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Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Published by Universitas Indonesia
ISSN : 19077505     EISSN : 24600601     DOI : https://doi.org/10.7454/kesmas
Core Subject : Health,
Health Professions Public Health
The focus of Kesmas is on public health as discipline and practices related to preventive and promotive measures to enhance the public health through a scientific approach applying a variety of technique. This focus includes areas and scopes such as Biostatistics, Environmental Public Health, Epidemiology, Health Policy, Health Services Research, Nutrition, Occupational Health and Industrial Hygiene, Public Health, Public Health Education and Promotion, Women Health.
Arjuna Subject : Kedokteran - Epidemilogi
Articles 928 Documents
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Analisis Kesehatan Kerja Pembantu Rumah Tangga di Surabaya Lestari, Tri Rini Puji
Kesmas Vol. 2, No. 2
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Perempuan pembantu rumah tangga (PRT) dipandang sebagai potret buram perempuan saat ini. Keberadaan PRT diselimuti oleh berbagai persoalan struktural seperti kemiskinan, diskriminasi, ideologi patriarki, feodalisme dan kelas. Penelitian ini bertujuan mengetahui kondisi kesehatan kerja PRT di Surabaya. Metode penelitian yang digunakan adalah metode kualitatif dengan melakukan wawancara mendalam kepada informan kunci. Hasil penelitian menunjukkan bahwa kapasitas kerja, beban kerja, dan beban tambahan yang diterima PRT menjadikan PRT disebut sebagai “pekerja yang serba bukan” karena posisi “marginal” dari status sekaligus posisi PRT. Selain itu, sampai saat in, di Surabaya PRT belum mendapat perlindungan hukum. Sebagai gambaran bahwa pekerjaan PRT masih belum dianggap sebagai profesi yang layak yang diatus secara khusus sebagaimana profesi-profesi yang lain. Housemaid (PRT) has been viewed as dark portrait of woman condition at the present. Structural problems such as poverty, discrimination, patriarchic ideology, feudalism and class conflict were surrounded PRT problem. The purpose of this study was to understand the health condition of PRT in Surabaya. The method used in this study was qualitative method by conducting in-depth interview to key informants. Result of this study indicates that capacities of work, work load, and additional burden of PRT its make PRT conceived of “worker whose none at all“ because of “marginal” position and status of PRT. Besides, there is no law protection for PRT in Surabaya and PRT job has not been viewed as a proper employment.
Dislipidemia dan Obesitas Sentral pada Lanjut Usia di Kota Padang Kamso, Sudijanto
Kesmas Vol. 2, No. 2
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Data-data di rumah sakit maupun di masyarakat menunjukkan penyakit kardiovaskuler yang terdiri dari penyakit jantung koroner, penyakit jantung hipertensi dan stroke adalah penyebab utama kematian pada kelompok lanjut usia. Penelitian-penelitian menunjukkan bahwa faktor yang dapat menyebabkan timbulnya penyakit kardiovaskuler tersebut adalah gangguan kadar lemak dalam darah (dislipidemia) dan obesitas sentral. Berbagai penelitian dibidang penyakit kardiovaskular telah dilakukan, tetapi data mengenai dislipidemia dan obesitas sentral pada lansia Indonesia masih dirasakan kurang. Tujuan utama penelitian ini adalah untuk mengetahui prevalensi dislipidemia dan obesitas sentral, serta faktor-faktor yang berhubungan dengan obesitas sentral pada lansia di Padang, daerah dengan prevalensi penyakit kardiovaskular yang tinggi. Suatu studi cross sectional dilakukan pada 205 lansia di kota Padang sebagai sampel, dengan menggunakan metode multistage random sampling. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner yang terstruktur, pengukuran antropometri dan tekanan darah serta analisa kadar lemak darah. Studi ini menunjukkan bahwa prevalensi dislipidemia dan obesitas sentral didapatkan cukup tinggi, masing-masing lebih dari 45% pada populasi studi. Kadar trigliserida darah diatas 200 mg/dl, dan rasio total/HDL kolesterol ≥5, meningkatkan resiko terjadinya obesitas sentral, dengan OR masing-masing 8.5 dan 3.08. Hasil ini menunjukkan bahwa pemeriksaan rutin kadar lemak darah dan pemeriksaan antropometri sederhana pada lansia perlu dilakukan sebagai pencegahan penyakit kardiovaskular. Cardiovascular disease has become the first cause of death among elderly. Many studies on the relationship between dyslipidemia, obesity and cardiovascular disease have been done, but studies investigating prevalence of dyslipidemia and central obesity among the elderly in Indonesia are lacking. Therefore, there is an urgent need to elaborate information on dyslipidemia and central