ANALYSIS OF POTENTIAL HEALTH AND ECONOMIC IMPACT OFLARGE AVIAN INFLUENZA EPIDEMICS IN INDONESIA

The analysis of potential health and economic impacts from large epidemics on avian flu in Indonesia had been conducted using several sources including data from health, agriculture, tourism and transportation sectors. This analysis aimed to socialize the understanding on negative impacts and the size of burden if a large epidemic happened in lndonesia. It was estimated 43.2 million people will suffer from avian flu with a total deaths in the first two weeks at about 525.000 persons and 605.000 cases need hospitalized in the first 2 (two) months of epidemics. The cost needed for case managements reach 539.9 million US Dollars. In agriculture sector, the direct lost because of disease or stumping out of poultry reached 97.2 million US Dollars and the preventing cost using vaccines for poultry is 74.7 million US Dollars. In tourism sector. the losses reached 8.6 million Dollars and in transportation sector reached 1.7 milliard US Dollars just in the first two months. The negative impact will increase if the epidemic was in a long duration or the virus type is more virulent. So the government and community efforts to do promotion and preventive activities including preventing the virus transmission in poultry, to protect if the epidemic starts and to decrease the negative impacts for community health is important to manage the situation. Key words: economic, health, impacts, avian flu, large epidemic

DAMPAK KESEHATAN DAN EKONOMI PERILAKU MEROKOK Dl INDONESIA

Indonesia is the fifth largest country in the world for tobacco consumption. Objective of the study is to estimate the health and economic impact of smoking behavior in 2005. Data used include National Socio economic Survey 2004, National Health Survey 2004, Population Projection for 2005, Medical expenditures of diseases related to tobacco collected from central government hospitals in Jakarta and the Indonesian Abridged Life Table. Global Burden of Disease method is used to estimate the disease burden. The results show that in 2005, about 399,800 people died due to diseases related to tobaccoor about 26% of total deaths (1,539,288). About 3, 846,373 DALYs (productive years) were lost due to premature mortality and 1,502,900 DALYs were lost due to morbidity and disability. The macro-economic loss due to tobacco was estimated in the amount of 44 Trillion Rupiahs and total medical expenditure due to tobacco was estimated in the amount of 2 Trillion rupiahs. Average cigarette consumption per person per day was 11 sticks or 330 sticks per month. Total budget spent in one month was Rp. 165,000 or equal to 20 days of income, based on Regional Minimum Wages (in Jakarta) of Rp. 8, 000 per person per day. It is concluded that smoking behavior produces negative health and economic impact at macro level aswell as at individual level. Therefore Cost-effective policies to control tobacco as suggested in the Framework Convention of Tobacco Control can reduce the negative impact of smoking behavior. Key words: smoking behavior, disease burden, economic impact, Indonesi

Dampak Kesehatan dan Ekonomi Perilaku Merokok Dl Indonesia

Indonesia is the fifth largest country in the world for tobacco consumption. Objective of the study is to estimate the health and economic impact of smoking behavior in 2005. Data used include National Socio economic Survey 2004, National Health Survey 2004, Population Projection for 2005, Medical expenditures of diseases related to tobacco collected from central government hospitals in Jakarta and the Indonesian Abridged Life Table. Global Burden of Disease method is used to estimate the disease burden. The results show that in 2005, about 399,800 people died due to diseases related to tobaccoor about 26% of total deaths (1,539,288). About 3, 846,373 DALYs (productive years) were lost due to premature mortality and 1,502,900 DALYs were lost due to morbidity and disability. The macro-economic loss due to tobacco was estimated in the amount of 44 Trillion Rupiahs and total medical expenditure due to tobacco was estimated in the amount of 2 Trillion rupiahs. Average cigarette consumption per person per day was 11 sticks or 330 sticks per month. Total budget spent in one month was Rp. 165,000 or equal to 20 days of income, based on Regional Minimum Wages (in Jakarta) of Rp. 8, 000 per person per day. It is concluded that smoking behavior produces negative health and economic impact at macro level aswell as at individual level. Therefore Cost-effective policies to control tobacco as suggested in the Framework Convention of Tobacco Control can reduce the negative impact of smoking behavior

