Evaluation of the completeness and timeliness nutrition surveillance data reporting in Wonogiri district, Central Java province, 2017

Some of the nutrition problems still found in Wonogiri district. To solve that problems, completeness, and timeliness of the nutrition surveillance data reporting are needed so the data can be used as the basis for making policy appropriately. Evaluation of nutrition surveillance system was conducted to find out completeness and timeliness of the nutrition surveillance data reporting. This was an evaluative study using quantitative descriptive analysis which conducted from December 2017 to January 2018. Subjects of this study were nutritionists in District Health Office and 25 Primary Health Care (PHC) which selected randomly using Slovin samples size. Data collected by interviews and observation on surveillance data reporting form. PHC that reported complete data were 6 PHC (24%). One PHC (4%) did not report malnutrition data due to poor of time management. Ten Puskesmas (40%) did not report Hemoglobin data because they assumed that it was the duty of the laboratory officer or midwife. Three PHC (12%) did not report exclusive breastfeeding data every month, because they consider that the data should be collected only once every six months. Nine PHC (36%) did not report goiter data because they considered that it was no need to report if no cases. Most PHC (52%), never report the data timely. Most nutritionists (84%) had another duty that inhibits them to finish the surveillance data timely. Only two PHC (8%) whom the nutritionists had another duty but always report the data timely. Completeness and timeliness of the nutrition surveillance data reporting were still unsatisfying. PHC should be encouraged to collect data completely and timely. The data collection procedure should be fixed on the indicator collected and the time period in the data collection

Low Birth-Body Weight as Wasting Predictor over Children Aged 6-59 Months in Indonesia

Approximately ten percent of children under five in Indonesia have suffered from wasting. Children with low birth body weight are considerably more at risk of suffering such disease. This current study aimed to analyze the relationship between low birth body weight and other risk factors of wasting among Indonesian children. This study utilized data from the 2018 Indonesian National Basic Health Research (Riskesdas). In total, 60,451 children aged 6-59 months were included. The data were analyzed using bivariate and logistic regressions. According to the data analysis, children with low birth-body weight had significantly higher odds of being wasted compared to children with normal birth-body weight (OR=1.5, 95%CI=1.3-1.8). In addition, boys and younger children (6-23 months) were 1.3 times more susceptible to wasting (OR=1.3, 95%CI=1.2-1.4). Unemployed fathers and mothers comprised of 1.3 and 1.1 times, respectively, to increase the risk of child wasting (OR=1.3, 95%CI=1-1.7; OR=1.1, 95%CI=1-1.2). Mothers with a low education level contributed to an increase in wasting prevalence 1.1 times (OR=1.1, 95%CI=1-1.2). Children who were lack of vitamin A supplements had a 1.2 times more chance of being wasted (OR=1.2, 95%CI=1.1-1.3). This research eventually suggested that low birth-body weight was the dominant factor in child wasting in Indonesia. Programs for improving the nutritional status of pregnant women and children with low birth-body weight should therefore be implemented intensively and comprehensively

Tantangan dalam Implementasi Program Deteksi Dini Kanker Serviks dengan Menggunakan Metode Inspeksi Visual dengan Asam Asetat di Kabupaten Wonogiri, Jawa Tengah