obesity in the Indonesian elderly, which will allow the policy makers to provide appropriate intervention programs against cardiovascular disease. The primary purpose of this study was to observe prevalence of dyslipidemia and central obesity, and also to find independent factors of central obesity among elderly in Padang, area with high prevalence of cardiovascular disease. A cross-sectional study was undertaken in Padang with total sample of 205 elderly using multistage random sampling. Data were collected through interview using structured questionnaires, anthropometric measurements, biochemical blood analysis, and blood pressure measurements. Prevalence of dyslipidemia (hypercholesterolemia and LDL-cholesterolemia) and ratio of total cholesterol to HDL cholesterol ≥5 found in the study was quite high, more than 50% and 45% respectively, in the study population both in elderly men and women. Prevalence of central obesity was also quite high in elderly women (46.3 %). This study showed that triglyceride level more than 200 mg/dl (OR 8.5) and ratio of total/HDL cholesterol ≥5 (OR 3.08) increase the risk of having central obesity 8.5 fold and 3.08 fold, respectively. Health education program to elderly group should emphasize the importance of regular check of plasma lipid and simple anthropometric measurement for early detection of cardiovascular disease risk factors.
Parental Smoking as Health-Risk Factors of Indoor Air Pollution Purwana, Rachmadi
Kesmas Vol. 2, No. 2
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Pengaruh dari kebisaan merokok terhadap gejala gangguan pernapasan telah banyak diteliti. Tulisan ini merupakan bagian dari disertasi doktoral berdasarkan studi potong lintang mengenai kesehatan lingkungan di perumahan kumuh di Jakarta, ibukota Indonesia yang dikenal tinggi polusi udaranya. Studi ini menemukan bahwa di samping faktor-faktor lain, merokok adalah faktor risiko kesehatan untuk gangguan pernapasan pada 263 balita di wilayah penelitian. Anak-anak yang direkrut tidak menunjukkan gejala gangguan pernapasan pada awal observasi dan diikuti selama dua minggu untuk mendeteksi kemunculan gangguan pernapasan. Faktor-faktor yang berhubungan dengan kondisi fisik perumahan dan aktifitas rumah tangga juga dicatat. Analisis data dilakukan dengan pengendalian konfounder. Cut-off yang dianggap paling spesifik dan sensitif dalam kaitannya dengan kemunculan gejala pernapasan pada anak konsentrasi PM10 dalam ruang sebesar 70 mg/m3. Studi ini menemukan bahwa konsumsi sigaret secara signifikan berhubungan dengan konsentrasi PM10 dalam ruang. Setiap batang rokok yang dihisap oleh ayah berhubungan dengan peningkatan PM10 dalam ruang sebesar 2.6 mg/m3 to 3.9 mg/m3. Namun studi ini tidak menemukan hubungan antara kondisi fisik rumah dengan PM10 dalam ruang. Kesimpulan akhir dari studi ini adalah bahwa di perumahan yang padat, kebiasaan merokok orang tua adalah faktor kritik kualitas udara dalam ruang , dan dengan demikian menjadi fakto risiko kesehatan bagi penghuninya. Statistically significant respiratory symptoms effects of smoking had been reported in many studies. The present paper was a partial report of a public health doctoral dissertation base on a cross-sectional environmental health study done in homes of a slum area in Jakarta, capital of Indonesia where ambient air pollution was significantly high. The paper described that among other factors, smoking was the health risk factor related to the development of respiratory symptoms among 263 children under-five in the research area. The children recruited were without any respiratory symptoms at the beginning of the observation, and then were followed for 2 weeks to detect the occurrence of any respiratory symptoms. Factors relating to physical conditions of homes and household activities were also recorded. Analysis of data was done including the control of confounding factors. A cut-off of 70 mg/m3 indoor PM10 concentration as the surrogate for quantitative measure of smoking was seen as the most specific and sensitive level in relation to the occurrence of respiratory symptoms among the children. The study signified that the consumption of cigarettes was significantly related to the increase of indoor PM10 concentration. Every single cigarette consumed by the father was related to of indoor PM10 increase in the range from 2.6 mg/m3 to 3.9 mg/m3. However, the study was not able to prove any influence on the variation of the indoor PM10 concentrations by the physical factor of the homes studied. The end conclusion of the study showed that in homes of an overcrowded area, parental smoking was the critical factor for the quality of indoor air, hence the health risk to the respiration system of the occupants.