PENINGKATAN KUNJUNGAN IBU HAMIL DI PUSKESMAS SEBAGAI EFEK DIGUNAKANNYA ULTRASOUND PADA PEMERIKSAAN KEHAMILAN

Abstract Background: Maternal and neonatal mortality rates are still a problem in Indonesia. Various efforts have been made, such as training and placing midwives in villages, increasing the number of deliveries performed in health facilities. There is a consensus that an important intervention is to provide appropriate health facilities managed by trained health workers who assist in childbirth, including midwives and doctors. One of the means of infrastructure that needs to be considered available at the community health center (puskesmas) is an ultrasound device to detect pregnancy complications. Objective: The purpose of this study was to determine the effect of the use of ultrasound devices to increase antenatal care (ANC) to health centers. Method: the study design was a quasi-experiment conducted at 20 puskesmas in Bogor district. Analyses was conducted in descriptive, the total sample participating in the study was 4,049 cases, but only 3,314 cases were analysed. Result: The results of the study prove that the availability of USG at the puskesmas increases ANC visits to the puskesmas. The availability of ultrasound and the use of ultrasound affect the number of ANC visits to health facilities, especially to puskesmas. As an attraction for screening and ANC during pregnancy, the government needs to provide an ultrasound device at puskesmas. Key words: Ultrasoundgraphic, antenatal care, Puskesmas, midwives, pregnancy complication Abstrak Latar belakang: Angka kematian ibu dan neonatal masih merupakan masalah di Indonesia. Berbagai upaya telah dilakukan, seperti melatih dan menempatkan bidan di desa, meningkatkan jumlah persalinan yang dilakukan di fasilitas kesehatan. Ada konsensus yang menyatakan bahwa intervensi yang penting dilakukan adalah memberikan fasilitas kesehatan yang layak dikelola oleh tenaga kesehatan terlatih yang menolong persalinan, antara lain bidan dan dokter. Salah satu sarana prasarana yang perlu dipertimbangkan tersedia di puskesmas adalah alat ultrasound untuk mendeteksi komplikasi kehamilan. Tujuan:  mengetahui pengaruh penggunaan alat USG terhadap peningkatan antenatal care (ANC) ke puskesmas. Metode: disain penelitian adalah quasi eksperimen yang dilakukan pada 20 puskesmas di kabupaten Bogor. Analisis dilakukan secara deskriptif, total sampel yang berpatisipasi dalam penelitian 4.049 kasus, namun yang di analisis hanya 3.314 kasus.  Hasil: Ketersedian USG di puskesmas meningkatkan kunjungan ANC ke puskesmas. Ketersediaan USG dan penggunaan USG mempengaruhi jumlah kunjungan ANC ke fasilitas kesehatan, khususnya ke puskesmas. Sebagai daya Tarik untuk melakukanskrining dan ANC pada saat kehamilan, maka pemerintah perlu menyediakan alat USG di puskesmas.   Kata kunci: Ultrasound, Antenatal Care, Puskesmas, Bidan, Komplikasi Kehamila

An Exploration of Cultural Perception and Communities Behaviour Related to Mortality: a Qualitative Study of Communities in Solo and Pekalongan, Central Java Province

Mortality data and understanding death patterns are considered to be essential for developing evidence-based health policy. This article is a qualitative research, examines current cultural perceptions of death in Indonesia that include a prominent and sensitive belief that emerged at the time of mourning/loss in Solo City and Pekalongan District, Central Java Province. The data collection was done by Focus group discussions (FGDs) with mosque officials, local health workers, local midwives, and staff of the community council, local school teachers, and local business people. Semi-structured interviews (SSIs) are conducted with key informants of bereaved and non-bereaved household. Also observation of the local economy and community activity patterns, modes of subsistence, cultural beliefs. The study revealed thatdeath notification and activities subsequent to a death fall into two parallel domains, the religious and the secular. Beliefs in the afterlife and the imperative of a speedy burial, with all that this implies in terms of treatment and disposal of the corpse, belong to the religious domain. The procedure for obtaining a death certificate occurs in a juridical framework also as the driving force to meet the needs of data on causes of death, acquire legal and financial arrangements associated with the death of household members, for example for inheritance issues. A further issue of interest was the timing of the verbal autopsy (VA). Ideally the VA should occur in the home of the deceased's family within 7-30 days after the death, and be conducted by a health official possibly accompanied by an office-bearing member of the local community. Coordination between all parties involved in the treatment of death is quite feasible

MORTALITAS DAN MORBIDITAS CEDERA PADA ANAK DI KABUPATEN PROBOLINGGO DAN TULUNGAGUNG-JAWA TIMUR 2005

Background: In Indonesia, births and deaths are seldom recorded, making basic health indices such as causes and rates of death difficult to know with any real degree of certainty. However, basic data available from National Institute of Health Research and Development-Ministry of Health Indonesia that namely Health National Survey (SURKESNAS) shows thirty three percent of people 12-24 years and thirteen percent of people 5-14 years are death due to injury, probability peoples 5-24 year of injury in male is five times from injury female. From this survey the risk factor and hazard of injury did not know. Drowning survey conducted (2003) in 0--5 years (balita) shows 0. 7 per 1000 population in rural area and 2.6 per 1000 population in urban area. Knowmg the environmental hazard and risk factor is important thing to make the preventive and awareness of safety and risk avoidance. This survey is conducting on two district in East Java, Probolinggoand Tulung Agung. Research methodology: Two districts was selected according UNICEF project area, namely Tulung Agung District and Probolinggo District. Estimation of total sample was 10,000 HH in each District. Using cluster Proportional Probability to Size (PPS) sampling were randomly sub-district and village in rural and urban area. All house hold was in the selected village was selected for sample. A house hold member was defined as a member living in the same house, sharing meal and information, for six month, including domestic helpers, long-term guest etch. Results: In the survey a total number of 784 deaths were identified in the preceding three years, in Tulung Agung District were 411 deaths and 373 in Probolinggo District. In the survey a total number of 304 deaths were identified in the preceding one year. In TulungAgung District were 163 deaths and 139 in Probolinggo District. In this survey, injury accounted for 21% of all classifiable deaths in children aged 1-17 years. Injury caused 5% of infant deaths, 11% of children (0--17 years) deaths drowning was the major cause of fatal injury (16/100,000) in children. The fatal injury rate from falls was 5/100,000,  drowning was occur in 1-4 age groups (24/100,000) and in 10--14 age groups (40/100,000). The fatal injury from falls was occur in infant age group (104/100,000). RTA (Road Transportation Accident) was the most cause non-fatal injury in aged 5-17 years old. The Second rank for leading causes non-fatal injury was fall. The other causes were electrocution, poisoining, and injury by mach me. All the children in aged 10--14 years had severe injury. While non-fatal injury rate in aged 15-17 years was highest but all cases had moderate severity.Key words: fatal injury, pilot study, east jav