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All Journal Sainstek Jurnal Statistika Universitas Muhammadiyah Semarang BAREKENG: Jurnal Ilmu Matematika dan Terapan J Statistika: Jurnal Ilmiah Teori dan Aplikasi Statistika Jambura Journal of Health Sciences and Research Journal Health & Science : Gorontalo Journal Health and Science Community Jambura Health and Sport Journal Sulolipu: Media Komunikasi Sivitas Akademika dan Masyarakat Abdi Wiralodra : Jurnal Pengabdian Kepada Masyarakat Health Information : Jurnal Penelitian Indonesian Journal of Global Health research Babali Nursing Research Jurnal Sibermas (Sinergi Pemberdayaan Masyarakat) Jurnal Pengabdian pada Masyarakat Kepulauan Lahan Kering International Journal of Health, Economics, and Social Sciences (IJHESS) Madu : Jurnal Kesehatan Jurnal Kolaboratif Sains Jurnal Pengabdian Kesehatan Masyarakat International Journal of Health Science & Medical Research International Journal of Public Health Excellence (IJPHE) AACENDIKIA: Journal of Nursing Jambura Medical and Health Science Journal JOURNAL OF Qualitative Health Research & Case Studies Reports JOURNAL OF Mother and Child Health Concerns Medic Nutricia : Jurnal Ilmu Kesehatan Sulolipu: Media Komunikasi Sivitas Akademika dan Masyarakat Genitri: Jurnal Pengabdian Masyarakat Bidang Kesehatan
Herlina Jusuf
Universitas Negeri Gorontalo
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Analisis Spasial Titik Lokasi Dan Jalur Evakuasi Dalam Mitigasi Pengurangan Risiko Bencana Banjir Kelurahan Biawu Kecamatan Kota Selatan Kota Gorontalo: Spatial Analysis of Location Points and Evacuation Routes in Flood Disaster Risk Reduction Mitigation in Biawu Village, South City District, Gorontalo City Fadila; Herlina Jusuf; Moh. Rivai NakoE
Jurnal Kolaboratif Sains Vol. 8 No. 6: Juni 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/jks.v8i6.7905

Abstract

Banjir menjadi jenis bencana yang sering terjadi di Indonesia. Kelurahan Biawu, Kecamatan Kota Selatan, Kota Gorontalo merupakan wilayah dengan tingkat kerawanan banjir tinggi. Penelitian ini bertujuan menganalisis secara spasial titik lokasi dan jalur evakuasi dalam rangka mitigasi pengurangan risiko bencana banjir. Metode penelitian, deskriptif kuantitatif dengan pendekatan Sistem Informasi Geografis (SIG) untuk menganalisis variabel fisik seperti kemiringan lereng, curah hujan, jenis tanah, dan penggunaan lahan, serta menentukan titik dan jalur evakuasi berdasarkan kriteria waktu tempuh, daya tampung, ketersediaan MCK, kemiringan lereng dan kondisi jalan. Hasil penelitian, Kelurahan Biawu memiliki curah hujan berkisar 0,3- 257 mm/tahun, kemiringan lereng 2-15%, jenis tanah fluvisol, dan penggunaan lahan dominan sebagai permukiman. Titik utama evakuasi yaitu Masjid Hunto Sultan Amai, lokasi ini merupakan lokasi yang sering digunakan sebagai tempat evakuasi ketika terjadi banjir. Jalur evakuasinya yaitu Jl. Hi. A. R. Konio dan Jl. Gn. Tilongkabila, kedua jalan aman untuk dilalui menuju titik lokasi evakuasi berdasarkan hasil route analyst. Penerapan analisis spasial SIG terbukti efektif dalam membantu perencanaan mitigasi bencana banjir, memberikan arah strategis dalam menentukan lokasi aman dan jalur evakuasi yang layak saat kondisi darurat. Penelitian ini diharapkan mampu menjadi bahan acuan dalam perencanaan mitigasi kebencanaan pleh pemerintah. Saran kepada pemerintah dan masyarakat untuk melakukan uji coba terkait keefektifan dari hasil penelitian.
The Influence of Behavioral Factors on the Use of the Polio Pin Program in Toddlers in the work Area of the West City Health Center Muslihatul Iskamia; Herlina Jusuf; Yasir Mokodompis
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.8163