Lingkungan Fisik Kamar Tidur dan Pneumonia pada Anak Balita di Puskesmas Kawalu Kota Tasikmalaya Widodo, Nur
Kesmas Vol. 2, No. 2
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Pneumonia masih menjadi masalah kesehatan masyarakat yang penting di Indonesia termasuk di Kota Tasikmalaya. Diperkirakan proporsi penyakit pneumonia bayi adalah 16,4%, dan pada balita adalah 25%. Tujuan penelitian ini adalah untuk mengetahui hubungan kejadian pneumonia pada balita dengan faktor lingkungan fisik kamar tidur dan karakteristik anak. Desain penelitian yang digunakan adalah case control. Sampel sebanyak 300 responden terdiri dari 150 orang kasus dan 150 orang kontrol. Dari hasil uji multivariat tanpa interaksi, faktor dominan yang mempengaruhi kejadian penyakit pneumonia pada anak balita adalah status gizi dengan nilai B 1,799 dan OR = 6,041 (CI 95%=1,607-22,713). Sedangkan hasil uji interaksi diperoleh hasil bahwa faktor dominan yang mempengaruhi kejadian pneumonia anak balita adalah interaksi antara asap obat nyamuk dengan status gizi dengan nilai B 1,040 dan OR=2,828 (CI 95%=1,667-4,7988). Pada perhitungan probabilitas didapatkan hasil bahwa balita yang menderita pneumonia memiliki probabilitas odds 15,6 kali punya riwayat status imunisasi tidak lengkap (DPT dan Campak), status gizi kurang dan ada asap obat nyamuk bakar di dalam kamar tidur dibanding balita yang tidak menderita pneumonia. Disarankan agar anak balita diimunisasi lengkap (DPT dan Campak), diberi asupan makanan dengan gizi seimbang, dan tidak menggunakan obat anti nyamuk bakar di dalam kamar tidur, serta perlu disosialisasikan faktor-faktor yang berhubungan dengan kejadian pneumonia pada balita. Pneumonia is still an important public health problem in Indonesia, especially in Tasikmalaya city, West Java. It was predicted that pneumonia contributed to fetal death at about 16.4%, while the incidence of the pneumonia among under 5 years children is 25%. The objective of this study is to know the relationship between physical environment of baby sleeping room and pneumonia. Design of the study used is case control study. The sample size is 300 subjects consists of 150 cases and 150 controls. Based on multivariate analysis, the nutritional status of children relate closely with pneumonia (OR = 6.041; 95% CI =1.607- 22.713). While from an interaction analysis it was found that there is an interaction effect of mosquito coil and nutritional status on pneumonia (OR=2.828 ;CI 95%= 1.667-4.7988). Based on probability computation it was known that under 5 years old children who suffer from pneumonia has probability odds of 15.6 times has incomplete diphteria and measles immunization, poor nutritional status, and using mosquito coil compared to healthy children. Under five years children is recommended to get complete DPT and measles immunization, provided balance nutritional intake and not using mosquito coil in sleeping room.
