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THE EFFECT OF DECENTRALIZATION ON THE HEALTH STATUS AND HEALTH CARE UTILIZATION PATTERNS ININDONESIA Tilden, Robert; Gani, Ascobat; Noor, Nur Nasry; Widjajanto, RM.; Sonnemann, James
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36457/gizindo.v29i2.29

Berbagai indikator pelayanan dan status kesehatan berdasakan tingkat pengeluaran konsumsi rumahtangga menurut quintile sebelum dan sesudah desentralisasi dinilai dan dikaji. Dilakukan juga penilaian perubahan status kesehatan pada periode desentralisasi, dan juga perbandingan antar wilayah yang menerima dan melaksanakan berbagai program pelayanan kesehatan atau wilayah yang tidak sama sekali mendapatkan inisiasi program pelayanan kesehatan. Data Susenas 2000 dan 2004 digunakan untuk menilai perubahan berbagai indikator kesehatan: morbiditas, pelayanan rawat jalan dan rawat inap, pelayanan kehamilan dan melahirkan, dan status gizi balita sebelum dan sesudah desentralisasi dilaksanakan. Perubahan rasio kematian bayi, kematian ibu, serta kematian balita juga termasuk analisis dari kajian ini. Seluruh analisis dilakukan pembobotan populasi dan analisa statistik dilakukan menggunakan SpssPC (rev 12). Dari hasil kajian menunjukkan bahwa terjadi sedikit peningkatan yang cukup berarti dari kejadian penyakit atau morbiditas penduduk antara tahun 2000 dan 2004, akan tetapi pemanfaatan pelayanan kesehatan (rawat jalan) meningkat di fasilitas pemerintah atau swasta. Peningkatan terbesar terjadi juga pada pelayanan kesehatan rawat inap. Dilaporkan juga pada tahun 2004 hanya sedikit sekali penyakit ditemukan oleh pelayanan kesehatan. Kajian ini juga menemukan bahwa sebelum dan sesudah desentralisasi, penggunaan pelayanan kesehatan terbanyak tetap dilakukan pada kelompok penduduk kaya. Provinsi yang mendapat tambahan biaya dari pinjaman menunjukkan penggunaan fasilitas pelayanan kesehatan yang meningkat terutama untuk pasien rawat jalan. Ada kecenderungan angka kematian balita menurun walaupun status gizi pada balita tidak mengalami perubahan atau peningkatan. Angka kematian bayi menurun cukup signifikan semenjak desentralisasi demikian juga kematian ibu. Terlihat jelas bahwa investasi pelayanan kesehatan yang nampaknya tidak menjadi prioritas pemerintah maupun masyarakat Indonesia. Sebelum dan sesudah desentralisasi Indonesia merupakan negara dimana investasi untuk pelayanan kesehatan menduduki urutan terendah dibandingkan dengan negara lain di dunia ini, terutama negara di ASEAN. Status kesehatan di Indonesia dapat dikatakan membaik walaupun kesepakatan pemerintah untuk memberikan alokasi kesehatan sangat rendah. Perubahan status kesehatan yang terjadi pada masa desentralisasi sebenarnya juga merupakan hasil dari kebijakan yang telah dilakukan sebelum desentralisasi. Selain itu, determinan kesehatan tidak selalu karena pendanaan dalam sistem kesehatan saja akan tetapi bisa saja berkaitan dengan sektor lain seperti pendidikan, dan pendapatan. Desentralisasi namapaknya tidak memberikan konsekuensi negatif terhadap memburuknya status kesehatan di Indonesia. Bahkan, beberapa indikator kesehatan terlihat membaik denagn perubahan lebih cepat pada saat desentaralisasi diibanding sebelumnya. Terutama pada provinsi dimana sosialisasi inisiatif sektor kesehatan diperkenalkan dengain menggunakan dukungan multilateral, terlihat terjadi peningkatan penggunaan pelayanan kesehatan, terutama pelayanan kelahiran dan peningkatan status kesehatan. Hanya gizi kurang pada balita yang nampaknya tidak membaik pada 10 tahun terakhir, kecuali membaik hanya pada saat adanya bantuan pada masa krisis moneter.Keywords: Decentralization, Health Sector Reform, Health Impact

