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All Journal Jurnal Kedokteran Syiah Kuala Jurnal Kedokteran Brawijaya Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Jurnal Kebidanan Dan Kesehatan Tradisional Majalah Obstetri dan Ginekologi Universa Medicina AcTion: Aceh Nutrition Journal Jurnal Kesehatan Reproduksi Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Journal of Epidemiology and Public Health Indonesian Journal of Medicine Journal of Health Policy and Management Journal of Health Promotion and Behavior Journal of Maternal and Child Health JKM (Jurnal Kebidanan Malahayati) Jurnal Pengabdian Masyarakat: Darma Bakti Teuku Umar Jurnal Kebidanan Harapan Ibu Pekalongan Placentum: Jurnal Ilmiah Kesehatan dan Aplikasinya Jurnal Abdidas Infokes : Jurnal Ilmiah Rekam Medis dan Informasi Kesehatan Nusantara Science and Technology Proceedings Plexus Medical Journal Indonesian Basic and Experimental Health Sciences Folia Medica Indonesiana
Uki Retno Budihastuti
Department Of Obstetrics And Gynecology, Faculty Of Medicine, Universitas Sebelas Maret, Surakarta/ Dr. Moewardi Hospital, Surakarta
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Does Health Center Have Contextual Effect on Midwife Performance? Multilevel Analysis Evidence from East Kalimantan, Indonesia Rahmadani, Latifah Nur; Budihastuti, Uki Retno; Poncorini, Eti
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: The maternal mortality rate (MMR) which is still high has now become the priority in order to find its solution. Midwives play a very significant role in making efforts to reduce MMR through antenatal care (ANC) services. The performance of midwives directly influences the quality of service and health outcomes in the public health centers. The performance of midwives in ANC can be seen based on the coverage of K1 and K4. This study aimed to determine the contextual effect of public health centers and other factors that influence the performance of midwives in antenatal care services.Subjects and Method: This study was conducted using observational analytic with cross sectional approach. It was done in 25 health centers in Samarinda, East Kalimantan in April-May 2019. The number of samples was 180 midwives selected using the total sampling technique. The dependent variable is the performance of the midwife. The independent variables include age, knowledge, tenure, training, workload, incentive, supervision, and motivation. The data were collected by questionnaire and analyzed by multilevel multiple logistic regression.Results: Midwife performance was influenced by age >45 years (b = -2.48; 95% CI = -4.53 to -4.34; p = 0.018), good knowledge (b = 1.35; 95% CI = 0.38 to 2.31; p = 0.006), tenure ≥13 years (b = 1.89; 95% CI = -0.07 to 3.86; p = 0.059), training ≥2 (b = 1.30; 95% CI = 0.29 to 2.30; p = 0.011), heavy workload (b = -1.30; 95% CI = -2.27 to -0.34; p = 0.008), incentive (b = 1.74; 95% CI = 0.30 to 3.18; p = 0.018), supervision (b = 1.12; 95% CI = 0.19 to 2.05; p = 0.017), and high motivation (b = 1.42; 95% CI = 0.45 to 2.38; p = 0.004). There was no contextual influence of public health center on the performance of midwives in antenatal care services (ICC = <1%).Conclusion: Age, knowledge, tenure, training, workload, incentives, supervision, and motivation are associated with midwives performance. There is no contextual influence of public health centers on the performance of midwives.Keywords: work performance, midwife, contextual effect, antenatal careCorrespondence: Latifah Nur Rahmadani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Jawa Tengah. Email: latifahnr8@gmail.com. Mobile: 085250118907.Journal of Health Policy and Management (2019), 4(3): 150-160https://doi.org/10.26911/thejhpm.2019.04.03.02
