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Adherence to mass drug administration and environmental factors related to lymphatic filariasis incidence: A case-control study in endemic area, Papua, Indonesia Wayangkau, Erich C.; Budiyono, Budiyono; Raharjo, Mursid; Martini, Martini
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.2143

Abstract

Papua has the highest number of lymphatic filariasis cases in Indonesia. Despite the implementation of mass drug administration (MDA), adherence to MDA remains low in this region. The aim of this study was to evaluate the influence of adherence to MDA and environmental factors on the incidence of lymphatic filariasis. The study was conducted in 11 areas in Sarmi Regency, Papua, in 2024. This case-control study included 135 respondents (45 cases and 90 controls) selected through a proportional random sampling method. Data were collected via structured interviews, observations, and medical record reviews. Data analysis was performed using logistic regression with the backward likelihood ratio method to identify risk factors. The study revealed that male (aOR: 4.88; 95%CI: 1.39–17.06; p=0.013), age ≥40 years (aOR: 4.65; 95%CI: 2.26–7.00; p=0.002), low education level (aOR: 0.24; 95%CI: 0.07–0.84; p=0.025), and income below the regional minimum wage (aOR: 15.66; 95%CI: 1.84–30.26; p=0.012) were significant risk factors for lymphatic filariasis incidence. Non-consumption of complete antifilarial drugs (aOR: 3.24; 95%CI: 1.00–10.50; p=0.050), not taking antifilarial drugs at the recommended time (aOR: 7.36; 95%CI: 1.99–27.23; p=0.003), and delayed consumption of antifilarial drugs (aOR: 3.73; 95%CI: 1.09–12.73; p=0.036) were adherence-related factors associated with an increased risk. Furthermore, not wearing long-sleeved clothing at night (aOR: 6.73; 95%CI: 1.81–24.94; p=0.004) was significantly associated with lymphatic filariasis incidence. The dimensions of MDA medication adherence, including the consumption of preventive antifilarial drugs, night-time dosing, and immediate consumption of antifilarial drugs after distribution, were associated with lymphatic filariasis incidence in Papua. This study suggests that MDA programs against filariasis in endemic areas need to be supported by adherence-focused interventions to enhance the effectiveness of prevention efforts.
FAKTOR VEKTOR DAN HOST YANG BERHUBUNGAN DENGAN KEJADIAN MALARIA DI DAERAH ENDEMIS KABUPATEN PESAWARAN PROVINSI LAMPUNG Aslina, Enna; Martini, Martini; Raharjo, Mursid
PREPOTIF : JURNAL KESEHATAN MASYARAKAT Vol. 9 No. 1 (2025): APRIL 2025
Publisher : Universitas Pahlawan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/prepotif.v9i1.41858

