Public Health and Preventive Medicine Archive
ublic Health and Preventive Medicine Archive (PHPMA) is an open access, peer reviewed journal published by Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University. Issues covered in the journal are as the following: Environmental and occupational health Field and Clinical Epidemiology Global health Health policy analysis Health promotion Health systems and health care management Maternal and child health Program monitoring and evaluation Public health nutrition Reproductive health, sexually transmitted infections and HIV related issues Travel health and health tourism Population and family planning Disaster management
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<![CDATA[Where do we go with HIV pre-exposure prophylaxis in Indonesia? ]]>
<![CDATA[I Nyoman Sutarsa]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p01
<![CDATA[PrEP is an effective additional prevention strategy at trial settings. Decision to adopt PrEP as a public health intervention must be made based on the need and capacity of current systems. Instead of allocating substantial resources for PrEP, the limited resources could be wisely allocated to scale-up the existing prevention strategies including access to ART, as well as to ensure equality of access of people to full-range of HIV prevention and treatment measures.]]>
<![CDATA[Continuation rates for injectable contraception and intra-uterine device (IUD) at Banyuning Village, Buleleng District ]]>
<![CDATA[Lina Anggaraeni Dwijayanti]]>;
<![CDATA[Dewa Nyoman Wirawan]]>;
<![CDATA[Anak Agung Sagung Sawitri]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p02
<![CDATA[Background and purpose: Surveys on the proportion of contraception uptake have been regularly conducted in Indonesia, including Bali Province. However, very limited studies have explored contraceptive continuation rates. This study aims to examine continuation rates for injectable contraception and IUD including its determinants. Methods: A cross-sectional survey was conducted in Buleleng District. A total of 100 reproductive age women who ever used or currently using injectable contraception or IUD were recruited to participate in the study. One village at Buleleng District was purposively selected and samples were selected from all registered reproductive age couples at the village using a systematic random sampling method. Data were collected through home interviews and were analysed using survival analysis to calculate contraceptive continuation rates. Multivariate analysis were performed using cox regression to identify factors associated to continuation rates for injectable contraception and IUD. Analysis was done using STATA SE 12.1. Results: The one year continuation rate for IUD for first child was 84.62% whereas for injectable contraception was 71.03%. When sex variable of the child was applied, the one year continuation rate for IUD for first child was higher among those who have male child (81.82%) than female child (66.67%). Similarly, the one year continuation rate for injectable contraception was higher among those who have male child (79.10%) than female child (57.58%). The one year contraceptive continuation rate is also higher for the second child than the first one (79.56 vs 71.03 for injectable and 87.88 vs 84.62 for IUD). The multivariate analysis showed that perceived quality of family planning services was associated to contraceptive continuation rates (AHR=2.54; 95%CI: 1.22-5.29). Conclusions: The continuation rate for IUD was higher than injectable contraception. Higher contraceptive continuation rate was found among those who have male children. The contraceptive continuation rate was associated with perceived quality of family planning services. Interventions to improve the quality of family planning services are warranted.]]>
<![CDATA[Electronic prescribing reduces prescription errors in Sanglah General Hospital Denpasar ]]>
<![CDATA[Ni Luh Putu Nurhaeni]]>;
<![CDATA[I Ketut Suarjana]]>;
<![CDATA[I Made Ady Wirawan]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p03
<![CDATA[Background and purpose: Medication error is any preventable event that may lead to inappropriate medication use or patient harm. Prescription error, one component of medication error, at Sanglah General Hospital Denpasar is high. An electronic prescribing has been piloted at Angsoka Ward, Sanglah General Hospital Denpasar to reduce prescription errors. However, the evaluation of such implementation is never been conducted. This study aims to evaluate the effect of electronic prescribing on prescription errors at Sanglah General Hospital Denpasar. Methods: An evaluation study was conducted by adopting pre and post control design at Sanglah General Hospital Denpasar. Prescription errors at Angsoka Ward where the electronic prescribing is implemented, were compared to Kamboja Ward that uses manual prescribing. Heterogeneity of patients in these two wards was comparable. Prescription samples were selected using a simple random sampling. Prescription samples prior to implementation of electronic prescribing were taken from June and July 2016, while samples after implementation were taken from March and April 2017. Prescription samples from the control group were also taken from the same periods. A total of 96 prescriptions were taken from each arm – leading to 384 prescription samples in total. Prescription error was evaluated using three requirements namely: administrative (9 components), pharmacy (5 components) and clinical (3 components). Results: Our study found that there was a significant difference of prescription errors between pre and post implementation of electronic prescribing at Angsoka Ward (p<0.05). The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [3] vs. 0 [0] (p<0.001); based on pharmacy requirements were 1 [2] vs. 0 [0] (p<0.001); based on clinical requirements were 1 [2] vs 0 [0] (p<0,001). In contrast, prescription error based on administrative and pharmacy requirements in Kamboja Ward was insignificantly reduced. The median values [IQR] for prescription error based on administrative requirements between pre and post intervention were 2 [2] vs. 2 [2] (p=0.505) and based on pharmacy requirements were 1 [2] vs. 1 [1] (p=0.295). There was a significant difference of prescription errors (p<0.05) based on clinical requirements with median values [IQR] of 1 [1] vs. 1 [1]. Implementation of electronic prescribing reduced the proportion of prescription errors by 67.8%. After implementation of electronic prescribing, some errors were still apparent related to drug administration and order duplication. Conclusions: Implementation of electronic prescribing reduces prescription errors. Scaling-up of electronic prescribing followed by training on standardised prescribing practices are warranted.]]>
<![CDATA[Causes of unwanted pregnancy among adolescents in Bali Province: a qualitative study ]]>
<![CDATA[Kadek Anggie Wisandewi Mayun]]>;
<![CDATA[Luh Seri Ani]]>;
<![CDATA[Ni Luh Putu Suariyani]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p04
<![CDATA[Background and purpose: Teenage pregnancy is a major contributing factor of high maternal and infant mortality rates in Indonesia. Unwanted pregnancy among adolescents is increasing, therefore an understanding of its causes is essential. This study aims to explore causes of unwanted pregnancy among adolescents. Methods: A qualitative study was conducted in Bali Province. Data were obtained through in-depth interviews with 10 adolescents aged between 12-21 years who experienced unwanted pregnancy. Data were collected between September and October 2016. Data were analysed thematically and presented using a narrative approach. Results: Our study revealed that determinants associated to unwanted pregnancy among adolescents included the lack of systematic education on sexual and reproductive health both at home and school, as well as the lack of self-efficacy of teenage girls to reject pre-marital sex with their partner. Our study found that this pre-marital sex was done as an expression of love, because of being forced by the partner, and due to stressful home environments. Conclusions: The main causes of unwanted pregnancy among adolescents are the lack of sexual and reproductive health education and a weak self-efficacy of teenage girls to reject pre-marital sex demanded by their partner. Given the complexities of teenage pregnancy, overarching policy to facilitate an early comprehensive sexual and reproductive health education program at home, schools, and youth-friendly health facilities is warranted.]]>
<![CDATA[Association of supplementary feeding with stunting among children in Kintamani, Bangli, Bali Province ]]>
<![CDATA[Istiana Marfianti]]>;
<![CDATA[I Made Ady Wirawan]]>;
<![CDATA[I Wayan Weta]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p05
<![CDATA[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.]]>
<![CDATA[Needs for sexual and reproductive health education for students with hearing impairment in Buleleng District, Bali Province ]]>
<![CDATA[Nyoman Sri Ariantini]]>;
<![CDATA[Desak Putu Yuli Kurniati]]>;
<![CDATA[Dyah Pradnyaparamita Duarsa]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p06
<![CDATA[Background and purpose: Adolescents with hearing impairment face a number of exclusion due to their limitation, including lack of access to information on reproductive health. This study aims to explore needs for sexual and reproductive health education for students with hearing impairment at Singaraja. Methods: A qualitative study was conducted at Buleleng District. Data were collected through in-depth interviews to 19 informants. Informants were purposively selected based on their specific roles. Our informants included students with hearing impairment, head of school, teachers and parents or carers. Data were analysed using a thematic approach. Results: The majority of students with hearing impairment had low level of knowledge associated to sexual and reproductive health. However, sexual and reproductive health practices between adolescents with and without hearing impairment were generally comparable. Needs for sexual and reproductive health education must cover several elements: (1) education material must be tailored based on age, (2) learning methods should be tailored based on their intellectual ability, and (3) learning methods must use contextual and real model approach to allow better transfer of information. Teachers faced difficulty to provide sexual and reproductive health education for students with hearing impairment even though some modules are already available. Conclusions: The provision of sexual and reproductive health education for students with hearing impairment requires tailored material, simple and attractive learning methods, and visual media. Further analysis of the existing reproductive health education curricula for students with hearing impairment is required in order to ensure fulfilment of reproductive rights of adolescent with special needs.]]>
<![CDATA[Willingness of private general practitioners to refer suspected tuberculosis patients in Badung District ]]>
<![CDATA[Ni Putu Eka Purnama Dewi]]>;
<![CDATA[Anak Agung Sagung Sawitri]]>;
<![CDATA[Ni Wayan Arya Utami]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p07
<![CDATA[Background and purpose: The national tuberculosis (TB) prevalence study showed that between 2013 and 2014 there was significant proportion of pulmonary TB patients received treatment from private healthcare facilities. Data from Bali Province and Badung District Health Offices revealed that of all suspected TB patients only a few were referred by their private general practitioner. A reward system was created in 2012 by providing credit points to every referral made by the private general practitioner. This study aims to examine association between the reward system, national health insurance scheme and willingness to refer suspected TB patients. Methods: A cross-sectional study was conducted from February to April 2017. A total of 111 private general practitioners who practice at Badung District were interviewed. In addition, medical record from these private general practitioners were also examined. Results: Our study found that as many as 55 (45.95%) of private general practitioners had ever referred suspected TB patients over the last year. The total suspected TB patient being reffered in the last year was 132 cases. A cross checking with the laboratory data revealed that only 47 cases (35.61%) presented at referral laboratory facilities. Multivariate analysis showed that the willingness of private general practitioners to refer suspected TB patient was associated to reward system (AOR=4.62; 95%CI: 1.23-17.32) and supervision from TB officials (AOR=13.07; 95%CI: 3.78-45.13). The enrollment of private general practitioners as a primary healthcare facility under the national insurance scheme was not associated with the willingness to refer suspected TB patients. Conclusions: About half of the private general practitioners have ever referred a suspected TB patient. Supervision from TB officials and a reward system in terms of credit points were associated with the willingness to refer suspected TB patients. Ongoing supervision, providing credit points, and improving referral systems are required to improve case findings and referral of suspected TB patients by private general practitioners]]>
<![CDATA[Risk factors of pre-eclampsia in Dompu District, West Nusa Tenggara Province ]]>
<![CDATA[Maria Ulfah]]>;
<![CDATA[Ni Luh Putu Suariyani]]>;
<![CDATA[Dyah Pradnyaparamita Duarsa]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p08