Abstract

Polio is an infectious disease that causes permanent paralysis, especially in children of toddler age. The Indonesian government has implemented National Polio Immunization Week (PIN) to prevent the spread of this disease. However, the coverage of the program at the West City Health Center has not met the national target, which is only 75.1% of 95%. This study aims to analyze the influence of behavioral factors on the use of the Polio PIN program. Analytical survey research method with cross-sectional design. The sample amounted to 297 mothers who had toddlers aged 0–59 months, taken by purposive sampling technique. Data were collected using questionnaires and analyzed by binary logistic regression test. The results showed that knowledge, attitudes, access to health services, family support, and health worker support had a significant influence on the use of Polio PIN (p < 0.05). Meanwhile, income showed no significant influence (p = 0.119). Behavioral factors are an important factor in the success of immunization programs. Intensive education and counseling efforts need to be carried out to increase community participation.
Evaluation of the Application of Electronic Medical Record Based on the Perspective of the Inpatient User Toto Kabila Regional General Hospital Stay Nurmita Hasan; Herlina Jusuf; Moh. Rivai Nakoe
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.8165

Abstract

The application of Electronic Medical Record (EMR) as a digital technology in healthcare that is used to record and store patient handling data, has become a major need in the transformation of healthcare services in Indonesia. However, the success of its implementation is largely determined by user acceptance. This study aims to identify the application of EMR from the perspective of users in the inpatient room of the Toto Kabila Regional General Hospital as seen from the factors of work expectation, business expectations, social influence and facility conditions. This study used a quantitative approach of a descriptive method, with a population of 150 nurses and a sample of 109 inpatient nurses and data collection through questionnaires. Based on the results of the study, it was found that in the work expectations 32.11% of respondents rated it as good, 67.89% adequate; business expectations of 26.61% were good, 73.39% adequate; social influence 19.27% was good, 75.23% was adequate and 5.50% was lacking; facility conditions were 28.44% good, 69.72% were adequate and 1.83% were poor. Overall, the implementation of EMR at Toto Kabila Hospital was considered good by 30.28% of respondents, and adequate by 69.72%. It is suggested that the implementation of EMR in the inpatient Toto Kabila Hospital can run optimally, improvements are needed in the form of periodic system evaluation, development of EMR features, strengthening team collaboration, improving technology infrastructure, and supporting a responsive IT team.
Efektivitas program kelas ibu balita pada penanganan stunting sangoi, Iin; Jusuf, Herlina; Hadju, Vidya
THE JOURNAL OF Mother and Child Health  Concerns Vol. 4 No. 5 (2025): June Edition 2025
Publisher : Indonesian Public Health-Observer Information Forum (IPHORR) Kerjasama dengan Persatuan Perawat Nasional Indonesia (PPNI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56922/mchc.v4i5.1216

Abstract

Background: Stunting is a serious child health problem in Indonesia, including in Gorontalo Province. Efforts to address stunting have been implemented through various programs, one of which is the mothers and Toddlers Class. Purpose: To describe the effectiveness of the mothers and Toddlers Class program in addressing stunting. Method: This study is a qualitative study. Key informants were the people in charge of the mothers and Toddlers Class program and cadres. Six supporting informants were participants in the mothers and Toddlers Class. This study was conducted at the Telaga Biru Community Health Center in May 2025. Results: The study shows that the program has been implemented routinely and integrated with integrated health post (Posyandu) activities, with indicators including goal achievement (timeframe, targets, and legal basis), integration (procedures and socialization processes), and adaptation (improved capacity and infrastructure). Conclusion: Although the program has shown a positive impact on improving maternal knowledge and behavior, obstacles remain, such as low understanding of stunting in some communities and limited active participation. The Mother and Toddler Class Program is quite effective in supporting stunting management, although there has been improvement in community understanding and involvement.
Hubungan self efficacy dan resiliensi dengan kualitas hidup caregiver yang merawat penderita skizofrenia Pratiwi, Retno Galuh; Jusuf, Herlina; Arsad, Nikmatisni
JOURNAL OF Qualitative Health Research & Case Studies Reports Vol 5 No 4 (2025): September Edition 2025
Publisher : Published by: Indonesian Public Health-Observer Information Forum (IPHORR) Kerjasama dengan Persatuan Perawat Nasional Indonesia (PPNI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56922/quilt.v5i4.1140

