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Risk Factors and Predictive Model of Diarrhea in Kupang Irfan, Irfan -
Jurnal Kesehatan Masyarakat Vol 12, No 1 (2016): JURNAL KESEHATAN MASYARAKAT (KEMAS) JULY 2016
Publisher : Jurusan Ilmu Kesehatan Masyarakat Fakultas Ilmu Keolahragaan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v12i1.4013

Abstract

Diarrhea is still endemic in NTT province and in Kupang City. The disease also includes as one of the 10 major diseases in Kupang City. Diarrhea prevention will work more effectively if it is conducted based on the knowledge of risk factors for diarrhea. The study aims at analyzing the risk factors of diarrhea and predictive models of diarrhea incidence in Kupang. The observational analytic research used case control design with case samples consisted of 62 patients with diarrhea in June 2015 taken by random sampling and control samples consisted of 62 children who were not listed as diarrhea patients in June 2015. The data was collected through interviews and observation. Bivariate and multivariate analyses were performed using logistic regression. Four variables that significant are age of stop getting breast milk (ASI) (OR 5.673), latrine type (OR 4.527), children age (OR 1.460) and number of family members (OR 0.484). The regression model resulted in the study is Ŷ = -0.630 + 1.736 age of stop drinking breast milk + 1.510 latrine type + 0.379 children age - 0.726 number of family members.
Risk Factors and Predictive Model of Diarrhea in Kupang Irfan, Irfan -
KEMAS: Jurnal Kesehatan Masyarakat Vol 12, No 1 (2016)
Publisher : Department of Public Health, Faculty of Sport Science, Universitas Negeri Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/kemas.v12i1.4013

Abstract

Diarrhea is still endemic in NTT province and in Kupang City. The disease also includes as one of the 10 major diseases in Kupang City. Diarrhea prevention will work more effectively if it is conducted based on the knowledge of risk factors for diarrhea. The study aims at analyzing the risk factors of diarrhea and predictive models of diarrhea incidence in Kupang. The observational analytic research used case control design with case samples consisted of 62 patients with diarrhea in June 2015 taken by random sampling and control samples consisted of 62 children who were not listed as diarrhea patients in June 2015. The data was collected through interviews and observation. Bivariate and multivariate analyses were performed using logistic regression. Four variables that significant are age of stop getting breast milk (ASI) (OR 5.673), latrine type (OR 4.527), children age (OR 1.460) and number of family members (OR 0.484). The regression model resulted in the study is Ŷ = -0.630 + 1.736 age of stop drinking breast milk + 1.510 latrine type + 0.379 children age - 0.726 number of family members.
Employment, Knowledge and Latrine Ownership as Risk Factors and Prediction Model of Diarrhea Incidence Irfan Irfan; Sulansi Sulansi
International Journal of Public Health Science (IJPHS) Vol 5, No 2: June 2016
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (108.581 KB) | DOI: 10.11591/ijphs.v5i2.4780

Abstract

Diarrhea is a leading cause of death ranked 3rd after Tuberculosis and Pneumonia in Indonesia. Diarrhea cases in NTT province and also in Kupang City is still high, with Pasir Panjang PHC in 2012 and 2013 ranked the top three, while Oepoi PHC always the lowest rank. This research was conducted to analyze the risk factors for the incidence of diarrhea and create a model equation to predict the diarrhea incidence. This observational analytic research using case control design. Samples with diarrhea cases were recorded in January - June 2015 in the register book Pasir Panjang PHC and Oepoi PHC taken by random sampling to obtain samples for cases 62 children of Diarrhea patient. The control samples are 62 children who are not registered as suffering from diarrhea in the month of June 2015, close to the patient’s house, and her mother or people who responsible to take care that children want as respondent. Data were obtained by interviews with the mothers of cases and controls using questionnaires and direct observation using a checklist. Data were analyzed using univariate, bivariate and multivariate logistic regression. There are three variables that significantly affect to the diarrhea incidence, namely employment, knowledge and latrine ownership and the most dominant variable influence that is knowledge (OR 4.353). The model equation Y = - 2.048 +1.153 employment + 1.483 knowledge + 1.480 latrine ownership with a percentage accuracy of the model in classifying observations is 68.5%.
Hepatitis B Virus Infection in Hemodialisis patient at Prof. DR. W.Z. Johannes Kupang Hospital, East Nusa Tenggara Irfan Irfan; Aris Wawomeo; Norma Tiku Kambuno
JURNAL KESEHATAN PRIMER Vol 4 No 1 (2019): JKP (Jurnal Kesehatan Primer)
Publisher : Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.5281/jkp.v4i1.262

