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BACKGROUND: Diabetic neuropathy reduces the patient’s quality of life and the quality of diabetes management itself and, as a result, worsens the prognosis of other diabetic complications. Various complaints that are often felt by diabetes mellitus (DM) patients due to neuropathy include pain in the legs, numbness, and weakness in the affected leg, paresthesia, or numbness, and the absence of tendon reflexes in the affected leg. AIM: This study aimed to determine the effectiveness of electric massage therapy on neuropathy healing in DM patients. METHODS: The pre-test and post-test experimental design without a control group was employed. Patients with neuropathy diabetic were recruited as the subject of the study. The total number of participants in the study was 30 people. All the subjects were assessed for neuropathy using the neuropathy assessment instrument and the monofilament test. The Kolmogorov–Smirnov test was employed to analyze the normality of the data. The Wilcoxon signed-rank test was employed for non-normally distributed data. The study used a 95% confidence interval, and significance was assessed at alpha

Dengue fever (DF) infection continues to present as a serious public health problem in Medan municipality, North Sumatera, Indonesia. The number of DF cases continuously increasing recently. However, space time clusters of DF have not been investigated yet. A study was undertaken to detect clusters of DF incidence during 2015-2018 in Medan. Spatial geo-reference was conducted to 151 village coordinates by geocoding each village’s offices. A retrospective space-time scan statistic analysis based on population data and monthly DF incidence was performed using SaTScan TM v9.4.4. Data of DF during 1 January 2015-31 December 2018 were analyzed using Poisson model to identify the villages at high risk of DF. The test of significance of the identified clusters of DF was based on comparing the likelihood ratio (LLR) against the null distribution obtained from Monte Carlo hypothesis testing. Total number of permutation was set to 999 and the significance level was set as 0.05. The highest LLR number was determined as the most likely cluster, while the rests were as the secondary clusters. This analysis identified 13 significant clusters. These DF clusters were initially spatially concentrated in the southwest and center of Medan and the last two years of study moved towards the northern part and identified in the last four months (September-December) of each year, which were the rainy seasons in the area. Most likely clusters were most frequently detected in the last three-year period of study in Anggrung village. Thirteen statistically significant DF clusters were identified in the 2015-2018 period. This may assist health authorities to improve the DF preventive strategies and develop public health interventions especially in the cluster’s area.

Tuberculosis (TB) is one of the leading causes of morbidity and mortality. It is carrying a heavy public health problem burden in Indonesia. This study aimed to determine the risk of poor knowledge of TB, socioeconomic status, malnutrition and contact history with TB cases with the incidence of TB in Medan. This was a cross sectional study conducted between May – August 2019 in Medan municipality, in the three highest TB cases incidence public health centers (puskesmas). Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. Logistic regression was conducted to assess the potential risk factors associated with the infection. We enrolled 260 clinically suspected cases of TB, comprising 135 (51.9%) cases positive for TB and 125 (48.1%) cases negative for TB. In multivariate model, those who had contact history with active TB cases and those who malnourished had higher odds of having TB infection, with adjusted odds ratio (aOR): 5.58 (95%CI:3.13–9.93) and aOR: 3.36 (95%CI: 1.87–6.02), respectively. Having contact history with TB active case and malnutrition were the most significant risk factors of TB incidence in Medan municipality, North Sumatera, Indonesia. Therefore, educating patients on the importance of cough or sneezes etiquette procedures including use of face masks to minimize the risk of infection.

Background Measles is a highly contagious and a vaccine-preventable disease. On 14 August 2015, a measles outbreak was reported in Langkat District, North Sumatra province of Indonesia. To investigate the risk factors of the outbreak and to recommend control measures, an epidemiological investigation was undertaken. Method A 1:1 matched case-control study was conducted. All suspect and confirmed cases were recruited and included. Controls were healthy neighbors of cases, matched for age and gender. House-to-house search for cases was carried out. Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. A two-step logistic regression was employed to assess the potential risk factors associated with the infection. Results During 20 July to 25 September 2015, a total of 28 measles cases were identified with no death. All tested blood samples were positive for measles-specific IgM antibodies confirming the outbreak. All cases presented with fever and rash; cough (80%), coryza (65%), and conjunctivitis (25%). The attack rate (AR) was 14.1% (age ranged between 1 and 14 years old), the highest AR (50.0%) occurred among those aged 1–4 years. In multivariate model, those who have not received measless vaccication and those who had contact with a measles case had higher odds of having infection, with adjusted odds ratio (aOR): 2.31 (95%CI: 1.22–4.27) and aOR: 1.15 (95%CI: 1.12–3.70), respectively. Conclusions Being unvaccinated and having a contact history increased the risk of measles are two risk factors of measles infection. A mass measles immunization to the school children was undertaken and a strict measles surveillance and notification system were recommended to control the transmission in the future.

