Faktor-faktor yang Berhubungan dengan Status Gizi Anak Umur 6-36 Bulan Sebelum dan Saat Krisis Ekonomi di Jawa Tengah

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN STATUS GIZI ANAK UMUR 6-36 BULAN SEBELUM DAN SAAT KRISIS EKONOMI DI JAWA TENGA

Analisis Kesesuaian Klaim dengan Realitas Pembayaran Ppk Rujukan dalam Jaminan Kesehatan Masyarakat Miskin

The main goal of health development in lndonesia is providing quality health care and assuring community access to equal health services for all citizen (universal coverage). In assuring the access to health services for the poor. Ministry of Health has launched special health insurance program for the poor (Askeskin). PT Askes was assigned by MOH to manage this program. Therefore, it is very important to improve facilities and management capabilities of health insurance administering bodies and health care providers. These include, improvement in case management, hospital accounting system, medical record, etc. This will be very useful for verification process and reducing the fraud and abuse. This study was conducted in order to provide valuable input for the Improvement of financing mechanism and payment system of referral providers in health insurance program for the poor (Askeskin). The objectives of this study are to calculate hospital claim on case management of Askeskin members and its real payment by PT Askes and to calculate the differences between claim and reimbursement (real payment) based on hospital components. The study design is cross-sectional. A Stratified Random Sampling method was conducted to select the study sites based on Human Development Index (HOI) and Fiscal Capacity (refers to Ministry of Finance Data) of district and city. Districts and cities were then classified into high, middle, or low level. The 3 selected study sites were: Kampar District (HPI 34,1) in Riau Province which represent high HOI; North Bengkulu District (HPI: 30.4) in Bengkulu province which represent middle HOI, and Pontianak City (HPI: 27.7) in West Kalimantan Province which represent low HOI. The results show that tariff agreement of case management for Askeskin members was not in accordance with local real condition. Therefore, clear operational and technical Askeskin guidelines are needed to gain similar perception between PT Askes and health care providers· beside Improvement of socialization activities to the community. The amount of differences between claim and reimbursement varied among study sites. The difference was influenced by following factors: (1) existed guidelines that were not suitable with local specific real demand and (2) disparity among hospital facilities. Hospital with limited facility has difficulty to refer patient to another closed hospital which doesn't have contract with PT Askes. Furthermore, in some cases hospital with good facility cannot optimalize using their advanced equipment for treatment, because not stated in the contract with PT Askes. Contract review, tariff adjustment, and re-negotiation between hospitals and PT Askes should be encouraged to provide better services for Askeskin members

Perilaku Konsumsi Tembakau Pelajar SMP Usia 13–15 Tahun di Sumatra dan Jawa (Analisis Indonesia–Gyts 2009) (Behavior Tobacco Consumption Of Junior High School Student Aged 13–15 Years In Sumatra And Java (Analysis Of Indonesia–Gyts 2009))

Background: adolescence is a crucial period that must be maintained properly, because it has a direct and long-termimpact of the act he/she was doing. Baseline Health Research (RISKESDAS) 2007 showed that 59.5% of the causes ofdeath in Indonesia were due non communicable diseases (NCD), and tobacco consumption contributed as trigger of majority of NCD cases. Information related to the behavior of youth tobacco consumption is required to formulate strategicplan to reduce the incidence. Method: standard questionnaires were fi lled by students of 40 junior high schools from 33 districts and cities in Sumatra and Java, with a total sample of 142 classes (covering grades 7 to 9). Results: a total of 3,319 junior high school students aged 13–15 years were covered with a 94.0% response rate. About 20.3% of students was active smokers and 11.5% non-smoker students planned to smoke in 2010. There was 4.2% of active smoker students showed symptoms of addiction to the nicotine in cigarettes. Eight out of 10 active smokers need help to quit smoking. The main factors that motivate junior high school students in Sumatra and Java to smoke were 15.7% of all/most of his close friends smoking and 7 out of 10 junior high school students have at least one parent as smoker. Recommendations: Efforts to prevent children from smoking should be conducted together with support of national tobacco control policies, and the local policies with support from non-governmental organizations, community leaders, health workers, educators, school personnel and families

