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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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Ketidaktepatan Sasaran Jamkesmas Berdasarkan Kriteria Miskin Pendataan Program Perlindungan Sosial Luthfiah, Umi; Setiawan, Ery; Lucia, Sindu Setia
Kesmas Vol. 9, No. 4
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Peserta Jaminan Kesehatan Masyarakat (Jamkesmas) hingga tahun 2010 mencapai 76,4 juta jiwa mencakup masyarakat miskin dan tidak mampu, sedangkan peserta Jaminan Kesehatan Daerah (Jamkesda) mencapai 31,6 juta jiwa. Secara prinsip, program Jamkesda dibentuk untuk memfasilitasi masyarakat miskin dan kurang mampu di luar kuota Jamkesmas yang dibiayai oleh pemerintah daerah. Penelitian ini bertujuan untuk meninjau ketepatan sasaran peserta program Jamkesmas berdasarkan kriteria miskin Pendataan Program Perlindungan Sosial (PPLS). Sumber data yang digunakan adalah data Survei Sosial Ekonomi Nasional (Susenas) tahun 2012. Populasi dari penelitian ini adalah seluruh rumah tangga di Indonesia tahun 2012. Sampel penelitian adalah rumah tangga terpilih dari masing-masing blok sensus. Analisis yang dilakukan adalah analisis univariat, bivariat hingga multivariat dengan regresi logistik. Masih terdapat 12,4% penduduk yang mendapatkan Jamkesmas, tetapi tidak miskin atau hampir miskin. Selain itu, masih terdapat 56,4% penduduk yang hampir miskin dan 41,1% penduduk miskin yang belum terjangkau pesertaan Jamkesmas. Layanan gratis merupakan faktor yang paling menentukan apakah penduduk dapat menjadi peserta Jamkesmas atau tidak. Mereka yang memiliki layanan kesehatan gratis berpeluang 5,462 kali mendapatkan layanan Jamkesmas dibandingkan mereka yang tidak memiliki layanan gratis. Perbaikan basis data, pengawasan, evaluasi serta sistem alokasi yang baik sangat diperlukan untuk mengurangi ketidaktepatan sasaran. Penyesuaian data antara Kementerian Kesehatan dan dinas kesehatan daerah berguna dalam penanganan peserta yang belum terdata. Participants of Public Health Insurance (Jamkesmas) up to 2010 reached 76.4 million including poor and disadvantaged people, meanwhile participants of Regional Health Insurance (Jamkesda) reached 31.6 million people. In principle, Jamkesda program is made to facilitate the poor and disadvantaged people outside Jamkesmas quota funded by local government. This study aimed to review the accuracy of Jamkesmas participant target according to the poor criteria of Data Collection for Social Protection Program. Data source used is national socio-economic survey (Susenas) 2012. Population of this study was all households in Indonesia within 2012. Sample of this study was households selected from each block sensus. Analysis conducted was univariate, bivariate, and multivariate with logictic regression. There were 12.4% people receiving Jamkesmas, but they were not poor or almost poor. Moreover, there were 56.4% the almost poor and 41.1% the poor not yet having access to Jamkesmas. Free service is the most determining factor whether people can be Jamkesmas participants. The people who having free health services had an opportunity 5.462 times to get Jamkesmas service compared to the people who did not. Database improvement, surveillance, evaluation as well as good allocation system are needed to reduce the inaccuracy of target. Adjustment of data between Health Ministry and local health agency is useful in handling uncovered participants.