Latar belakang: Kanker serviks merupakan kanker dengan prevalensi tertinggi di Indonesia. Program untuk mengendalikan kanker serviks adalah dengan deteksi dini menggunakan metode Inspeksi Visual dengan Asam Asetat (IVA) dan krioterapi untuk IVA positif. Jumlah WUS yang melakukan tes IVA di Wonogiri sejak 2015 masih di bawah target, tetapi IVA positif yang ditemukan cukup banyak, yaitu 10,29% tahun 2016 dan 6,3% tahun 2017. Studi dilakukan untuk mengetahui tantangan yang dihadapi dalam pelaksanaan program skrining kanker serviks dengan metode IVA. Metode: Studi dilakukan secara kuantitatif dan kualitatif menggunakan pendekatan logic model pada Juli-Agustus 2018.  Responden adalah penanggungjawab Penyakit Tidak Menular (PTM) dan atau bidan di 10 Puskesmas yang memiliki petugas IVA terlatih dan 6 Puskesmas yang tidak memiliki petugas terlatih; kepala seksi PTM dinas kesehatan; serta dokter spesialis obsgyn RSUD. Pengumpulan data dilakukan dengan wawancara dan wawancara mendalam. Analisis data secara deskriptif. Hasil: Petugas IVA terlatih hanya ada di 10 Puskesmas dari 34 Puskesmas. Dari 24 Puskesmas yang tidak memiliki petugas IVA, hanya tiga Puskesmas yang pernah melaksanakan skrining IVA massal. Empat Puskesmas mengeluhkan tidak adanya dana untuk kegiatan, seperti pembelian bahan, penggandaan form, sosialisasi serta jasa petugas. Hambatan dalam sosialisasi adalah rasa takut dan malu untuk melakukan tes IVA. Puskesmas yang tidak memiliki petugas IVA kesulitan mendorong warga untuk melakukan tes IVA karena pemeriksaan harus dilakukan di Puskesmas lain. Koordinasi dengan RSUD terkait rujukan pasien IVA positif belum berjalan baik. Krioterapi belum dapat dilakukan, karena alat baru tersedia di dua Puskesmas pertengahan tahun 2018 dan belum ada petugas yang mengikuti uji kompetensi. Simpulan: Deteksi dini kanker serviks dengan metode IVA di Wonogiri masih menemui banyak tantangan. Diperlukan beberapa upaya perbaikan seperti penggunaan dana BOK untuk pelaksanaan tes IVA, proses sosialisasi yang lebih efektif, memperjelas alur rujukan pasien IVA positif, serta penguatan kapasitas petugas IVA agar dapat melakukan krioterapi.Tujuan. Kanker serviks merupakan kanker dengan prevalensi tertinggi di Indonesia. Program untuk mengendalikan kanker serviks adalah dengan deteksi dini menggunakan metode Inspeksi Visual dengan Asam Asetat (IVA) dan krioterapi untuk IVA positif. Jumlah WUS yang melakukan tes IVA di Wonogiri sejak 2015 masih di bawah target. Namun, WUS dengan IVA positif yang ditemukan cukup banyak, yaitu 10,29% pada tahun 2016 dan 6,3% pada tahun 2017. Evaluasi program dilakukan untuk mengetahui tantangan yang dihadapi dalam pelaksanaan program deteksi dini kanker serviks dengan metode IVA dan upaya perbaiknya yang sebaiknya dilakukan.Konten. Tantangan yang dihadapi dalam program deteksi dini kanker serviks dengan metode IVA meliputi beberapa aspek.Aspek sumber daya manusia:- petugas IVA terlatih hanya ada di 10 Puskesmas dari 34 Puskesmas- belum ada petugas IVA yang mengikuti uji kompetensi sehingga belum ada petugas yang mampu melakukan krioterapi pada pasien IVA positifAspek sarana dan pra sarana :- unit krioterapi baru mulai tersedia di dua Puskesmas pada pertengahan 2018- speculum disposable tidak tersedia di PuskesmasAspek pendanaan :- tidak ada dana untuk kegiatan, seperti untuk pembelian bahan, penggandaan form, sosialisasi serta jasa petugasAspek sosialisasi :- rasa takut dan malu dari masyarakat untuk melakukan tes IVA- Puskesmas yang tidak memiliki petugas IVA kesulitan mendorong masyarakat untuk melakukan tes IVA karena tes IVA hanya dapat dilakukan di Puskesmas lain yang berada di luar wilayahAspek tindak lanjut pasien dengan IVA positif :- belum dapat dilakukan krioterapi- proses rujukan dengan RSUD belum berjalan baik- terdapat ketidaksamaan prosedur rujukan antar PuskesmasUpaya perbaikan yang dapat dilakukan, seperti penambahan petugas IVA terlatih, uji kompetensi petugas IVA agar dapat melakukan krioterapi, pemanfaatan dana BOK untuk pelaksanaan kegiatan, proses sosialisasi yang lebih efektif, dan memperjelas alur rujukan pasien IVA positif