Abstract

Background: Hepatitis B or serum hepatitis is a liver infection caused by the hepatitis B virus (VHB) a member of the Hepadnavirus family that can lead to acute and chronic liver inflammation that can continue to be liver cirrhosis or liver cancer. Purpose: This research aims to determine the description of hepatitis B in hemodialysis patients in the Hospital Prof. Dr. W. Z. Johannes Kupang. Methods: This research is a descriptive study. Sampling was done by purposive sampling technique and a total sample of 63 hemodialysis patients. The inclusion criteria of the sample were those had got hemodialysis therapy> 6 months. Data was taken by interview based on a questionnaire to determine the history of hemodialysis, frequency of hemodialysis, history of blood transfusion and examination of blood serum by researchers who were accompanied by laboratory instructors. Results: The results showed that the infection of hepatitis B in hemodialysis patients in hospital Prof. Dr. W.Z. Johannes Kupang from 63 samples obtained 7 positive/reactive HBsAg (11%). Conclusion: History of hemodialysis, frequency of hemodialysis and history of blood transfusion were factors that have the potential to be a source of hepatitis B infection.
Penyakit Malaria dan Faktor Risikonya Wanti Wanti; Stephani Mangi; Oktovianus Sila; Johanes P. Sadukh; Irfan Irfan
Jurnal Riset Kesehatan Vol 4, No 3 (2015): September 2015
Publisher : Poltekkes Kemenkes Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31983/jrk.v4i3.370

Abstract

This analytic observational research used case control study with the research variables are knowledge, attitude, practice, and breeding place distance. All of the positive malaria patients are used as case group that are 32 people and as a control group used 32 healthy people around the case group. The data were collected by applying interview and observation and then data be analysed using chi square (α 0,05) to know the relation between the independent and dependent variables. The research result shows there are relation between the malaria prevalence with attitude (ρ 0,017), practice (ρ 0,013), and breeding palce distance (ρ=0,000). The conclusion is that the good knowledge can not influence the community to have a good attitude and to apply in daily life to do malaria combating. It is important to do health promotion of malaria especially to improve the knowledge and to apply their knowledge in daily activities to combat the malaria disease.
Factors Affecting the Incidence of Filariasis in Welamosa Village Ende District East Nusa Tenggara Irfan Irfan; Norma Tiku Kambuno; Israfil Israfil
Global Medical & Health Communication (GMHC) Vol 6, No 2 (2018)
Publisher : Universitas Islam Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (520.132 KB) | DOI: 10.29313/gmhc.v6i2.3208