Efektivitas Ovitrap Bambu terhadap Jumlah Jentik Aedes sp yang Terperangkap Aditama, Wiwit; Zulfikar, Zulfikar
Kesmas Vol. 9, No. 4
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Demam berdarah dengue (DBD) masih menjadi masalah kesehatan masyarakat di Banda Aceh. Banda Aceh merupakan daerah endemik DBD dengan meningkatnya angka kejadian dan case fatality rate setiap tahun. Insiden tertinggi DBD berada di Kecamatan Baiturrahman dengan angka kejadian 120 per 100.000 penduduk dan tertinggi kedua adalah Kecamatan Jaya Baru dengan angka kejadian 84 per 100.000 penduduk. Keberadaan larva Aedes sp di masyarakat merupakan salah satu indikator populasi nyamuk Aedes aegypti di daerah tersebut. Penelitian ini bertujuan untuk mengetahui jumlah jentik nyamuk Aedes sp yang terperangkap pada masing-masing wadah ovitrap (tempurung kelapa, gelas plastik, dan potongan bambu) serta tingkat kepadatan jentik nyamuk Aedes sp sebelum dan setelah pemasangan wadah ovitrap. Jenis penelitian adalah explanatory study dengan desain eksperimental quasi. Teknik pengambilan sampel adalah proportional sampling. Populasi unit penelitian adalah 30 rumah. Ovitrap diletakkan merata pada 30 titik lokasi dari 10 kelurahan secara acak. Data jumlah jentik nyamuk Aedes yang terperangkap diambil empat kali secara berulang dengan selang waktu satu minggu. Analisis dengan rerata jumlah jentik di dalam ovitrap dan indeks ovitrap. Hasil jumlah jentik Aedes aegypti yang terperangkap sebanyak 1.265. Ovitrap yang paling efektif, yaitu potongan bambu rerata = 123, nilai p = 0,006, HI = 10,01% (16,66 – 26,67%), CI = 36,8% (336,06 – 39,74%), BI = 29,97% (73,33 103,3%). Otoritas kesehatan harus mempromosikan ovitrap bambu kepada masyarakat sebagai upaya pengendalian Aedes sp. Dengue hemorrhagic fever (DHF) is a public health problem in Banda Aceh. Banda Aceh is a DHF endemic city by increasing incidence rate (IR) and case fatality rate every year. The highest DHF incidence was in Baiturrahman District (IR = 120 per 100,000 people) and Jaya Baru District (IR = 84 per 100,000 people). Aedes sp larvae existence among people is one of Aedes aegypti population indicators in such region. This study aimed to find out numbers of Aedes sp trapped in each ovitrap (coconut shell, plastic cup, and piece of bamboo) and Aedes sp density level before and after ovitrap installation. This study was explanatory study using quasi-experimental design. The sampling technique was proportional sampling. Population of study was 30 houses. Ovitraps were randomly located in 30 places of 10 subdistricts. Data of trapped Aedes sp larvae numbers was collected four times repeatedly within one week time-lapse. Analysis was conducted using the mean number of larvae in ovitraps and ovitrap index. The number of Aedes sp larvae trapped was 1,265. The most effective ovitrap is piece of bamboo, mean = 123, p value = 0.006, HI = 10.01% (16.66 26.67%), CI = 36.8% (336.06 - 39.74%), BI = 29.97% (73.33 - 103.3%). Health authorities should promote bamboo ovitrap, especially to public as an effort to control Aedes sp.
Studi Intervensi Klaster Kawasan Tanpa Rokok pada Tingkat Rumah Tangga Najmah, Najmah; Etrawati, Fenny; Yeni, Yeni; Utama, Feranita
Kesmas Vol. 9, No. 4
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Perilaku merokok memberikan dampak negatif, baik bagi perokok aktif maupun pasif, ditinjau dari sudut pandang kesehatan maupun ekonomi. Regulasi mengenai Kawasan Tanpa Rokok (KTR) yang telah diterbitkan belum ada yang mengatur mengenai penerapan KTR di tingkat rumah tangga. Penelitian ini bertujuan untuk mengidentifikasi perubahan perilaku melalui intervensi terpadu KTR pada tingkat rumah tangga. Penelitian dilakukan pada bulan Juli - September 2014 menggunakan desain cluster trial pada empat desa di Kabupaten Ogan Ilir, Sumatera Selatan. Selanjutnya, 200 sampel kepala keluarga dipilih melalui metode cluster random sampling. Intervensi yang dilakukan meliputi konseling terpadu, pemberian permen pengganti rokok, dan tabungan sehat. Hasil penelitian menunjukkan bahwa proporsi responden yang merokok setiap hari dalam sebulan terakhir dan komitmen untuk tidak akan merokok di masa yang akan datang mencapai 71,6% dan 62% pada kelompok intervensi serta 91% dan 38% pada kelompok non-intervensi. Intervensi ini berpeluang 46% mengurangi perilaku merokok responden (RP = 0,46) setelah dikontrol oleh variabel pendidikan (RP = 0,152) dan sikap (RP = 0,216) dengan nilai p < 0,0001. Intervensi terpadu ini terbukti berhasil mengubah perilaku merokok pada kawasan rumah tangga sehingga diperlukan partisipasi masyarakat dan dinas kesehatan setempat untuk menindaklanjuti penerapan intervensi ini dalam jangka panjang. Smoking behavior has negative impacts, both for active and passive smokers, as reviewed from health and economic perspectives. Regulation concerning non-smoking area issued has not yet arranged implementation of non-smoking area at household level. This study aimed to identify any behavior change through integrated intervention of non-smoking area at household level. This study was conducted on July - September 2014 using cluster trial design in four villages at Ogan Ilir District, South Sumatra. Then 200 household head samples were selected through cluster random sampling method. The intervention included integrated counseling, distribution of candy as substitute for cigarette, and healthy saving. Results of study showed that proportion of respondents who smoked every day in a recent month and had a commitment not to smoke in the future reached 71.6% and 62% in the intervention group, then 91% and 38% in the non-intervention group respectively. This intervension had opportunity worth 46% reducing the smoking behavior of the respondents (RP= 0.46) after controlled by the variable of education (RP = 0.152) and attitude (RP = 0.216) with p value < 0.0001. This integrated intervention was profoundly successful changing smoking behavior at household level. So that, public participation and health agency need to follow up the implementation of this intervention in a long term.