EVALUASI PEMBERDAYAAN MASYARAKAT DALAM PENANGGULANGAN GAKI DENGAN METODE SWOT DI KABUPATEN WONOSOBO

Abstrak Latar Belakang. Iodium merupakan komponen kunci pembentukan hormon tiroid. Akibat kekurangan iodium menimbulkan beban penyakit global, oleh karena itu Indonesia sepakat berperan dalam upaya global melawan Gangguan Akibat Kekurangan Iodium (GAKI). Perubahan persepsi masyarakat atau intervensi pengetahuan tentang iodium dapat dilakukan dengan pemberdayaan masyarakat. Upaya intervensi tersebut juga perlu dilakukan evaluasi. Tujuan. Analisis ini bertujuan untuk mengevaluasi dan menentukan strategi terhadap pelaksanaan penerapan model pemberdayaan masyarakat untuk pencegahan GAKI. Metode. Jenis penelitian dengan mixed method, yakni menggabungkan metode kuantitatif dan metode kualitatif. Teknik penentuan informan menggunakan purposive sampling. Pengumpulan data menggunakan teknik wawancara mendalam, Focus Group Discussion dan pengamatan langsung di lapangan. Analisis menggunakan SWOT. Hasil. Hasil IFAS 0,40 dan EFAS 0,27 menempatkan posisi pemberdayaan penanggulangan GAKI berada pada titik (x,y)=(0,40;0,27) kuadran I (Strategi Mendukung Agresif). Kesimpulan. Model pemberdayaan masyarakat untuk pencegahan GAKI di desa Pulosaren dapat diterapkan. Penerapan model pemberdayaan masyarakat sangat prima dan mantap, memperbesar pertumbuhan dan meraih kemajuan secara maksimal. Strategi utama adalah mempertahankan dan mengoptimalkan kekuatan sosial dari kearifan lokal ‘guyub rukun’ yang dimiliki masyarakat; memastikan posyandu tetap aktif ataupun melakukan inovasi program posyandu; serta terus melakukan penyegaran pelatihan penyuluhan dengan menyederhanakan materi pelatihan ataupun model penyampaian pengetahuan yang lebih efektif.   Kata kunci: perubahan, pemberdayaan, GAKI, SWO

POTENSI INTEGRASI PROGRAM SKRINING HIPOTIROID PADA NEONATAL DI DAERAH REPLETE DEFISIENSI IODIUM

Latar Belakang. Prevalensi hipotiroid kongenital (HK) lebih tinggi di daerah endemik Gangguan Akibat Kekurangan Iodium (GAKI) menyebabkan deteksi dan intervensi dini hipotiroid bayi menjadi penting. Belum ditemukan penelitian pelaksanaan skrining dengan Neonatal Hypothyroid Index (NHI) serta potensi integrasi skrining hipotiroid. Tujuan. Mengidentifikasi program skrining hipotiroid bayi di daerah endemik GAKI dan menganalisis potensi integrasinya. Metode. Penelitian ini adalah penelitian kualitatif yang dilaksanakan di Kabupaten Magelang. Data diambil dengan wawancara mendalam semi terstruktur pada 14 informan terdiri dari penanggung jawab program tingkat Dinas Kesehatan Kabupaten (DKK) Magelang, puskesmas, dan pelaksana program. Dinas Kesehatan dan 4 Puskesmas di Kabupaten Magelang menjadi informan penelitian. Wawancara direkam dengan alat perekam digital, disusun dalam transkrip, dianalisis menggunakan analisis isi (content analysis). Trustworthiness data diperoleh melalui triangulasi sumber. Hasil. Terdapat dua program skrining hipotiroid kongenital di Kabupaten Magelang, yaitu Skrining Hipotiroid Kongenital (SHK) dan skrining dengan form NHI. Faktor pemungkin keberhasilan program bersumber kebijakan dan implementasi. Komitmen pendanaan mandiri SHK melalui APBD pada 500 bayi per tahun, skrining form NHI pada setiap bayi baru lahir, dan integrasi pelaksanaannya melalui program managemen terpadu bayi muda (MTBM). Program SHK dan NHI telah diimplementasikan bidan desa dan petugas gizi terintegrasi MTBM, pada usia lebih tinggi di posyandu. Faktor penghambatnya, dari sisi SDM adalah kurangnya supervisi/koordinasi serta bidan desa pelaksana belum mendapatkan pelatihan SHK, NHI, maupun MTBM. SOP rujukan penemuan kasus HK belum jelas.Hasil skrining berhasil menemukan kasus HK. Kesimpulan. Deteksi dini hipotiroid kongenital telah dilakukan di Kabupaten Magelang. Keterbatasan anggaran menyebabkan SHK mencakup sebagian kecil sasaran, kemudian dijangkau dengan skrining NHI semua neonatus. Integrasi MTBM dilakukan dalam pelaksanaan, pelaporan, dan melampirkan form NHI dalam pemeriksaan MTBM. Fisibilitas integrasi terbukti dalam penemuan kasus HK dengan NHI terintegrasi MTBM. Integrasi program perlu diperluas dengan mengintegrasikan pelatihan NHI, HK, dan MTBM untuk pengembangan keterampilan bidan pelaksana program

Non-Communicable Disease Morbidity Among Young Adults: A Cross-Sectional Study in Indonesia

