Social Determinants of Covid-19 Morbidity in Indonesia: Observational District Level Analysis

Since the COVID-19 pandemic globally struggled in late 2019, the global community has become aware that outbreaks of infectious diseases are associated with conditions beyond health factors, such as social, economic, demographic, geographic, and lifestyle. This paper aims to identify the influence of Social Determinants of Health (SDOH) on COVID-19 morbidity rates in Indonesia. The study analyzed morbidity cases during the second wave of the COVID-19 pandemic, namely the Delta variant wave. Multivariate analysis with linear regression was used to determine the predictors that affect COVID-19 morbidity in 128 districts/cities of the Java and Bali isles, which were controlled by the pandemic stages including pre, resurgence, decline, and post. Morbidity data was collected cross-sectionally from the National COVID-19 Task Force dataset and the social determinant of the 2021 Central Statistics Agency report. The number of health facilities is the most influential characteristic of the regency/city to COVID-19 morbidity at the pre-and resurgence-pandemic stages. The ratio of the immune population is the most influential characteristic when the pandemic experiences a decline stage; meanwhile, during the post-pandemic, the second dose of vaccination is the most influential characteristic. We recommended that testing, tracing, quarantine, and isolation intervention should be prioritized in the districts/cities with higher health facilities (pre- and resurgence-stage), higher herd immunity (decline-stage), and booster vaccination (post-stage). Social determinants of health are suggested to be used as a basis for predicting the risk factors for an outbreak of infectious diseases in a region and contributing to different SDOH factors in different outbreak stages

Analysis of Successful Implementation of Hospital Information System in Bhayangkara Polda DIY Hospital with MMUST Method

Since 2010, Bhayangkara Polda DIY Hospital has been using Hospital Information System (HIS), but the system still needs to be optimized. In the context of optimizing HIS implementation, it is necessary to analyze the success of HIS implementation. This study examines the factors that influence the successful implementation of Hospital Information System (HIS) in Bhayangkara Polda DIY Hospital based on the Model for Mandatory Use of Software Technologies (MMUST) method. This research is a descriptive study with a cross-sectional quantitative approach. The study sample used purposive sampling, which amounted to 98 respondents. Data analysis using the Structural Equation Modeling Partial Least Squares (SEM-PLS) technique using SmartPLS software version 4.1.0.3. The results stated that information satisfaction is influenced by information quality, performance expectations are influenced by information satisfaction and social influence, performance expectations and facility conditions influence attitudes, attitudes influence usage and overall satisfaction, and net benefits are influenced by usage and overall satisfaction. This study proves empirically that all hypotheses are accepted. HIS has proven to be a successful implementation because it can produce accurate, fast, and complete information, accelerate user performance, and provide benefits in its implementation

Foodborne Outbreak Investigation in Elementary School Students in Bantul, Yogyakarta, 2023

Bantul District Health Office received notification that 75 students in elementary school were sick with symptoms of nausea, vomiting, and dizziness after they consumed snacks from the school canteen. An epidemiological investigation was conducted to confirm the outbreak, identify additional cases, determine risk factors and causes, and recommend preventive measures. This investigation conducted active case finding followed by a retrospective cohort study. Individuals who experience one or more symptoms, such as nausea, vomiting, diarrhea, stomach pain, dizziness, fever, and malaise after consuming snacks were defined as cases. Data was collected through direct interviews with students, teachers, staff, and food sellers. Samples of food and vomit were collected and sent to the health laboratory. Data were analyzed using chi-square and multiple binomial regression. There were 150 cases. Most cases were found in the female group (53.22%), 9-year-old group (55.32%), and third-grade students (65%). Dizziness (66.67%), vomiting (56.67%), and nausea (46%) were the most common symptoms. The epidemic curve was a common source, with incubation periods ranging from one to 26 hours. Meatballs were associated with the increased risk of becoming a case in this outbreak (aRR = 1.49; 95% CI = 1.22-1.81). The causative agent was suspected to be Salmonella spp, but the laboratory analysis results were inconclusive due to contamination. Potential risk factors were large storage in the refrigerator, insufficient reheating, and cross-contamination. Improvements in food safety monitoring for schools and food handlers, along with appropriate sampling by healthcare facilities, are required to control outbreaks

Problems Scanning Related to Stunting Using Iceberg Theory Model in Salakbrojo Village Central Java

The prevalence of stunting to date is 21,6%, which is far from target which is 14%.  Research aimed to elaborate on problem of stunting using iceberg method model analysis. The research is a qualitative study with a phenomenological approach to obtain idea of stunting occurrence pattern as well as the root of problem. Data was collected by assigning focused group discussion. Correspondents were ten mothers of toddlers, five health cadres, a secretary of rural, and a rural midwife. Validity test was done by doing data source triangulation during focused group discussions. Mental model analysis was taken using directly elicited mental model technique by doing content analysis. Result of iceberg analysis found that occurrence of stunting was 3,42%. Patterns and trends include wasting 2,92%, normal nutrition 84,39%, risk of overnutrition 5,85%, overnutrition 1,95%, and obesity 1,46%. Systemic structure has shown there are relation between direct cause include lack of food intake, exclusive breastfeeding, complementary food, infectious diseases and incomplete basic immunization. Indirect causes for stunting include lack of knowledge of stunting, access of health services, house condition triggers infectious diseases and poor sanitation.   The mothers’ analysis on mentality who are confident about their children being healthy and active despite nutritional problems. Mental model of health cadres, rural midwives, rural government and public health centers believe that collaboration in solving stunting problems is needed. It can be concluded that iceberg model can be applied in analyzing stunting problem and results of it can be considered in the implementation of stunting treatment

Risk of Vitamin D Deficiency in Smokers: Mix-Method

Cigarettes are one of the leading causes of death in the world and  Indonesia. Cigarettes emit cigarette smoke, which contains toxins and has pro-inflammatory properties that interfere  the metabolism of vitamin D in the lungs. The study aimed to determine the risk of vitamin D deficiency in active smokers in Rungkut Village, Surabaya City. This research method is a mix-method with a  Convergent Parallel Design type strategy, which is a way of collecting quantitative (cross-sectional) and qualitative data (interpretative phenomenological analysis) simultaneously, with purposive sampling technique. The variable was the risk of vitamin D deficiency and vitamin D level. Subjects were active smokers aged ≥19 years in the Rungkut Subdistrict. The number of samples involved in this research was 125 samples in the quantitative phase, and 15 people in the qualitative phase.  The highest level of smoking severity was light smokers (45.60%). Most of respondents had normal vitamin D levels (≥20 mg/mL) of 73.33%, averaging of 37.66 ± 5.89 mg/mL. Most active smokers are at risk of vitamin D deficiency. Risk factors for deficiency in heavy smokers are not consuming foods containing vitamin D (such as fish, eggs, and milk), not consuming fish oil supplements and vitamins, and not sunbathing. However, the level of physical activity tended to be moderate-heavy. The conclusion is that smokers must pay attention to their intake of foods containing vitamin D and exposure to sunlight to achieve sufficient vitamin D levels

Risk Factors of Chronic Kidney Disease in Indonesian Patients with Diabetes Mellitus

Chronic Kidney Disease (CKD) is a public health problem with increasing prevalence and incidence. About 1 in 3 adults with Diabetes Mellitus (DM) has CKD. This study aims to determine the risk factors for Chronic Kidney Disease in Diabetes Mellitus (CKD-DM) patients in Indonesia. A cross-sectional study was conducted with secondary data, Indonesia Basic Health Research 2018. Data analysis was carried out univariate, bivariate, and multivariate. Also, spatial analysis was carried out to map the prevalence of cases. Among 14.932 samples, the prevalence of CKD-DM in Indonesia was 1.8%. Multivariate analysis results found that gender (aPR=3.24; 95%CI 3.182-3.306), every day smoker (aPR: 2.47; 95%CI 2.415 – 2.535), someday smoker (aPR=1.93; 95%CI 1.875 – 1.987), hypertension (aPR=1.56; 95%CI 1.540 – 1.591), pre elderly (aPR=1.13 95%CI 1.098 – 1.158), elderly (aPR=0.81; 95%CI 0.790 – 0.834), exercise (aPR =1.07; 95%CI 1.055 – 1.090), and obesity (aPR=0.90; 95%CI 0.891 – 0.924) have a significant relationship with the incidence of CKD-DM in Indonesia. This study found that gender is the dominant variable in the incidence of CKD-DM in Indonesia. It is desired that healthcare providers and program makers should recognize gender differences in the progression of CKD and conduct screening program for risk factors of CKD-DM

Dietary Habit and Physical Activity as Risk Factors of Metabolic Syndrome among Civil Servants in Jambi City

The prevalence of Metabolic Syndrome (MetS) is an important health problem due to the association with increased cardiovascular disease as the main cause of death. Approximately 20-25% of the global adult population including Indonesia suffers from MetS. The high prevalence is attributed to several factors namely lifestyle changes such as dietary habit and physical activity. Therefore, this study aimed to investigate the relationship between dietary habit and physical activity with MetS incidence among civil servant employees in Jambi City, Indonesia. A cross-sectional design was used to assess the proportion of MetS, dietary habit, and physical activity. A total of 108 civil servant employees were selected as respondents from six agencies using a multistage random sampling technique. Data collection was carried out through physical examination and interviews using a questionnaire. The results showed that the prevalence of MetS was 60.2%, with three risk indicators, namely central obesity (74.1%), blood pressure (66.7%), and HDL (63%). Based on the chi-square test, dietary habit (OR=2.571, 95%CI=1.151-5.744) and physical activity (OR=3.692, 95%CI=1.625-8.388) were significantly related to MetS. The persistently high prevalence of MetS was significantly related to dietary habit and physical activity among civil servant employees in Jambi City-Indonesia. These results underscored the need to improve understanding of healthy diets by adopting a balanced nutritional intake, increasing the intensity of physical activity according to age, and engaging in regular exercise

Building Hope: Program for Handling Psychosocial Problems of People Living with HIV/AIDS in Denpasar

The research aims to describe the forms of Psychosocial Problems Experienced by People Living with HIV/AIDS (PLWHA) and the programs of the Spirit Paramacitta Foundation to overcome the psychosocial problems of PLWHA. The research location was the Spirit Paramacitta Foundation Denpasar, Bali Province. The research uses a qualitative descriptive. The data collection techniques are through observation, interviews, and documentation. Research subjects and informants were determined purposively. Data analysis techniques refer to the perspective of Miles, Huberman, and Saldana, which includes the processes: data collection, data condensation, data presentation, and conclusion and verification. The data validity techniques used are extended observations and source triangulation. The results of the research show that the psychosocial problems of PLWHA at the rejection response stage are in the form of hopelessness, suicidal ideation, and drug use, while at the self-acceptance stage, the psychosocial problems are in the form of social anxiety, feelings of inferiority, social withdrawal, social stigma, and discrimination. Meanwhile, the program for handling psychosocial problems carried out by the Spirit Paramacitta Foundation is a social support program and a social mentoring program. The social support program includes emotional, appreciation, and socialization support. In contrast, the social assistance program includes health service referrals, assistance in taking medication, and home visits. The social services provided by the Spirit Paramacitta Foundation positively impact providing life hope for PLWHA. The practical implications of this research are as a model for institutional social service practices and scientific studies in developing social support for marginalized groups

Nurse Managers\u27 Experiences in Managing Inpatient Wards During a Crisis: Lessons from the COVID-19 Pandemic

The COVID-19 pandemic has provided valuable lessons for all parties, including nursing services in hospitals. To date, literature has been lacking on the role of nurse managers in managing inpatient wards for COVID-19 patients, especially in Indonesia. This study aims to explore the experiences of, and the challenges encountered by nurse managers in managing inpatient wards during the crisis. This is a qualitative study with a phenomenology design. The study used a purposive sampling technique involving four nurse managers from several hospitals in South Sulawesi Province, Indonesia. Data were obtained through semi-structured interviews and were analyzed using thematic analysis. This study yielded three themes and nine sub-themes. Nurse managers experienced panic and fear but carried out inpatient management immediately. There was also a solid commitment to protect the fellow nurses from infection. Valuable lessons include the availability of human resources, strong commitment from all lines, management support, and teamwork. Meanwhile, nurse managers encountered challenges such as the lack of personal protective equipment, frequently changing service procedures and the psychological needs of nurses.  Nurse managers obtained numerous lessons from the COVID-19 pandemic related to their capabilities in managing inpatient wards. The findings suggest the adaptability of nurse managers to similar challenging crisis encounters in the future by analysing the effects of frequent workflow changes on care quality and staff adaptation, examining the long-term psychological impact of pandemic work on nurses developing strategies to enhance organizational support for nurses including coping mechanisms and well-being related trainings and services, and to build dynamics of effective teamwork during crisis

Potential of Noni Leaf Extract (Morinda citrifolia L.) As Aedes aegypti Mosquito Repellent

Dengue fever is transmitted every year by the Aedes aegypti mosquitoes in Indonesia. One way to prevent this is by using repellents, such as the noni leaf extract (Morinda citrifolia L.). The objective of this study was to analyze the potential of the noni fruit (Morinda citrifolia L.) leaf extract as a repellent against Aedes aegypti. The study employed a post-test research design with only a control group, using concentrations of 12.5%, 25%, and 37.5%, and 25 mosquitoes with 6 repetitions. The technique for data collection involved counting mosquitoes that perched on hands. The study was conducted from November 2022 to May 2023. Data analysis was performed using SPSS Anova One Away Post Hoc and the power protection formula. The research on Aedes aegypti mosquitoes that perched for 6 hours showed that the noni leaf extract concentration of 37.5% had an average of 2.5 tails perched. The concentration of the noni leaf extract is 37.5%, according to the Pesticide Committee standard (1995). The average protection power for 6 hours is 90.86%. The study also suggests investigating the side effects of use and the addition of an HPMC gelling agent. However, for concentrations of 12.5% and 25%, the protective power is less than 90%. This study shows that concentrations of 37.5% are effective for repelling Aedes aegypti mosquitoes. Further research can be conducted using old or yellowed leaves, as well as for repelling culex and Anopheles mosquitoes