STUDY ON BREAST-FEEDING PRACTICESOF POOR AND NONPOOR HOUSEHOLD Eddy S. Mudjajanto; Ali Khomsan; Dadang Sukandar; Faisal Anwar; Hadi Riyadi
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36457/gizindo.v29i2.30

Breast-feeding is a natural way to feed babies. A good breastfeeding practice is important for a continued growth, health, and nutrients for babies and young children. Therefore, the period of exclusive breast-feeding is one of important health problems in the community. This research used a control group design. The control group is nonpoor household. The collected data from the two groups (poor and nonpoor) and from the two locations, Bogor and Indramayu, (highland and coastal) were compared. Sample was drawn as random. Sample size of poor households are 513 in both location, while nonpoor households are 238. Total sample size are 751 households. The data collected through questionnaires. The results of the studies conducted in Bogor and Indramayu show that most mothers either from poor or nonpoor households do not breastfeed their babies, and they have problems with their excessive breast milk and continuously dripping breast milk. The results of the study reveal that almost all mothers have got the experience of breast-feeding their last babies, either those of poor households or those of nonpoor ones in both Bogor and Indramayu. Most mothers of poor households both in Bogor and Indramayu do not generally understand about exclusive breast-feeding, with the figures reaching 95.6% and 97.7% respectively. The figures for the breast-feeding period of between 12 and 23 months were 27.4% in Bogor, and 30% in Indramayu.Key words: breast-feeding, households, breast milk, mothers, babies

HUBUNGAN PERTAMBAHAN BERAT BADAN SELAMA KEHAMILAN DENGAN BERAT LAHIR BAYI DI KECAMATAN SUKARAJA KABUPATEN BOGOR TAHUN 2001 - 2003 Elmy Rindang T; Fatmah .; Anies Anies
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36457/gizindo.v29i2.31

THE RELATIONSHIP BETWEEN WEIGHT GAIN DURING PREGNANCY AND BIRTH WEIGHT IN SUKARAJA SUBDISTRICT, BOGOR IN 2001 - 2003Maternal body weight gain during pregnancy is important for women suffering from wasting when pregnancy started. Many studies in Indonesia show that low maternal weight gain during pregnancy (less than 10 kg) and high prevalence of pregnant women who had cronic energy deficiency (27.6%) are still problem. The objective of the study is to determine relationship between of maternal weight gain during pregnancy and low birth weight (2500-2999 gram) and its related factors. The study desain was cross-sectional, involving 270 pregnant women, at early stages (12 weeks) who delivered a normal body weight and full term babies ( 37 weeks). Data analysis was done using logistic regression. The result showed that the babies with low birth weight (2500-2999 gram)was 47.8 persen with the average weight of 3015 gram. The average of maternal weight gain during pregnancy was 9.098 kg and those who gained less than 9 kg during pregnancy was 48.9 persen. A significant relationship was found birth weight gain during pregnancy (p=0.000, OR 7.28, 95% CI; 4.25-12.46), and energy intake ((p=0.000, OR 5.15, 95% CI; 2.976-8.913). Multivariate analysis shows that the interaction between energy intake and weight gain during pregnancy is statistically significant (p=0.000, OR 5.8, 95% CI; 1.574-21.536). In conclusion, women who had gain weight at least 9 kg during pregnancy and energy intake more than 70 persen RDA might baby between with birth weight of less than 3000 gram. It is important especially to those who get pregnant suffering from wasting.Keywords: weight gain, pregnancy, birth weight