Human Health Risk to Ultrafine Particles in Jakarta Haryanto, Budi
Kesmas Vol. 4, No. 2
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Perhatian terhadap pencemaran udara ini menjadi semakin meningkat ketika banyak diketemukan dampaknya pada anak-anak, terutama kaitannya dengan insidens dan prevalens asma. Sumber utama pencemaran udara di Jakarta adalah dari kendaraan bermotor dan industri, dimana transportasi berkontribusi terhadap 71% NOX, 15% SO 2, dan 70% partikel debu kurang dari 10 mikronmeter (PM 10). Tujuan penelitian mengetahui jumlah partikel debu berdiameter ultrafine (partikel berukuran <0,1 mm) yang terhirup oleh anak sekolah dasar, pekerja pengguna kendaraan pribadi dan kendaraan umum. Studi ini menggunakan desain crosssectional dan dilakukan di Jakarta tahun 2005. Sebanyak 30 responden anak sekolah dasar, pekerja pengguna kendaraan pribadi dan kendaraan umum dipilih secara purposif sebagai subyek penelitian. Jumlah partikel ultrafine terhirup secara individu diukur selama 3 x 24 jam menggunakan Condensation Particle Counter (CPC) real time personal exposure measurement (jumlah ultrafine partikel per cm 3). Rerata konsentrasi partikel ultrafine terhirup pada anak sekolah dasar di rumah, di perjalanan, dan di sekolah adalah berurutan sebagai berikut: 29.254/cm 3, 147.897/cm 3 dan 61.033/cm 3. Pada pekerja pengguna kendaraan pribadi di rumah, di perjalanan, dan di kantor diperoleh rerata konsentrasi secara berurutan sebagai berikut: 29.213/cm 3, 310.179/cm 3 dan 42.496/cm 3. Sedangkan pada pekerja pengguna kendaraan umum adalah: 35.332/cm 3 di rumah, 453.547/cm 3 di perjalanan, dan 69.867/cm 3 di kantor. In Jakarta, the main pollution sources are vehicles and industry, with motorized traffic accounting for 71% of the oxides of nitrogen (NOX), 15% of sulphur-dioxide (SO2), and 70% of particulate matter (PM 10 ) of the total emission load. Both urban population size and the fraction of the population that owns a private vehicle are increasing. The study objective is to determine the numbers of ultrafine particulate matter with an aerodynamic diameter of 0.1 mm or less, or PM0.1 inhaled by elementary school children, commute workers with private car and commute workers with public transport. A cross-sectional study design is implemented in Jakarta 2005. Ten elementary school children, ten commuters with private car and ten commuters with public transports are purposively selected as subjects and measured personally for 3 x 24 hours using Condensation Particle Counter (CPC) real-time personal exposure measurement (measured in terms of the number of particles per cubic centimeter, or # cm-3). The average concentration of ultrafine particulate matter of elementary school children at home, on the road and at school is 29,254/cm3, 147,897/cm3 and 61,033/cm3 respectively. For those commuters with private car at home, on the road and at office is 29,213/cm3, 310,179/cm3 and 42,496/cm3 respectively. For those commuters with public transport, the concentration average of at home, on the road and at office is found higher: 35,332/cm3, 453,547/cm3, and 69,867/cm3, respectively.