Does Secondary Smoking and Posyandu Affect the Risk of Hypertension in Pregnancy? Multilevel Evidence from Magelang, Central Java Rizkiana, Erin; Budihastuti, Uki Retno; Widyaningsih, Vitri
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Pregnancy hypertension was a complication of pregnancy which became one of the causes of maternal and perinatal morbidity and mortality in the world. This study aimed to determine the effect of individual and contextual factors of integrated health post (posyandu) on hypertension in pregnancy.Subjects and Method: A case control study was conducted in 5 posyandus in Magelang, Central Java, from April to May 2019. A sample of 210 women was selected by simple random sampling. The dependent variable was hypertension in pregnancy. The independent variables were age, parity, nutritional status, family history of hypertension, history of hypertension before pregnancy, history of hormonal contraceptive, and exposure to cigarette smoke. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression.Results: Hypertension in pregnancy increased with age <24 or > 35 years old (b= 2.10; 95% CI= 0.16 to 4.04; p= 0.033), parity (b= -3.81; 95% CI = - 6.31 to -1.32; p = 0.003), nutritional status (b= 3.35; 95% CI= 1.36 to 5.33; p= 0.001), family hypertension history (b= 3.35; 95% CI= 1.33 to 5.37; p= 0.001), hypertension history before pregnancy (b= 2.46; 95% CI= 1.1 to 3.81; p<0.001), hormonal contraceptive history (b= 2.6; 95% CI= 0.53 to 4.72; p= 0.014), and cigarette smoke exposure (b= 2.87; 95% CI= 1.15 to 4.58; p= 0.001). Posyandu had negligible contextual effect on hypertension in pregnancy with ICC= 7.6%.Conclusion: Hypertension in pregnancy increases with age <24 or > 35 years old, parity, nutritional status, family hypertension history, hypertension history before pregnancy, hormonal contraceptive history, and cigarette smoke exposure. Posyandu has negligible contextual effect on hypertension in pregnancy.Keywords: Hypertension, pregnancy, cigarette smoke, multilevel analysisCorrespondence: Erin Rizkiana, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: erinrizkiana777@gmail.com. Mobile: 085729883106Journal of Epidemiology and Public Health (2019), 4(3): 247-258https://doi.org/10.26911/jepublichealth.2019.04.03.12 
Multilevel Analysis on the Contextual Effect of Community Health Center on Health Workers Performance Wardhani, Anindyah Tri Lhaksmi Kusuma; Tamtomo, Didik; Budihastuti, Uki Retno
Journal of Health Policy and Management Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: One of the high maternal mortality rates is caused by bleeding factors. The imple­mentation of preventive effort that is less than optimal as well as the ability, understanding, and compliance of health personnel with Standard Operating Procedures (SPO) is still lacking and not in accordance with professional standards, allegedly a factor that affects the Maternal Mortality Rate (MMR). The performance of midwives in accordance with the SPO would have an impact on reducing mortality and improving the welfare of mothers and babies. This study aimed to analyze the factors that influence the performance of midwives in the early detection of bleeding.Subjects and Method: This was a cross sectional study conducted at 25 public health centers in Banyuwangi, East Java, from February to May 2019. A total sample of 200 midwives was selected for this study by simple random sampling. The dependent variable was midwife performance. The independent variables were training, skill, leadership style, incentive, work motivation, age, and human source. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression run on Stata 13. Results: Midwife performance increased with training (b= 1.46; 95% CI= 0.48 to 2.42; p= 0.003), skill (b= 2.32; 95% CI= 1.28 to 3.36; p= 0.001), high motivation (b= 1.66; 95% CI= 0.71 to 2.61; p= 0.001), incentive >Rp 1,000,000 (b= 2.59; 95% CI= 1.53 to 3.65; p= 0.001), positive leadership style (b= 1.95; 95 % CI= 0.93 to 2.96; p= 0.001), and human source>8 midwives (b= 1.05; 95% CI= 0.08 to 2.02; p= 0.033). Midwife performance decreased with age ?35 years (b= -1.16; 95% CI= -2.16 to -0.16; p= 0.023). Community health center had strong contextual effect on midwife performance with ICC= 25.74%.Conclusion: Midwife performance increases with training, skill, high motivation, incentive >Rp 1,000,000, positive leadership style, and human source>8 midwives. Midwife performance decreases with age ?35 years. Community health center has strong contextual effect on midwife performance.Keywords: work performance, midwives, multilevel analysisCorrespondence: Anindyah Tri Lhaksmi Kusuma Wardhani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: anin­dyah­tri@­gmail.com. Mobile: +6285258917339.Journal of Health Policy and Management (2019), 4(3): 182-194https://doi.org/10.26911/thejhpm.2019.04.03.06
Path Analysis on the Effects of Peer Support and Sanitation Facilities on Personal Hygiene among Female Student having Menstruation in Sragen Central Java Kunaryanti, Kunaryanti; Budihastuti, Uki Retno; Dewi, Yulia Lanti Retno
Journal of Health Promotion and Behavior Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Poor personal hygiene during menstruation causes the risk of Reproductive Tract Infection (RTI) in adolescent. It threatens women's health. Personal hygiene is affected by attitude, peer support, and the availability of personal hygiene facilities. This study aims to analyze the determinant of personal hygiene in adolescents during menstruation in Sragen Regency, Central Java.Subjects and Method: This study was an analytic observational study with a cross sectional design. The study was conducted in June 2019. A sample of 200 study subjects was selected for this study by simple random sampling. The dependent variable was personal hygiene. The inde­pendent variables were attitude, peer support, and the availability of personal hygiene facilities. The study was collected by questionnaire and analyzed by path analysis.Results: Personal hygiene was directly and positively affected by positive attitude (b=1.38; 95% CI=0.78 to 1.98; p<0.001). Personal hygiene was indirectly affected by strong peer support and the availability of good personal hygiene facility.Conclussion: Personal hygiene is directly and positively affected by positive attitude. Personal hygiene is indirectly affected by strong peer support and the availability of good personal hygiene facility.Keywords: personal hygiene, attitude, peer support, personal hygiene facilitiesCorrespondence:Kunaryanti. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: kunaryanti@yahoo.com. Mobile: +6285700900029.Journal of Health Promotion and Behavior (2019), 4(3): 170-177https://doi.org/10.26911/thejhpb.2019.04.03.02 
Biopsychosocial Factors Associated with the Occurrence of Female Infertility Sari, Suci Arsita; Budihastuti, Uki Retno; Pamungkasari, Eti Poncorini
Journal of Maternal and Child Health Vol 4, No 6 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: Infertility is not a disease that needs to be worried. However, it becomes a serious problem for certain people such as causing divorce. Infertility in women can be affected by Polycystic Ovary Syndrome (PCOS), Body Mass Index (BMI), lifestyle, age, occupation, stress, metabolic disorder, endometriosis, and uterine myoma. This study aimed to determine the factors associated with female infertility.Subjects and Method: This was an analytic observational study with a case-control design. This study was conducted at Dr. Moewardi hospital, Surakarta, Central Java, from May to July 2019. A sample of 200 women was selected by fixed disease sampling. The dependent variable was infertility. The independent variables were PCOS, BMI, lifestyle, age, occupation, stress, metabolic disorder, endometriosis, and uterine myoma. The data were collected by questionnaire and medical record. The study was analyzed by multiple logistic regression.Results: Female infertility was affected by age ?35 years (OR= 9.05; 95% CI= 2.61 to 31.39; p= 0.001), occupation (OR= 8.29; 95% CI= 2.25 to 30.48; p= 0.001), BMI ?25 (OR= 8.16; 95% CI= 2.44 to 27.29; p=0.001), PCOS (OR=117.34; 95% CI=10.31 to 1334.83; p <0.001), endometriosis (OR= 5.01; 95% CI= 1.17 to 21.38; p=0.029), uterine myoma (OR=6.59; 95% CI= 1.76 to 24.67; p= 0.005), and metabolic disorder (OR= 15.39; 95% CI= 4.02 to 58.84; p<0.001).Conclusion: Female fertility is affected by age ?35 years, occupation, BMI ?25, PCOS, endometriosis, uterine myoma, and metabolic disorder.Keywords: female infertility, PCOS, endometriosisCorrespondence:Suci Arsita Sari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: suciarsita@gma­il.com. Mobile: 08578­617­99­94.Journal of Maternal and Child Health (2019), 4(6): 507-515https://doi.org/10.26911/thejmch.2019.04.06.11 
Path Analysis on Determinants of Postpartum Bleeding at Dr. Moewardi Hospital, Central Java Hidayati, Siti Nur; Budihastuti, Uki Retno; Widyaningsih, Vitri
Journal of Maternal and Child Health Vol 4, No 6 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Postpartum hemorrhage is bleeding that exceeds 500 ml after the baby is born. The main causes of postpartum bleeding are uterine atony, placental retention, birth canal laceration, and blood clotting abnormalities. Predisposing factors of postpartum hemorrhage are age, parity, anemia, premature rupture of membranes, preeclampsia, prolonged labor, uterine overdistention, labor of action, history of previous bleeding, and distance of pregnancy. Postpartum hemorrhage will cause maternal death if it is not treated immediately. This study aimed to analyze the determinants of postpartum hemorrhage.Subjects and Method: This study used observational analytic with a case control approach. The study was conducted at Dr. Moewardi, Central Java, from April to May 2019. The total sample was 225 maternity mothers who were selected based on fixed disease sampling by using a ratio of 1: 2 between the case and control groups. The dependent variable was postpartum bleeding. The independent variables were age, parity, anemia, premature rupture of membranes, preeclampsia, prolonged labor, uterine overdistention, action delivery, obstetric history, uterine atony, placental retention, birth canal laceration, and pregnancy distance. Data collection techniques used secondary data medical record records which were analyzed by using path analysis.Results: Postpartum hemorrhage was directly and positively associated with atonia uterine (b= 2.46; 95% CI= 1.53 to 3.40; p<0.001), vaginal laceration (b= 1.76; 95% CI= 0.78 to 2.75; p <0.001), poor obstetric history (b= 0.93; 95% CI= 0.11 to 1.76; p= 0.026), and type of labor (b= 1.70; 95% CI= 0.94 to 2.46; p <0.001). It was indirectly affected by preeclampsia, parity, prolonged labor, premature rupture of membrane, age, anemia, uterine overdistention, birth spacing, and placental retention.Conclusion: Postpartum hemorrhage is directly and positively associated with atonia uterine, vaginal laceration, poor obstetric history, and type of labor. It is indirectly affected by pre­eclampsia, parity, prolonged labor, premature rupture of membrane, age, anemia, uterine overdistention, birth spacing, and placental retention.Keywords: Postpartum hemorrhage, placental retention, atonia uterine, path analysis Correspondence: Siti Nur Hidayati. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: sitihidayati58@gmail.com. Mobile: 082133­679586.Journal of Maternal and Child Health (2019), 4(6): 35-47https://doi.org/10.26911/thejmch.2019.04.06.04
The Difference of Endometrial Leptin Expression in Woman with Polycystic Ovarian Syndrome (PCOS) Compared to Normal Besar, Dwi Sakti Berlian; Budihastuti, Uki Retno; Sulistyowati, Sri; Melinawati, Eriana
Indonesian Journal of Medicine Vol 5, No 1 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Decreased endometrial recep­ti­vity is suspected to be one of the factors causing in­fertility in women with Polycystic Ovary Syn­dro­me (PCOS). Endometrial abnormalities in PC­OS­ due to impaired balance include estrogen, pro­­­­gesterone, growth factors, cytokines and cell at­tach­­­ment modulators including leptin. This study aims to determine the expression of leptin in the endometrium which is suspected to be more common in PCOS patients and related factors.Subjects and Method: A retrospective-case control study was conducted at Dr. Moe­wardi general hospital, Surakarta. A total of 60 women were involved; 30 infertile women with PCOS based on Rotterdam criteria (if found two of the three symptoms, including hyperandrogenism, ovu­la­tion dysfunction and/or polycystic ovaries from ultrasonography) and 30 normal women as con­trol group. Demographic data such as age, family history of PCOS, menarche, BMI, occupation, and edu­cation were recorded. Leptin expression was acquired from endometrium biopsy with IHC examination on day 19-24 of the menstrual cycle; under the condition that inclusion and exclusion cri­teria are fulfilled. The statistical analysis was per­formed using the Mann-Whitney test.Results: Mean of leptin expression was found significantly higher in PCOS group (Mean= 59.16; SD= 49.34) compared to control group (Mean= 6.00; SD= 22.98, with p= 0.001. PCOS (b= 0.42; 95% CI= 0.10 to 0.73; p= 0.010) and obesity (b= 0.31; 95% CI= 0.41 to 0.58; p= 0.025) increased leptin expression.Conclusion: There is a difference in leptin ex­pres­­sion in the endometrium of PCOS compared to nor­mal.  Leptin expression is higher in the en­do­metrium of women with PCOS and obesity compared to nor­mal.Keywords: Leptin expressions, endometrium, polycystic ovarian syndrome.Correspondence: Dwi Sakti Berlian Besar. Department of Obs­tetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi General Hos­pital, Surakarta, Indonesia. Email: dwiesakti@student.uns.ac.id. Mobile: +628121845054Indonesian Journal of Medicine (2020), 05(01): 38-46https://doi.org/10.26911/theijmed.2020.05.01.06 
Contextual Effect of Community Health Center and Other Determinants of Midwife Performance in the Implementation in the Prevention Mother to Child Transmission Counselling and Testing: A Multilevel Model Evidence Sringatin, Sringatin; Budihastuti, Uki Retno; Sulaeman, Endang Sutisna
