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Association of supplementary feeding with stunting among children in Kintamani, Bangli, Bali Province Istiana Marfianti; I Made Ady Wirawan; I Wayan Weta
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p05

Abstract

Background and purpose: The prevalence of stunting among under-five children in Indonesia and also in Bali is high. Studies on risk factors of stunting have been widely conducted in Indonesia, however association between stunting and diet pattern is still inconsistent. The aim of this study is to examine association of supplementary feeding pattern with stunting among children aged 1-3 years. Methods: A case control study was conducted in Bangli District. A total of 48 cases and 48 controls were selected to participate in the study. Age and sex variables between cases and controls were matched. Cases and controls were selected using a systematic random sampling method from 26 health post registers in Kintamani I Public Health Centre between November and December 2016. Data were collected in March 2017 by interviewing the mother at the health post. Data were analysed using bivariate and multivariate analysis. A logictic regression was performed to calculate adjusted odd ratio (AOR). Results: Cases and controls were comparable for age (p=0.773), sex (p=0.219), mother’s education (p=0.673) and history of infectious diseases (p=0.584). Cases and controls differed in several variables: frequency, variability and type of supplementary feeding (p=0.002, <0.001 and <0.001), family income (p=0.038), poor personal hygiene (p<0.001), environmental sanitation (p=0.022) and access to clean water (p<0.001). Our analysis showed that several variables were associated with stunting among children aged 1-3 years, which included lack of supplementary feeding variability (AOR=12.45; 95%CI: 2.25-69.71), poor personal hygiene (AOR=3.52; 95%CI: 1.03-12.03), and poor access to clean water (AOR=6.49; 95%CI: 1.61-26.19). Other variables included supplementary feeding initiation, frequency of supplementary feeding, consistency or type of supplementary feeding, sex, and family income were not associated with stunting among children aged 1-3 years. Conclusions: Variability of supplementary feeding, personal hygiene, and access to clean water were all associated with stunting among children aged 1-3 years.
Perceptions of patients and providers on the use of acupressure services at Public Health Centres, Tabanan District, Bali I Made Sukawinaca; Komang Ayu Kartika Sari; I Made Ady Wirawan
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p10

Abstract

Background and purpose: Acupressure services are available at some public health centres (PHCs) in Bali, but the service utilisation remains low. The purpose of this study is to explore the perception of patients and service providers on the use of acupressure services at PHC in Tabanan. Methods: This study used a qualitative design based on observation and in-depth interviews with 13 informants consisting of patients, health service practitioners, head of PHC and program manager at Tabanan Health Office. The informants were chosen purposively and the data were analysed thematically. Results: There were different perceptions regarding the benefits of acupressure services between patients utilising the services and those who had not. Patients who had undergone acupressure demonstrated positive perception of the service. Acupressure services are considered to be effective in dealing with patient complaints, have no side effects, and patients reported being satisfied with the services provided by the PHC. Patients who did not utilise acupressure services, view acupressure as an ineffective therapy with potential side effects that may endanger their health. These patients experienced trauma from similar massage techniques. Service providers lamented the absence of government support in the form of local regulations that would enable them to access funding, increase human resources and facilitate promotion of the services. Conclusions: Patient perceptions of acupressure services still vary, with some contraints in the implementation that consist of local regulation, operational fund and human resources. Acupressure services still require synergy between central and local government policies to support its implementation.
The association between hypertension self-management and stroke event in male patients at the Badung District Hospital, Bali Ni Kadek Sutini; Ni Wayan Septarini; I Made Ady Wirawan; Anak Agung Sagung Sawitri
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p02