Kualitas Bakteriologis Air Minum Isi Ulang di Wilayah Kota Bogor Pratiwi, Astri Wulandari
Kesmas Vol. 2, No. 2
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Kebutuhan masyarakat terhadap air minum yang meningkat terutama di perkotaan mendorong tumbuhnya Industri Air Minum Dalam Kemasan (AMDK) dan usaha Depot Air Minum (DAM) isi ulang yang siap melayani masyarakat. Tujuan penelitian ini mengetahui kualitas bakteriologis depot air minum isi ulang di Wilayah Kota Bogor. Jenis penelitian deskriptif, data primer yang digunakan mencakup peralatan yang digunakan pada 27 Depot Air Minum Isi Ulang, pemeriksaan laboratorium total coliform dan E.coli pada air sampel air minum isi ulang, observasi dan data sekunder yang diperoleh dari Dinas Kesehatan Kota Bogor tentang lokasi Depot Air Minum Isi Ulang. Hasil penelitian menunjukkan bahwa sumber air baku yang digunakan yang paling banyak (81,5 %) dari mata air pegunungan, jumlah tabung filter yang dipakai pada alat penyaring (51,9%) dengan jumlah tabung yang digunakan 3 buah, jenis bahan tabung filter yang digunakan (63,0%) dengan jenis bahan stainless steel, frekuensi pergantian Catridge filter (63,0%) dengan frekuensi pergantian catridge filter 1 kali dalam sebulan, sistem desinfeksi/sterilisasi yang digunakan (55,6%); sistem desinfeksi/sterilisasi ozonisasi dan ultraviolet (UV), Hasil Pemeriksaan Total Coliform ( 92,6%) yang memenuhi syarat dan yang tidak memenuhi syarat (7,4%) dengan jumlah bakteri 7 APM gram/100 ml, sedangkan hasil pemeriksaan Escherichia coli yaitu 96,3% yang memenuhi syarat dan 3,7% yang tidak memenuhi syarat dengan 3 APM gram/100ml. Rata-rata penjualan air minum isi ulang antara 20 galon perhari sampai dengan 120 galon perhari. Kualitas bakteriologis air minum isi ulang di Kota Bogor termasuk baik dikarenakan dari 27 Depot Air Minum Isi Ulang hanya 2 Depot yang masih belum memenuhi syarat kesehatan. Sebelum mengkonsumsi air minum isi ulang masyarakat perlu memperhatikan kualitas air minum sebelum dimasak terlebih dahulu. The increasing need of drinking water in city population has driven the growth of drinking water industry and water-refilling industry. The objective of this study is to know the bacteriological quality of water-refilling depot in Bogor city. The study is a descriptive one with primary data collection using laboratory analysis on total coliform and E. coli. and secondary data from Bogor Health office. The study shows that the source of drinking water was mostly mountain water (81.5%), the use of filter tube (51.9%) with number of tubes of 3 pieces, 63% using stainless steel material, 63% change the filter cartridge once a month, 55.6% using disinfection/sterilization by ozonisation and UV ray. Laboratory results shows that in term of total coliform 92.6% fulfill the required condition and 7.4% did not fulfill required condition with bacteria count of 7 APM/100 ml, in term of E.coli 96.3% had fulfilled required condition and 3.7% did not fulfill the required condition with bacteria count of 3 APM gram/100 ml. The average sales of refilled water was between 20-120 gallon/days. Bacteriological quality of water-refilling station in Bogor city could be considered as good and only 2 out of 27 stations did not fulfill health conditions. Community should pay attention on drinking water quality and the need to boil the water before consumption.
Analisis Manajemen Pengawasan dan Pengendalian Penyalahgunaan Formalin di Dinas Kesehatan Kabupaten Tangerang Hartati, Hendri
Kesmas Vol. 2, No. 2
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Banyak industri makanan Tangerang ditemukan menggunakan bahan pengawet formalin. Tujuan penelitian ini mengetahui peranan Dinas Kesehatan (Dinkes) Kabuppaten Tangerang mengawasi dan mengendalikan formalin pada makanan. Penelitian ini dilakukan pada Nopember 2006-Pebruari 2007. Dengan metode kualitatif wawancara mendalam dan penelusuran dokumen. Sumber data adalah Dinkes Kabupaten Tangerang dan Puskesmas terpilih. Para responden adalah Kepala Dinkes Kabid Yankes; Kasi Pengawasan makanan dan minuman; Staf pelaksana Dinkes dan Puskesmas. Hasil yang ditemukan meliputi pengawasan dan pengendalian formalin dilakukan oleh dinas kesehatan secara rutin sejak tahun 2004. Namun, program intensif ketika merebak issue kandungan formalin dalam makanan, tahun 2006. Masalah yang dihadapi: peraturan belum tersosialisasi, dana terbatas, tenaga wasdal terbatas dan tugas rangkap. Pemeriksaan sampel secara kuantitatif dilakukan di BPOM, pemeriksaan kualitatif mulai dilakukan tetapi masih terbatas