Difference in Satisfaction Levels of National Health Insurance Patients at Four Types of First Level Health Facilities

Backgrounds and purpose: The road map of the National Health Insurance Scheme (JKN) aims to ensure that 75%of patients are satisfied with the quality of health facilities. This study was designed to determine differences inpatients' satisfaction in general, as well as at each individual first-level health facility (FKTP) and based on dimensions ofquality.Methods: Study was a cross-sectional sample survey with the respondents of 148 JKN patients selected consecutivelyfrom 4 types of FKTP. A total of 4 health centers, 3 government clinics, 4 private clinics and 4 general practitionersrandomly selected from 11 health centers, 7 government clinics, 13 private clinics and 70 general practitioners in thecity of Denpasar. Data were collected through interviews over March-April 2015 in each health facility usingquestionnaires by trained interviewers. Data were analyzed by univariate, bivariate and multivariate.Results: A total of 69,59% of JKN patients said that they were satisfied with the quality of FKTP services. This figurewas lower than the target of JKN i.e. 75%. The highest satisfaction (90,00%) was in the general practitioners whilelowest was in the private clinics (47,46%). Based on the dimensions of quality, JKN patients' satisfaction in the fourFKTPs was significantly different (p=0,008) in physical and empathic dimensions (p=0,013). In the multivariate analysis,variables found related to the satisfaction of the respondents were the FKTP of general practitioners (adjusted PR=1,91;95%CI: 1,05-3,47) and health centers (adjusted PR=1,76; 95%CI: 1,04-2,97).Conclusion: In general, the patients' satisfaction rate was still lower than the target of JKN and when viewed per carefacilities, the highest satisfaction was found in FKTP of general practitioners and health centers

Reason Behind Non-Exclusive Breasfeeding by Working Women in Mataram City West Nusa Tenggara

Background and purpose: The purpose of this study was to determine why working mothers choose to not exclusively breast feed their infants in Mataram, West Nusa Tenggara. Methods: The study used a qualitative design with a phenomenological approach. Data collection in this study involved focus group discussions and in-depth interviews. In-depth interviews with 9 working women not exclusively breastfeeding. Focus group discussions two comprising of 21 respondents were husbands, in-laws, mother's family, healthcare provider, workplace representatives, religious and community leaders. Result: Study findings indicated that the primary reason for working women to not exclusively breastfeed, because of a lack of individual motivation, pressures of a high workload, lack of permitted time off, lack of infrastructure and concerns about losing employment due to time off. Obstacles included fear of losing employment, maternal physical factors (low/no milk production), psychological factors (stress/anxiety/frustration), lack of facilities and supporting infrastructure. Conclusion: The predominant reasons behind non-exclusive breastfeeding were lack of personal motivation, high workload, lack of permitted time off, lack of supporting infrastructure and fear of losing employment. The external obstacles for providing exclusive breastfeeding were economic factors, the mother's ability to produce milk, psychological factors, lack of supporting infrastructure. Keywords: exclusive breastfeeding, qualitative, West Nusa Tenggara &nbsp

Hormonal Contraceptive Use and History of Sexually Transmitted Infection as Risk Factors of the Pre-Cancerous Cervical Lesions

Background and purpose: Screening for pre-cancerous cervical lesions is already being implemented in Bali. Thisstudy aimed to determine of hormonal contraceptives and STI history as risk factors of pre-cancerous cervical lesions.Methods: A case-control study was conducted involving 76 women of childbearing age diagnosed with pre-cancerouscervical lesions who screened at two health centers in Denpasar Bali from January to March 2015. Control was 76women of childbearing age with no pre-cancerous cervical lesions who screened at the same period. Consecutivesampling was used to select cases and controls. Data were collected by interview using questionnaires and analyzedusing logistic regression to calculate adjusted odd ratio of each risk factors.Results: Multivariate analysis indicated that the use of hormonal contraceptives over ?5 or <5 years increase risk ofpre-cancerous cervical lesions with OR=10,7 (95%CI: 1,04-108,17) and OR=3,0 (95%CI: 1,16-7,84) compared to thosewho were not using hormonal contraception. History of sexually transmitted infections also increases risk of precancerouscervical lesions with OR=9,7 (95%CI: 3,83-24,18).Conclusion: The use of hormonal contraceptives and history of sexual transmitted infections increased risks of precancerouscervical lesions

Acceptance of Post-Placental Intrauterine Contraceptive Device in Denpasar

Background and purpose: The Indonesian Demographic Health Survey of 2012 indicated that the prevalence of contraceptive use in Bali Province has decreased compared to 2007. In addition, the proportion of the use an intrauterine device (IUD) also continues to decline. To increase number of IUD acceptors is to promote post-placental intrauterine device (PPIUCD), however the acceptance remains low. This study aims to determine factors associated with acceptance of post-placental intrauterine device in Denpasar.Methods: Study was cross sectional with a total of 100 respondents selected by consecutive sampling. Respondents were mothers who had gave birth in January-February 2016 at Wangaya General Hospital and three health centers (Dauh Puri Sub Health Center, East Denpasar I and South Denpasar IV). Data were collected by interview in hospital and health center. Chi square test was conducted for bivariate analysis and multivariate using logistic regression.Results: Proportion of PPIUCD acceptance was 35%. Multivariate analysis indicated that PPIUCD acceptance was associated with perception of benefits (AOR=10.39; 95% CI: 2.792-38.56), perception of low side effects (AOR=5.288; 95%CI: 1.085-25.761), role of health workers (AOR=7.1; 95%CI: 1.781-28.60) and support of the husband (AOR=12.020; 95% CI=2.888-50.01).Conclusion: Variables associated with PPIUCD acceptance were perception of low side effects, perception of benefits, role of health workers and husband support