Efektivitas Collaborative Governance dalam Pelayanan Komprehensif Berkesinambungan untuk Menanggulangi HIV/AIDS Demartoto, Argyo
Kesmas Vol. 9, No. 4
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Di tingkat nasional dan daerah telah terdapat kebijakan publik, program dan kegiatan untuk menanggulangi HIV/AIDS, namun jumlah kasus HIV/AIDS meningkat setiap tahun. Tujuan penelitian ini untuk mengetahui efektivitas collaborative governance antarpemangku kepentingan dalam pelayanan komprehensif berkesinambungan untuk menanggulangi HIV/AIDS di Kota Surakarta. Penelitian ini merupakan studi kasus jenis exploratory. Informan ditentukan dengan menggunakan purposive sampling. Pengumpulan data dilakukan pada 2 Juli – 2 September 2013 dengan wawancara mendalam, observasi, focus group discussion, dan dokumentasi. Teknik analisis data dengan model analisis interaktif. Hasil penelitian menunjukkan bahwa pemberi dan penerima layanan berperan dalam penanggulangan HIV/AIDS sesuai tugas dan fungsinya masing-masing. Program pencegahan dan penjangkauan, layanan kesehatan, reduksi bahaya, dan pemberdayaan belum efektif karena komitmen terhadap tujuan dan sikap saling percaya antarpemangku kepentingan belum optimal, petugas lapangan kurang profesional, terdapat konflik laten antarpemangku kepentingan, kurang optimalnya koordinasi antaranggota Komisi Penanggulangan AIDS Daerah Kota Surakarta dan rendahnya anggaran untuk penanggulangan HIV/AIDS karena HIV/AIDS belum menjadi isu prioritas dalam pembangunan daerah. Disimpulkan bahwa kolaborasi governance antarpemangku kepentingan belum efektif. Untuk meningkatkan kualitas dan efektivitas kolaborasi governance antarpemangku kepentingan, harus ada norma, struktur, dan proses yang jelas dalam menanggulangi HIV/AIDS. There have been public policies, programs and activities to cope with HIV/AIDS in Indonesia at national and local level, but number of HIV/AIDS cases is increasing every year. This study aimed to determine effectivity of collaborative governance between stakeholders in a sustainable comprehensive service to cope with HIV/AIDS in Surakarta City. This study was an exploratory study. Informants were selected using purposive sampling technique. Data collection was conducted on 2 July – 2 September 2013 using in-depth interview, observation, focus group discussion, and documentation. Technique of data analysis was an interactive analysis model. Results showed that service provider and receiver had taken roles in HIV/AIDS coping based on their own duty and function. Prevention and outreach, healthcare service, harm reduction and empowerment programs had not been yet effective because of less optimal commitment to purpose and mutual trust between stakeholders, less professional fieldworkers, latent conflict occurred between stakeholders, less optimal coordination between AIDS Coping Commission of Surakarta City members, and low budget for HIV/AIDS coping as HIV/AIDS is not yet a priority issue in regional development. In brief, collaborative governance between stakeholders is not yet efffective. To improve the quality and the collaborative governance effectivity between stakeholders, there should be any clear norm, structure and process in coping with HIV/AIDS.