Dengue fever (DF) infection continues to present a seriuos public health problem in North Sumatera, Indonesia. A DF outbreak was reported in Merek Sub-district, Karo District which is one tourist destination in North Sumatera during April-May 2017. An epidemiological investigation was conducted to identify the risk factors and recommend control measures. An observational study with a matched case control design was conducted. A case was defined as any resident of Merek sub-district who had suffer major clinical symptoms of DF such as fever, severe headache, pain behind eyes, muscle and joint pains, and rash from April – May, 2017. A control was defined as neighbors of cases who did not have clinical signs and symptoms of DF and were matched for age and sex. We interviewed 37 cases and 37 controls. Age cases ranged from 2 year to 37 years (median= 12 years). The multivariate analyses showed that presence of mosquito breeding sites (OR=4.87, 95%CI=1.33-17.85) and habit of hanging worn clothes (OR=5.12, 95%CI=1.25-21.03) were significant risk factors. It is recommended to eliminate mosquito breeding sites routinely, avoid habit of hanging worn clothes, and conduct strict surveillance of DF continously.

Rabies merupakan masalah kesehatan masyarakat di Sumatera Utara. Tujuan dari program pencegahan dan pengendalian rabies adalah untuk mencapai Sumatera Utara bebas rabies tahun 2020. Penelitian ini merupakan penelitian observasional dengan desain cross sectional dengan mengumpulkan dan menganalisis laporan bulanan dan tahunan kasus rabies di Sumatera Utara sejak tahun 2007-2017. Evaluasi dilakukan terhadap seluruh proses program pencegahan dan pengendalian rabies. Hasil didapatkan bahwa pelaksanaan program pencegahan dan pengendalian rabies di Sumatera Utara belum berjalan optimal, seperti pelaksanaan surveilans epidemiologi, pelacakan kasus, tata laksana kasus di fasilitas pelayanan kesehatan, masih kurangnya partisipasi masyrakat, kurangnya rabies center di kabupaten/kota, serta kurangnya kerja sama antara dinas kesehatan dan dinas peternakan kabupaten/kota. Program pencegahan dan pengendalian rabies di Sumatera Utara belum berhasil dalam menurunkan kasus lyssa, masih terdapat 9 kabupaten/kota yang selama 2 tahun terakhir memiliki kasus lyssa. Disarankan lebih meningkatkan kerja sama lintas sektor dan program untuk mencapai Sumatera Utara bebas rabies 2020.

Background: Chikungunya is a serious emerging arbovirus in Indonesia. On 12 October 2013, an outbreak of chikungunya was reported in Serdang Bedagai District, North Sumatera, Indonesia. Objective: An epidemiological investigation was conducted to identify the risk factors for the outbreak and recommend control measures. Method: A 1:1 matched case-control study was conducted. A case of chikungunya was defined as a previously well resident of Sei Suka Subdistrict who had clinical symptoms of chikungunya fever such as fever, arthralgia, myalgia, rash and headache of at least two days duration between 8 August and 17 November 2013. Cases were identified by active case finding through the affected area; a control was defined as a neighbor of a case that did not have clinical signs and symptoms of chikungunya, matched for age and gender. Blood samples were tested using ELISA assay to confirm the presence of anti-CHIKV specific IgM antibody. Results: Total of 94 cases and 94 controls were included in the case control study. Age ranged from 1 year to 76 years (median 35 years) and 57% were female. In multivariate analyses, being a household contact of a chikungunya case (adjusted OR=11.4, 95%CI=4.69-27.55) and lack of routinely eliminating mosquito breeding sites were risk factors (adjusted OR=3.3, 95%CI=1.50-7.05). Six out of ten cases were positive for CHIKV IgM antibody. Conclusions: In this confirmed outbreak of chikungunya, using anti mosquito measures were protective, reinforcing the need for routine elimination of mosquito breeding sites as well as control measures in affected households and communities.

Background: Tuberculosis (TB) is a direct infectious disease caused byMycobacterium tuberculosis. Most of the TB germs attack the lungs, but they can also affect other organs. From the health profile data in Lhoong Community Health Center (CHC) in 2015 there were 5 pulmonary tuberculosis cases, while in 2016 there were 13 pulmonary TB cases. Aim: This study aims to determine the correlation between ventilation, lighting, humidity, occupancy density, type of floor and house temperature with the incidence of pulmonary tuberculosis in the work area of Lhoong CHC Aceh Besar District in 2018. Methods: This was an observational study with case control design. The total samples were 39 people including 13 case samples plus 26 control samples during 2018. Data for the independent variables were obtained by questionnaire, observation and measurement. Data analysis used chi square. Results: Bivariate analysis resulted that ventilation, lighting, occupancy density, humidity, and type of floor were related to the incidence of pulmonary TB in the work Area of Lhoong CHC, Aceh Besar District. The multivariate analysis resulted that occupancy density (OR= 30.8; 95%CI= 2.8-336.4) and ventilation (OR= 17.2; 95%CI= 1.6-178.9) were the most risk factors of pulmonary TB. Conclusions: Occupancy density and ventilation were the most risk factors of pulmonary TB in the work area of Lhoong CHC Aceh Besar District in 2018.

