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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 965 Documents
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Determinants of Behavioral Intention to Change Sexual and Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis Rahman, Md Mizanur; Ahi, Gerraint Gillan; Ramli, Rafazila; Safii, Rasitasam; Minoi, Jacey Lynn; Li, Stephanie Chua Hui; bin Shminan, Ahmad Sofian; Choi, Lee Jun
Kesmas Vol. 21, No. 2
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Abstract

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, sociodemographic factors, and TPB-related changes in knowledge, attitude, subjective norm, control beliefs, perceived power, and perceived control. The conventional intervention produced significantly higher intention-to-change scores at 1 and 3 months, with moderate-to-large effects. In regression analyses (N = 209), Model 1 (type + demographics) significantly predicted change in intention (adjusted R² = .074), with only intervention type significant. Model 2 (adding TPB change scores) improved the fit (adjusted R² = .120; ΔR² = .069, p-value = .014), with perceived power positively and control beliefs inversely associated with change in intention; intervention type was no longer significant. Adolescents in the conventional group showed a larger and more sustained increase in intention to change their SRH behaviors than those in the web-based group, an effect that appeared to operate through changes in underlying psychosocial factors such as control beliefs and perceived power.
Environmental Contamination of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus in Primary Care Clinics: Implications for Occupational Safety Ahmad, Subki; Awang, Normah; Abdull Hamid, Ermie; Ithnin, Anuar; Kamaludin, Nurul Farahana; Muhd Nor, Noraizah
Kesmas Vol. 21, No. 2
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Abstract

Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) are major contributors to healthcare-associated infection, yet data from primary care clinics remain limited. This study assessed environmental contamination in eight clinics in the Klang Valley, Malaysia, and evaluated associated environmental factors. Samples were collected from environmental surfaces and equipment in Medical Officer and Patient Treatment Rooms, then cultured and tested for antimicrobial susceptibility. Environmental parameters, including temperature, relative humidity, air movement, and room density, were measured. Data were analyzed using Kruskal–Wallis, Mann–Whitney, and multiple linear regression analyses. MRSA was detected on 19.8% of environmental surfaces (patient treatment beds (47.3%) and side tables (31.6%)), and 2.1% of equipment surfaces. No VRE was detected; however, Vancomycin-Sensitive Enterococcus was identified in several samples. Significant variation in MRSA contamination across sampling sites was observed (χ² = 25.664, p-value = 0.007). Regression analysis showed that room density (β = −3.285, p-value = 0.006) and temperature (β = −7.922, p-value = 0.012) were significant predictors of aerobic colony counts (R² = 0.157). The detection of MRSA on high-touch surfaces highlights occupational exposure risks in PHC. Strengthened infection prevention and control measures, targeted cleaning strategies, and improved spatial management are urgently required to mitigate environmental transmission.
Intervention Levers for Stunting Reduction in Indonesia: Evidence from the 2023 Indonesian Health Survey Data Ariawan, Iwan; Jusril, Hafizah; Afifa, Zahra Izza; Fitri, Azka; Utami, Elmarizha Sekar; Hasan, Mikail; Puspasari, Dwi
Kesmas Vol. 21, No. 2
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Abstract

Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12–24-month age range. While the highest prevalence is in Eastern provinces (e.g., Central Papua, 39.4%), 51% of children with stunting were concentrated in five densely populated provinces (e.g., West and Central Java). The SEM consistently identified underweight (standardized coefficient: 0.69) and wasting (standardized coefficient: 0.57) as the strongest positive determinants of provincial stunting prevalence. Controlling acute malnutrition is essential; a 1% decrease in wasting is projected to reduce stunting prevalence by 1.2%. Furthermore, increasing coverage of key interventions, such as complete basic immunization and appropriate complementary feeding, is negatively associated with stunting, providing critical operational targets.
The Feasibility of Long-Term Care within Indonesia’s National Health Insurance Scheme: A Qualitative Study Adyas, Atikah; Baros, Wan Aisyiah; Manurung, Khaterina Kristina; Revelino, Dedy; Susanna, Dewi; Yulianty, Vetty; Lubis, Anita Pebrina; Atmawikarta, Arum; Nuryasini, Iis Sinsin; Alamin, Ahmad Jet
Kesmas Vol. 21, No. 2
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Abstract