karena puskesmas belum punya alat. Material sudah mendukung pelaksanaan wasdal formalin. Jadwal kegiatan ada dan disusun di tingkat puskemas. Data tersedia tetapi tidak tersusun dalam sistem informasi. Buku panduan kegiatan belum ada. Faktor yang mendukung antara lain kerja sama lintas sektor; partisipasi laporan masyarakat, dan supervisi oleh POM/ Dinkes Propinsi. Kabupaten Tanggerang Faktor yang menghambat adalah area kerja luas, sumber daya dan faktor pendukung, industri makanan terbatas (UKM), jasa boga, rumah makan dan pasar yang banyak. Perlu dilakukan upaya peningkatan sumber daya dan faktor-faktor yang mendukung serta mengatasi hambatan yang ada. The district of Tangerang is a high risk area of the misuse of formaldehyde as food preservative. Researches show that many types of food are contaminated by formaldehyde. The aim of this study was to obtain in-depth information on the implementation, supervision and control of formaldehyde misuse managed by the Tangerang District Health Office. This study is a descriptive study using qualitative technique with District Health Office as analysis unit. In-depth interview technique and document analysis were used to collect data. The variables of this research were determined before the research conducted. The study showed that the process of management had not been successfully implemented in an intensive way except in the occasion when the issue was published extensively in the media. Non-intensive supervision and controlling happened due to some factors namely, lack of resources (regulation, money, personnel, laboratory, equipment, and guideline), non-routine inter-sector collaboration, and non-periodic supervision from province level. In order to achieve the optimal supervision and controlling activity, it is suggested that the resources and supporting factors should be enhanced through varied strategies.
Pengaruh Iklim terhadap Kasus Demam Berdarah Dengue Sintorini, Margareta Maria
Kesmas Vol. 2, No. 1
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Penyakit demam berdarah dengue (DBD) telah menjadi penyakit endemik di kota-kota besar di Indonesia. Ramalan Intergovernmental Panel on Climate Change tahun 1996 menyebutkan insidens DBD di Indonesia dapat meningkat tiga kali lipat pada tahun 2070. Tujuan penelitian ini untuk membuat model dinamika sistem dengan analisis ekologi untuk mengetahui dinamika kejadian DBD dalam kaitan dengan pola variablitas iklim di DKI Jakarta. Rancangan penelitian digunakan adalah ecologic study dengan uji hipotesis, permodelan, simulasi, dan intervensi. Wawancara terhadap 844 responden untuk mengetahui tingkat pengetahuan, sikap, dan perilaku (PSP) masyarakat. Pengukuran faktor iklim meliputi curah hujan, suhu, kelembaban, intensitas cahaya, dan kadar CO2. Aspek vektor yang diukur adalah angka hinggap per jam nyamuk Aedes (AHJ) dan nyamuk istirahat per rumah (NIR). Hasil penelitian menunjukkan kasus DBD dipengaruhi curah hujan (p:0,000..), suhu lingkungan (p:0,000..), kelembaban ruang (p:0,003), kelembaban lingkungan (p:0,000..), AHJ Aedes (p:0,016), NIR Aedes (p:0,000..) dan pengetahuan masyarakat (p:0,008). Disimpulkan, faktor iklim yang paling berpengaruh terhadap kasus DBD adalah curah hujan, suhu dan kelembaban serta pengetahuan masyarakat yang rendah. Sedangkan AHJ Aedes dapat dijadikan indikator kenaikan kasus DBD. Dengue hemorrhagic fever (DHF) has become endemic in many big cities in Indonesia. It was predicted by Intergovernmental Panel on Climate Change, that in 1996 the DHF in Indonesia in 2070 would be tripled. The objective of this research is to make a system dynamic model using ecological analysis to identify the dynamic of DHF cases related to the pattern of the climate variability in Jakarta. This research uses the design of ecological study with hypothesis testing, modeling, simulation, and intervention. Respondents of 844 households were interviewed to explore their knowledge, attitude and practice (KAP) regarding DHF using a standard questionnaire. Precipitation, humidity, light intensity and CO2 concentration were determined per week. AHJ (Man Landing Rate) and NIR (resting habit) were determined for Aedes population density. The results indicate that the DHF cases all are influenced by precipitation (0.000), temperature ambient (0.000), indoor humidity (0.003), outdoor humidity (0.000), AHJ (0.016), NIR (0.000), and knowledge (0.008). The most influencial climate factor to the DHF cases are precipitation, temperature, humidity and the low level of the community knowledge.