Demam chikungunya adalah penyakit arbovirosis dengan angka kesakitan yang tinggi dan berdampak terhadap kondisisosial ekonomi. Tanggal 17 Januari 2014, Dinas Kesehatan Kabupaten Tapanuli Selatan melaporkan adanya kejadian luarbiasa (KLB) demam chikungunya di Kecamatan Batang Toru dengan jumlah kasus sebanyak 74 orang. Penelitian analitikmenggunakan desain kasus kontrol, dilakukan untuk mengidentifikasi faktor risiko terjadinya KLB demam chikungunya.Kasus adalah penduduk yang sedang sakit atau baru mengalami sakit dengan gejala klinis utama demam, nyeri padapersendian dan bintik-bintik merah pada kulit. Kontrol adalah penduduk yang tidak sedang sakit dan tidak baru mengalamisakit dengan gejala klinis utama demam, nyeri pada persendian dan bintik-bintik merah pada kulit, diambil dari desa laindengan karakteristik penduduk dan topografi yang hampir sama dengan daerah penelitian. Analisis secara bivariatmenggunakan chi-square dan regresi logistik dengan derajat kepercayaan 95%. Sampel darah pasien diuji menggunakanrapid diagnostic test (RDT) Chikungunya IgM. Analisis bivariate menunjukkan variabel yang berhubungan dengankejadian demam chikungunya adalah tidak menggunakan kelambu pada saat tidur pagi dan sore hari (p- value: 0,000; OR=4,825, CI= 2,379-9,782) dan terdapat jentik nyamuk di tempat penampungan air (TPA) sekitar rumah (p-value= 0,000;OR= 6,206; CI= 2,905-13,257). Analisis multivariat menunjukkan faktor risiko yang paling berpengaruh adalah terdapatjentik nyamuk di TPA sekitar rumah (p-value= 0,013; OR= 3,837; CI= 1,322-11,131). Hasil uji dengan RDT pada 7 sampeldarah didapatkan 2 positif Chikungunya IgM. Telah terjadi KLB Demam Chikungunya di Kecamatan Batang ToruKabupaten Tapanuli Selatan. Penularan chikungunya terjadi secara terus-menerus dan sumber penularan lebih dari 1orang.Kata kunci: faktor risiko, KLB, demam chikungunyaABSTRACTChikungunya fever is a vector-borne disease with high morbidity rates it caused socioeconomic impact. On 17 January2014, an outbreak of Chikungunya fever was reported in Batang Toru Sub-district, South Tapanuli District, North Sumatera.The total number of cases were 74 with no fatalities. An analytical study with case control design was undertaken todetermine the risk factors of the outbreak. The cases were population with major clinical symptoms of Chikungunya, such asfever, arthralgia, myalgia, rash and headache. Controls were neighbours of the cases who did'nt have clinical symptoms ofchikungunya. The study used bivariate analyses with chi-square and logistic regression (95% confidence level). Somepatient's blood were tested with rapid diagnostic test (RDT) of IgM Chikungunya. The bivariate analysis showed thatvariable associated with the incidence of chikungunya were sleeping without bednets in the morning anf afternoon (p- value:0,000; OR= 4.825, CI= 2.379-9.782) and the mosquitoes larvaes in the water reservoirs around the house (p-value: 0.013;OR=3.837; CI=1.322-11.131). The result of RDT confirmed that two of seven cases were positive for IgM Chikungunya.Outbreak of chikungunya fever was confirmed. Chikungunya transmission occured continuosly and the source oftransmission was more than one person.Key words: risk factor, outbreak, chikungunya fever

Diabetes Mellitus (DM) is a chronic disease that is frightening because a lifelong disease and can not be cured. Diabetics should pay attention to their blood sugar levels to improve their quality of life and can be a burden not only for the patient's but also their family. One of the interventions to overcome this problem is psychoeducation. It is a therapy to provide information to individuals who are experiencing distress, providing education to improve skills and be able to understand and have coping due to illness that causes problems in family relationships. The study objective was to determine the effect of psychoeducation on the family and DM patients at the clinic of Prof. Dr Soerojo Magelang. It was an experimental design with pretest and post test. Intervention group will be given psychoeducation both patient and family while control group without psychoeducation. Respondents were patients and family with random allocation sampling. Before and after psychoeducation will be measured to the family about family burden, control regularly and family support. The result showed that variable of psychoeducation was realted to family burden (p