Abstract

Background: Self-efficacy and resilience significantly influence the quality of life of caregivers caring for patients with schizophrenia. High levels of self-confidence and the ability to recover from emotional stress can improve physical, psychological, and social well-being, and support the ongoing role of caregivers in optimal patient care. Purpose: To analyze the relationship between self-efficacy and resilience and the quality of life of caregivers caring for patients with schizophrenia. Method: This was an analytical survey study using a cross-sectional approach. A sample of 31 caregivers was selected using purposive sampling based on inclusion and exclusion criteria. Data were analyzed univariately and bivariately using the Spearman correlation test. Results: Most caregivers had high levels of self-efficacy (58.1%) and high levels of resilience (54.8%), with a p-value of 0.000. Conclusion: There is a significant relationship between self-efficacy and the quality of life of caregivers (p = 0.000), caregivers with high self-efficacy have more good quality of life and between resilience and the quality of life of caregivers (p = 0.000), caregivers with high levels of resilience tend to have better quality of life.   Keywords: Self-efficacy, Resilience, Caregiver, Schizophrenia   Pendahuluan: Self efficacy dan resiliensi memiliki pengaruh yang signifikan terhadap kualitas hidup caregiver yang merawat penderita skizofrenia, di mana tingkat keyakinan diri yang tinggi dan kemampuan untuk bangkit dari tekanan emosional dapat meningkatkan kesejahteraan fisik, psikologis, sosial, serta mendukung keberlangsungan peran caregiver dalam merawat pasien secara optimal. Tujuan: Untuk menganalisis hubungan self efficacy dan resiliensi dengan kualitas hidup caregiver yang merawat penderita skizofrenia. Metode: Penelitian survei analitik dengan pendekatan cross sectional. Sampel berjumlah 31 caregiver dipilih menggunakan teknik purposive sampling berdasarkan kriteria inklusi dan eksklusi. Analisis data dilakukan secara univariat dan bivariat menggunakan uji Korelasi Spearman. Hasil: Sebagian besar caregiver memiliki tingkat self efficacy tinggi (58.1%) dan resiliensi tinggi (54.8%) dengan perolehan nilai p sebesar (0.000). Simpulan: Ada hubungan yang signifikan antara self efficacy dengan kualitas hidup caregiver (p = 0.000), caregiver dengan self efficacy tinggi lebih banyak memiliki kualitas hidup yang baik dan antara resiliensi dengan kualitas hidup caregiver (p = 0.000), caregiver dengan tingkat resiliensi tinggi cenderung memiliki kualitas hidup yang lebih baik.   Kata Kunci : Self efficacy, Resiliensi, Caregiver, Skizofrenia
Analysis of Factors Related to Consciousness Occupational Safety and Health (K3) in Students Class XII Automotive Department High School Vocational School (SMK) Negeri 3 Gorontalo Mamonto, Regina Pratidina; Jusuf, Herlina; Nurfadillah, Ayu Rofia
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.7567