Abstract

Malaria adalah satu penyakit tular vector yang dapat menyebabkan kematian, Indonesia menjadi salah satu negara yang beresiko terhadap penyakit malaria karena iklim di Indonesia sangat cocok untuk perkembangbiakan vector Anopheles yang menjadi perantara penularan penyakit malaria. Pada tahun 2020 tercatat sebanyak 254.050 kasus terjadi dengan API (annual parasite incidence) 0,94 per 1000 penduduk. Provinsi Lampung khususnya Kabupaten Pesawaran adalah kabupaten yang belum mencapai eliminasi untuk penyakit malaria dan merupakan daerah endemis dengan kondisi alam berada didaerah pesisir Pantai, hutan, tambak terlantar yang berpotensi sebagai perindukan vector. Selain vector, factor host menjadi salah satu factor pendukung untuk terjadinya kasus malaria, karena dalam setiap kegiatan manusia akan selalu berkaitan dengan pengetahuan, sikap dan perilaku. Pengandalian dan Pencegahan malaria akan efektif bila berangkat dari factor resiko yaitu vector dan host yang mempengaruhi kasus malaria. Maka tujuan penelitian ini adalah mengatahui tentang ekologi vector dengan kejadian malaria serta mengetahui pengetahuan, sikap dan perilaku host yang mempengaruhi kejadian malaria. Jenis penelitian yang dilakukan oleh penulis adalah penelitian observasional dengan desain penelitian cross sectional. Prosedur yang dilakukan dalam penelitian cross sectional adalah mengidentifikasi variabel penelitian, menetapkan subyek penelitian, melakukan observasi dan atau pengukuran serta melakukan analisis data dengan menggunakan uji statistic korelasi. Untuk kepadatan vector berdasarkan survey vector yang dilakukan nilai Man Bitting Rate sudah melebihi ambang batas sesuai dengan peraturan yang diperbolehkan, sedangkan untuk factor host untuk bahwa tidak ada hubungan yang signifikan antara kategori Sikap dengan Kejadian Malaria. Sedangkan untuk pengetahuan disimpulkan bahwa ada hubungan yang signifikan antara kategori pengetahuan dengan Kejadian Malaria. Vektor nyamuk Anopheles yang kontak dengan manusia memiliki nilai melebihi standar baku mutu Kesehatan lingkunga, yang artinya kepadatan vektor sangat mempengaruhi kejadian malaria.
Technical Management Impact Assessment Wastewater Against Health Problems in Sanitarian Workers at Hospital X With A Life Cycle Analysis (LCA) Approach Nurdiyanto, Miftakhul; Joko, Tri; Raharjo, Mursid
Journal of Social Research Vol. 4 No. 6 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v4i6.2574

Abstract

Hospital wastewater, laden with organic, microbial, and chemical contaminants, poses significant environmental and occupational health risks. Despite regulations, gaps persist in integrated assessment and mitigation strategies. This study evaluates the environmental and health impacts of wastewater management at Hospital X using LCA, identifying hotspots in energy use, chemical toxicity, and worker exposure. A mixed-methods approach combined LCA (SimaPro 9.0, ReCiPe 2016 Midpoint) with surveys of 33 sanitarian workers. Data included WWTP performance metrics, effluent quality, and health complaints. The WWTP (100 m³/day) exceeded capacity (105 m³/day), with aeration (45% of GHG emissions) and chlorine use (20% human toxicity) as key hotspots. Health surveys revealed 85% of workers suffered respiratory/skin issues, correlating with LCA-identified exposure risks. The study underscores the need for capacity expansion (?300 m³/day), automation (sludge handling), and renewable energy integration, offering a model for sustainable hospital wastewater management in Indonesia.
Hazard Identification and Exposure Assessment for Wastewater Management Workers Nurdiyanto, Miftakhul; Joko, Tri; Raharjo, Mursid
Indonesian Journal of Global Health Research Vol 7 No 5 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i5.6696

Abstract

Sanitation workers in hospitals are at high risk of developing health disorders due to direct exposure to wastewater during the operation and maintenance of wastewater treatment plants (WWTP). This study aims to identify the types of health problems experienced by 33 sanitation personnel at Sentra Medika Cibinong Hospital and to analyze the contribution of wastewater treatment processes to these health risks using the Life Cycle Assessment (LCA) approach. Methods: This study employed a qualitative descriptive method using a Life Cycle Assessment (LCA) approach. From a total population of 33 individuals, the researcher selected all 33 as the study sample. Data were analyzed using both quantitative and qualitative approaches. Additionally, the Life Cycle Assessment (LCA) methodology was employed to identify environmental impacts and potential health risks arising from the hospital's wastewater management system. Results: The results showed that 87.9% of the workers reported health complaints, including skin irritation, respiratory symptoms (shortness of breath, coughing), dizziness, nausea, vomiting, and gastrointestinal disorders. The highest exposure occurred during chemical dosing, sludge pit cleaning, and wastewater sampling. The LCA results indicated that the aeration and disinfection stages contributed significantly to hazardous emissions such as hydrogen sulfide (H₂S), chlorine, and fine particulates, which can pose serious health risks. Conclusion: This study highlights the urgent need to improve occupational health protection through proper use of personal protective equipment (PPE), routine training, and redesigning WWTP systems to be more worker-friendly. LCA proved to be an effective tool in identifying health-related risk hotspots throughout the wastewater management cycle.
Association Between Pesticide Exposure and Type 2 Diabetes Mellitus Among Female Farmers: A Cross-Sectional Study Masyithah, Wulan; Onny Setiani; Yusniar Hanani Darundiati; Mursid Raharjo; Nurjazuli
JURNAL KESEHATAN LINGKUNGAN Vol. 17 No. 3 (2025): JURNAL KESEHATAN LINGKUNGAN
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jkl.v17i3.2025.220-229

Abstract

Introduction: The widespread use of pesticides in agriculture has been linked to an increased risk of diabetes mellitus. Long-term exposure to pesticides can disrupt glucose metabolism, trigger insulin resistance, and raise susceptibility to diabetes mellitus. This study investigates the association between pesticide exposure and the incidence of type 2 diabetes mellitus. Methods: This analytical observational study with a cross-sectional design involved 162 female farmers selected by purposive sampling from a population of 2,187, using the Lemeshow formula. Independent variables included work duration, types and frequency of pesticide use, spraying duration and direction, PPE usage, and cholinesterase levels. The dependent variable was type 2 diabetes mellitus. Data were collected through questionnaires, observation, and clinical tests for blood glucose and cholinesterase levels. Logistic regression was performed at 95% CI and α = 0.05. Result and Discussion: The results showed that 69.1% of female farmers exposed to pesticides had diabetes with lower cholinesterase levels as a significant indicator (p<0.001; OR=3.897; 95% CI=2.087-7.277). Factors such as working duration ≥10 years (p=0.010; OR=3.564; 95% CI=1.359-9.346), number of pesticides types (p=0.023; OR=3.370; 95% CI=1.187-9.570), spraying duration (p=0.020; OR=3.083; 95% CI=1.197-7.940), and PPE usage (p=0.007; OR=3.601; 95% CI=1.416-9.159) were associated with type 2 diabetes mellitus. Conclusion: Pesticides, particularly organophosphates and carbamates, act as endocrine-disrupting chemicals that impair pancreatic function and increase oxidative stress, contributing to insulin resistance. Female farmers more vulnerable to these effects due to hormonal sensitivity, making gender specific approaches essential. Strict regulations and farmer education are crucial to reduce long-term health risks.
Pesticide Spraying Practices and Hypertension Risk among farmers in Bumen Village, Indonesia Masyithah, Wulan; Onny Setiani; Darundiati, Yusniar Hanani; Suhartono; Raharjo, Mursid; Hasim, Jamal Hisham
Gema Lingkungan Kesehatan Vol. 23 No. 3 (2025): Gema Lingkungan Kesehatan
Publisher : Poltekkes Kemenkes Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36568/gelinkes.v23i3.317

Abstract

This study investigated the association between pesticide spraying practices and hypertension in horticultural farmers in Bumen Village, Sumowono District, Indonesia. A cross-sectional study was conducted among 132 male farmers selected through purposive sampling. Data were collected through structured interviews, blood pressure measurements, and field observations. Logistic regression revealed that mixing ≥2 pesticide types (OR=4.828; p=0.028), spraying ≥4 times per week (OR=4.552; p=0.010), and incomplete PPE use (OR=3.551; p=0.015) were significantly associated with hypertension. These findings underscore the need for stricter pesticide regulation, improved PPE use, and regular health monitoring to reduce health risks among farmers.
Behavior determinants of malaria incidence in endemic areas of Kaligesing District, Purworejo Regency Fitriani, Dwi; Raharjo, Mursid
BKM Public Health and Community Medicine Vol 41 No 06 (2025)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v41i06.21207