Noncommunicable Disease (NCD) has continued to pose a significant global burden, specifically regarding morbidity among young adults which has not been well studied. Therefore, this study aimed to assess the burden of NCD among young adults and identify correlating factors. It analyzed the 2018 Indonesian Basic Health Research, a nationwide study employing a cross-sectional design and linear systematic with Two Stage Sampling. The subject involved comprised 319,355 individuals in the 18-40 age group. Data were further analyzed using bivariate and multivariate analysis with logistic regression. The analysis results showed that 6% of young adults in Indonesia had one NCD or more. Young adults with higher Waist Circumference (WC) and higher Body Mass Index (BMI) had a higher risk of NCD (OR:1.58; 95%CI;1.52-1.65 and OR: 1.14; 95%CI:1.09-1.19, respectively). Furthermore, several sociodemographic factors exhibited significant correlation including older age, female sex, unemployment, higher educational and socioeconomic status, married and divorced, as well as living in an urban area (p-value<0.05). Unhealthy behavior such as consuming alcohol and smoking also increased the risk for NCD morbidity (OR:1.20; 95%CI;1.10-1.30 and OR: 1.19; 95%CI:1.10-1.27). Therefore, it was crucial to strengthen preventive programs targeting NCD among young adults by focusing on sociodemographic characteristics. This study also emphasized the importance of campaigns aimed at improving health behavior in this age group

SURVEI FAKTOR RISIKO PENYAKIT TIDAK MENULAR KABUPATEN REMBANG (ANALISIS DENGAN STEPWISE WHO)

Penyakit Tidak Menular (PTM) di Kabupaten Rembang menunjukkan pola peningkatan. Namun, pemerintah setempat belum melakukan survei faktor risiko PTM. Pencegahan PTM perlu dilakukan dengan diprioritaskan pada pencegahan faktor risiko. WHO telah mengembangkan metode STEPWISE untuk faktor risiko PTM. Penelitian ini bertujuan untuk mengukur proporsi faktor risiko PTM pada usia dewasa di Kabupaten Rembang. Jenis penelitian ini adalah deskriptif dengan rancangan cross sectional. Jumlah sampel pada penelitian ini adalah 384 kepala keluarga, dipilih dengan teknik Multi-stage Cluster Sampling. Hasil penelitian menunjukkan karakteristik responden meliputi 32,0 % berusia 45-54 tahun; lama menempuh pendidikan rata-rata 8 tahun; 44,8 % tingkat pendidikan tertinggi tamat SD; 69,1 % bekerja sebagai wiraswasta dan pendapatan per kapita Rp. 4.550.995,5076. Perilaku merokok responden manunjukkan bahwa 59,6 % merupakan perokok dengan 94,3 % di antaranya merupakan perokok harian. Rata-rata umur mulai merokok responden adalah 20 tahun dan sudah merokok selama 26 tahun. Sebesar 91,7 % responden merupakan pengonsumsi rokok buatan pabrik. Rata-rata jumlah rokok yang dikonsumsi per hari adalah 11,05 batang rokok buatan pabrik; 0,57 batang rokok lintingan; 0,12 batang rokok pipa dan 0,00 batang cerutu. Responden yang memiliki riwayat merokok adalah 9,6 % dan rata-rata telah berhenti merokok selama 10 tahun. Responden yang mengalami over weight sebesar 11,7 % dan yang obese sebesar 2,7 %. Terdapat 15,6 % responden yang mengalami hipertensi. Dari penelitian ini disipulkan bahwa faktor risiko PTM yang meliputi perilaku merokok, status obesitas dan tekanan darah tinggi masih cukup tinggi. Disarankan surveilans faktor risiko PTM lebih aktif dilakukan sebagai langkah awal menyusun program pencegahan. Kata Kunci: faktor risiko PTM, merokok, obesitas, hipertensi, STEPWISE WH