Abstract

Awareness of K3 behavior must be instilled from an early age. Vocational schools are one of the means to introduce and instill students' awareness to behave in K3. Therefore, it is important to provide education and implement K3 correctly in the school environment. factors that affect K3 awareness in schools are knowledge, K3 supervision from both teachers and schools, K3 facilities such as (PPE) or special equipment, and K3 information. Awareness of K3 in students must be really applied in the form of their attitude during practice and their actions when practicing, so that accidents can be avoided even from the source of the material. The purpose of this study is to analyze factors related to K3 awareness in automotive students. This type of research is with a cross sectional approach. The research population of all grade XII students majoring in automotive at SMK Negeri 3 Gorontalo was 46 students, with a sampling technique, namely total sampling. Data in univariate and bivariate analyses used chi squere tests. The results of the study showed that the variables related to K3 awareness were K3 knowledge (p=0.015), supervision (p=0.007), PPE use (p=0.037), and information sources (p=0.010). It can be concluded that there is a significant relationship between K3 knowledge, supervision, the use of PPE and information sources and K3 awareness in students. Advice for students to always improve and implement the K3 knowledge that has been obtained and for the school to improve learning media, or add or add references to books about K3 besides also paying attention to students' attitudes and actions during the practical learning process.
Determinant Analysis Related to the Implementation of Occupational Safety and Health Culture in Workers of the Bulango Ulu Dam Project Pt. Hutama-Basuki-Lestari, KSO Osama; Herlina Jusuf; Putri Ayuningtias Mahdang
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.8199

Abstract

K3 culture is the attitudes, values, beliefs, norms, and perceptions that underlie safe behavior in the work process and its practical application to create a safe and healthy work environment for all workers. The formulation of what determinant problems are related to the implementation of occupational safety and health culture in the workers of the Bulango Ulu Dam project of PT. Hutama-Basuki-Lestari, KSO. This study aims to analyze determinants related to the implementation of occupational safety and health culture in workers of the Bulango Ulu Dam project of PT. Hutama-Basuki-Lestari, KSO. The design of the quantitative research uses an analytical survey with a Cross Sectional design. The research population was 43 workers. The sampling technique in this study uses the total sampling technique. Data analysis using Chi-Square test and Rank-Spearman test. The results of this study show that there is a significant relationship between K3 knowledge, K3 training, safety patrol, and safety talk to the implementation of occupational safety and health culture in workers of the Bulango Ulu Dam project of PT. Hutama-Basuki-Lestari, KSO with a value of p = 0.000 (p ? 0.05). It is recommended that companies improve K3 training, especially for workers with low education, increase safety patrol personnel, and make safety talks more interactive. Strict enforcement of sanctions is also needed to strengthen the K3 culture.
The Effect of the Implementation of Standard Operating Procedures (SOP) Code of Ethics and Work Discipline on the Performance of Employees of the Talaga Jaya Health Center in Talaga Jaya Regency Nadia Nazwa Mohamad; Herlina Jusuf; Yasir Mokodompis
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.8201

Abstract

The implementation of SOPs, codes of ethics and work discipline is a problem that needs to be considered in order to create good service and ethical standards as well as professionalism among medical and non-medical staff. The formulation of the problem is whether the application of operational standards, procedures, codes of ethics and work discipline affects the performance of employees of the Talaga Jaya health center, Gorontalo Regency. The purpose of the research was to determine the effect of the implementation of operational standards, procedures, code of ethics and work discipline on the performance of employees of the Talaga Jaya Health Center, Gorontalo Regency. Quantitative research design uses Analytic survey with Cross Sectional approach design. Sampling uses total sampling. The population in this study is all permanent employees who are actively working at the Talaga Jaya Health Center in 2024 totaling 54 people. The results of this study show that the standard variable of the code of ethics procedure was obtained with a value of 8,247 with a significance value of 0.00 < 0.05 where the value of t shows that there is a significant influence of the standard operating procedure variable on the performance of the work discipline variable has a value of 25.769 with a t level of 0.01 indicating that the discipline variable has a significant influence on the performance variable. It is recommended that the Talaga Jaya Health Center further improve the supervision and evaluation system. For the next researcher, it is recommended to research other variables related to employee performance
Analysis of Physiological and Psychological Workload Using the Cardiovascular Load Method and Rating Scale Mental Effort in Members Police Satreskrim Polresta Gorontalo City Tarisa Ramadhani Gobel; Herlina Jusuf; Ayu Rofia Nurfadillah
International Journal of Health, Economics, and Social Sciences (IJHESS) Vol. 7 No. 3: July 2025
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/ijhess.v7i3.8213