Faktor-faktor Yang Berhubungan Dengan Pelayanan Bayi Di Indonesia: Pendekatan Analisis Multilevel

Background: Improving maternal and child health is one of the national development priorities of 2015-2019. Efforts to reduce infant mortality require information on appropriate infant health intervention model in Indonesia. Objective: The study aimed to identify factors related to infant health services in order to reduce infant mortality rate in Indonesia. Method: This study used multilevel analysis of data from 2010 Riskesdas, 2010 PODES and 2011 Rifaskes, with dependent variable of child survival, and independent variables were infant, maternal, household and area factor (Puskesmas). Results: Factors that contribute to the survival of infants were ANC, history of complications and preterm status, as the factor of preterm birth is twice as high as infant mortality compared to other factors. Conclusion: Factors that contribute to improving infant health services are the handling of premature infants, well handled complication cases and ANC services and postpartum contacts that meet the standards

Determinan yang Berhubungan dengan Ketahanan Hidup Bayi Neonatal di Indonesia

Background: Health care for children under five year in Indonesia was still a problem that should be cope with. Infant mortality (IMR), maternal mortality (MMR), and the IMR in Indonesia, ware still ranked the highest in Southeast Asia. According Soemantri (2004), infant mortality reached 46 per 1000 live births during the period 1998-2002. According SKRT 2001, the highest cause for infant mortality was perinatal disturbances (34%) and for neonatal mortality are premature and low birth weight babies (29%) and birth asphyxia (27%) (Soemantri S, et al: 2004). Baby's health is associated with several maternal factors during pregnancy and birth, infant factors, and environmental factors. The cause of death of a baby has two kinds, namely endogen and exogen. Endogen infant death or neonatal was death that happens at the first month after birth, and generally caused by factors that brought by the child since birth, obtained from the parents at the time of conception or during pregnancy. Exogen baby's death or post-neonatal mortality was happen after the age of one month until the age of one year that is affected by external environment. Obj ective: This analysis is to ascertam the probabtlity and detenninants related to the live endurance of neonatal infants. Methods: This research design was cross sectional, using data of Health Basic Research (Riskesdas) 2007. Data analysis was conducted univariate, bivariate, and multivariate with the life table method, Kaplan Meier and Cox regression. Results: The analysis indicate that premature variables and barier have relationships with the live endurance of neonatal infants, where babies those are born premature have risk 1.4 times higher for death compared with infants those ware not born premature. For a baby that is born with barier haverisk 1.5 times higher for death compared with infants born without barier. Babies born premature and have barier have risk 2.02 times higher than babies born premature, and not without barier

Pengetahuan, Sikap, dan Perilaku Masyarakat dalam Memilih Obat yang Aman di Tiga Provinsi di Indonesia

Medicine is an important component that cannot be replaced in health service. Indonesia National Agency of Drug and Food Control conducted survey to assess knowledge, attitude, and practice (KAP) of communities on selecting safe and quality medicines. The aim of the study is to get description KAP of community in choosing a safe medicine. Data were collected in West Java, DKI Jakarta, and South East Sulawesi. Sampling calculation use probability proportional to size sampling and census block. There were 1271 households as samples that analysed. Data results were analysed using descriptive and index analysis. Knowledge relates to criteria of quality medicines, rules for antibiotics use, and medicines logo. Attitude relates to how to select over the counter medicines, reasons of taking traditional medicines, and opinion about giving half dose of adults medicines to children. Practice relates to source of medicines information, the way to buy prescribe medicines, and reading label information. The results showed that KAP of communities on selecting safe and quality medicines close to 50%. According to score of index analysis are 4.65 (1 to 10 scale), it is recommended that information, education, and communication has to be delivered to communities intensively and continuously by the governmen

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC