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Rachmad Suhanda
Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Serum biomarkers associated with disease stage and pain severity among women with endometriosis in Indonesia Mustaqin Mustaqin; Rajuddin Rajuddin; Tgk. Puspa Dewi; Cut M. Yeni; Rusnaidi Rusnaidi; Rachmad Suhanda
Narra J Vol. 6 No. 2 (2026): August 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i2.3082

Abstract

Endometriosis is a chronic estrogen-dependent disease characterized by the presence of endometrial-like tissue outside the uterine cavity, resulting in chronic inflammation, recurrent pain, and infertility, and affecting approximately 190 million women worldwide. Chronic inflammation in endometriosis may stimulate overexpression of cyclooxygenase-2 (COX-2), which catalyzes prostaglandin E2 production, whereas cancer antigen 125 (CA-125) is a glycoprotein biomarker released by endometrial and mesothelial cells in response to inflammatory processes. The aim of this study was to analyze the correlations between serum COX-2 and CA-125 levels and the degree of endometriosis, based on the revised American Society for Reproductive Medicine classification, and between these levels and pain severity, based on the Numeric Rating Scale. A cross-sectional study was conducted among patients with endometriosis at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The levels of COX-2 and CA-125 were measured using enzyme-linked immunosorbent assay and chemiluminescence immunoassay, respectively. Spearman correlation and ordinal logistic regression were used for statistical analysis. The median age of the participants was 36 years (range: 19-51 years), and most patients had Stage IV endometriosis (78.6%). COX-2 showed a significant positive correlation with both the degree of endometriosis (r=0.526; p<0.001) and pain severity score (r=0.769; p<0.001). CA-125 also showed a significant positive correlation with the degree of endometriosis (r=0.433; p=0.004), but not with pain severity (r=0.256; p=0.102). Receiver operating characteristic curve analysis showed that COX-2 had good discriminative ability for severe endometriosis (AUC=0.865) and for severe pain (AUC=0.864). In the multivariable model, COX-2 and CA-125 were also significantly associated with pain severity. These findings suggest that COX-2 was more strongly associated with pain severity, whereas CA-125 was more closely related to the degree of endometriosis. Further studies with larger sample sizes and prospective designs are needed to validate these findings and clarify the clinical utility of these biomarkers in endometriosis management.
Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh Febrina Yolanda; Tgk. Puspa Dewi; Sarah I. Nainggolan; Munawar Munawar; Munizar Munizar; Rijal Bulqini; Rachmad Suhanda; Rusnaidi Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3022

Abstract

Indonesia is committed to the WHO's cervical cancer elimination strategy through the National Action Plan (RAN) 2023–2030, targeting 75% screening coverage by 2030. However, current rates remain critically low at 7.02%. This study explores multi-stakeholder perspectives to identify implementation barriers and facilitators for policy enhancement. A qualitative descriptive case study was conducted in Banda Aceh (July-August 2025) involving 25 stakeholders: City Health Office Head, 11 puskesmas heads, 11 VIA coordinators and 2 community organization representatives. Thematic analysis using NVivo v.16 identified key implementation factors. Five major themes emerged: (1) Knowledge gaps—screening perceived necessary only when symptomatic despite available information; (2) Access paradox—excellent geographic access and flexibility undermined by limited examination rooms, insufficient midwives, and psychosocial barriers (shame, fear, lack of spousal support); (3) Financial sustainability—free services threatened by complex BPJS claims and low reimbursement affecting logistics; (4) Service quality variation—dependent on cross-sector collaboration and staff competency, with uneven training and limited cryotherapy (only 2 centers); and (5) Communication challenges—inconsistent digital media use necessitates face-to-face counseling and cadres, though reach remains limited. Implementation faces psychological barriers, capacity limitations, and uneven digital adoption despite strong infrastructure. Priority policy recommendations include: (1) HPV DNA self-sampling to overcome privacy barriers; (2) simplified BPJS claims with adequate reimbursement; (3) systematic competency-building and cryotherapy expansion; and (4) culturally-adapted education integrating local language and religious leaders. These evidence-based enhancements could accelerate Indonesia's RAN 2030 elimination targets.
Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior Dean R. Purnama; Tgk. Puspa Dewi; Rusnaidi Rusnaidi; Niken A. Utami; Rizka Aditya; Rachmad Suhanda
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3025

Abstract

The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.
Associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy in remote areas of Indonesia: An application of Social Cognitive Theory framework Liza Muknisa; Tgk. Puspa Dewi; Munizar Munizar; Niken A. Utami; Rusnaidi Rusnaidi; Rachmad Suhanda
Narra J Vol. 6 No. 3 (2026): December 2026 (In Press)
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i3.3133

Abstract

Teenage pregnancy remains a major public health challenge in Indonesia, particularly in remote settings where sociocultural norms strongly influence adolescent behavior. In Gayo Lues Regency, Aceh Province, Indonesia, adolescent pregnancy continues to occur within a context of early marriage, limited reproductive health access, and strong community norms. The aim of this study was to examine the associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy within the framework of Social Cognitive Theory. A quantitative cross-sectional study was conducted among female adolescents aged 10 to 19 years registered across four community health centers (Puskesmas) in Gayo Lues. Participants were selected using cluster random sampling. Data were collected through structured face-to-face interviews using a validated questionnaire. The associations were analyzed using simple and multiple binary logistic regression. A history of teenage pregnancy was reported by 29.5% of participants. Bivariate analysis showed that self-efficacy, outcome expectancies, and socio-structural factors were significantly associated with the history of teenage pregnancy. In the multivariate model, higher outcome expectancies were most strongly associated with lower odds of teenage pregnancy history (odds ratio (OR): 0.424; p<0.001), followed by higher self-efficacy (OR: 0.628; p=0.027), whereas socio-structural factors were not independently associated (OR: 0.810; p=0.318). These findings suggest that personal cognitive factors play a stronger role than socio-structural factors in this setting. Interventions to prevent teenage pregnancy should prioritize strengthening adolescents’ self-efficacy and shaping positive outcome expectancies through comprehensive reproductive health education and supportive social environments.
Co-Authors Cut M. Yeni Dean R. Purnama Febrina Yolanda Liza Muknisa Munawar Munawar Munizar Munizar Munizar Munizar Mustaqin Mustaqin Niken A. Utami Rajuddin Rajuddin Rijal Bulqini Rizka Aditya Rusnaidi Rusnaidi Rusnaidi Rusnaidi Rusnaidi Rusnaidi Rusnaidi Rusnaidi Sarah I. Nainggolan Tgk. Puspa Dewi Tgk. Puspa Dewi Tgk. Puspa Dewi Tgk. Puspa Dewi