Overcoming Shortage of Pharmacists to Provide Pharmaceutical Services in Public Health Centers in Indonesia Yuniar, Yuyun; Herman, Max Joseph
Kesmas Vol. 8, No. 1
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Indonesia masih menghadapi keterbatasan jumlah apoteker di puskesmas, sehingga pihak pemerintah daerah dan puskesmas harus berupaya mengatasi permasalahan tersebut. Penelitian ini bertujuan untuk menggambarkan ketersediaan dan distribusi tenaga pelayanan kefarmasian di puskesmas serta permasalahan dan alternatif pemecahannya. Data diambil dari hasil Riset Fasilitas Kesehatan (Rifaskes) tahun 2011I. Data kuantitatif tentang tenaga pelayanan kefarmasian di puskesmas dianalisis secara deskriptif berdasarkan regional. Data kualitatif sebagai pendukung diperoleh melalui wawancara mendalam dengan bagian kepegawaian dinas kesehatan dan apoteker empat puskesmas di Kota Bogor dan Bekasi, 3 kemudian dianalisis dengan metode analisis tema. Hasil analisis menunjukkan bahwa Sulawesi memiliki persentase puskesmas dengan tenaga apoteker tertinggi (29,1%) sedangkan Indonesia Timur memiliki persentase puskesmas tertinggi dengan tenaga pelayanan kefarmasian tanpa latar belakang pendidikan farmasi (51,5%). Persentase tenaga kefarmasian terbesar di puskesmas adalah tenaga teknis kefarmasian kemudian perawat. Permasalahan utama yang dihadapi puskesmas adalah beban kerja yang berat dengan kondisi tenaga yang terbatas. Alternatif pemecahan masalah yaitu pengangkatan apoteker baru, namun jika tidak memungkinkan maka penempatan apoteker pada puskesmas dengan kebutuhan mendesak merupakan prioritas utama. Pilihan lain yang memungkinkan adalah pemberdayaan tenaga teknis kefarmasian dan staf lain yang sudah dilatih atau memanfaatkan tenaga siswa magang. Indonesia is facing shortage of pharmacist in public health centers (PHCs), therefore the local government and PHCs have to cope with this problem. This paper aimed to describe the pharmaceutical manpower availability in PHCs, the problems occurred and potential applied solutions. Data was taken from National Health Facility Research 201. Quantitative data related to pharmaceutical manpower in PHCs was analyzed descriptively based on regions. Supporting qualitative data through in-depth interviews with the health office staffs in Bogor and Bekasi and pharmacists in four PHCs were conducted and being analyzed using thematic analysis. It was found that Sulawesi had the highest percentage of PHCs having pharmacist (29.1%) while Eastern Indonesia 51.5% of PHCs didn’t have any staff with pharmacy related educational background. The highest percentages of staff composition were pharmacy technician followed by nurse. The main problem was due to high workload with limited manpower available. The proposed solutions are recruitment of new pharmacists, but in case it is not possible then placing pharmacist in certain type of PHCs with urgent needs is a priority. Empowering pharmacy technician, all available trained staff and other resources such as on job students are other feasible choices.
The Correlation of Age with Thrombocytes and D-Dimer Values in COVID-19 Patients at Hospital X in Jakarta, Indonesia Prasetyoningsih, Nanik; Gani, Ascobat
Kesmas Vol. 19, No. 5
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Coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, spread globally, with research indicating that prognosis severity can be assessed by thrombocyte and D-dimer levels; while, patient age serves as a mortality predictor. This study aimed to analyze the relationship between age with thrombocytes and D-dimer in COVID-19 patients. This cross-sectional study used laboratory testing samples from 667 COVID-19 patients at Hospital X in Jakarta, Indonesia, collected from August 2020 until May 2021. The data was collected using cluster random sampling and analyzed using descriptive statistics and the Chi square test (95% CI). The results showed that age and thrombocytes positively correlated with the D-dimer levels in COVID-19 patients (p-value
Systematic Review of Factors Related to PM2.5 Exposure on the Risk of Type 2 Diabetes Mellitus Salma, Rifka Putri; Fitria, Laila
Kesmas Vol. 19, No. 5
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Diabetes mellitus is a major public health problem in many countries, and most of them are type 2 diabetes mellitus (T2DM). Air pollution is thought to contribute to the T2DM incidence, and one of the most important pollutants is PM2.5. This study aimed to determine factors related to PM2.5 exposure and individual factors in increasing the risk of T2DM based on a systematic review. The PRISMA was used as a method of data collection and selection. Of 176 relevant articles identified and screened, 12 articles from various countries published in 2013-2021 were synthesized in this study. Results showed that long-term PM2.5 exposure, high PM2.5 concentrations, and living in densely-populated areas, close to roads, and in areas with industrial activity could increase the risk of T2DM. Population with an older age (>40 years) and a BMI of overweight or obese were more vulnerable. However, men and persons who stopped or never smoked were also at higher risk; thus, further studies need to be carried out along with other risk factors. A future study is recommended to determine the effects of PM2.5 exposure on the incidence of T2DM in Indonesian populations.