Abstract

Purpose: The purpose of this study is to analyze the behavior of the community with the incidence of malaria in Kaligesing District. Methods: Using quantitative methods that were analyzed observationally with case-control studies. Sampling employed purposive sampling techniques, involving a total of 80 respondents, comprising 40 case group respondents and 40 control group respondents each. The instrument used is a questionnaire. Results: The results showed that the case group had lower knowledge (52.5%), which was higher compared to the control group (30%), as determined by the chi-square test with a p-value of 0.069. Negative attitudes were more prevalent in the case group (52.5%) compared to the control group (40%), as indicated by a chi-square test with a p-value of 0.370. Low action was found in the case group (50%) compared to the control (17.5%) and based on the chi-square test obtained a value of p=0.005, OR=4.714 and 95% CI OR (1.693 – 13.131) meaning that people who have less action on malaria prevention and control are 4.714 times more at risk of developing malaria than with people who have good measures on malaria prevention and control. Conclusion: There is no relationship between knowledge and attitudes with the incidence of malaria, and there is a relationship between actions and the incidence of malaria.
KOLABORASI LINTAS SEKTOR DALAM IMPLEMENTASI INTEGRATED VECTOR MANAGEMENT (IVM) UNTUK ELIMINASI MALARIA: STUDI KUALITATIF DI KABUPATEN MUARA ENIM Lewinsca, Maurend Yayank; Raharjo, Mursid; Setiadi, Robby
Jurnal 'Aisyiyah Medika Vol 10, No 2: Agustus 2025 Jurnal 'Aisyiyah Medika
Publisher : stikes 'aisyiyah palembang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36729/jam.v10i2.1432

Abstract

Latar Belakang: Malaria tetap menjadi masalah kesehatan masyarakat yang signifikan di Indonesia, dengan dampak yang besar terhadap kesehatan, ekonomi, dan kualitas hidup. Kabupaten Muara Enim menjadi kabupaten yang difokuskan pemerintah untuk melakukan eliminasi malaria yang ditargetkan di tahun 2024. Penelitian ini mengeksplorasi bagaimana upaya pengendalian vektor terpadu (PVT) yang dilakukan berdampak terhadap keberhasilan eliminasi malaria yang dilakukan. Tujuan: untuk mengetahui keterlibatan lintas sektor dalam pengendalian malaria di Kabupaten Muara Enim. Metode: berupa pendekatan kualitatif deskriptif, teknik wawancara mendalam dengan instrumen penelitian berupa pedoman wawancara mendalam atau interview guide. Informan dalam penelitian ini berjumlah 11 orang yang berasal dari instansi dinas kesehatan, puskesmas, pemerintah kecamatan, pemerintah desa, dan pihak sekolah. Pengolahan data dilakukan dengan transkrip wawancara, input, coding, nodes, matrix coding query, dan project map. Analisis data menggunakan aplikasi pengolah data kualitatif NVivo 12 Pro mulai dari data reduction, data display (visualisasi data dari total referensi pendapat dan project map), dan penarikan kesimpulan serta verifikasi. Hasil: Kolaborasi lintas sektor malaria di Kabupaten Muara Enim belum maksimal dilakukan karena beberapa program yang hanya ditahap perencanaan dan belum berkelanjutan, sinergitas antara pemerintah, organisasi non-pemerintah, dan masyarakat lokal dalam mencapai tujuan eliminasi malaria belum aktif dilakukan. Saran: Penelitian ini diharapkan dapat menjadi masukan bagi pembuat kebijakan dan peneliti dalam merancang strategi pengendalian malaria yang lebih komprehensif dan berkelanjutan agar eliminasi malaria dapat dilaksanakan.Kata kunci: Eliminasi, Malaria, Pengendalian, Vektor Terpadu
KOLABORASI LINTAS SEKTOR DALAM IMPLEMENTASI INTEGRATED VECTOR MANAGEMENT (IVM) UNTUK ELIMINASI MALARIA : STUDI KUALITATIF DI KABUPATEN MUARA ENIM Lewinsca, Maurend Yayank; Raharjo, Mursid; Setiadi, Robby
Jurnal 'Aisyiyah Medika Vol 10, No 2: Agustus 2025 Jurnal 'Aisyiyah Medika
Publisher : stikes 'aisyiyah palembang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36729/jam.v10i2.1434

Abstract

Latar Belakang: Malaria tetap menjadi masalah kesehatan masyarakat yang signifikan di Indonesia,dengan dampak yang besar terhadap kesehatan, ekonomi, dan kualitas hidup. Kabupaten Muara Enimmenjadi kabupaten yang difokuskan pemerintah untuk melakukan eliminasi malaria yang ditargetkan ditahun 2024. Penelitian ini mengeksplorasi bagaimana upaya pengendalian vektor terpadu (PVT) yangdilakukan berdampak terhadap keberhasilan eliminasi malaria yang dilakukan. Tujuan: untukmengetahui keterlibatan lintas sektor dalam pengendalian malaria di Kabupaten Muara Enim. Metode:berupa pendekatan kualitatif deskriptif, teknik wawancara mendalam dengan instrumen penelitianberupa pedoman wawancara mendalam atau interview guide. Informan dalam penelitian ini berjumlah11 orang yang berasal dari instansi dinas kesehatan, puskesmas, pemerintah kecamatan, pemerintahdesa, dan pihak sekolah. Pengolahan data dilakukan dengan transkrip wawancara, input, coding, nodes,matrix coding query, dan project map. Analisis data menggunakan aplikasi pengolah data kualitatifNVivo 12 Pro mulai dari data reduction, data display (visualisasi data dari total referensi pendapat danproject map), dan penarikan kesimpulan serta verifikasi. Hasil: Kolaborasi lintas sektor malaria diKabupaten Muara Enim belum maksimal dilakukan karena beberapa program yang hanya ditahapperencanaan dan belum berkelanjutan, sinergitas antara pemerintah, organisasi non-pemerintah, danmasyarakat lokal dalam mencapai tujuan eliminasi malaria belum aktif dilakukan. Saran: Penelitian inidiharapkan dapat menjadi masukan bagi pembuat kebijakan dan peneliti dalam merancang strategipengendalian malaria yang lebih komprehensif dan berkelanjutan agar eliminasi malaria dapatdilaksanakan.Kata kunci: Eliminasi, Malaria, Pengendalian, Vektor Terpadu
Spatial Analysis Of Environmental Factors On Malaria Incidence In The Working Area Of Bener Health Center, Purworejo Regency Pratiwi, Dian Eka; Raharjo, Mursid; Setiani, Onny
Jurnal Impresi Indonesia Vol. 4 No. 8 (2025): Jurnal Impresi Indonesia
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jii.v4i8.6930

Abstract

The Bener Health Center is one of the highest contributors to malaria cases in Purworejo District. In 2023, there were 134 malaria cases with an API of 2.25 per 1,000 population spread across 14 villages at the Bener Health Center. This study aims to determine the relationship between environmental factors and malaria incidence in the working area of Bener Health Center through a spatial approach. This study is a descriptive-analytical observational study with a case-control design. The case population in this study consists of 134 individuals, while the control population comprises 59,457 individuals. The sample size for this study is 81 cases and 81 controls. Data were collected through interviews and observations. Data analysis included statistical analysis (univariate, bivariate, multivariate) and spatial analysis. Bivariate analysis showed a relationship between the absence of wire netting (p-value = 0.024 and OR = 2.567), the presence of livestock shelters (p-value = 0.039 and OR = 2.029), and the presence of breeding places (p-value = 0.008 and OR = 3.403) with malaria incidence. Multivariate analysis showed that the absence of wire netting, the presence of livestock shelters, and the presence of breeding places simultaneously influenced the incidence of malaria in the working area of Bener Health Center. The distribution of malaria cases in the working area of Bener Health Center showed a clustered pattern.
Co-Authors -, Fitni Hidayati AA Sudharmawan, AA Adilasari, Philomena Larasati Aditya, Vanessa Rizky Agus Subagio Aini Nurul Alfia Nugrahani Sidhi Amarullah, Novi Ana Fauziah Andika Agus Iryanto Annisa Zolanda Annisa Zolanda Antonius Tae Asa, Antonius Tae Apoina Kartini Aslina, Enna Astri Wulandari Atyaf Umi Faizah Bagoes Widjanarko Bahri Bahri Bahri Bahri Bahri Bahri Baji Subagyo Budi, Waella Septamari Budiyono Budiyono Budiyono Budiyono Charisna Neilal Muna Damayanti, Wida Ayulia Desy Mery Dorsanti Dewi, Candrawati Puspita Dinar Andaru Mukti Dorsanti, Desy Mery Dwi Fitriani Dwi Fitriani Dwi Sutiningsih Fachrizal Ganiwijaya Fajar Sari, Ridhona Familiantoro, Familiantoro Farid Agushybana Farid Farid Agushybana Fauziah El Syani Ferawati, Nour Baeti Fernando P, Nickolas Fitri, Clara Ghinaa Maniiah Hansen Hanung Nurany Hariyanti, Fika Harmendo Hartini Sulistyandari, Hartini Haryanti, Nelly Hasim, Jamal Hisham Hasrah Junaidi Helmin Rumbiak, Helmin Hendrika Puspita Sari, Hendrika Puspita Husni, Siti Hajar i Joko, Tr Intan Sekar Arumdani Irawati, Roosdiana Jamal Hisham Hashim Kartika Permatasari Khaira Ilma Lewinsca, Maurend Yayank Liena Sofiana Mardhiyah, Lailatul martini MARTINI Martini Martini Martini Martini Martini Martini Martini Martini2 Masyithah, Wulan Mateus Sakundarno Adi, Mateus Sakundarno Maulida Khairunnisa Maurend Yayank Lewinsca Maurend Yayank Lewinsca Mitha Karunia Baeti Mohammad Zen Rahfiludin Muhammad Auliya Rahman Mutia Permata Iryanti Nabilah Zahra Nadiva Dzikriyati Nadiva Dzikriyati Nickolas Fernando Parmualan Niki Astorina Yunita Dewanti Nikie Astorina Yunita Dewanti Nilna Fasyya Salsabila Nopi Reknasari Nopi Reknasari Nor Aisyah Purnamasari Novia Luthviatin Nugraha, Ferry Satya Adi Nur Endah Wahyuningsih Nur Endah Wahyuningsih Nuraini Nuraini Nurdin Nurdin Nurdiyanto, Miftakhul Nurjazuli Nurjazuli Nurjazuli Nurjazuli Nurjazuli Nur’Aini Nur’Aini Onny Setiani Onny Setiani Pramudiyo Teguh Sucipto, Pramudiyo Teguh Pratiwi, Dian Eka Puguh Ika Listyorini Purnama, Wary Purnamasari, Nor Aisyah Raharjo, Puspito Rahman, Muhammad Auliya Rasyid, Khairul Restiana, Shafira Azura Retno Hestiningsih Retno Murwani Richard Victor Ombuh Rosa Rantetoding, Rosa Saffira Kusuma Anggraeni Saherman, Mohammad Sakundarno Adi Sari Lestari Rahmawati Saudin Yuniarno Setiadi, Robby Setiani , Onny Sigit Tri Ambarwanto, Sigit Tri Solly Aryza Sri Mulyati Sri Poerwati1, Ari Probandari2, Joko Sutrisno3, Ari Handono Ramelan4 Sri Slamet Mulyati, Sri Slamet Subekhi, Tatag Fajar Suci Kurniawati Sugeng Juwono Mardihusodo Suhartono Suhartono Suhartono Suhartono Suhartono, Suhartono Sujarwo Sujarwo Sularno, Suryo Sulistiyani SULISTIYANI SULISTIYANI Sulistiyani Sulistiyani Sulistiyani Sulistiyani Sulistyani Sulistyani Supri Ahmadi, Supri Sutikno Sutikno Sutrisno, Sutrisno Suwito Suwito Tampubolon, Sinthania Karunia Magdalena Tika, Vira Tri Joko Tri Joko Tri Joko Vijja Ratano Vira Tika Yuniar Waella Septamari Budi Wahyudi Wahyudi Wahyunita, Sunindy Watmanlusy, Efraim Wayangkau, Erich C. Wayangkau, Erich Christian Windy Cintya Dewi Windy Cintya Dewi Yana afrina Yundari, Yundari Yusniar Hanani Yusniar Hanani Yusniar Hanani Darundiati Yusniar Hanani Darundiati Yusran Fauzi Yusuf Afif Zahra, Nabilah