Abstract

Filariasis is a chronic communicable disease caused by filarial worms, which consists of three species: Wucherria bancrofti, Brugaria malayi, and Brugaria timori. This disease is transmitted through mosquito bites, infects lymph tissue (lymph) and causes swelling of the legs, breasts, arms and genital organs. Welamosa village, Ende district, located in East Nusa Tenggara (NTT) province is reported as one of the highest cases of 40 cases in 2015. This research aims to analyze the influence of social factor of demography and socio-cultural environment factor to elephantiasis incident in Welamosa village, Ende district. The study was conducted in July–September 2016 in Welamosa village and Wolowaru sub-district, Ende district. The type of research was observational analytic with case-control with 49 people as sampling. The research instrument used questionnaire and check list. The data analysis used statistical test of SPSS program with backward regression logistic test. The results showed five variables as risk factors of elephantiasis occurrence, age (OR=42.518), education (OR=38.248), occupation (OR=8.404), outdoor activity at night (OR=5.097) and sex (OR=0.193). In conclusion, social demographic factors (age, gender, occupation, and education) and environmental and social-cultural factors of attitude (outdoor activities at night) are risk factors for filariasis incidence in Welamosa village, Ende district. FAKTOR YANG MEMENGARUHI KEJADIAN PENYAKIT FILARIASIS DI DESA WELAMOSA KABUPATEN ENDE NUSA TENGGARA TIMURFilariasis adalah penyakit menular menahun yang disebabkan oleh parasit berupa cacing filaria yang terdiri atas tiga spesies, yaitu Wucherria bancrofti, Brugaria malayi, dan Brugaria timori. Penyakit ini menginfeksi jaringan limfe (getah bening) dan menular melalui gigitan nyamuk, serta menyebabkan pembengkakan kaki, tungkai, payudara, lengan, dan organ genital. Desa Welamosa, Kabupaten Ende terletak di Provinsi Nusa Tenggara Timur (NTT) dilaporkan sebagai salah satu kecamatan dengan kasus filariasis tertinggi, yakni 40 kasus pada tahun 2015. Tujuan penelitian adalah menganalisis pengaruh faktor sosial demografi dan faktor lingkungan sosial budaya terhadap kejadian filariasis di Desa Welamosa, Kabupaten Ende. Penelitian dilaksanakan pada bulan Juli–September 2016 di Desa Welamosa dan Kecamatan Wolowaru, Kabupaten Ende. Jenis penelitian merupakan analitik observasional dan pengambilan sampel menggunakan case control sebanyak 49 orang. Instrumen penelitian menggunakan kuesioner dan ceklis. Analisis data menggunakan uji statistik program SPSS dengan backward regression logistic test. Hasil penelitian menunjukkan lima variabel yang merupakan faktor risiko kejadian filariasis, yaitu usia (OR=42,518), pendidikan (OR=38,248), pekerjaan (OR=8,404), aktivitas di luar rumah pada malam hari (OR=5,097), dan jenis kelamin (OR=0,193). Simpulan, faktor sosial demografi (usia, jenis kelamin, pekerjaan, dan pendidikan) serta faktor lingkungan sosial budaya sikap (aktivitas di luar rumah pada malam hari) merupakan faktor risiko terhadap kejadian filariasis di Desa Welamosa, Kabupaten Ende. 
The Availability of Health Resources on the Performance of Maternal and Child Health Policy Implementation in East Nusa Tenggara Florentianus Tat; Irfan Irfan; Maria Magdalena Bait
Global Medical & Health Communication (GMHC) Vol 8, No 3 (2020)
Publisher : Universitas Islam Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (268.823 KB) | DOI: 10.29313/gmhc.v8i3.6082