Cost Effectiveness Upaya Penanggulangan Gizi Metode Positif Deviance dan Pemberian Makanan Tambahan di Puskesmas Gekbrong Kabupaten Cianjur 2006 Suharyati, Suharyati
Kesmas Vol. 1, No. 6
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Abstract

Provinsi Jawa Barat masih menghadapi masalah rawan gizi serius, terlihat pada 18.094 balita rawan pangan yang terhimpun di tiga kantong utama, Kabupaten Cirebon (4.005), Bandung (2.991) dan Cianjur (2.670). Di Kabupaten Cianjur, balita gizi buruk dan gizi kurang ditemukan 2.670 (1,3%) dan 24.447 (11,7%) dari 208.572 balita yang ada. Tujuan penelitian ini membandingkan cost effectiveness upaya perbaikan gizi pemberian Makanan Tambahan (PMT) yang bersifat top down dan Positive Deviance (PD) yang besifat bottom up. Data ditinjau dari sisi provider dan perhitungan biaya peraktifitas menggunakan metoda Activity Based Costing (ABC Methode). Komponen biaya penanggulangan gizi terbesar berturut-turut adalah biaya operasional, investasi dan pemeliharaan (85%, 14,5% dan 0,3%). Metoda PD memerlukan waktu 54 hari dan metoda PMT 102 hari. Rata-rata kenaikan berat badan (BB) selama tiga bulan pada metoda PD (920 gram) adalah lebih besar daripada metoda PMT (650 gram). Rata-rata kenaikan BB pada bulan I, II, dan II, pada metoda PD (470, 220 dan 230 gram) adalah lebih tinggi daripada metoda PMT (300, 170 dan 180 gram). Kenaikan BB balita dalam 3 bulan berdasar pita warna KMS, BB sangat kurang dan kurang pada PD (54%, 17%) lebih rendah daripada PMT (78%, 22%). Nilai CER metoda PD (Rp 446.828,- /balita) terlihat lebih kecil daripada metoda PMT (Rp 768.887,-/balita). Disimpulkan bahwa metoda PD lebih cost effective daripada metoda PMT. The Province of West Java still faces serious malnutrition problem that can be seen in 18094 cases of under 5 years old children who suffer from malnutrition particularly in districts of Cirebon (4005), Bandung (2991) and Cianjur (2670). In Cianjur it was found that 2670 (1.3%) cases of severe under-nutrition and 24447 (11.7%) cases of under-nutrition out of 208572 children. The objective of this study is to compare the cost effectiveness between positive deviance (PD) and food supplementation (PMT) methods. The data were observed from the provider side using Activity Based Costing (ABC) method. The study shows that the biggest cost component is the operational cost (85%), investment cost (14.5%) and maintenance cost (0.3%). The time frame for PD method (54 days) is shorter than that of PMT method (102 days). The average body weight gain in three months, the PD method (920 grams) is smaller than that of PMT method (650 grams). The monthly average gain in the first, second and third for the PD method (470, 220 and 230 grams) is higher than that of the PMT method (300, 170 and 180 grams). From growth chart (KMS) in three months, below red line (BGM) and under-weight in the PD method (54%, and 17%) is lower than the PMT (78% and 22%). The CER value for PD method is Rp 446,828,-/child, lower than that of the PMT method ( Rp 768,887,-/child). It was concluded that PD method is more cost effective than PMT method.