Abstract

Members of the Criminal Investigation have a tough task in dealing with physical and mental demands during investigations and investigations, thus contributing to the emergence of a high workload. The purpose of the study was to analyze physiological and psychological workload using the Cardiovascular Load and Rating Scale Mental Effort methods in members of the Gorontalo City Police Satreskrim Police. This type of research uses a descriptive research design, where data was collected through measuring workers' pulse from the CVL method and data from the RSME questionnaire on 35 samples of members of the Gorontalo City Police Satreskrim. The results of the CVL and RSME analysis for the physiological and psychological workload level of 35 members, showed that the physiological load of 25 members needed to be improved (30% to 60%) while 10 members did not experience fatigue (30%). At the level of Psychological workload, there were 4 members with a large effort (86-100), 9 members with a very large effort (101-114) and 22 members with a very large effort (115-150). The results of the calculation of physiological and psychological workload were proposed to increase the number of workers because they experienced a high workload. Police institutions are advised to conduct periodic evaluations to manage the physiological and psychological workload of satreskrim members, so that they remain optimal.
Pengaruh Edukasi Terhadap Tingkat Pengetahuan Tentang Teknik Pemindahan dan Balut Bidai Pada Pertolongan Pertama Korban Kecelakaan Lalu Lintas pada Siswa Smk 1 Kota Gorontalo: The Influence of Education on the Level of Knowledge of Transfer and Splinting Techniques in First Aid for Traffic Accident Victims among Students of Vocational High School 1, Gorontalo City Zakia I. Dotutinggi; Herlina Jusuf; Ibrahim Suleman
Jurnal Kolaboratif Sains Vol. 8 No. 7: Juli 2025 - In Progress
Publisher : Universitas Muhammadiyah Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56338/jks.v8i7.7594