Abstract

Background and purpose: Hypertension is a major risk factor for stroke. Despite efforts to control hypertension with pharmacological and non-pharmacological therapies, the prevalence of and death from stroke is reported to be increasing. This study aims to determine the association of hypertension self-management with the incidence of stroke in patients with hypertension. Methods: A case-control study was conducted involving 44 patients suffering from hypertension and who had suffered a stroke as cases, as well as 44 patients with hypertension and without stroke as controls. Cases and controls were conveniently selected at the outpatient clinic of Badung District Hospital. Data on self-management of diet, physical activity, stress mitigation efforts, alcohol consumption, and medication adherence were collected using self administered questionnaire. Data on the diagnosis of hypertension, stroke and history of comorbidities were obtained from the patient’s medical records. Multivariate analysis using logistic regression was employed to assess the association between hypertension self-management with the incidence of stroke in patients with hypertension. Results: Characteristics of cases and controls did not differ in education, marital and socioeconomic status, but differed in age and employment. Multivariate analysis showed that there were three components of hypertension self-management associated with the incidence of stroke, namely poor adherence to medication (AOR=7.28; 95%CI: 2.19-24.17), poor self-management of stress (AOR=5.45; 95%CI: 1.56-18.99), and poor management of self-regulated diet (AOR=5.28; 95%CI: 1.31-21.32). Conclusion: Medication adherence, diet and stress management are the three main components of self-management that are associated with stroke events among hypertension patients. Efforts to increase medication adherence, diet and stress management should be enhanced.
Factors affecting the use of electronic cigarettes in Udayana University students Luh Pitriyanti; Dewa Nyoman Wirawan; Komang Ayu Kartika Sari; I Made Ady Wirawan; Desak Putu Yuli Kurniati
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p03

Abstract

Background and purpose: Electronic cigarettes (e-cigarettes) have been marketable since 2003 and first became for sale in Indonesia in 2010. Users tend to be predominately young people. The purpose of this study is to determine the proportion, characteristics and factors that influence the use of e-cigarettes among university students. Methods: This study used a cross sectional survey with 351 undergraduate students from a variety of study programs at Udayana University. Students were selected by multistage random sampling. In the first step, 10 out of 47 study programs at Udayana University were chosen randomly. Students who responded by filling out online questionnaires were included in this study. Data collection was conducted using questionnaires with the Survey Monkey Application. Analysis with logistic regression was applied to determine the factors influencing e-cigarettes use. Results: The proportion of university students who used tobacco cigarettes was 14.53%. The number of respondents who reported had ever used e-cigarettes was 61 (17.38%, 95%CI: 13.46%-21.3%) and 25 of them (40.98%) were current smokers. As many as 88.52% of respondents who had ever used e-cigarettes were male and 11.48% were female. Students who had ever used e-cigarettes in the campus area were 22 (36.07%). The reasons of using e-cigarettes included a desire to stop using tobacco cigarettes (29.51%), the fact that e-cigarettes are considered safer (26.23%), are considered “cool” (22.95%) and other reasons (26.23%). Multivariate analysis showed that the variables found to be associated with the use of e-cigarettes were gender (AOR=14.72; 95%CI: 4.34-49.87), a history of smoking tobacco cigarettes (AOR=42.16; 95%CI: 13.56-131.08), a history of consuming alcoholic beverages (AOR=5.72; 95%CI: 2.04-16.04) and coming from a smoking household (AOR=3.87; 95%CI: 1.33-11.21). Conclusion: The proportion of university students who had ever used e-cigarettes was found to be higher than tobacco cigarettes users. In addition, use was found to be greater among male students than females. Influencing factors associated with the use of e-cigarettes are gender, a history of tobacco smoking, a history of consuming alcoholic beverages and coming from a smoking household. There is a need for prevention efforts including education and regulations to reduce the use of e-cigarettes among students as well as community in general.
Hospital facilities, occupational safety environment and self-efficacy as predictors of healthcare-associated infections prevention and control compliance in nurses of inpatient care units Luh Yulia Adiningsih; Ni Made Sri Nopiyani; Made Ady Wirawan
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p04