Journal of Health Policy and Management Vol. 5 No. 1 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: High transmission of HIV from mother to child can contribute to an increase in the number of pandemic events. Transmission of HIV from mother to baby can be prevented by the PMTCT (Prevention of Mother to Child HIV Transmission) program. The purpose of this study is to analyze the implementation of PMTCT program policies by midwives.Subjects and Method: The design used in this study was observational analytic with cross sectional approach. The number of samples is 184 subjects. The sampling was done using total sampling. The independent variables included midwives' knowledge, midwife's age, job satisfac­tion, team performance, work environment, community support, training, and length of work. Meanwhile, the dependent variable is the implementation of PMTCT policies. Variable data collec­tion was performed using a questionnaire and analyzed using multilevel analysis with Stata 13.Results: The implementation of PMTCT policies increased influenced by period of working ≥8 years (b= 0.50; 95% CI= 0.61 to 0.85; p= 0.004), training ≥2 times (b= 0.44; 95% CI= -0.13 to 0.76; p= 0.005), good midwife knowledge (b= 0.65; 95% CI= 0.36 to 0.93; p<0.001), midwife satisfaction is good (b= 0.05; 95% CI= -0.21 to 0.31; p= 0.694), and midwife performance is good (b= 0.59; 95% CI= 0.25 to 0.93; p= 0.001). The implementation of PMTCT policies decreased influenced by bad working environment (b= -0.09; 95% CI= -0.36 to 0.16; p= 0.451), age ≥35 years (b= -0.51; 95% CI= -0.80 to -0.24; p<0.001), and small community support (b= -0.06; 95% CI= -0.38 to 0.25; p= 0.692). Public health ceneters have weak contextual influence on the implementa­tion of PMTCT program policies with ICC= 6.6%.Conclusion:The midwife's period of work, knowledge, training, midwife's performance, and midwife's satisfaction improve PMTCT implementation. Whereas midwives' age, work environ­ment and community support reduce PMTCT implementationKeywords: HIV / AIDS, implementation of PMTCT, multiple linear regression analysis.Correspondence:Sringatin, Dolopo Regional Public Hospital, Madiun, East Java. Jl. Raya Dolopo no.117 Dolopo, Madiun 63174, East Java. Email: sringatine22@gmail.com. Mobile: 081231683090Journal of Health Policy and Management (2020), 5(1): 35-47https://doi.org/10.26911/thejhpm.2020.05.01.04
Factors Affecting Late Infertility Examination Budihastuti, Uki Retno; Melinawati, Eriana; Sari, Arum Dessy Rahma; Jatiningtyas, Abida Zuhra
Journal of Maternal and Child Health Vol 5, No 2 (2020)
Publisher : Journal of Maternal and Child Health

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Background:  Infertility is the inability of a couple to get pregnant after 12 months of regular sexual intercourse at least 2-3 times a week with­out using contraception. Delay in the examina­tion will have a bad impact considering that in­creas­ing age will affect the success of the hand­ling of infertility, especially in women so it is neces­sary to know the factors that influence the delay of the initial examination in order to be over­come. This study aims to determine the factors that influence the late infertility examin­ation.Subjects and Method: This was an analytic observational study with a cross sectional design. The study was conducted at Sekar Polyclinic, Dr. Moewardi Hospital, Surakarta, Central Java, from June to August 2019. A sample of 90 out­patients was selected by purposive sampling. The depen­­dent variable was late infertility exami­nation. The independent variables were family sup­port, knowledge, accessibility, and education. The data was collected by medical record and question­­naire. The data were analyzed by a multiple logistic regression.Results: Late infertility examination decreased with strong family support (OR= 0.20; 95% CI= 0.06 to 0.62; p= 0.006), high knowledge (OR= 0.29; 95% CI= 0.09 to 0.92; p= 0.036), good accessibility (OR= 0.18; 95% CI= 0.05 to 0.59; p= 0.005), and high education (OR= 3.41; 95% CI= 0.95 to 12.17; p= 0.059).Conclusion: Late infertility examination decreases with strong family support, high know­ledge, good accessibility, and high education.Keywords: infertility examination, family sup­port, accessibility, knowledgeCorrespondence: Uki Retno Budihastuti. Department of Obstetrics and Gynecology, Dr. Moewardi Hospital,Jl. Kolo­nel Sutarto132, Jebres, Surakarta, Central Java. Email: ukiretno@gmail.com. Mobile: 0812­26­56­140.Journal of Maternal and Child Health (2020), 5(2): 206-212https://doi.org/10.26911/thejmch.2020.05.02.11
