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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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The Association Between Rapid Growth in Children Under the Age of Five and Adolescent Obesity Sartika, Ratu Ayu Dewi; Wirawan, Fadila; Liberty, Iche Andriyani; Shukri, Nurul Husna Mohd; Pujonarti, Siti Arifah; Purwanto, Edy; Fauziah, Munaya
Kesmas Vol. 21, No. 3
Publisher : UI Scholars Hub

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Abstract

Early-life nutrition is a critical predictor of long-term health, yet the association between rapid early-childhood growth and adolescent obesity, particularly in relation to the “double burden of malnutrition,” remains under-researched in Indonesia. This study aimed to analyze the association between rapid growth and adolescent obesity. Data were obtained from the 1997, 2000, and 2014 waves of the Indonesian Family Life Survey (IFLS). This study included 641 children (aged 0–23 months at baseline) with complete anthropometric measurements across all three waves. Rapid growth was defined as an increase in z-scores of >0.67 in weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) between 1997 and 2000. Multivariable logistic regression, stratified by baseline nutritional status, was used to estimate adjusted risk ratios (aRRs). The adolescent obesity prevalence was 4.5%. Rapid WAZ growth was significantly associated with adolescent obesity (aRR = 4.49; 95% CI: 1.32–15.25), whereas rapid WHZ growth showed a borderline association (aRR = 2.90; 95% CI: 0.87–9.47). Stratified analysis showed that the association between rapid weight gain and adolescent obesity was markedly stronger among children with a history of undernutrition (aRR = 14.99 for WAZ; aRR = 9.52 for WHZ) than among those without. Rapid weight gain during early childhood, particularly in children with a history of undernutrition, is a strong predictor of adolescent obesity. These findings emphasize the importance of integrating longitudinal growth-trajectory monitoring into routine child health assessments to promote healthy growth while minimizing future metabolic risks.
Environmental Perspective for System Dynamics Modeling of Stunting Mitigation to Achieve the Sustainable Development Goals in West Sumatra, Indonesia Yuniarti, Elsa; Azzahra, Nabila; Yulhendri, Yulhendri; Heldi, Heldi; Delvina, Mery; Azeli, Saskia Putri
Kesmas Vol. 21, No. 3
Publisher : UI Scholars Hub

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Abstract

This study developed a system dynamics model to simulate stunting reduction in West Sumatra Province, Indonesia, by integrating infant and toddler health, maternal health, and environmental determinants. Secondary data from 2020–2024 on low birth weight, immunization, malnutrition, exclusive breastfeeding, maternal chronic energy deficiency, iron and folic acid supplement distribution, sanitation, and safe drinking water access were compiled from West Sumatra Provincial Health Office and Statistics Indonesia, and validated through consultation with five stakeholder institutions. Causal Loop Diagrams mapped feedback relationships among determinants and were translated into Stock Flow Diagrams using Powersim Studio 10. The model was validated through structural verification, extreme-condition testing, and historical-fit testing. Baseline and intervention scenarios were simulated over 25- to 100-year horizons. Enhanced immunization and breastfeeding increased immunized toddlers from 180,000 to over 240,000 (33% improvement) and reduced malnutrition cases by approximately 25% relative to baseline. In the integrated multisectoral scenario combining maternal nutrition, breastfeeding, immunization, and sanitation improvements, projected stunted toddlers decreased from 164,321 under baseline conditions to 72,143 over 25 years, a 56% reduction, despite the toddler population nearly doubling to 150,473. These findings indicate that coordinated, multisectoral interventions addressing environmental, maternal, and child health determinants can substantially reduce stunting despite population growth and support integrated policies to accelerate SDG 2 achievement in West Sumatra Province and comparable regions.
Self-Management Interventions for Adults with Type 2 Diabetes Mellitus in Thai Primary Care and Community Settings: A Scoping Review Seetangkham, Sansanee; Seetunya, Supaluk; Yodprong, Subhawan
Kesmas Vol. 21, No. 3
Publisher : UI Scholars Hub