Abstract

Background and purpose: The implementation of healthcareassociated infections (HAIs) prevention and control program in hospitals remains sub-optimal. The present study aims to determine the relationships between nurse’s self-efficacy, hospital’s occupational safety environment, and the availability of facilities, with the compliance on HAIs prevention and control in hospital inpatient care units. Methods: Cross-sectional survey was conducted with 128 nurses selected using systematic random sampling at Buleleng District Hospital’s inpatient care units. Data collection was conducted in March 2018 using self-administered questionnaires. The questionnaire consisted of five sections including characteristics of respondents, HAIs prevention and control practices, self-efficacy, occupational safety environment and the availability of facilities. Bivariate analysis was conducted to calculate the Pearson correlation coefficients between variables. Multivariate analysis was performed with multiple linear regressions to examine self-efficacy, occupational safety environment and availability of facilities as predictors of the compliance on HAIs prevention and control. Results: The study shows that 56.2% of nurses reported good compliance on HAIs prevention and control practices. Bivariate analysis shows a significant correlation between HAIs prevention and control compliance scores and self-efficacy (r=0.45; p=0.00), occupational safety environment (r=0.53; p=0.00), and the availability of facilities (r=0.65; p=0.00). Multivariate analysis shows that the availability of facilities is a significant predictor of HAIs prevention and control compliance (β=0.49; p<0.01) while self-efficacy and the occupational safety environment are also found to be significant predictors, although with lower standardized coefficients: β=0.16 (p=0.03) and β=0.17 (p=0.04), respectively. Conclusion: The significant predictors of compliance on HAIs prevention and control are availability of facilities, self efficacy and hospital’s occupational safety environment. This study highlights the importance of optimizing the availability of facilities, improving the occupational safety environment, and enhancing nurses’ self-efficacy in order to reduce the incidence of HAIs in hospitals.
Association between participation in a chronic disease management program, medication adherence and decrease of blood pressure I Ketut Indra Wiguna Cakera; Ni Made Sri Nopiyani; I Made Ady Wirawan
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p08

Abstract

Background and purpose: The prevalence of hypertension is increasing globally. A comprehensive approach is necessary including a community based chronic disease management program which has been implemented in public health centres in Indonesia. Only few studies have been published in Indonesia that evaluate the program, especially regarding the management of hypertension in primary care settings. This study aims to examine the association between participation in a chronic disease management program,medication adherence and decrease of blood pressure. Methods: A cross-sectional study was conducted in public health centres in Tabanan District. A total of 136 patients with hypertension were recruited at five groups that participate in the community based chronic disease management program called Program Pengelolaan Penyakit Kronis (Prolanis). The prolanis groups were purposively selected based on the size of participants in the program. One group was selected at urban area and four groups at rural areas. Data were collected from May to June 2017 by conducting interviews, blood pressure measurements, and secondary data extraction from the medical record of the prolanis database. The logistic regression analysis was used to determine the association between participation in a chronic disease management program, medication adherence and decrease of blood pressure. Results: As many as 75.7% of respondents actively participated in the prolanis program, and 81.6% were found with decreased blood pressure. Our study found a significant association between blood pressure decrease and active participation in the prolanis program with an adjusted odds ratio (AOR) of 6.38 (95%CI: 1.96–20.79), the good adherence towards medication with AOR=11.94 (95%CI: 3.60–39.56), and routine physical activities with AOR=3.84 (95%CI: 1.16-12.73). Conclusion: Active participation in the prolanis program, good adherence to medication and routine physical activities are independent factors of decreased blood pressure. These findings suggest the need for scaling up the prolanis program and increasing its coverage.
Pharmacist counseling intervention to improve patient antibiotic compliance I Gusti Ayu Rai Widowati; I Made Ady Wirawan; Ni Made Sri Nopiyani; Komang Ayu Kartika Sari
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p10

Abstract

Background and purpose: Reported microbial resistance to antibiotics is increasing. One of the main factors is patient noncompliance in use of antibiotics. The purpose of this study was to determine the effectiveness of pharmaceutical counseling in a pharmacy setting to increase compliance with antibiotic use. Methods: A randomized controlled trial was conducted on 104 adult patients aged 18 years and over who purchased antibiotics by prescription at a pharmacy in Denpasar City, Bali Province. Subjects were divided into intervention and control groups using block randomization method. The intervention group was provided with pharmaceutical counseling by a pharmacist, while the control group was provided drug information according to the pharmacy service standard. Subject compliance was measured by telephone interview using the Morisky Medication Adherence Scale-8 questionnaire within 3-5 days after purchasing the medication. Statistical analysis with the Mann Whitney U Test was performed to determine the difference in mean rank of compliance scores. Logistic regression analysis was conducted to determine the adjusted compliance ratio. Results: The number of subjects analyzed was 98, as five subjects could not be contacted by telephone and one subject was hospitalized. The mean rank of compliance scores in the intervention group (61.05) was significantly higher (p<0.01) than the comparison group (37.95). The proportion of compliance in the intervention group was 65.3% and the control group was 18.4%, with the proportion ratio (PR) of 3.56 (95%CI: 1.90- 6.64). Logistic regression analysis showed that variables which significantly increased compliance with antibiotic use were pharmacist counseling (APR=9.33; 95%CI: 3.24 26.87), frequency of taking medication (APR=6.94; 95%CI: 2.01-23.92) and method of payment (APR=4.30; 95%CI: 1.18-15.66). Conclusion: Pharmaceutical counseling at a pharmacy setting was found to increase compliance of antibiotic use. Compliance of antibiotic use is also influenced by the frequency of taking medication and the method of payment. Pharmacist counseling when accessing medication at a pharmacy is crucial for improving patient compliance of antibiotic use.
Incidence of dispensing errors before and after root cause analysis at Sanglah General Hospital, Denpasar Ni Kadek Erna Erawati; I Made Ady Wirawan; Cokorda Bagus Jaya Lesmana
Public Health and Preventive Medicine Archive Vol. 7 No. 2 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i2.p06

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Background and purpose: Drug dispensing errors have a major impact on the incidence of medication errors, and can be very dangerous to patients and affect the quality of care. Root cause analysis (RCA) is an approach to prevent dispensing errors by identifying the root of the problem, make efforts to improve comprehensively across departments so that incidence of dispensing errors are not repeated. The purpose of this study is to determine the differences in the incidence of dispensing errors before and after the RCA. Methods: This is a descriptive study by calculating the incidence of dispensing errors before and after the RCA, conducted in four inpatient wards at Sanglah Hospital Denpasar. Dispensing errors were categorized into ten types namely errors in drug’s identity, name, dosage, number of drugs, absence of high alert labels, incorrect drug preparations, incorrect strength, expired drugs, incorrect place of delivery and incorrect instructions. In February and April 2018 there were 80 and 40 dispensing errors which met the study criteria, respectively. Results: Crude incidence of dispensing errors before and after RCA were 2.54 per 1000 (95%CI: 1.98-3.10) and 1.26 per 1000 (95%CI: 0.87-1.65), respectively. The decrease in dispensing error after RCA was 50.39%. The ratio of dispensing error incidence rates after and before the RCA is 0.49. Significant decrease in the incidence of dispensing errors was only found in drug identity errors of 1.27 per 1000 (95%CI: 0.88-1.66) before an RCA and 0.06 per 1000 (95%CI: -0.03-0.15) after RCA, or decreased by 95.27% and there was no significant decrease in other dispensing errors. Conclusion: The decrease of dispensing errors after the RCA was only found in the medication identity error and not found in the other dispensing errors. Direct observation and intensive supervision are needed in order to accurately calculate and reduce the incidence of dispensing errors.
Risks factors for diarrhea among travellers visiting Bali Ni Wayan Mega Sri Wahyuni; I Made Ady Wirawan; Made Agus Hendrayana
Public Health and Preventive Medicine Archive Vol. 7 No. 2 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i2.p08

Abstract

Background and purpose: The number of foreign travellers visiting Bali continues to increase and diarrhea often occur among them. The purpose of this study is to determine the risk factors for the incidence of diarrhea in foreign travellers. Methods: A case-control study was conducted in foreign travellers visiting the international clinic at the Port Health Office at Ngurah Rai International Airport in Denpasar during the period from May to October 2018. Cases were foreign travellers visiting the clinic with diarrhea symptoms. Controls were non-diarrhea foreign travellers visiting the clinic for other purposes. The number of cases and controls was 87 people each and were matched by gender and citizenship. Data collected were age, travel plans, type of food and beverage consumption, hand washing habits and type of food providers (roadside food sellers, restaurants, hotel restaurants and food stalls). Multivariat analysis was performed using logistic regression to determine the adjusted odds ratio (AOR) of each risk factor. Results: Characteristics of cases and controls do not differ in terms of gender and citizenship. Multivariate analysis shows that significant risk factors associated with diarrhea in foreign travellers are a history of consuming street food with AOR=3.94 (95%CI: 1.19-12.97) and a history of traditional barbequed pork consumption (called babi guling) with AOR=6.24 (95%CI: 2.09-18.64). Other risk factors, namely consumptions of Indonesian food, traditional mixed chopped meat and vegetables (called lawar), mixed rice and drinks with ice cubes, are not found to be associated with the incidence of diarrhea in foreign travellers. Conclusion: Consumptions of street food and traditional barbequed pork were found to be associated with the incidence of diarrhea in foreign travellers during a visit to Bali. Street food hygiene, education for food vendors and information provision to foreign travellers on choosing food types need to be improved
Implementation of six patient safety goals at a public health centre with in-patient services in Bali, Indonesia: A qualitative case study Gunawan, I Made Abdi; Wirawan, I Made Ady; Lubis, Dinar Saurmauli
Public Health and Preventive Medicine Archive Vol. 9 No. 1 (2021)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (797.878 KB) | DOI: 10.53638/phpma.2021.v9.i1.p03