Contextual Effect of Community Health Center on Visual Inspection Acetic Acid Uptake in Magelang, Central Java: A Multilevel Analysis Martaningrum, Herlina Ika; Budihastuti, Uki Retno; Murti, Bhisma
Journal of Maternal and Child Health Vol 5, No 2 (2020)
Publisher : Journal of Maternal and Child Health

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Abstract

Background: Cervical cancer is a major prob­lem in women's. Cervical cancer can be prevented by early examinations i.e. visual inspection acetic acid (VIA). This study aimed to analyze the contex­tual effect of community health center on VIA up­take in Magelang, Central Java.Subjects and Method: This was analytic obser­­­­vational study with cross-sectional design. The stu­dy was conducted at 25 community health cen­­­­­ters in Magelang, Central Java, from Sep­tem­ber to October 2019. A to­tal sample of 200 women aged 30 to 50 years was selected ran­domly. The dependent variable was VIA uptake. The independent variables were knowledge, ob­ser­­­vational lear­ning, behavioral reinforcement, cues for action, access to information, family sup­port, attitude, self-efficacy, outcome expec­tation, and contextual factor of community health cen­ter. The data were collected by ques­tion­naire and analyzed by a multilevel multiple logistic reg­res­sion run on Stata 13.Results: VIA uptake increased with good know­ledge (b= 4.02; 95% CI= 0.61 to 7.42; p= 0.021), obser­­vational learning (b= 2.28; 95% CI= -0.35 to 4.93; p= 0.090), strong behavioral rein­force­ment (b= 4.11; 95% CI= 0.82 to 7.40; p= 0.014), strong cues to action (b= 5.36; 95% CI= 0.65 to 10.07; p= 0.026), good access to information (b= 3.71; 95% CI= 0.42 to 7.01; p= 0.027), strong family support (b= 4.23; 95% CI= 0.21 to 8.25; p= 0.039), positive attitude (b= 3.29; 95% CI= -0.23 to 6.81; p= 0.067), strong self-efficacy (b= 2.94; 95% CI= 0.10 to 5.78; p= 0.042), and strong outcome expectation (b= 3.39; 95% CI= 0.35 to 6.44; p= 0.029). Community health cen­ter had strong contextual effect on VIA uptake with intra-class correlation (ICC)= 23%.Conclusion: VIA uptake increases with good know­ledge, observational learning, strong beha­vi­o­ral rein­forcement, strong cues to action, good access to information, strong family support, posi­tive attitude, strong self-efficacy, and strong out­come expectation. The community health center has a strong contextual effect on VIA uptake.Keywords: visual inspection acetic acid, social cognitive theory, multilevel analysisCorrespondence: Herlina Ika Martaningrum, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Su­tami 36A, Surakarta 57126, Central Java, Indo­nesia. Email: herlinaika21@gmail.com. Mobile: 085643528156Journal of Maternal and Child Health (2020), 5(2): 129-140https://doi.org/10.26911/thejmch.2020.05.02.02   