Direct and Indirect Factors Influencing Selection of Birthing Attendants in Gunungsari, West Lombok (NTB)

Background and purpose: This study aims to determine the direct and indirect factors influencing the selection of birth attendants in Gunungsari subdistrict, West Lombok.Methods: This study was cross-sectional with a purposively selected sample of 27 mothers giving birth assisted by non-health professionals. Samples of those assisted by health professionals were taken by means of proportional systematic random sampling in Gunungsari and Penimbung health centers, respectively 29 of 916 and 14 of 437. Exogenous factors were maternal education levels, attendance to ANC classes, knowledge levels regarding to birthing attendants, maternal attitude, family support, and access to facilities. Birth attendant selection was the endogenous factor. Data were collected by means of interviews. Data analysis includes descriptive and inferential analysis with path analysis by linear regression.Results: The majority of respondents were 21-25 years old (87.4%) , housewives (47.14%) had educat ion under high school (65.72%) and were married (88.57%). Family support had a direct influence in decision making with a coefficient of 0.534 and 35.54% influence overall. Attendance to ANC classes in addition to family support had an indirect influence with a coefficient of 0.520 and 34.78% influence overall. Family support had a direct influence and the factor of attendance to ANC classes and family support has an indirect effect with the overall effect of 70.32%.Conclusion: The presence of the husband/family was needed in ANC class, through an implementation of schedule agreement

Association of Socio Demographic Characteristics and Husband Social Supports to the Participation of Mother in Antenatal Class

Background and purpose: Antenatal class has been applied in three different health centers located in Denpasar to increase maternal and child health with group learning method about pregnancy, delivery, post natal care, infant care and others. However, attendances of pregnant mothers were low. The aim of this study was to investigate association between mother's characteristics and husband's social supports to the their participation in attending the antenatal class.Methods: This study was a cross-sectional survey involving 122 samples. Sample were pregnant mothers which was selected by systematic random sampling from antenatal registration book. Data were collected by interview conducted in their house or when they were visiting the clinics. Data were analyzed by univariate, bivariate (chi square test) and multvariate (poisson regression method).Results: Proportion of mother attended antenatal class in three different health centers was 29.5%. Bivariate analysis showed that variables which associated with mother attendance were parity (p=0.036), husband social support (p=0.001) which include emotional support (p=0.001), instrumental support (p=0.001) and reward. Multivariate analysis showed that the only variable related to mother attendance in the antenatal class was husband social support (PR=2.71; 95%CI: 8.13-90.46).Conclusions: The attendance of mother in antenatal class in three different clinics were low. Factors that influence the attendance of mother's was social support from husband

Factors That Contribute to the Acceptance of Vasectomy as Contraception Option in East Lombok Regency

Background and purpose: The national family planning program currently promotes the role of husbands asacceptors of vasectomy as contraception. The Wanasaba Sub-district of the East Lombok Regency is one of the areaswith a high number of acceptors. This phenomenon needs to be understood more deeply in order to increasevasectomy contraception uptake in other areas. This study aims to understand in depth the factors that contribute tothe acceptance of vasectomy as contraception in the Sub-District of Wanasaba of East Lombok.Methods: The study used a qualitative design with phenomenology approach. The data were collected through indepthinterviews. The study was conducted among 20 participants consisting of five couples of vasectomy acceptorsand five couples of non-vasectomy acceptors. Data were analyzed using thematic analysis.Results: Research showed that the decision to undergo vasectomy was voluntarily and swift without any pressure orcoercion from providers or others. The main factor contributing to the acceptance of vasectomy was the availability offree, direct and fast services facilitated efficiently by providers and cadres. Another factor was economical owing to thefact that hormonal contraceptive was considered costly. The driving factor for the acceptance of vasectomy was activesupport from the spouse along with social acceptability of the process from the community.Conclusion: Service availability, in addition to the involvement from health workers and cadres were crucial inproviding information on the procedure, and in promoting and facilitating vasectomy uptake. It is necessary to improvethe capacity of cadres, family planning field workers and family planning motivators in order to increase the number ofvasectomy acceptors

Risk of in House Cigarette Smoke Exposure to the Premature Birth in Denpasar City

Background and purpose: Indonesia is ranked fifth in the world in term of premature birth prevalence, which isestimated 10-20%. This study aimed was to find out risk of in house cigarette smoke exposure to premature birth inDenpasar.Methods: This study is a case control. Case is a mother experienced premature delivery, while the control is motherswho been registered in the same period with mature delivery. Samples either case or control were selected usingsystematic random sampling, which preceded by listing premature and mature birth in each puskesmas in 2013. Dataanalyzed bivariate and multivariate using chi-square test and logistic regression.Results: Bivariate analysis showed no significant different of characteristic (age, education, occupation and paritystatus) between case and control group. However, significant different of ANC behavior and average of armcircumference were found between case and control. Multivariate analysis showed that the adjusted OR of tobaccosmoke exposure at home after being controlled by ANC and upper arm circumference was 3.647 (95%CI: 1.683-9.903).Conclusion: In house cigarette smoke exposure increases significantly the risk of premature birth in Denpasar