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Background and purpose: The Indonesian government requires all health care facilities including public health centres (PHCs) to implement a patient safety program as part of the accreditation standard process. The implementation of patient safety in PHCs have faced various problems, including human resources and infrastructure issues. This study aims to explore the implementation of patient safety target procedures in an accredited inpatient PHC in Tabanan District, Bali, Indonesia.Methods: We conducted a qualitative case study that adopts four main domains in patient safety, consisting of executive officers, community or patient who received services, systems in service delivery and methods, and elements in each domain. The research location was at Penebel I PHC, an inpatient PHC with the accreditation status of “utama”. Data collection was carried out from March to April 2020. It includes observation of the patient safety implementation, review on tracking patient safety documents and in-depth interviews with 11 informants who are PHC staff, patients’ safety task force and the family of patients. The data were analysed using thematic analysis by creating a grid of themes, sub-themes and data reduction to narrative presentation. Results:The patient safety procedure in Penebel I PHC has been carried out through the standard and procedure according to the Ministry of Health (MoH) regulation which consist of patient identification; communication between staff and patients; maintain the safety of High Alert and Look Alike Sound Alike (LASA) medications. However, there is a need to improve the capacity of implementing officers to increase their communication competencies as well as to enhance cooperation between officers in health services to avoid patient safety incidents. Conclusion:The implementation of six patient safety goals in-corporate through four main domains of health care services has been running according to the MoH’s standard. There is a need to improve the competence of officers, cooperation between officers in carrying out patient safety management and improve communication between officers and patients so that the information conveyed by officers is truly understood by patients.
Co-Authors Akatsu, Haruko Ariana, Putu Agus Aryanita, Made Ayu Ratih Astawastini, I Dewa Ayu Mas Manik Bagus Komang Satriyasa Carolyna Mairing Cokorda Agung Wahyu Purnamasidhi Cokorda Bagus Jaya Lesmana Cokorda Bagus Jaya Lesmana, Cokorda Bagus Jaya Desak Nyoman Widyanthini Desak Putu Yulita Kurniati Deswandri Deswandri Dewa Nyoman Wirawan Dewa Nyoman Wirawan, Dewa Nyoman Dinar Lubis Dyah Pradnyaparmita Duarsa Egiya Goldarosa Sinuraya Erawati, Ni Kadek Erna Ervan Suryanti Umbu Lapu Fabiola Supit Florensia, Maria Frangklin Refelino Jotlely Futi Nurul Destya Ganesa Puput Dinda Kurniawan Gede Parta Kinandana Gunawan, I Made Abdi HARI MULYAWAN I Dewa Ayu Inten Dwi Primayanti I Gusti Agung Dyah Ambarawati I Gusti Ayu Made Julari I Gusti Ayu Made Juliari I Kadek Pendi Aprinta I Ketut Indra Wiguna Cakera I Ketut Suyasa I Komang Widarma Atmaja I Made Artana I Made Bakta I Made Jawi I Made Kerta Duana I Made Krisna Dinata I MADE MULIARTA . I Made Niko Winaya I Made Pande Dwipayana I Made Sukawinaca I Nyoman Mangku Karmaya I Wayan Putu Sutirta Yasa I Wayan Weta Ida Ayu Ary Pramita Ida Bagus Subanada Ida Bagus Yorky Brahmantya IKW. Suryawan Indra Wiguna Cakera, I Ketut IP. Adiartha Griadi Isabella Soerjanto Putri Istiana Marfianti J. A. Pangkahila Josua Aditya Manuel Kadek Dena Ayu Ersafira Kadek Tresna Adhi Karya, I Kadek Jony Dwi Ketut Ariawati Ketut Suarjana Komang Ayu Kartika Sari Lesmana, Cokorda Agung Bagus Jaya LMIS. Handari Adiputra Louise Cinthia Hutomo Luh Pitriyanti Luh Pitriyanti Luh Yulia Adiningsih Luh Yulia Adiningsih Made Agus Hendrayana MADE RATNA SARASWATI . Malcolm Abernethy Marfianti, Istiana Mia Ayustina Prasetya Nadila Sari, Putri Ngurah Agus Sanjaya ER Ni Kadek Dian Candra Dewi Ni Kadek Erna Erawati Ni Kadek Sutini Ni Ketut Sri Lestari Ni Luh Made Susanthi Pramandani Ni Luh Putu Mira Anggriani Ni Luh Putu Nurhaeni Ni Made Dian Kurniasari Ni Made Sri Nopiyani Ni Made Suasti Wulanyani Ni Nyoman Sri Budayanti Ni Putu Ita Mahayati Ni Wayan Mega Sri Wahyuni Ni Wayan Septarini Nijyoti, Nitya Nitya Nijyoti Nurhaeni, Ni Luh Putu Pande Putu Januraga Paramita, Ni Putu Pradnya Peter Larsen Prihandhani, I Gusti Agung Ayu Sherlyna Purnamawati, Susy Putu Astawa Putu Ayu Indrayathi Putu Ayu Sani Utami Putu Eka Arimbawa Putu Ika Anggaraeni Putu Imas Audina Putu Intan Tillama Putu Lestari Sudirman Putu Ratna Kusumadewi Giri Putu Rima Adilitha Widyasari Putu Wulan Putri Amerta R. A.T. Kuswardhani Rania Ayu Permata Putri Kornia Rodney Wu Rosita, Ni Putu Indah Santosa, I Gusti Ngurah Putra Eka Sarah Aldington Saraswati, Ni Luh Putu Gita Karunia Sari, Komang Ayu Kartika Sawitri, Anak Agung Sagung Sugijanto - Sukawinaca, I Made Sulawa, I Ketut Sulyastini, Ni Komang Susy Purnawati Tiara Alexander Wahyuddin, Wahyuddin Wahyudin - Wahyuni, Ni Wayan Mega Sri Wayan Citra Wulan Sucipta Putri Widowati, I Gusti Ayu Rai - Yenny Kandarini Yuntari, Gusti Ayu Krisma