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Public Health and Preventive Medicine Archive
Published by Universitas Udayana
ISSN : 23031816     EISSN : 25032356     DOI : https://doi.org/10.53638/
Core Subject : Health,
Public Health
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
Arjuna Subject : Kedokteran - Kesehatan Masyarakat, Kesehatan Lingkungan dan Pekerjaan
Articles 315 Documents
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Needs for sexual and reproductive health education for students with hearing impairment in Buleleng District, Bali Province Nyoman Sri Ariantini; Desak Putu Yuli Kurniati; Dyah Pradnyaparamita Duarsa
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.p06

Abstract

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.
Willingness of private general practitioners to refer suspected tuberculosis patients in Badung District Ni Putu Eka Purnama Dewi; Anak Agung Sagung Sawitri; Ni Wayan Arya Utami
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.p07

Abstract

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
Risk factors of pre-eclampsia in Dompu District, West Nusa Tenggara Province Maria Ulfah; Ni Luh Putu Suariyani; Dyah Pradnyaparamita Duarsa
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.p08

Abstract

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.
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 Ketut Adi Jaya Sutana; Komang Ayu Kartika Sari; I Wayan Weta; Ketut Suastika
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.p09

Abstract

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.
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.
Predictors of treatment interruption among tuberculosis patients in public health centres in Bali, Indonesia Putu Ika Farmani; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri; I Wayan Gede Artawan Eka Putra
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.p11

Abstract

Background and purpose: Tuberculosis treatment interruption (TB TI) is one factor that leads to treatment failure, tuberculosis (TB) drug resistance and drop out. The purpose of this study is to identify the incidence and the predictors of TB TI in public health centres (PHCs) in Bali. Methods: A retrospective longitudinal study was conducted using secondary data of 644 cohorts of TB patients on the first regiment who enrolled in 11 PHCs in Denpasar Bali during 2011-2012. Information from TB program officers in PHCs was also obtained to determine the differences within the practical implementation of TB treatment. Data were analysed using Kaplan Meier and Cox Proportional Hazard Regression. Results: The study revealed that 378 patients experienced TB TI with the total events of 535. The incidence rate of TB TI event was 5.1 per 1.000 person days and the median time was 56 days (IQR: 56-57). Predictors of the TB TI were male (AHR=1.22; 95% CI: 1.02-1.45; p=0.027) and a more flexible schedule to take the medicine (AHR=1.47; 95%CI: 1.22-1.76; p<0.0001). Conclusions: The implementation of fixed schedule and shortened time lapse for patients to take TB drug will enable more close contact between patients and health providers. Intensive adherence counselling especially tailored for male patients is also required.
Relationship between institution status and the organizational culture of community health centres in Bali Maria Magdalena Zulian Puji Astuti; Ni Made Sri Nopiyani; Pande Putu Januraga
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.p12

Abstract

Background and purpose: The adoption of an appropriate organizational culture model can be instrumental in ensuring the success of an institution. Currently, public health centres (PHCs) in Indonesia are being remodeled to function as independent units managed as regional public service agencies (BLUD). This study aims to determine whether there are differences in the organizational culture of BLUD PHCs with non BLUD PHCs. Methods: Survey was conducted with 142 staff from BLUD PHCs and with 109 staff from non BLUD PHCs, selected using stratified random sampling technique. Data were collected by completing the organizational culture assessment instrument (OCAI) according to the concept of Competing Values ​​Framework (CVF) and analyzed descriptively to determine aspects of the organizational culture. Results: Staff at the BLUD PHCs presented with lower education levels, were older and with an average longer working period compared to staff at the non BLUD PHCs. A hierarchical organizational culture was found in three BLUD PHCs and in one BLUD PHCs, while the other two non BLUD PHCs indicated a tendency towards a clan culture. It is hoped that in the next two years all PHC will adhere to a clan organizational culture model. Conclusions: Significant differences in age, education and number of working years between BLUD PHCs and non BLUD PHCs determine the organizational culture model adopted. The current adopted organizational culture is hierarchical whereas a transition to clan culture is desired.
The provision of promotive and preventative healthcare services by private primary care physicians in the era of the national health insurance program Ketut Ary Diana Artha; I Ketut Suarjana; Pande Putu Januraga
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.p13