Demam Berdarah Dengue (DBD) masih merupakan masalah kesehatan masyarakat di SumateraUtara yang merupakan daerah endemis. Program pengendalian DBD diharapkan dapat memberikan informasitentang endemisitas dari suatu daerah, musim penularan dan perkembangan penyakit yang dapat digunakanuntuk menjadikan sistem lebih efektif dan efisien. Penelitian ini adalah sebuah studi deskriptif yang dilakukandengan mengumpulkan dan menganalisis data DBD dari tahun 2010-2012. Evaluasi mengenai cara pencegahandan program pengendalian DBD telah dilakukan. Cara pencegahan dan program pengendalian DBD diSumatera Utara antara lain: pengamatan epidemiologi yang dilakukan pada semua kasus DBD; penemuan danmanajemen kasus di Rumah Sakit, dokter pribadi dan perawatan kesehatan primer; perluasan dan peningkatanpartisipasi masyarakat, pengendalian vektor di daerah DBD, sistem peringatan dini dan pengendalianperjangkitan, kerjasama dari berbagi sektor, monitoring dan evaluasi. Program pengandalian DBD di SumateraUtara perlu ditingkatkan dengan menambah kerjasama lintas sektor dan program untuk mengoptimalkanprogram tersebut, merotasi insektisida untuk menghindari resistensi vektor.Kata kunci: evaluasi, program pengendalian DBD, Sumatera UtaraABSTRACT. Dengue Hemorrhagic Fever (DHF) is still a public health problem in North Sumatera which is anendemic area. DHF control program is expected to result information about endemicity of an area, season oftransmission and disease progression that can be use to make the system more effective and efficient. It was adescriptive study by collecting and analyzing DHF data from 2010-2012. Evaluated had been done to the processof the DHF prevention and control program. The process of DHF prevention and control program in NorthSumatera such as: epidemiological surveillance conducted to all the DHF cases; discovery and management ofcases at hospitals, private physicians, and primary health care; extension and improvement of communityparticipation, vector control in the area of DHF, early warning systems and controlling outbreaks, partnerships /networks of multiple disciplines and sectors, monitoring and evaluation. DHF control program in NorthSumatera needs to be improved, increasing collaboration across sector and programs to optimize the program,rotate the insecticide to avoid resistance vectors.Key words: Evaluation, DHF Control Program, North Sumatera

Introduction: Dengue Haemorrhagic Fever (DHF) is still a public health problem in Singkawang Municipalitywhich was an endemic area. DHF surveillance is expected to inform endemicity of an area, season of transmission anddisease progression that can be use to make the system more effective and efficient.Methods: Observational study by using a structured questionnaire. Interview was conducted to all DHF surveillanceofficers. Evaluated had been done to the variable of input, process, and output of the surveillance system. We conducted anon the job training to all DHF surveillance officers after the evaluation.Results: 66.7% officers never got any trainings of surveillance, 83.3% had double duty, budgeting limited to physicalneeds, facilities and infrastructures. Process variable, data collection was late; analysis and recommendation had notbeen directed to the distribution of cases, the relationship between risk factors and the mortality of DHF incidence, andenvironment changing, feedback; data distribution had not been implemented optimally. Output variable was still weak,no surveillance epidemiology profile. Attribute surveillance such as simplicity, flexibility, and positive predictive valuewere good, but still weak in acceptability, sensitivity, representativeness, and timeliness. Short-term evaluation resultedthat there was an increasing knowledge of surveillance officers (p value was an increasing of completeness and accuracy of DHF report from 80% to 100%, active case finding, epidemiologyinvestigation conducted to all DHF cases.Discussion and Conclusions : DHF surveillance system in Singkawang needs to be improved, there were many attributesof surveillance system that had not done well. Training of surveillance system is needed to improve capability and capacityof the surveillance officers.Keywords: Evaluation, Surveillance, DHF, Singkawang

Background Chikungunya fever is a vector-borne disease with high morbidity rates, prolonged polyarthritis in some cases and it cause substantial socioeconomic impact. On 4 January 2010, an outbreak of Chikungunya fever was reported in West Borneo in Indonesia. The total number of cases was 65 with no fatalities. An analytical study was undertaken to determine the risk factors for the outbreak. Method This was an observational study with case control design. Cases were those with major clinical symptoms of Chikungunya fever, such as fever, arthalgia, myalgia, rash and headache. Controls were neighbours of cases who did not have clinical symptoms of the disease. The study used bivariate and multivariate analyses with χ 2 and logistic regression. OR was used to determine risk factors. Some patient9s blood was tested to confirm the diagnosis. Results From the bivariate analyses, risk factors were farming in the forest (p value Conclusions Farming in the forest was a risk factor for infection. This was the basis for health promotion and prevention of future cases of Chikungunya fever in West Borneo.