Ambient Particulate Matter with Blood Pressure in Adult Women Living in Urban City Aliyyah, Nurusysyarifah; Kusnoputranto, Haryoto; Wispriyono, Bambang; Fitria, Laila
Kesmas Vol. 19, No. 5
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Ambient air pollution, especially from fine particles, contributes to human mortality from cardiovascular and respiratory diseases, for which high blood pressure (BP) is a major modifiable risk factor. This study aimed to analyze the influence of ambient particulate matter (PM2.5) on the risk of high BP leading to hypertension. This study used a cross-sectional design on 118 adult women living in Central Jakarta, Indonesia. Participants were selected from a 1-km radius of the nearest air quality monitoring station with available data PM2.5. Linear regression was analyzed to examine the relationship between PM2.5 and systolic and diastolic BPs adjusted for potential confounders. The annual means of PM2.5 concentration was 36±5.74 μg/m3. The linear regression model showed that PM2.5 exposure was associated with systolic BP after controlling with age and body mass index (r = 0.408; R2 = 0.167). The second model showed that exposure to PM2.5 concentration could explain about 10.9% variation of diastolic BP after controlling with age, length of stay, body mass index, smoking status, and diabetes mellitus record. Ambient air PM2.5 has a risk of BP and hypertension among adult women in Central Jakarta.
Health and Environmental Pollution: A Literature Review Yuniarti, Elsa; Exposto, Levi Anatolia S.M.; Dewata, Indang; Nugraha, Fitra Arya Dwi; Alfitri, Alfitri
Kesmas Vol. 19, No. 5
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This study aimed to review various studies focusing on pollution that could adversely affect health, including sources, types, and mitigation efforts. The data used were obtained through a search on the Scopus website using the keywords "Health" AND "Pollution" from 2016 to 2023. Using these two keywords, 72 titles and abstracts of papers were successfully found. The results of this literature review were then analyzed with the assistance of NVivo 12 Pro, which grouped the findings based on their impact on health, reasons for pollution, types of pollution, and preventive measures. It was identified that the most common disease was respiratory disorder. One of the leading causes was vehicle combustion, emitting carbon monoxide due to the incomplete combustion of fossil fuels, such as petroleum and natural gas. This study also revealed that the dominant focus of those studies was on air and water pollution. These studies also indicated that solutions to pollution-causing diseases generally include using renewable fuels, waste management, public health literacy, and adopting electric vehicles.
Capitation Management Through Performance-Based Capitation Mechanism of Primary Health Care in Malang, Indonesia Purnamasari, Ayu Tyas; Ningrum, Herlinda Dwi; Ardhiasti, Anggi; Zahroh, Asri Hikmatuz
Kesmas Vol. 19, No. 5
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Primary health care (PHC) has one of the largest funding sources, capitation, which BPJS Healthcare Security transfers monthly. Capitation fund receipts were frequently insufficient due to failure to meet performance-based capitation/Kapitasi Berbasis Kinerja (KBK) targets, including for PHC in Malang City, Indonesia. This study aimed to examine the management and utilization of capitation funds through a KBK mechanism. This descriptive study used a qualitative approach supported by quantitative data. This study was conducted from July to August 2023 and purposely selected nine informants from BPJS Healthcare Security, the local health office, and PHC. The interviews were transcribed verbatim and analyzed using a thematic analysis approach. Three themes were identified from data analysis: revenue allocation, utilization allocation, and budget expenditure appropriateness. The use of capitation follows the Mayor's regulations, which allocate service and operational costs. However, remaining capitation funds always occur due to unavoidable conditions. Separating accounts between capitation and other funding sources is necessary to track capitation utilization. Therefore, BPJS Healthcare Security needs to participate in capitation reporting and monitoring.

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