Co-Authors -, Kartika ., Darto Abdurahman Laqif Abdurahman Laqif Abdurahman Laqif Abida Zuhra Jatiningtyas Adhimukti, Fahmi Agung Sari Wijayanti Agustina, Devita Alfi Marita Tristiarti Alfi Marita Tristiarti Alfi Marita Tristiarti Ali Djamhuri Alifa, Rosita Ambar Mudigdo Amir, Nikmah Ayu Ramadhani Angelia Ratnasari, Affi Anggraeni, Asih Anik Lestari Anik Lestari Annang Giri Moelyo Argyo Demartoto, Argyo Arianty, Meike Arifiana, Ratna Arifin, Ayu Kusuma Puspasari Aris Sudiyanto Armadhani, Riska Asih Anggraeni Astuti, Susiana Yuni Bachnas, Muhammad Adrianes Bachtiar, Harrys Besar, Dwi Sakti Berlian Bhisma Murti Cahyono Hadi Chintya, Shally Ayu Cut Sheira Elnita Damalita, Annisa Fitriana Damayanti, Siti Darto Darto Darto Darto - Darto . Darto . Darto Darto Debree Septiawan Dewanto Suryoningrat Dewi, Rizqa Kartika Dewi, Yulia Lanti Ratna Dewi, Yulia Lanti Ratna Dian Asih Ning Utami Dian Kusumawardani Dian Kusumawardani Dian Rahmawati Diani Octaviyanti Handajani Didik Gunawan Tamtomo Didik Tamtomo, Didik Dwi Apriyanti Endang Sutisna Endang Sutisna Sulaeman Eriana Melinawati Eric Edwin Yuliantara Erin Rizkiana Ermawati, Dwi Hesti Ertiana, Dwi Eti Poncorini Pamungkasari Fahsan, Fatmiyanti Farras Wahdan, Arib Fatmawati, Zeny Fauzia, Raina Lola Fazrina, Gina Firdausia, Shalsabilla Tiara Fitria Wulandari Frafitasari, Dika Yanuar Habibatullah, Afifa Intifadha Hadi, Cahyono Hadianti, Ayunita Dwi Hafi Nurinasari Hafiizha, Attahira Amalia Hafiizha, Atthahira Amalia Handriani, Winei Haniah, Alfi Zamilul Hanifah, Rofi'atul Hanifah, Rofi’atul Harsono Salimo Harsono Salimo Hastuti, Tri Ari Hermawan Udiyanto Heru Priyanto Heru Priyanto Hidayah, Fristyaningrum Ida Nurwati Ilmiyah, Desy Eka Indradewa, Rhian Jannah, Ahadyah Miftahul Jannah, Ahadyah Miftahul Jatiningtyas, Abida Zuhra Jayanti, Saktryana Endang Ragil Juhrotun Nisa, Juhrotun Ksatriya, Yudhistya Ngudi Insan Kunaryanti, Kunaryanti Kunaryanti, Kunaryanti Kusnandar Kusnandar Laqif, Abdurahman Laqif, Abdurrahman Lunardhi Susanto Lutfiana Puspita Sari Maghfiroh, Ainul Mahendra Wijaya Mahendra Wijaya Marbun, Yohan Pamuji Marliana, Wiwit Martaningrum, Herlina Ika Metanolia Sukmawati Mufidah, Amatullah Muhammad Adrianes Bachnas Mulyoto Pangestu Murdikawati, Dayang Fitri Murdikawati, Dayang Fitri Mushthafa, Mufti Mutiara, Bunga Ngudi Insan Ksyatria, Yudhistira Ningrum, Sintia Ayu Ningsih, Hepti Widia Nugrahani, Rosi Rizqi Nurul Qomariah Nurul Wahidah Nutria Widya Purna Anggraini Nuur, Aliffudin Octavia, Dhamayanti Eka Ode, Diana Oktaviani, Anisa Sevi Pamungakasari, Eti Poncorini Pawito -, Pawito Pertiwi, Mumpuni Intan Poncorini, Eti Prasetya, Hanung Prastyoningsih, Aris Prisasanti, Dympna Prameilita Puspita, Ita Fijanah Putriarsih, Ryanawati Qadrijati, Isna Qomariah, Nur Laili Quinita M. J. Noronha Rahardjo, Setyo Sri Rahayu, Baiq Zulvita Rahayu, Putu Sri Rahmadani, Latifah Nur Rakano Kautsar Dwiyana Rantasari, Affi Angelia Ratih Sakti Prastiwi Ratih Sakti Prastiwi, Ratih Sakti Ratna Dewi Permatasari Ratnasari, Affi Angelia Regita, Immanuela Maria Reso, Mulya Cunda Ratu Reso, Mulya Cunda Ratu Retno, Yulia Lanti Ria, Matilda Bupu Riawati, Meida Siwi Risang Bhaskoro Rita Adriani Benya Adriani Rizkiani, Inne Rofi’atul Hanifah Saputra, Ricky Bernadi Sari, Arum Dessy Rahma Sari, Lutfiana Puspita Sari, Prafista Wulan Satria, Yohanes Aditya Adhi Selvia Febrianti Septiana, Yesika Cahya Simarmata, Imelda Dearni Simarmata, Imelda Dearni SITI KHOLIFAH Siti Munawaroh Siti Nur Hidayati Soetrisno Soetrisno Sri Sulistyowati Sri Sulistyowati Sri Sulistyowati Sri Sulistyowati Sri Widarti, Sri Sringatin, Sringatin Suci Arsita Sari Sulistyoningrum, Indah SUMIYATI SUMIYATI Sunarta, Elfania Arumma Suparno, Amalia Ulfah Supriyadi Hari Respati Supriyadi Hari Respati Supriyadi Hari Respati Tanti Arianti Teguh Prakosa, Teguh Teha, Zadia Dara Cynintya Tri Nugraha Susilawati Verasita, Prissy Vitri Widyaningsih Wardana, Aisyah Puspa Wardhani, Anindyah Tri Lhaksmi Kusuma Wasyanto, Trisulo Wesliaprilius, Todung Antony Wijayanti, Agung Sari Wisnu Prabowo WISNU PRABOWO Wulandari, Rizqi Amalia Wulandari, Umianita Risca yulia lanti retno dewi Yulyanti, Yulyanti