Hubungan Status Reproduksi, Status Kesehatan, Akses Pelayanan Kesehatan dengan Komplikasi Obstetri di Banda Sakti, Lhokseumawe Tahun 2005 Huda, Lasmita Nurul
Kesmas Vol. 1, No. 6
Publisher : UI Scholars Hub

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Abstract

Di Indonesia, angka kematian ibu (AKI) masih tinggi jika dibanding dengan negara-negara ASEAN. Penyebab utama kematian ibu adalah komplikasi obstetri yang merupakan penyulit atau penyakit yang timbul pada waktu kehamilan, persalinan dan pasca persalinan. Di Indonesia, komplikasi obstetri (20% dari seluruh ibu hamil) masih sangat tinggi, sementara yang mampu ditangani hanya sekitar 10%. Berbagai faktor yang mempengaruhi komplikasi obstetri adalah status reproduksi, perilaku pencarian pelayanan kesehatan dan status kesehatan. Penelitian yang berujuan mengetahui faktor-faktor yang berhubungan dengan komplikasi obstetri ini menggunakan desain studi cross-sectional dengan sumber data primer. Sampel adalah 220 ibu yang melahirkan bayi hidup atau mati pada tahun 2005 yang ditarik secara sistematik random sampling. Hasil penelitian mendapatkan prevalensi komplikasi obstetri 46,8%, komplikasi pada waktu hamil dan persalinan merupakan yang terbanyak (12,27%) dan paling sedikit adalah komplikasi waktu hamil dan nifas masing-masing 2,27%. Model multivariat akhir mendapatkan lima variabel yang berhubungan dengan komplikasi obstetri meliputi penolong persalinan OR=4,32 (95% CI: 0,49-37,98); paritas OR=1,86 (95% CI: 0,83-4,16); sikap OR=1,66 (0,94-2,94)[ riwayat komplikasi hamil sebelumnya OR=1,79 (0,83-3,83) dan tempat persalinan OR=1,18 (95% CI: 1,01-3,26. Upaya yang perlu dilakukan untuk menurunkan kejadian komplikasi obstetri di Kecamatan Banda Sakti adalah pelatihan bidan, pengembangan PONED dan PONEK, serta memberikan pelayanan KB segera setelah bersalin kepada ibu yang memiliki paritas berisiko dan riwayat komplikasi hamil. The Maternal Mortality Rate (MMR). in Indonesia is still high compared to other ASEAN countries. The cause of the maternal death is obstetrical complications which arise at the period of pregnancy, childbirth. The complications badly affect the maternal death. The rate of the obstetrical complications is still high in Indonesia. It is about 20% of the whole pregnant women, but the case of complications treated is still less than 10%. A variety of factors influence the occurrence of the complications. They are reproduction status, health seeking behavior service, and health status. Therefore, this study was conducted to know the factors related to the obstetrical complications. This study uses cross-sectional design. Data were collected by questionnaires. Samples are women delivering their babies alive or dead in 2005, the number of which are 220 at minimum. Before analyzing, the data were cleaned, then, categorized according to the operational definition. The data were analyzed in three steps, namely univariate, bivariate, and multivariate.The results show that of out of 46.8% of obstetrical complications incidence, the complication mostly happened (12.27%) at the pregnancy and delivery and 2.27% of it happened at pregnancy and parturition. The last analysis without interaction results in five variables related to the complications. They are delivery helper OR=4.32 (95% CI: 0.49-37.98), parity OR=1.86 (95% CI: 0.83-4.16), attitude OR=1.66 (0.94-2.94), pregnant complication history OR=1.79 (0.83-3.83). The dominant factor is place of delivery, OR=1.18 (95% CI: 1.01-3.26). Based on the study, the incident of obstetrical complication in Banda Bakti Sub district can be decreased by training the midwives so that they have knowledge, motivation, and skill in dealing with obstetrical complications, developing PONED and PONEK, providing family planning service soon after the delivery to the women who are at risk of parity and pregnant complication history, and building partnership with midwives (helping the delivery traditionally).

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