Abstract

Kecelakaan lalu lintas merupakan salah satu penyebab utama kematian di Indonesia, terutama di kalangan remaja, termasuk siswa sekolah menengah kejuruan (SMK). Kondisi korban kecelakaan sering diperburuk oleh kurangnya pengetahuan mengenai pertolongan pertama yang benar, terutama terkait teknik pemindahan dan balut bidai. Oleh karena itu, edukasi mengenai teknik ini sangat penting.Penelitian ini bertujuan untuk mengetahui pengaruh edukasi terhadap tingkat pengetahuan siswa SMK Negeri 1 Gorontalo tentang teknik pemindahan dan balut bidai pada pertolongan pertama korban kecelakaan lalu lintas. Penelitian ini menggunakan metode quasi eksperimen dengan desain pretest dan posttest. Sampel penelitian dipilih secara purposive sampling, melibatkan 127 siswa yang dibagi menjadi dua kelompok. Edukasi pada kelompok intervensi dilakukan melalui ceramah dan demonstrasi, sedangkan pada kelompok kontrol menggunakan media leaflet. Pengambilan data dilakukan melalui kuesioner sebelum dan sesudah intervensi. Data dianalisis menggunakan uji Wilcoxon untuk melihat perbedaan sebelum dan sesudah edukasi, serta uji Mann-Whitney untuk membandingkan antara kelompok intervensi dan kontrol. Hasil penelitian menunjukkan peningkatan signifikan pada tingkat pengetahuan siswa setelah diberikan edukasi dengan p-value < 0,05. Hal ini menunjukkan bahwa metode edukasi melalui ceramah dan demonstrasi efektif dalam meningkatkan pengetahuan siswa mengenai teknik pemindahan dan balut bidai pada pertolongan pertama korban kecelakaan lalu lintas.
Co-Authors Abas, Indri Abdurrahman, Tri Novita Jihan K. Agus Suharsono Amanah Yassin Rizkia Amanda Adityaningrum amanda ratna ningrum Angraini Nani Armin salote Arsad, Nikmatini Aulia, Ulfa Aurora Pratiwi Dwirachmawaty Avianti Hadju, Vidya Ayu Rofia Nurfadillah Azis, Sri Sudaryani Sy. Abd. Azzahra Natasya Hambali Baid, Chairunnisyah Bambang Widjanarko Otok Bambang Widjanarko Otok Basir, Ita Sulistiani Basri Kisianta Bobihhu, Fenadila Kanaila Putri Botutihe, Citrawati Botutihe, Virana Putri Alghefira Bunga, Amaliyah Ramadhan S. Cindy Arsyad Delavita Yunus Dewi Suryaningsi Hiola Dihyat Hasan Djuna Lamondo Dwi Anhari, Sabriah Ekawaty Prasetya Eko Maulana Syaputra Fadila Fadilla Amalia Bahsoan Faradila Wahab Fatmawati Lasulika Filman Afrian Badu Firli Oktaviani Bahute Flora Ninta Tarigan, Sylva Gusti Pandi Liputo Hadju, Vidya Hemu, Thya Julyantika Huntoyungo, Dian Rahmatia Igirisa, Nurwulan Intan Tiara Kartika Ismail Djakaria Isra Nur Jusna Ahmad Kadir, Laksmyn Koday, Yunita Angriani La Ode Nashar Ladjali, Sri Indriani Lailany Yahya Lia Amalia Lintje Boekoesoe Mamonto, Regina Pratidina Mamonto, Tri Nurlaila Manto, Diman Apriyadi Moh. Rivai Nakoe Musa, Andini Nurlatiffah H. Muslihatul Iskamia Mutiara Juniarshi A. Mohune Nadia Nazwa Mohamad Nakoe , Moh Rivai Nikmatisni Arsad Nikmatisni Arsad Nikmatisni Arsyad ningrum, amanda ratna Ninta Tarigan, Sylva Flora Nirwanto K. Rahim Nngareng, Ranggina Sadewi Nur Ayini S Lalu Nur Wahyuniza Matana Nurdiana Djamaluddin Nurfadillah, Ayu Rofiah Nurmita Hasan Nurwulan Igirisa Nurwulan Igirisa Nur’Aida Badu Osama Pakaya, Nadia Paputungan, Fitria Pradita Pristi Nusi Pratiwi, Retno Galuh Putri Adelina Mokodenseho Putri Ayuningtias Mahdang Putri Ayuningtias Mahdang Putri Prisilya Bau Putri Syansudin, Anisya Rahim, Eman Ramly Abudi Rayyani Yunus Ridha Hafid Rivaldo I. Berahim Ronaldi Rosmin Ilham Ryman Napirah Sahrain, Patmawati Salawali, Siti Hajar Salihi, Sri Meysin sangoi, Iin Saputri, Dea Dwi Sari, Wahyuningsih Ratna Sarinah Basri K Sartika Setia Ningsih Sitti Fatimah Meylandri Arsad Sitti Radhia Sri Manovita Pateda Sri Manovita Pateda Sri Susanti Latabi Suleman Ibrahim Taha, Febriyanti Tarisa Ramadhani Gobel Tayong Siti Nurbaeti Tri Septian Maksum Tri Yuliana Soga Ulfa Aulia Ulfa Aulia ummi salami yatuu Usman, Dwiyatno Junaidi Usman, Tasya Nuranda Utiarahman, Ramadhan Vidya Avianti Hadju Vidya Avianti Hadju Vidya Hadju Vivi Kurnia Syukur Labasengko Vivien Novarina Kasim Wia Amalia Kartika Widya Waty M. Danial Yasir Mokodompis Yunus, Hairun Nisa Yusuf, Nur Ayun K. Yusuf, Nur Ayun R. Zainuddin Zainuddin Zakia I. Dotutinggi Zein Anggraini A. Ismail zulfikar Ahmad