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Abstract

Diabetes mellitus is a leading cause of mortality and economic burden, with significant impacts on health outcomes and quality of life. Effective self-management is crucial for controlling Type 2 Diabetes Mellitus (T2DM). Thailand has implemented diverse self-management interventions for adults with T2DM in primary care and community settings, but the components, delivery, duration, and outcomes of these interventions have not been synthesized. Following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR, five databases were searched from inception to June 2025. Eligible English-language intervention studies involved Thai adults with T2DM in primary care or community settings. Study characteristics and outcomes were summarized descriptively and narratively. Twenty-one studies involving 2,162 participants were included; 11 were randomized controlled trials. Interventions lasted approximately 4 weeks to 9 months, most commonly 12 weeks. Activities formed a three-phase pattern: preparation through education and skills training; action through self-management practice, monitoring, and follow-up support; and evaluation of clinical, behavioral, and psychosocial outcomes. Most studies reported improvements in at least one outcome, but no clear pattern by intervention duration was evident. Evidence was concentrated in Bangkok and Central Thailand, and few studies reported systematic needs assessment, stakeholder involvement, long-term follow-up, or digital delivery.
Determinants of Multimorbidity Among Stroke Patients for Epidemiological Management in Indonesia's Agro-Coastal Communities Robby, Krish Naufal Anugrah; Ma'rufi, Isa; Ningtyias, Farida Wahyu; Izzah, Latifatul; Nurjazuli, Nurjazuli; Suhartono, Suhartono; Sofro, Muchlis Achsan Udji; Astuti, Ida Srisurani Wiji; Listiowati Prawoto, Olivia; Sutinbuk, Dedek; Kurrohman, Taufik; Ouassou, Elhoussin
Kesmas Vol. 21, No. 3
Publisher : UI Scholars Hub

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Abstract

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models with bootstrapping procedures. The structural model demonstrated moderate explanatory power (R² = 0.543), explaining 54.3% of the variance in multimorbidity among stroke patients. Anthropometric status, represented by body weight, height, and waist circumference (β = 0.414; p-value <0.05), family history of stroke (β = -0.384; p-value <0.01), healthy dietary lifestyle (β = 0.588; p-value <0.001), and healthcare access (β = -0.403; p-value <0.001) were significant determinants of multimorbidity. An unhealthy dietary lifestyle (high-fat intake and low fruit and vegetable consumption) was significantly associated with multimorbidity, suggesting possible reverse causality due to dietary changes after stroke diagnosis.
Clinical, Geographic, and Administrative Factors Associated with Onset-to-Groin Puncture Time in Mechanical Thrombectomy Permana, Affan Priyambodo; Hidayat, Yoga Arif Syah; Ilato, Khairunnisa Farina; Hasanah, Nur Afianti; Adisasmita, Asri Chasanah
Kesmas Vol. 21, No. 4
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Abstract

Acute ischemic stroke requires timely reperfusion, yet treatment delays remain a challenge in urban referral systems. This retrospective cohort study evaluated factors associated with onset-to-groin puncture time among 204 patients with acute ischemic stroke who underwent mechanical thrombectomy at a national brain center hospital in Jakarta, Indonesia. Clinical, geographic, administrative, and time-related variables were analyzed using non-parametric tests and multivariable linear regression. The median onset-to-groin puncture time was 455 minutes, with an interquartile range of 236.8 minutes. Hospital referral was independently associated with longer delays, with an adjusted delay of approximately 111 minutes compared with non-referred patients. Private insurance payment was also associated with a longer delay, but this finding should be interpreted with caution because only four patients were included in this subgroup. Residential distance and arrival outside office hours showed non-significant trends, while age, sex, baseline stroke severity, residential region, public health center referral, out-of-pocket payment, and cost-sharing payment were not independently associated with delay. These findings indicated that the onset-to-groin puncture delay in this urban referral cohort was driven primarily by interhospital referral and administrative pathway rather than by the measured clinical or geographic characteristics.

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