Abstract

Maternal and child health problems continue to be priority health issues in Indonesia, especially in East Nusa Tenggara (NTT). The maternal mortality rate in NTT has reached 159/100,000 live births, while infant and under-five mortality rates have reached 32/1000 live births and 40/1,000 live births, respectively above the national value of 23/1000 live births and 32/1,000 live births. It indicates that the health and maternal and child health policies in NTT have not been maximally implemented. One of the causes is the lack of available health worker resources that provide health services. The research objective is to identify the effect of health resources' availability on the performance of maternal and child health policy implementation in NTT. A quantitative research method for data collection was carried out in 11 districts in NTT and 104 public health centers (pusat kesehatan masyarakat, puskesmas) towards 235 health workers from August to December 2019. The results show that the health workers were categorized as insufficient/not available (mean value of 2.64), and puskemas did not have doctors, midwives, and nurses conforming to standards. There was also inadequacy in some aspects such as budget (average value of 2.45), medical devices (average value of 2.75), medicines and medical supplies, buildings, and transport. A correlation was found between resources and the performance of maternal and child health policies (p=0.00) with a coefficient correlation of 0.546. It indicates a strong and positive correlation, which means that if there is an increase in resources, maternal and child health policy implementation will also. Partial linear regression tests showed t arithmetic=13.304 >t table 1.97, which means that H0 was rejected. It suggests a significant effect between resources and the performance of maternal and child health policy implementation in NTT. In conclusion, resources had a positively impact on the performance of maternal and child health policy in NTT. PENGARUH KETERSEDIAAN SUMBER DAYA KESEHATAN TERHADAP KINERJA IMPLEMENTASI KEBIJAKAN KESEHATAN IBU DAN ANAK DI NUSA TENGGARA TIMURPermasalahan kesehatan ibu dan anak (KIA) terus menjadi prioritas masalah kesehatan di Indonesia khususnya di Nusa Tenggara Timur (NTT). Angka kematian ibu di NTT mencapai 159/100.000 kelahiran hidup (KH), sedangkan angka kematian bayi dan balita mencapai 32/1.000 KH dan 40/1.000 KH yang masing-masing di atas nilai nasional, yaitu 23/1.000 KH dan 32/1.000 KH. Kondisi tersebut mengindikasikan bahwa penerapan kebijakan KIA di NTT belum dilaksanakan secara maksimal. Salah satu penyebabnya adalah sumber daya manusia kesehatan yang memberikan pelayanan kesehatan kurang tersedia. Tujuan penelitian adalah mengidentifikasi pengaruh ketersediaan sumber daya manusia kesehatan terhadap kinerja penerapan kebijakan KIA di NTT. Metode penelitian adalah kuantitatif. Pengumpulan data dilakukan di 11 kabupaten dan 104 pusat kesehatan masyarakat (puskesmas) pada 235 tenaga kesehatan dari bulan Agustus hingga Desember 2019. Hasil penelitian menunjukkan bahwa tenaga kesehatan dikategorikan tidak cukup/tidak tersedia (nilai rerata 2,64) dan puskesmas tidak memiliki dokter, bidan, dan perawat sesuai standar. Selain itu, terdapat juga kekurangan di beberapa aspek seperti anggaran biaya (nilai rerata 2,45), alat kesehatan (nilai rerata 2,75), obat dan perbekalan kesehatan, alat medis, bangunan, serta alat transportasi. Korelasi ditemukan antara sumber daya dan kinerja penerapan kebijakan KIA (p=0,00) dengan koefisien korelasi 0,546. Hal ini berarti korelasi cukup kuat dan positif, artinya jika sumber daya ditingkatkan maka kinerja implementasi kebijakan KIA juga meningkat. Uji regresi linier parsial menunjukkan t hitung=13,304 >t tabel 1,97 yang bermakna H0 ditolak. Hal ini menunjukkan pengaruh yang signifikan antara sumber daya dan kinerja penerapan kebijakan KIA di Provinsi NTT. Simpulan, sumber daya berpengaruh positif terhadap kinerja penerapan kebijakan KIA di NTT.
Pelatihan Penerapan Perilaku Hidup Bersih Sehat (PHBS) untuk Pencegahan Covid 19 di Lingkungan Pondok Pesantren Irfan Irfan; Ririn Widyastuti; Fitri Handayani
Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM) Vol 5, No 6 (2022): Volume 5 No 6 Juni 2022
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v5i6.6104

Abstract

ABSTRAK Corona virus 19 (covid 19) disebabkan oleh sars-Cov-2 yang menyerang sistem pernafasan. Covid 19 mewabah di seluruh dunia termasuk Indonesia yang memberikan dampak pada semua sektor termasuk di pendidikan. Pondok pesantren merupakan institusi pendidikan keagamaan dimana  santri/murid pada umumnya tinggal di pondok/asrama yang disediakan oleh pihak sekolah. Masalah kesehatan di pondok pesantren tidak berbeda dengan anak sekolah umum. Tujuan dari kegiatan ini  untuk meningkatkan pengetahun siswa (santriwan/santriwati) untuk menerapkan PHBS di lingkungan pondok pesantren Hidayatullah Kota Kupang. Bentuk kegiatan pengabdian masayarakat adalah pelatihan penerapan PHBS pada siswa Pondok Pesantren Hidayatullah Kota Kupang. Peningkatan hasil pre dan post tes siswa dalam menerapkan PHBS di lingkungan Pondok Pesantren Hidayatullah Kota Kupang menunjukkan rerata pretest 64,90 dan rerata post test 81,90. Pemberian pelatihan penerapan PHBS efektif meningkatkan pengetahuan siswa untuk mencegah covid 19 di lingkungan Pondok Pesantren Hidayatullah Kota Kupang. Kata Kunci: Pelatihan, PHBS, Covid 19  ABSTRACT Corona virus 19 (covid 19) is caused by SARS-CoV-2 which attacks the respiratory system. Covid 19 is endemic throughout the world, including Indonesia, which has an impact on all sectors including education. Islamic boarding school is a religious education institution where students generally live in a boarding house provided by the school. Health problems in Islamic boarding schools are no different from public school children. Purpose to increase the knowledge of students to implement PHBS in the Hidayatullah Islamic boarding school, Kupang City. Training on the application of PHBS to Hidayatullah Islamic Boarding School students, Kupang City. Result: The increase in students' pre and post test results in implementing PHBS in the Hidayatullah Islamic Boarding School in Kupang City showed a pretest mean of 64.90 and a post test average of 81.90. Conclusion: the provision of training on the application of PHBS is effective in increasing student knowledge to prevent covid 19 in the Hidayatullah Islamic Boarding School, Kupang City. Keywords : Training, PHBS, Covid 19
Pemanfaatan Video Kehamilan Berkualitas Untuk Meningkatkan Pengetahuan Ibu Hamil Di Masa Pandemic Covid 19 Irfan Irfan; Ririn Widyastuti; Fitri Handayani
JURNAL KREATIVITAS PENGABDIAN KEPADA MASYARAKAT (PKM) Volume 4 Nomor 5 Oktober 2021
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v4i5.4192

Abstract

ABSTRAK Ibu hamil lebih rentan terhadap morbiditas Covid 19 dikarenakan perubahan fisiologis dan imunologis selama masa kehamilan. Salah satu upaya asuhan pada masa pandemi covid untuk mencegah penularan dan penyebaran covid 19 adalah adalah dengan meningkatkan pengetahuan ibu hamil melalui promosi kesehatan tentang kehamilan berkualitas. Tujuan pengabdian masyarakat adalah untuk meningkatkan pengetahun ibu hamil melalui pemberian video kehamilan berkualitas pada masa pandemic covid 19. Pelaksanaan kegiatan pengabdian masyarakat dengan cara memberikan penyuluhan, konseling informasi dan edukasi (KIE) kepada ibu hamil dengan menggunakan media video kehamilan berkualitas di Puskesmas Oepoi Kota Kupang. Analisis univariate disajikan dalam bentuk tabel distribusi frekuensi. Analisis bivariate dengan menggunakan uji paired sample t – test untuk mengetahui perbedaan sebelum dan setelah pemberian penyuluhan dan KIE pada ibu hamil. Hasil Pengabdian masyarakat adalah terjadi  Peningkatan rerata pengetahuan ibu hamil sebelum perlakuan 64.25 dan setelah perlakuan meningkat menjadi 81.08. Hasil uji paired samples t-test menunjukkan bahwa ada perbedaan bermakna pengetahuan ibu hamil tentang kehamilan berkualitas pada masa covid 19 (p < 0,05); Saran: perlu pengembangan telemedicine untuk memberikan asuhan pada masa kehamilan di masa pandemic covid 19. Kata kunci: Ibu hamil, Pengetahuan, Kehamilan berkualitas, Covid 19  ABSTRACK Pregnant women are more prone to Covid 19 morbidity due to physiological and immunological changes during pregnancy. One of the care efforts during the Covid pandemic to prevent the transmission and spread of Covid 19 is to increase the knowledge of pregnant women through health promotion about quality pregnancies. The aim of community service is to increase the knowledge of pregnant women by providing quality pregnancy videos during the COVID-19 pandemic. Implementation of community service activities by giving counseling, information counseling, and education (IEC) to pregnant women using quality pregnancy video media at Oepoi Health Center, Kupang City. Univariate analysis is presented in the form of a frequency distribution table. Bivariate analysis using paired sample t-test to determine the differences before and after counseling and IEC for pregnant women. The result of community service was that there was an increase in the mean knowledge of pregnant women before treatment of 64.25 and after treatment increased to 81.08. The results of the paired samples t-test showed that there were significant differences in the knowledge of pregnant women about quality pregnancies during the Covid 19 period (p <0.05); Suggestion: it is necessary to develop telemedicine to provide care during pregnancy during the Covid pandemic 19. Keywords: Pregnant women, knowledge, quality pregnancy, Covid 19
Pendampingan Umkm Kelompok Tani Kelor ”Sejahtera Bersama” Wanti Wanti; Ragu Harming Kristina; Kusmiyati Kusmiyati; Irfan Irfan; Ferry WF Waangsir; Indhira Shagti; Christina Rosanty Nenotek; Yurissetiowati Yurissetiowati
Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM) Vol 5, No 12 (2022): Volume 5 No 12 Desember 2022
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v5i12.8151