Abstract

Background and purpose: In addition to their duties in addressing the curative and rehabilitative needs of the community, private primary care physicians (PCP) play an important role in providing promotive and preventative healthcare services. This study aims to determine the behaviours, enabling and inhibiting factors involved with the provision of promotive and preventative services by PCP in the era of national health insurance (JKN) implementation. Methods: This research is a mix method study using a combination of quantitative and qualitative approaches. Quantitative surveys were conducted with all PCPs already in working collaboration with the Social Security Administering Agency (BPJS) in the Denpasar City area (61 people). Data analysis techniques used descriptive techniques in order to explore the kinds of promotion and preventative services provided by PCPs. Qualitative research was conducted through in-depth interviews of 8 informants selected by purposive sampling and analyzed thematically to discover the enabling and inhibiting factors of the provision of promotive and preventative services by PCPs. Results: The results showed that 91.8% of PCPs did perform promotive and preventative services in their practice site. PCPs who did not carry out promotive and preventative services demonstrate perceptions, beliefs and motivations categorized as low and weak as well as attitudes that do not support the implementation of such services. Enabling factors of promotion and preventative services by PCPs, include among others, quality of facilities and infrastructure, the receipt of awards from BPJS and capitation systems that benefit physicians financially. Inhibiting factors include a low willingness of the patient to carry out doctor's advice, limitations in the PCPs work time and limited funds to perform preventative/promotive services. Conclusions: Promotive and preventative services are not being optimally carried out by PCPs in Denpasar. This is due to the low willingness of the patients, the limited time of the doctor, and the limited allocated funds for promotive and preventative services and low capitation.
Predictors of improved nutritional status among HIV/AIDS patients who received antiretroviral therapy (ART) at Sanglah General Hospital Denpasar Gusti Ayu Eka Utarini; Anak Agung Sagung Sawitri; Ketut Tuti Parwati Merati
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.p14

Abstract

Background and purpose: Antiretroviral therapy (ART) is associated with improved nutritional status among HIV/AIDS patients. This study aims to examine proportion, median time, incidence rate, and predictors of improved nutritional status among HIV/AIDS patients who received ART at Sanglah General Hospital Denpasar. Methods: A restrospective cohort study was conducted in Denpasar City. A total of 207 medical records of HIV/AIDS patients who received ART between 1st of January 2012 and 30th of June 2015 were included in the study. Kaplan Meier analysis was performed to calculate incidence rate and median time of improved nutritional status among HIV/AIDS patients. Sociodemographic characteristics and clinical variables included body mass index (BMI), body weight, haemoglobin level, CD4 count, HIV clinical stadium, ART regiments, and opportunistic infections (OIs). Data were analysed using cox proportional hazard model to identify predictors of improved nutritional status among HIV/AIDS patients. Results: As many as 65.22% of HIV/AIDS patients who received ART experienced an improvement in their nutritional status with the incidence rate of 9.1 per 100 person months and median time of 6.1 months. Multivariate analysis showed that predictors of improved nutritional status were BMI at ART initiation (AHR=1.34; 95%CI: 1.16-1.5), HIV clinical stadium (AHR=1.45; 95%CI: 1.02-2.06), CD4 count at ART initiation (AHR=0.89; 95%CI: 0.81-0.99) and the presence of diarrhoea (AHR=1.83; 95%CI: 1.06-3.14). Conclusions: Predictors of improved nutritional status among HIV/AIDS patients who received ART were BMI, HIV clinical stadium, CD4 count and diarrhoea.
The role of communication contact in capitation implementation at public health centres in Denpasar Ni Putu Purlimaningsih; I Ketut Suarjana; Pande Putu Januraga
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.p15

Abstract

care is the contact between the provider and the recipient (communication contact). Targets set regarding communication contacts are often not achieved which in turn results in consequent cuts in the capitation rates received by the public health centres (PHCs). The purpose of this research is to understand the implementation, inhibiting and enabling factors of supporting communication contact in the era of National Health Insurance (Jaminan Kesehatan Nasional/JKN). Methods: This study used a qualitative explorative design through in-depth interviews and focus group discussion (FGD) with 22 informants consisting of heads of PHCs, PHCs staff, Head of Denpasar Health Office, Head of Social Security Administering Agency (BPJS) Denpasar Branch and JKN members. This research was conducted at 11 PHCs in Denpasar City from April to July 2017. The informants were chosen purposively and the data were analysed thematically to explore aspects of implementation, the inhibiting and enabling factors of communication contact. Results: Communication contacts can be assessed both inside and outside the PHCs buildings. The inhibiting factor of communication contact implementation related to difference in understanding of the concept of PHCs working area, the absence of a standard operational procedure (SOP) for communication contact, heavy workload of PHCs service providers, lack of optimal means of supporting application of pcare convoluted and confusing information from BPJS, and lack of understanding from JKN enrolees on the particulars of the administration and desire for speedy service. Supporting factors are the availability of media, training and orientation for the implementing staff and the feedback from BPJS to PHCs staff. Driving factors are the effective authority of the PHCs head, commitment and motivation from government agencies and cross-sectoral support. Conclusions: Implementation of communication contact is influenced by both inhibiting and enabling factors, from the BPJS stakeholders and the members of the BPJS. Achieving the target of communication contact requires synergy of central government policy and BPJS managers.

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