The rising prevalence of chronic diseases and disabilities, along with the aging of the population, has reduced individual independence and increased the demand for long-term care (LTC). This study aimed to assess the feasibility of integrating home healthcare services into Indonesia’s National Health Insurance (NHI) scheme. A qualitative study using purposive sampling was conducted in Bandar Lampung, Yogyakarta, and Jakarta, Indonesia, selected based on disease burden, proportion of older adults, and regional development. Data was collected through in-depth interviews, focus group discussions, and observation between August and September 2024, involving 68 informants, including regulators, community members, and health facility staff. This study used content analysis with a scoring approach to synthesize informants’ perspectives. Informants’ statements were rated using a 1–10 scale to reflect perceived feasibility, with higher scores indicating greater feasibility. The overall feasibility score was high (8.10). Among the six aspects of feasibility, the operational aspect received the lowest feasibility score (7.87), mainly due to resource constraints, while the market aspect had the highest score (8.40). indicating a strong demand for home healthcare services. These findings suggested that integrating home healthcare services into LTC under the NHI scheme is feasible. However, policy efforts should prioritize strengthening operational capacity, workforce readiness, service delivery, and resource allocation to support effective implementation. This study highlights the importance of feasibility assessment as a critical step in developing new health programs.
Factors Associated with Public Health Centers’ Achievement of Health Service Target in Yahukimo District, Highland Papua Province, Indonesia Heluka, Emaus; Suryanti, Venty; Indasah, Indasah; Kusumawati, Prima Dewi
Kesmas Vol. 21, No. 2
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Abstract

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health workers' motivation was also associated with health services (T = 1.961; p-value = 0.050). Other variables, including health services, service targets toward the MSS, self-management, health behavioral skills, and family health services, showed positive but statistically no associations (p-value > 0.05). These results showed that improving the achievement of health targets and strengthening health workers' motivation could enhance the performance of PHCs in Yahukimo District, despite its geographical and structural limitations.
Validation of a Home-Based Tool for Preschool Children Fall Prevention: A Rasch Analysis Octaviani, Devie Fitri; Lestari, Fatma; Trihandini, Indang; Erwandi, Dadan
Kesmas Vol. 21, No. 3
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Unintentional falls are a leading cause of injury among preschool children, primarily occurring in home environments, yet validated tools to assess household fall prevention capacity in low- and middle-income countries remain limited. This study aimed to develop and psychometrically validate the Home-Based Preschool Fall Prevention Instrument using the Rasch Measurement Model. A cross-sectional validation study was conducted in Depok City, Indonesia, involving 167 primary caregivers of preschool children enrolled in kindergartens selected through multistage cluster random sampling. The instrument was developed based on an etiological injury model, socio-ecological perspectives, and risk management principles, and comprised four main factors: child, home, agent, and caregiver knowledge. Rasch Rating Scale Model analyses were conducted by dimension within the four factors to evaluate item fit, item difficulty hierarchy, and reliability. The validation retained 58 items across four factors: child factor (12), home factor (19), agent factor (6), and caregiver knowledge factor (21). All retained items met acceptable fit criteria, with overall infit mean square values ranging from 0.72 to 1.33 and outfit mean square values ranging from 0.70 to 1.38. The analyses also revealed meaningful item-difficulty hierarchies. The validated Home-Based Preschool Fall Prevention Instrument provides a psychometrically sound and contextually relevant foundation for household safety assessment and evidence-based preschool fall prevention programs.
Cost Analysis of Rheumatoid Arthritis in Insured Patients and Its Determinant Factors: Data from a National Referral Hospital in Indonesia Hidayat, Rudy; Fauzia, Fara; Alfansyah Dhifanra, Mochammad; Maulana, Aries
Kesmas Vol. 21, No. 3
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Rheumatoid arthritis (RA) leads to progressive functional impairment and considerable economic burden. This study estimated the annual (12-month) cost per patient among patients with RA and its determinant factors. A descriptive cross-sectional economic study of RA patients who had been treated for at least one year at the outpatient clinic of a national referral hospital in Jakarta, Indonesia, and met the 2010 ACR–EULAR criteria. Data collected from January 2023 to December 2024 were obtained from medical and billing records for demographic characteristics, direct medical costs, and DAS28-based disease activity, whereas non-medical and indirect costs were collected through structured patient interviews. Costs were viewed from a societal perspective, direct medical costs were calculated from hospital tariffs and expressed in 2023 USD. Associations between total cost and its determinant factors were examined using bivariate analyses and multivariable linear regression. Disease-modifying antirheumatic drug (DMARD) utilization was summarized by frequency and annual cost. A total of 150 RA patients were analyzed, predominantly female (94.7%), and all covered by the National Health Insurance (NHI). The mean annual total cost per patient was USD 790, driven mainly by direct medical costs (mean USD 591), particularly medicines (mean USD 337). Total cost was significantly associated with age (p = 0.02) and disease activity (p < 0.01), both remaining significant in multivariable analysis. Higher disease activity was consistent with more frequent combination DMARD. In conclusion, the annual outpatient cost of RA increased with older age and higher disease activity, with medicines being the primary cost driver.
Understanding Oral Habits and Malocclusion in School-Aged Children: Insights from Parental and Child Knowledge, Attitudes, and Practices Sanjaya, Maria Laurentia; Pratomo, Evan Raditya; Santoso, Markus; Asaeli, Agrippine Putricia; Darmadi, Eveline Yulia; Thenarianto, Joy Janny; Purwono, Jennifer Regina Putri; Widarto, Eunike Jacquelyn
Kesmas Vol. 21, No. 3
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Malocclusion is a prevalent oral health problem in children associated with oral bad habits, yet the extent to which parental and child knowledge, attitudes, and practices (KAP) influence orthodontic status remains insufficiently understood. This cross-sectional study investigated relationships between parental and child KAP, oral habits, and malocclusion in school-aged children, involving 67 child–parent pairs from an elementary school in Surabaya, Indonesia. Parental and child KAP as well as child-reported oral habits were assessed using a validated questionnaire. Children subsequently underwent standardized clinical orthodontic examinations, including alginate jaw impressions to produce dental study models, which were evaluated using the Index of Complexity, Outcome, and Need (ICON) to determine malocclusion severity and the need for orthodontic treatment. Parents demonstrated higher levels of knowledge than children. Statistical differences were found between parent- and child-reported habits for lip biting (p-value = 0.008) and tongue thrusting (p-value = 0.025). Although parental intervention was common, it was not significantly associated with overall child-reported oral habit scores. The median ICON score was 41, and 46.3% of children required orthodontic treatment. Child attitude was significantly associated with malocclusion severity (p-value <0.001), orthodontic treatment need (p-value = 0.005), and ICON score (r = 0.432, p-value <0.001), whereas parental knowledge showed no significant association with orthodontic outcomes. These findings highlight the relevance of child-related factors, particularly attitudes, in orthodontic outcomes and support integrating child-centered oral health education, parental guidance, and objective orthodontic assessment for early identification and prevention of malocclusion.
Provincial Disparities in Adolescent Fertility in Indonesia: An Ecological Analysis of Child Marriage, Median Age at First Marriage, and Family Development Index Afidah, Andi Nisa Fathimiyah; Herdayati, Milla
Kesmas Vol. 21, No. 3
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Adolescent fertility remains a public health concern in Indonesia, with substantial variations across provinces. However, the evidence explaining provincial disparities using population-level indicators remains limited. This study aimed to examine provincial disparities in adolescent fertility and assess the association of child marriage, median age at first marriage among women, and the Family Development Index called iBangga with adolescent fertility across Indonesia. This ecological, cross-sectional study used aggregated data from 34 Indonesian provinces. Descriptive statistics, spatial visualization, Pearson’s correlation, and multiple linear regression analyses were performed. The mean adolescent fertility rate was 25.0 births per 1,000 female adolescents aged 15–19 years, ranging from 7.8 to 47.0 across provinces, demonstrating substantial geographical disparities. Higher adolescent fertility was predominantly concentrated in eastern Indonesia, whereas lower rates were observed in Java and several western provinces. Child marriage showed a positive correlation with adolescent fertility and remained associated after adjustment for provincial-level indicators. Although the median age at first marriage among women and the Family Development Index were associated with adolescent fertility in the bivariate analysis, these associations were not retained in the adjusted model. Overall, child marriage was the primary province-level factor associated with provincial disparities in adolescent fertility.
Spatial Association of Acute Respiratory Infection, Diarrhea, and Low Birth Weight with Stunting Prevalence in Indonesia, 2024 Rosadi, Dian; Husaini, Husaini; Triawanti, Triawanti; Musafaah, Musafaah
Kesmas Vol. 21, No. 3
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Stunting remains unevenly distributed across Indonesia, but national evidence integrating spatial analysis and spatial regression is limited. This study examined the spatial distribution of stunting and its associations with acute respiratory infection (ARI), diarrhea, and low birth weight (LBW) across Indonesian provinces. An ecological cross-sectional study used data from the 2024 Indonesian Nutritional Status Survey. Stunting-only analyses included all 38 provinces, whereas analyses involving ARI, diarrhea, and LBW included 37 provinces with complete data. Spatial analyses used a row-standardized symmetric four-nearest-neighbor spatial weights matrix and included Global Moran’s I, bivariate spatial analysis, Local Indicators of Spatial Association, ordinary least squares, and spatial regression. Stunting showed positive spatial autocorrelation (Moran’s I = 0.368; pseudo p-value = 0.002). Global bivariate Moran’s I showed negative spatial associations between stunting and neighboring ARI (I = −0.296; pseudo p-value = 0.001) and stunting and diarrhea prevalence (I = −0.292; pseudo p-value = 0.001), whereas LBW was not associated. In the final spatial error model, LBW was positively associated with stunting (B = 1.455; p-value = 0.008), whereas ARI and diarrhea were not associated. No significant residual spatial autocorrelation remained. These findings indicate that stunting prevalence in Indonesia is spatially clustered and that LBW remains an important province-level correlate of stunting after accounting for spatial dependence.

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