<![CDATA[Background and purpose: Pre-eclampsia is a major contributing factor of maternal mortality. Dompu District has a high rate of maternal mortality relative to the rest of districts in West Nusa Tenggara Province. Pre-eclampsia is the major cause of maternal mortality in Dompu District. This study aims to examine risk factors of pre-eclampsia among pregnant women. Methods: A case control study was conducted in five public health centres in Dompu District. A total of 104 women who gave birth and have diagnosed with pre-eclampsia during the pregnancy were recruited as cases. A total of 104 women who gave girth and did not have pre-eclampsia were selected as controls. All cases and controls were selected using a systematic random sampling technique from the 2016 pregnant women cohort at five public health centres. Data were collected through interview and extraction from the maternal and child health book. Data were analysed using bivariate and multivariate techniques. Results: Our multivariate analysis found that pre-eclampsia was associated with parity of 1 or >3 (AOR=3.64; 95%CI: 1.85-7.17), body mass index of >27.0 kg/m2 (AOR=3.01; 95%CI: 1.39-6.48), history of chronic diseases (AOR=16.43; 95%CI: 3.32-81.22) and smoke exposure (AOR=3.71; 95%CI: 1.95-7.05). Conclusions: Parity of 1 and >3, BMI of >27.0 kg/m2, history of chronic illnesses and smoke exposure are risk factors for pre-eclampsia in Dompu District, West Nusa Tenggara.]]>
<![CDATA[Association between blood glucose level with glycemic load, physical activity and compliance to medication among Diabetes Mellitus (DM) patients in Buleleng District General Hospital, Bali Province ]]>
<![CDATA[Ketut Adi Jaya Sutana]]>;
<![CDATA[Komang Ayu Kartika Sari]]>;
<![CDATA[I Wayan Weta]]>;
<![CDATA[Ketut Suastika]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p09
<![CDATA[Background and purpose: The prevalence of diabetes mellitus (DM) in Indonesia is increasing, including in Buleleng District, Bali Province. Studies regarding determinants of blood glucose control in DM patients show varied findings. This study aims to examine association between blood glucose level with physical activity, compliance to medication and glycemic load among DM patients. Methods: A cross-sectional survey was conducted in Buleleng District General Hospital from March to April 2017. A total of 73 patients were concecutively recruited to participate in our study. Data were collected through interview, observation and measurement. Data collected included socio-demographic characteristics, fasting blood glucose level, 1-hour and 2-hour postprandial blood glucose levels, carbohydrate intake, body mass index, glycemic index, glycemic load, physical activity, genetic or family history, and compliance to medication. A bivariate analysis was performed to examine association between independent variables and blood glucose levels. Multivariate analysis was also conducted to calculate adjusted odd ratio using a binary logistic regression. Results: Our study found that blood glucose levels of most respondents were relatively well managed–63% for fasting, 61.6% for 1-hour postprandial, and 63% for 2-hours postprandial. Multivariate analysis revealed that fasting blood glucose level were associated with regular physical activities (AOR=74.09; 95%CI: 7.52-729.69) and compliance to medication (AOR=11.90; 95%CI: 2.24-63.29). Furthermore, 1-hour postprandial blood glucose level were associated with breakfast glycemic load (AOR=0.63; 95%CI: 0.47-0.85) and compliance to medication (AOR=27.29; 95%CI: 2.29-323.95), while 2-hour postprandial blood glucose level were associated with breakfast glycemic load (AOR=0.69; 95%CI: 0.54-0.89) and compliance to medication (AOR=19.81; 95%CI: 2.31-170.14). Conclusions: Factors associated with fasting blood glucose level were regular physical activities and adherence to medication, while 1-hour and 2-hours postprandial blood glucose levels were both influenced by breakfast glycemic load and compliance to medication.]]>
<![CDATA[Perceptions of patients and providers on the use of acupressure services at Public Health Centres, Tabanan District, Bali ]]>
<![CDATA[I Made Sukawinaca]]>;
<![CDATA[Komang Ayu Kartika Sari]]>;
<![CDATA[I Made Ady Wirawan]]>
<![CDATA[ Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017) ]]>
Publisher : <![CDATA[Universitas Udayana ]]>
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DOI: 10.53638/phpma.2017.v5.i2.p10
<![CDATA[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.]]>