Abstract

ABSTRAK Wilayah NTT merupakah wilayah yang banyak ditumbuhi oleh tanaman tropis salah satunya adalah kelor. Pohon kelor memunyai banyak manfaat bagi kesehatan oleh karena itu pohon ini mempunyai nama lain sebagai pohon ajaib. Pemerintah Propinsi NTT membuka lahan untuk budidaya kelor sampai dengan menghasilkan produk seperti bubuk kelor, teh kelor dan kopi kelor. Namun usaha tersebut mengalami banyak kendala di lapangan sampai dengan proses pengepakan serta uji standar mutu Produk yang dihasilkan oleh karena itu dibutuhkan kerjasama dari banyak pihak untuk memberikan support sistem terhadap kebijakan pemerintah tersebut. Tujuan dari pengabdian masyarakat ini adalah memberikan pelatihan pengelolaan pangan yang higienes dan pendampingan pengembangan berbagai jenis produk pangan berbahan dasar kelor. Metode pengabdian masyarakat yang digunakan adalah memberikan pelatihan dan pendampingan tentang pengelolaan pangan yang higienes dan pengembangan berbagai jenis produk pangan berbahan dasar kelor terhadap 6 peserta di Desa Otan Kecamatan Semau Kabupaten Kupang Provinsi Nusa Tenggara Timur pada tanggal 03 Juli – 04 Juli 2021. Hasil kegitaan ini diambil menggunakan penilaian pre test dan post test. Pada aspek pengetahuan dan keterampilan mitra terdapat perubahan yang signifikan bahwa seluruhnya dari peserta memiliki pengetahuan baik tentang pengelolaan pangan yang higienes dan pengembangan berbagai jenis produk pangan berbahan dasar kelor. Kesimpulan terdapat peningkatan pengetahuan dan keterampilan peserta tentang pengelolaan pangan yang higienes dan pendampingan pengembangan berbagai jenis produk pangan berbahan dasar kelor. Kata Kunci: Pendampingan, Kelor, UMKM  ABSTRACT The NTT region is an area that is overgrown by tropical plants, one of which is Moringa. Moringa tree has many benefits for health, therefore this tree has another name as a magic tree. The NTT Provincial Government opened land for the cultivation of Moringa to produce products such as Moringa powder, Moringa tea and Moringa coffee. However, the business encountered many obstacles in the field, up to the packaging process and testing of product quality standards, therefore cooperation from many parties was needed to provide system support for the government's policy. The purpose of this community service is to provide training in hygienic food management and assistance in the development of various types of moringa-based food products. The community service method used is to provide training and assistance on hygienic food management and the development of various types of moringa-based food products to 6 participants in Otan Village, Semau District, Kupang Regency, East Nusa Tenggara Province on 03 July – 04 July 2021. The results of this activity taken using pre-test and post-test assessments. In the aspect of knowledge and skills of partners, there was a significant change that all of the participants had good knowledge of hygienic food management and the development of various types of moringa-based food products. The conclusion is that there is an increase in participants' knowledge and skills about hygienic food management and assistance in the development of various types of moringa-based food products. Keywords: Mentoring, Moringa, UMKM