KADAR IODIUM DALAM GARAM PADA DAERAH DENGAN KASUS HIPOTIROID DAN HIPERTIROID TINGGI

Background. Iodized salt is universal effort to eliminate iodine deficiency disorders (IDD). Iodine consentration in iodized salt needs to be evaluated due to many cases of hypothyroid and hyperthyroidism. Objective. The purpose of this study was to describe whether iodized salt consumed by peoples contributes to hypothyroidism and hyperthyroidism cases. Method. This was a descriptive study in area with the highest cases of hypothyroidism and hyperthyroidism based on data from Klinik Litbang GAKI Magelang 2005-2012. Samples were taken using purposive sampling with a sample size of 90 households per area. Area with the highest case of hyperthyroidism is Mertoyudan Sub District while area with the highest case of hypothyroidism is Salaman Sub Districts, both in Magelang District. Iodine content in salt was by taking sample of salt from households which used for daily consumption. Statistic analysed used were independent sample t test and Chi Square. Result. The results showed that salt consumed in both areas already contains iodine. Salt iodine content level in area with the highest hyperthyroidism (55.1±23.84 ppm) was higher than in the area with the highest hypothyroidism (49.79±39.28 ppm). According to the category of iodine content in salt, iodine content below standards (&lt;30 ppm) is higher in area with the highest hypohyroidism (25.6 percent). Iodine content above standars (&gt;80 ppm) is higher in area with the highest hyperthyroidism (13.2 percent). However iodine content in both areas showed no significant difference (p=0.27). Conclusion. Iodized salt consumption does not contribute to the high case of hypothyroidism or hyperthyroidism. Salt consumed in area with the highest cases of hypothyroidism and hyperthyroidism already contains iodine as standard. It is possible that there are other factors that cause high incidence of hypothyroidism and hyperthyroidism in those areas that needs further research.Keywords: hyperthyroidism, hypothyroidism, iodine, salt</p

KARAKTERISTIK PASIEN DISFUNGSI TIROID : STUDI EPIDEMIOLOGI

Background. Iodine is an essential element for thyroid hormone synthesis important for growth and development. An Epidemiological study is important to describe who the case were, area mostly affected and trends of disease over time. Objective. The purpose of this study was to describe the epidemiological characteristics of patients with thyroid dysfunction. Method. This is a descriptive study. Data taken from medical record of 291 patients with hypothyroidism and hyperthyroidism diagnoses from Klinik Litbang GAKI Magelang in 2011-2012. Medical records used were the one that recorded age and gender, address and time of diagnose. The differences characteristic comparation of hypothyroidism and hyperthyroidism were analyzed using Chi Square. Results. Result found that hypothyroidism affected younger (&lt;20 years) patients while hyperthyroidism affected older (20-39 years), p=0.00. Women suffered thyroid dysfunction more than men with 58.8% hypothyroidism and 88.35% hyperthyroidism, p=0.00. Patients with hypothyroidism and hyperthyroidism came from areas with history of mild endemic area (p=0.247). The trend showed that hypothyroidism and hyperthyroidism increase from 2011 to 2012, although not statistically significant (p=0.194). Conclusion. Hypothyroidism and hyperthyroidism are more common in female. Hyperthyroidism affected older age group compare to hypothyroidism. Both hypothyroidism and hyperthyroidism more prevalent on patient came from areas with history of mild endemic and showed increasing trend

KADAR IODIUM DALAM GARAM PADA DAERAH DENGAN KASUS HIPOTIROID DAN HIPERTIROID TINGGI

Background. Iodized salt is universal effort to eliminate iodine deficiency disorders (IDD). Iodine consentration in iodized salt needs to be evaluated due to many cases of hypothyroid and hyperthyroidism. Objective. The purpose of this study was to describe whether iodized salt consumed by peoples contributes to hypothyroidism and hyperthyroidism cases. Method. This was a descriptive study in area with the highest cases of hypothyroidism and hyperthyroidism based on data from Klinik Litbang GAKI Magelang 2005-2012. Samples were taken using purposive sampling with a sample size of 90 households per area. Area with the highest case of hyperthyroidism is Mertoyudan Sub District while area with the highest case of hypothyroidism is Salaman Sub Districts, both in Magelang District. Iodine content in salt was by taking sample of salt from households which used for daily consumption. Statistic analysed used were independent sample t test and Chi Square. Result. The results showed that salt consumed in both areas already contains iodine. Salt iodine content level in area with the highest hyperthyroidism (55.1±23.84 ppm) was higher than in the area with the highest hypothyroidism (49.79±39.28 ppm). According to the category of iodine content in salt, iodine content below standards (&lt;30 ppm) is higher in area with the highest hypohyroidism (25.6 percent). Iodine content above standars (&gt;80 ppm) is higher in area with the highest hyperthyroidism (13.2 percent). However iodine content in both areas showed no significant difference (p=0.27). Conclusion. Iodized salt consumption does not contribute to the high case of hypothyroidism or hyperthyroidism. Salt consumed in area with the highest cases of hypothyroidism and hyperthyroidism already contains iodine as standard. It is possible that there are other factors that cause high incidence of hypothyroidism and hyperthyroidism in those areas that needs further research.Keywords: hyperthyroidism, hypothyroidism, iodine, sal