO 14040 and 14044, with adaptation for local impact indicators. This study defined cocoa-agroforestry as raw and sequential of cocoa–coconut and cocoa–rubber agroforestry, combined with shading trees Leucaena sp. and Gliricidia sepium . The analysis considered cocoa production at farm level, from cradle to on-farm gate boundary for 1 metric tonne of cocoa pod. The results showed that cocoa–coconut agroforestry had the least contribution to global impact categories of global warming, acidification and eutrophication, accounting for 3.67E+01 kgCO 2 -eq, 4.31E-02 kgSO 2 -eq, and 2.25E-05 kgPO 4 -eq respectively. Cocoa–coconut agroforestry also had the highest organic carbon and soil organic matter, conditions supporting the growth and activity of beneficial soil microbeds ( Pseudomonas sp. and Trichoderma sp.). In addition, total land equivalent ratio of cocoa–coconut agroforestry had the highest value at 1.36, indicating a highest yield advantage was gained. Therefore, cocoa–coconut agroforestry could be a wise option to promote environmental sustainability of cocoa cultivation. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.DesignPre–post evaluation between two surveys.SettingTwenty-four villages in West Java.SubjectsPoor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6–11 months (n 318/n 335) and children aged 12–59 months (n 469/477), and cohorts of children aged 5–9 years (n 186) and women aged 15–29 years (n 171), alongside food and oil consumption from dietary recall.ResultsFortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12–23 months, 24–59 months, 5–9 years, lactating and non-lactating women, respectively. Serum retinol was 2–19 % higher at endline than baseline (P<0·001 in infants aged 6–11 months, children aged 5–9 years, lactating and non-lactating women; non-significant in children aged 12–23 months; P=0·057 in children aged 24–59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5–18 % across groups at baseline, and 0·6–6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6–59 months (P=0·003) and 5–9 years (P=0·03).ConclusionsAlthough this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children. [ABSTRACT FROM PUBLISHER]

Objectives. We investigated the population burden of betel quid abuse and its related impact on oral premalignant disorders (OPDs) in South, Southeast, and East Asia. Methods. The Asian Betel-Quid Consortium conducted a multistage sampling of 8922 representative participants from Taiwan, Mainland China, Malaysia, Indonesia, Nepal, and Sri Lanka. Participants received an interviewer-administered survey and were examined for oral mucosal disorders. Results. The prevalence of betel quid abuse was 0.8% to 46.3% across 6 Asian populations. The abuse frequency was over 40.5% for current chewers, with the highest proportion in Nepalese and Southeast Asian chewers (76.9%-99.6%). Tobacco-added betel quid conferred higher abuse rates (74.4%-99.6%) among Malaysian, Indonesian, and Sri Lankan men than did tobacco-free betel quid (21.8%-89.1%). Gender, lower education level, younger age at chewing initiation, and clustering of familial betel quid use significantly contributed to higher abuse rates. Indonesian betel quid abusers showed the highest prevalence of OPDs and had a greater risk of OPDs than did nonabusers. Conclusions. Betel quid abuse is high in regions of Asia where it is customarily practiced, and such abuse correlates highly with OPDs. By recognizing abuse-associated factors, health policies and preventive frameworks can be effectively constructed to combat these oral preneoplasms. [ABSTRACT FROM AUTHOR]

Background. Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micron utrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact. Objective. To evaluate the efficacy ofprenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron-folic acid supplementation. Methods. We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron-folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality. Results. The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron-folic acid group). The women consumed the supplements on average 5 days per week. Although there were no significant differences between the groups in the percentage of infants with LBW, there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients (6.3% vs. 7.3%), and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron-folic acid group, although the difference was not significant. Among those who consumed 90 or more supplements during pregnancy, women taking multiple micronutrients had a 3.3% combined rate of miscarriage, stillbirth, or neonatal death, as compared with 6.9% for those taking iron-folic acid only (p < .049). The anemia rates in the two groups were similar after supplementation, even though the amount of iron in the multiple micronutrient supplement was half that in the iron-folic acid supplement. Serum retinol was higher in the group receiving multiple micronutrients. Conclusions. Multivitamin supplementation use among pregnant women is as effective as iron-folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status. [ABSTRACT FROM AUTHOR]

Deficiencies of iron and zinc are prevalent worldwide. Interactions between these micronutrients therefore have important consequences, also for supplementation. To investigate effects on hemoglobin and zinc concentrations and interactions of iron and zinc supplementation in infants, data from 4 parallel, randomized, placebo-controlled, double-blind trials in Indonesia, Thailand, and Vietnam were pooled. Infants (n=2468), aged 4-6 mo, were supplemented daily with iron (10 mg) and/or zinc (10 mg) for 6 mo. At 3 sites, infants were given vitamin A capsules (VAC) at recruitment. Combined supplementation reduced prevalences of anemia by 21% (P<0.01) and zinc deficiency by 10% (P<0.05) but was less effective (P<0.05) than supplementation with either iron (28% reduction in anemia) or zinc alone (18% reduction in zinc deficiency). Iron reduced the effect of zinc supplementation (interaction P<0.01), but had no separate effect on zinc status, whereas zinc supplementation had a negative effect on hemoglobin concentrations (-2.5 g/L, P<0.001), independent of iron supplementation (Pinteraction=0.25). The effect of iron supplementation on hemoglobin concentrations was almost twice as large in boys than in girls (effect size 12.0 vs. 6.8 g/L, respectively). In infants not receiving iron, VAC administration tended to be associated with lower (3.2%, P=0.07) hemoglobin concentrations. Combined supplementation of iron and zinc was safe and effective in reducing the high prevalences of anemia and iron and zinc deficiencies. Zinc supplementation may negatively affect iron status but iron supplementation does not seem to affect zinc status. Furthermore, VAC administration in the absence of iron supplementation may increase the incidence of anemia. [ABSTRACT FROM AUTHOR]

Background: The quality of obstetric care has been identified as a contributing factor in Indonesia's persistently high level of maternal mortality, and the country's restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals. Methods: Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia's most populous island, we applied a signal functions analysis to measure the health system's capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures. Results: Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia's current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C). Conclusions: Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java's health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service. [ABSTRACT FROM AUTHOR]

The article details a community-based study on the application of the Confidante Method and a direct-report approach to measure the incidence of induced abortion in Java, Indonesia from November 2018 to January 2019. Results include the rate of self-reporting of abortion, the percentage of respondents who had disclosed their abortion to their confidante, and the presence of transmission bias between women who had an abortion and third confidantes. The limitations of the study are explained.

Abstract: This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The sample consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client''s belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses. [Copyright &y& Elsevier]

This article focuses on a midwife programme launched by the Government of Indonesia. The article explains that the program, started in 1989, appointed a midwife to every village in order to provide antenatal and perinatal care, family planning, and reproductive services. The goal of the programme was to reduce maternal and neonatal mortality. The author explains that much is to be learned from the programme, mainly that reduction of mortality rates is related to available health care.

Purpose: This study aims to analyse the direct and indirect relationship between the prevalence of depression and hypertension through central obesity in the Indonesian population. Material and methods : This quantitative analytical observational study is based on secondary data with a cross-sectional design. The data is taken from the Indonesian Baseline Health Research of the Health Research and Development Agency in 2018, which is aggregated data from survey results on household members in 34 Indonesian provinces. We used path analysis and the Sobel test using AMOS 23.0 program to assess the direct and indirect relationship of depression and obesity to hypertension. Multiple linear regression analysis was used to determine the effect of confounding factors on hypertension. Results: The average prevalence (± SD) of depression, central obesity and hypertension in 2018 was 6.21% (± 2.30), 31.26% (± 4.80), and 31.07% (± 4.76). There was an indirect positive relationship between depression and hypertension through central obesity ( p  = 0.041). The direct effect of depression was associated with a 17% chance of being centrally obese ( p  = 0.009), and the direct effect of depression and central obesity was associated with a 32.7% chance of becoming hypertensive ( p  = 0.001). There is no significant direct relationship between depression and hypertension. The effect of confounding factors on hypertension was 21.9% ( p  = 0.007), lower than the effect of depression and central obesity. Conclusion: Central obesity might be an intermediate variable linking depression and hypertension.

Objective: The objective of this research is to estimate the probability of pregnancy resumption after discontinuing reversible contraceptives-pills, injectables, implants and IUDs, and to examine the factors associated with the resumption of fertility., Method: The study uses pregnancy calendar data from Indonesia Demographic and Health Surveys (IDHS) of 2007, 2012 and 2017. A hazard model survival method is used for estimating the time needed to resume pregnancy since discontinuing reversible contraceptives. Retrospective data on 4,573; 5,183 and 5,989 episodes of reversible contraceptive discontinuation at the three surveys respectively have been analysed., Results: This study shows that women regained fecundity within one year of discontinuing IUD, pill, injectables or implants. Women using IUD could resume their pregnancy faster than those using implants, pills and injectables. Over the three IDHS 2007, 2012 and 2017 the age-specific percentages of women becoming pregnant after one year of contraceptive discontinuation vary between 72 and 85 for IUD, 75 and 81 for pills, 72 and 76 for implants and 64 and 67 for injectables, with the percentages being higher among younger women. The analysis further shows that length of contraceptive use, parity, prior sexually transmitted infections, knowledge of fertile period, household wealth status and place of residence have no impact on occurrence of pregnancy after contraceptive discontinuation., Conclusion: The analysis disproves a myth that reversible contraceptives make women infertile. Depending on the type of reversible contraceptive used, 65% to 85% of the women were able to conceive after one year of discontinuation., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Obstetric anal sphincter injury (OASI) is one of the most common complication during delivery. Simulation models using manikin can be used as an effective medical learning method to improve students' abilities before meeting patients. It aimed to describe the development of anal sphincter injury model and assess the resident satisfaction and self-confidence after perineal repair workshop with anal sphincter injury simulator in Indonesia., Methods: This was cross-sectional study with evaluation of outcome before and after workshop. We created silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and made it as simulation model for workshop. We asked residents' satisfaction repairing anal sphincter injury using simulation model and residents' self-confidence when practicing the anal sphincter injury repair., Results: All residents felt the simulation-based workshop was valuable (100%). Most of score for similarity simulation model were good (about 8). The self-assessment of confidence was measured prior to the workshop and after the workshop. The overall self-confidence was increased significantly after workshop in procedure identification external sphincter ani (EAS) (P=0.031), suturing anal mucosa (P=0.001), suturing internal sphincter ani (P=0.001), suturing external sphincter ani (EAS) (P <0.001), evaluation of sphincter ani tone (P=0.016)., Conclusion: Anal sphincter injury simulator improves the self-confidence of residents in procedure identification external sphincter ani (EAS), suturing anal mucosa, suturing internal sphincter ani, suturing external sphincter ani (EAS) and evaluation of sphincter ani tone.

Objectives: The perceptions of family-planning (FP) acceptors regarding contraception influence the reasons for which they choose to switch their method of contraception. The objective of this study was to analyze the perceptions of contraception and rationales for switching contraceptive methods among female FP acceptors in West Nusa Tenggara, Indonesia., Methods: This study involved the analysis of secondary data from the Improve Contraceptive Method Mix study, which was conducted in 2013 by the Center for Health Research, University of Indonesia. The design of the study was cross-sectional. We performed 3 stages of sampling using the cluster technique and selected 4819 women who were FP acceptors in West Nusa Tenggara Province, Indonesia as the subjects of this study. The data were analyzed using multiple logistic regression., Results: The predominant pattern of switching contraceptive methods was switching from one non-long-term method of contraception to another. Only 31.0% of the acceptors reported a rational pattern of switching contraceptive methods given their age, number of children, and FP motivations. Perceptions of the side effects of contraceptive methods, the ease of contraceptive use, and the cost of the contraceptives were significantly associated (at the level of α=0.05) with rational patterns of switching contraceptive methods., Conclusions: Perceptions among FP-accepting women were found to play an important role in their patterns of switching contraceptive methods. Hence, fostering a better understanding of contraception through high-quality counseling is needed to improve perceptions and thereby to encourage rational, effective, and efficient contraceptive use.

Aim: To identify the effectiveness of rational-emotive-behavior-based therapy (REBT-based therapy) on improved mental health and antiretroviral (ART) therapeutic adherence in women infected with HIV/AIDS (female subjects with HIV/AIDS)., Methods: A randomized and single-blinded clinical trial in women infected with HIV/AIDS who had their treatment at the outpatient clinic of Pokdiksus AIDS RSCM and at the AIDS Comprehensive Diagnostic Unit of Dharmais Hospital was conducted between October 2011 and March 2012. A block randomization of 160 female subjects with AIDS was performed that resulted in a REBT-based treatment group (n=80) and a control group (n=80). The treatment group received REBT-based intervention of 8 sessions weekly including 6 individual-therapeutic sessions/week and 2 group-therapeutic sessions/week. Instruments used in the study were questionnaires on demography, ART adherence (measured by self report and pill count), and mental health (SRQ-20). Data were analyzed using Chi-Square test, Generalized Linear Model, and Generalized Estimating Equations., Results: There were 148 respondents analyzed including in the REBT-based group (n=72) and in the control group (n=76) with mean age of 33-34 years. After 8 weeks of REBT-based intervention, there was improved (increased) mean value of the self-reported adherence score (self-report) compared to control group (100%; CI 95%,83.3-96.7 vs. 84%; CI 95%,77.5-87.8) and improved (decreased) SRQ-20 mean score in REBT-based treatment group compared to control group (2.9; CI 95%, 2.7-13.0 vs. 5.4; CI 95%: 5.0-13.6). ART adherence based on viral load titer was not analyzed in both group since most of VL titer were undetected (<400 copies/mL). GLM analysis showed decreased SRQ-20 mean score and increased mean value of self-reported ART adherence (self-report) in the REBT-based treatment group, which were more significant (p<0.000) than control group on the 8th week. GEE analysis showed that 1 point decrement of SRQ-20 would increase self-reported ART adherence as much as 0.722 point and the correlation was statistically significant (p<0.00)., Conclusion: After 8 weeks of REBT-based intervention to female subjects with HIV/AIDS, there is a decrease of SRQ-20 mean score which may result in increased ART adherence mean score in the treatment group compared to the control.

Background: Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact., Objective: To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron-folic acid supplementation., Methods: We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron-folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality., Results: The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron-folic acid group). The women consumed the supplements on average 5 days per week. Although there were no significant differences between the groups in the percentage of infants with LBW there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients (6.3% vs. 7.3%), and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron-folic acid group, although the difference was not significant. Among those who consumed 90 or more supplements during pregnancy, women taking multiple micronutrients had a 3.3% combined rate of miscarriage, stillbirth, or neonatal death, as compared with 6.9% for those taking iron-folic acid only (p < .049). The anemia rates in the two groups were similar after supplementation, even though the amount of iron in the multiple micronutrient supplement was half that in the iron-folic acid supplement. Serum retinol was higher in the group receiving multiple micronutrients., Conclusions: Multivitamin supplementation use among pregnant women is as effective as iron-folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status.