PENGARUH BERAT BADAN TIDAK NAIK TERHADAP PERTUMBUHAN PADA BAYI 6-12 BULAN DI KABUPATEN BOGOR Minarto .
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36457/gizindo.v29i2.32

The objective of the study is to examine the effect of not gaining weight on growth achievement and to identify its risk factors. The design of the study is a prospective cohort. Some 219 6-month old infants met sample inclusion criteria at enrollment (did not suffer from chronic diseases, had normal nutritional status, and the parents willing to involve in the study). The data collected include weight and length, morbidity, food consumption and child care practices, and socio-economic status of the family. The weight of infant was measured using SECA digital scale, and length was measured using standardized length board. Precision and accuracy test was carried out based on WHO procedure. The study found that the frequency and consecutive events of not gaining weight have a significant effect on weight achievement at 12 months of age. The differences of weight increment from 6 to 12 months between infants who did not experience growth failure and those who did not gain weight 1 time, 2 times, and 3 times were 200 grams, 450 grams and 1150 grams respectively. The frequency and consecutiveness of not gaining weight was associated with food consumption patterns and morbidity status of infants. Further analysis showed that infants suffered from coughing 14 days had risk ratio of 2.2 times (95% CI 1.197-3.930) higher having 2 times not gaining weight than those who suffered 14 days. While, infants suffered from coughing 28 days had a risk ratio of 5 times (95% CI 1.472-15.678) higher having 3 times not gaining weight than those who suffered =28 days. There is no association between the age of not gaining weight with weight achievements at 6 and 12 months. The frequency and subsequent events of not gaining weight of were consistently determining the growth of infant at 12 months of age. Child’s morbidity was significantly associated with the event of 2 times and 3 times not gaining weight. It is recommended that infants who do not gain weight 2 times should have health examination for prompt treatment.

PENGARUH PENAMBAHAN FRUKTO-OLIGOSAKARIDA (FOS) PADA MP-ASI TERHADAP KEJADIAN DIARE DAN PERTUMBUHAN BAYI UMUR 6-12 BULAN (Studi eksperimen lapangan di Kabupaten Bogor, Jawa Barat) Widjojo, Sunarno Ranu; F, Agus; Utomo, Budi; L. Achadi, Endang
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36457/gizindo.v29i2.33

THE EFFECT OF FOS SUPPLEMENTATION TO COMPLEMENTARY FEEDING IN DIARRHEA CASES AND GROWTH IN BABY 6-12 MONTHThe overall objective of this study was to evaluate the impact of adding fructo oligosaccharides (FOS) to complementary foods on the frequency and duration of diarrheal episodes and physical growth of 6-12 month old infants. The study was a double-blind randomized controlled trial carried out in the District of Bogor, Indonesia in 2004. Enrollees were 6-month old infants. Subjects were allocated to one of three study groups: Group FOS 4.0 received complementary food (CF) with 4.0% FOS added, Group FOS 3.2 received CF with 3.2% FOS, and Group FOS 0.0 received CF with no FOS. Infants received CF daily during the 6-month duration of the study. Among 192 infants enrolled, 163 had complete data for analysis. The results of the analysis on the cumulative number of general episode of diarrhea showed that only the FOS 3.2 group had significantly fewer episodes than the FOS 0.0 group with 1.10±1.30 episode and 1.73±1.90 episode respectively (p=0,02). Analysis on the number of episodes with =2 days of duration of diarrhea showed both FOS 4.0 and FOS 3.2 groups had significantly fewer episodes than the FOS 0.0 group, with 0,62+0,97 for the FOS 4.0 group, 0,62±1,17 for the FOS 3.2 group, and 1,21±1,59 for the FOS 0.0 group (P=0,02). The significant effect of FOS appeared after 4 months of intervention and continued up to 12 months of age. The analysis showed no significant effect of FOS on the cumulative duration of diarrhea and on the physical growth of the babies.Keywords: babies, MP-ASI, FOS, diarrhea, and physical growth

STUDY ON BREAST-FEEDING PRACTICESOF POOR AND NONPOOR HOUSEHOLD Mudjajanto, Eddy S.; Khomsan, Ali; Sukandar, Dadang; Anwar, Faisal; Riyadi, Hadi
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (106.795 KB)

Breast-feeding is a natural way to feed babies. A good breastfeeding practice is important for a continued growth, health, and nutrients for babies and young children. Therefore, the period of exclusive breast-feeding is one of important health problems in the community. This research used a control group design. The control group is nonpoor household. The collected data from the two groups (poor and nonpoor) and from the two locations, Bogor and Indramayu, (highland and coastal) were compared. Sample was drawn as random. Sample size of poor households are 513 in both location, while nonpoor households are 238. Total sample size are 751 households. The data collected through questionnaires. The results of the studies conducted in Bogor and Indramayu show that most mothers either from poor or nonpoor households do not breastfeed their babies, and they have problems with their excessive breast milk and continuously dripping breast milk. The results of the study reveal that almost all mothers have got the experience of breast-feeding their last babies, either those of poor households or those of nonpoor ones in both Bogor and Indramayu. Most mothers of poor households both in Bogor and Indramayu do not generally understand about exclusive breast-feeding, with the figures reaching 95.6% and 97.7% respectively. The figures for the breast-feeding period of between 12 and 23 months were 27.4% in Bogor, and 30% in Indramayu.Key words: breast-feeding, households, breast milk, mothers, babies

HUBUNGAN PERTAMBAHAN BERAT BADAN SELAMA KEHAMILAN DENGAN BERAT LAHIR BAYI DI KECAMATAN SUKARAJA KABUPATEN BOGOR TAHUN 2001 - 2003 Rindang T, Elmy; ., Fatmah; Anies, Anies
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (126.95 KB)

THE RELATIONSHIP BETWEEN WEIGHT GAIN DURING PREGNANCY AND BIRTH WEIGHT IN SUKARAJA SUBDISTRICT, BOGOR IN 2001 - 2003Maternal body weight gain during pregnancy is important for women suffering from wasting when pregnancy started. Many studies in Indonesia show that low maternal weight gain during pregnancy (less than 10 kg) and high prevalence of pregnant women who had cronic energy deficiency (27.6%) are still problem. The objective of the study is to determine relationship between of maternal weight gain during pregnancy and low birth weight (2500-2999 gram) and its related factors. The study desain was cross-sectional, involving 270 pregnant women, at early stages (12 weeks) who delivered a normal body weight and full term babies (> 37 weeks). Data analysis was done using logistic regression. The result showed that the babies with low birth weight (2500-2999 gram)was 47.8 persen with the average weight of 3015 gram. The average of maternal weight gain during pregnancy was 9.098 kg and those who gained less than 9 kg during pregnancy was 48.9 persen. A significant relationship was found birth weight gain during pregnancy (p=0.000, OR 7.28, 95% CI; 4.25-12.46), and energy intake ((p=0.000, OR 5.15, 95% CI; 2.976-8.913). Multivariate analysis shows that the interaction between energy intake and weight gain during pregnancy is statistically significant (p=0.000, OR 5.8, 95% CI; 1.574-21.536). In conclusion, women who had gain weight at least 9 kg during pregnancy and energy intake more than 70 persen RDA might baby between with birth weight of less than 3000 gram. It is important especially to those who get pregnant suffering from wasting.Keywords: weight gain, pregnancy, birth weight

PENGARUH BERAT BADAN TIDAK NAIK TERHADAP PERTUMBUHAN PADA BAYI 6-12 BULAN DI KABUPATEN BOGOR ., Minarto
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (185.097 KB)

The objective of the study is to examine the effect of not gaining weight on growth achievement and to identify its risk factors. The design of the study is a prospective cohort. Some 219 6-month old infants met sample inclusion criteria at enrollment (did not suffer from chronic diseases, had normal nutritional status, and the parents willing to involve in the study). The data collected include weight and length, morbidity, food consumption and child care practices, and socio-economic status of the family. The weight of infant was measured using SECA digital scale, and length was measured using standardized length board. Precision and accuracy test was carried out based on WHO procedure. The study found that the frequency and consecutive events of not gaining weight have a significant effect on weight achievement at 12 months of age. The differences of weight increment from 6 to 12 months between infants who did not experience growth failure and those who did not gain weight 1 time, 2 times, and 3 times were 200 grams, 450 grams and 1150 grams respectively. The frequency and consecutiveness of not gaining weight was associated with food consumption patterns and morbidity status of infants. Further analysis showed that infants suffered from coughing >14 days had risk ratio of 2.2 times (95% CI 1.197-3.930) higher having 2 times not gaining weight than those who suffered <14 days. While, infants suffered from coughing >28 days had a risk ratio of 5 times (95% CI 1.472-15.678) higher having 3 times not gaining weight than those who suffered <=28 days. There is no association between the age of not gaining weight with weight achievements at 6 and 12 months. The frequency and subsequent events of not gaining weight of were consistently determining the growth of infant at 12 months of age. Child’s morbidity was significantly associated with the event of 2 times and 3 times not gaining weight. It is recommended that infants who do not gain weight 2 times should have health examination for prompt treatment.

PENGARUH PENAMBAHAN FRUKTO-OLIGOSAKARIDA (FOS) PADA MP-ASI TERHADAP KEJADIAN DIARE DAN PERTUMBUHAN BAYI UMUR 6-12 BULAN (Studi eksperimen lapangan di Kabupaten Bogor, Jawa Barat) Widjojo, Sunarno Ranu; F, Agus; Utomo, Budi; L. Achadi, Endang
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (170.578 KB)

THE EFFECT OF FOS SUPPLEMENTATION TO COMPLEMENTARY FEEDING IN DIARRHEA CASES AND GROWTH IN BABY 6-12 MONTHThe overall objective of this study was to evaluate the impact of adding fructo oligosaccharides (FOS) to complementary foods on the frequency and duration of diarrheal episodes and physical growth of 6-12 month old infants. The study was a double-blind randomized controlled trial carried out in the District of Bogor, Indonesia in 2004. Enrollees were 6-month old infants. Subjects were allocated to one of three study groups: Group FOS 4.0 received complementary food (CF) with 4.0% FOS added, Group FOS 3.2 received CF with 3.2% FOS, and Group FOS 0.0 received CF with no FOS. Infants received CF daily during the 6-month duration of the study. Among 192 infants enrolled, 163 had complete data for analysis. The results of the analysis on the cumulative number of general episode of diarrhea showed that only the FOS 3.2 group had significantly fewer episodes than the FOS 0.0 group with 1.10±1.30 episode and 1.73±1.90 episode respectively (p=0,02). Analysis on the number of episodes with <=2 days of duration of diarrhea showed both FOS 4.0 and FOS 3.2 groups had significantly fewer episodes than the FOS 0.0 group, with 0,62+0,97 for the FOS 4.0 group, 0,62±1,17 for the FOS 3.2 group, and 1,21±1,59 for the FOS 0.0 group (P<=0,02). The significant effect of FOS appeared after 4 months of intervention and continued up to 12 months of age. The analysis showed no significant effect of FOS on the cumulative duration of diarrhea and on the physical growth of the babies.Keywords: babies, MP-ASI, FOS, diarrhea, and physical growth

THE EFFECT OF DECENTRALIZATION ON THE HEALTH STATUS AND HEALTH CARE UTILIZATION PATTERNS ININDONESIA Tilden, Robert; Gani, Ascobat; Noor, Nur Nasry; Widjajanto, RM.; Sonnemann, James
GIZI INDONESIA Vol 29, No 2 (2006): September 2006
Publisher : PERSATUAN AHLI GIZI INDONESIA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (993.123 KB)

Berbagai indikator pelayanan dan status kesehatan berdasakan tingkat pengeluaran konsumsi rumahtangga menurut quintile sebelum dan sesudah desentralisasi dinilai dan dikaji. Dilakukan juga penilaian perubahan status kesehatan pada periode desentralisasi, dan juga perbandingan antar wilayah yang menerima dan melaksanakan berbagai program pelayanan kesehatan atau wilayah yang tidak sama sekali mendapatkan inisiasi program pelayanan kesehatan. Data Susenas 2000 dan 2004 digunakan untuk menilai perubahan berbagai indikator kesehatan: morbiditas, pelayanan rawat jalan dan rawat inap, pelayanan kehamilan dan melahirkan, dan status gizi balita sebelum dan sesudah desentralisasi dilaksanakan. Perubahan rasio kematian bayi, kematian ibu, serta kematian balita juga termasuk analisis dari kajian ini. Seluruh analisis dilakukan pembobotan populasi dan analisa statistik dilakukan menggunakan SpssPC (rev 12). Dari hasil kajian menunjukkan bahwa terjadi sedikit peningkatan yang cukup berarti dari kejadian penyakit atau morbiditas penduduk antara tahun 2000 dan 2004, akan tetapi pemanfaatan pelayanan kesehatan (rawat jalan) meningkat di fasilitas pemerintah atau swasta. Peningkatan terbesar terjadi juga pada pelayanan kesehatan rawat inap. Dilaporkan juga pada tahun 2004 hanya sedikit sekali penyakit ditemukan oleh pelayanan kesehatan. Kajian ini juga menemukan bahwa sebelum dan sesudah desentralisasi, penggunaan pelayanan kesehatan terbanyak tetap dilakukan pada kelompok penduduk kaya. Provinsi yang mendapat tambahan biaya dari pinjaman menunjukkan penggunaan fasilitas pelayanan kesehatan yang meningkat terutama untuk pasien rawat jalan. Ada kecenderungan angka kematian balita menurun walaupun status gizi pada balita tidak mengalami perubahan atau peningkatan. Angka kematian bayi menurun cukup signifikan semenjak desentralisasi demikian juga kematian ibu. Terlihat jelas bahwa investasi pelayanan kesehatan yang nampaknya tidak menjadi prioritas pemerintah maupun masyarakat Indonesia. Sebelum dan sesudah desentralisasi Indonesia merupakan negara dimana investasi untuk pelayanan kesehatan menduduki urutan terendah dibandingkan dengan negara lain di dunia ini, terutama negara di ASEAN. Status kesehatan di Indonesia dapat dikatakan membaik walaupun kesepakatan pemerintah untuk memberikan alokasi kesehatan sangat rendah. Perubahan status kesehatan yang terjadi pada masa desentralisasi sebenarnya juga merupakan hasil dari kebijakan yang telah dilakukan sebelum desentralisasi. Selain itu, determinan kesehatan tidak selalu karena pendanaan dalam sistem kesehatan saja akan tetapi bisa saja berkaitan dengan sektor lain seperti pendidikan, dan pendapatan. Desentralisasi namapaknya tidak memberikan konsekuensi negatif terhadap memburuknya status kesehatan di Indonesia. Bahkan, beberapa indikator kesehatan terlihat membaik denagn perubahan lebih cepat pada saat desentaralisasi diibanding sebelumnya. Terutama pada provinsi dimana sosialisasi inisiatif sektor kesehatan diperkenalkan dengain menggunakan dukungan multilateral, terlihat terjadi peningkatan penggunaan pelayanan kesehatan, terutama pelayanan kelahiran dan peningkatan status kesehatan. Hanya gizi kurang pada balita yang nampaknya tidak membaik pada 10 tahun terakhir, kecuali membaik hanya pada saat adanya bantuan pada masa krisis moneter.Keywords: Decentralization, Health Sector Reform, Health Impact

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