Faktor Determinan Penolakan Imunisasi di Desa Bonjor Kabupaten Temanggung Tahun 2018

Determinant factors immunization refusal in Bonjor Village Temanggung DistrictPurpose: Temanggung district is one of two districts in Central Java that have refusal immunization. Highest refusal immunization in Temanggung district located in Bonjor Village. Based on this, researchers wanted to see determinants of refusal immunization in Bonjor Village. Method: Study design was sequential explanatory mixed method used 1: 1 paired case-control study, which was equipped with qualitative sequential explanatory. Research sample were parents who refused and did not refuse their children to be immunized who lived in Bonjor Village. Quantitative analysis using bivariate analysis and multivariate analysis, while qualitative analysis using data triangulation.Results: Sample collected was 114 heads of families. The results of study showed that 58% respondents had education level of junior high school, 57% working as farmers and the average age of 31.75 years with youngest age was 19 years and oldest was 48 years. The results of multivariate analysis showed that mother's belief in breastfeeding (OR=5.54; 95% CI=1.91-16.05), vaccine was not an option in increasing immunity (OR=20.32; 95% CI=3, 98-103.68), and the experience of mothers that after immunization her child became fussy (OR = 3.92; 95% CI=1.32-1156) had a relationship with the refusal immunization in Bonjor Village, Temanggung District in 2018. Belief and experience of mothers about immunization supporting occurrence of vaccines is not an option in increasing immunity.Conclusion: Increasing knowledge and restoring public belief are initial choices for increasing immunization coverage. Refusal immunization problem cannot be solved by one sector but requires cross-sector cooperation.Tujuan: Kabupaten Temanggung merupakan satu dari dua kabupaten di Jawa Tengah yang terdapat penolakan imunisasi. Pada Kabupaten Temanggung penolakan imunisasi tertinggi yaitu pada Desa Bonjor. Berdasarkan hal tersebut peneliti ingin melihat faktor determinan penolakan imunisasi di Desa Bonjor. Metode: Desain studi sequential explanatory mixed method, menggunakan case control study berpasangan dengan perbandingan 1:1 yang di lengkapi dengan kualitatif sequential explanatory. Subjek penelitian adalah orang tua yang menolak dan tidak menolak anakanya untuk diimunisasi yang tinggal di Desa Bonjor. Analisis kuantitatif menggunakan analisis bivariat dan analisis multivariate sedangkan analisa kualitatif menggunakan triagulasi data. Hasil: Besar sampel yang berhasil dikumpulkan adalah 114 kepala keluarga. Hasil penelitian menunjukan 58% responden pendidikan SMP dengan 57% bekerja sebagai petani dan rata-rata usia 31,75 tahun dengan usia termuda 19 tahun dan usai tertua 48 tahun. Hasil analisis multivariate menunjukan bahwa kepercayaan ibu terhadap pemberian asi (OR=5,54; 95% CI= 1,91-16,05), vaksin tidak sebagai pilihan dalam meningkatkan kekebalan tubuh (OR=20,32; 95% CI=3,98-103,68) dan pengalaman ibu setelah imunisasi anak menajdi rewel (OR=3,92; 95% CI=1,32-1156) memiliki hubungan dengan penolakan imunisasi di Desa Bonjor Kabupaten Temanggung tahun 2018. Kepercayaan dan pengalaman ibu tentang imunisasi mendukung terjadinya vaksin tidak sebagai pilihan dalam meningkatkan kekebaan tubuh. Kesimpulan: Peningkatan pengetahuan dan mengembalikan kepercayaan masyarakat menjadi pilihan awal untuk meningkatkan cakupan imunisasi. Permasalahan penolakan imunisasi tidak bias diselesaikan oleh satu sektor tetapi  memerlukan kerjasama lintas sektor.

Non-ideal Critical Realism Analysis on the Ethical Positions of Secular Doctors Towards Human Genome Editing

Human genome editing could be used to improve human intelligence, appearance, and physical strength. The ethical issues posed by the technology are causing public concern. Secularism views efforts to find moral truth do not depend on supernatural authority. The existence of a secular minority in Indonesia is considered an anomaly in public discourse and is left behind in the morally critical policy-making deliberations on genome editing regulations. The research explored Indonesian secular doctor’s view of human genome editing. This qualitative research used a non-ideal critical realism approach through in-depth interviews and literature review. Secular doctors say that human genomic editing has no different weight from other artificial selection. After conducting a risk-benefit analysis through moral calculus, secular doctors generally have positions and attitudes that support the research and implementation of human genomic editing technology

Analisis Kebutuhan Program Promosi Pencegahan Diare pada Anak Berusia di Bawah Dua Tahun

Background: Diarrhea is one of environmental based diseases and still the cause of major health problems in Indonesia. It is attributed to the poor condition of basic sanitation, physical environment and the poor behavior of community in personal hygiene. Diarrhea is considered as one of the infectious diseases and the main cause of mortality and morbidity in children under-five particularly under two-years old. Various health promotion activities have been conducted to control diarrhea disease, yet the diarrhea incident rate still high. Even for certain period there has been an increasing number of diarrhea patients.Objective: This research was aimed at describing the community's need for the health education of diarrhea prevention.Method: This was a qualitative research using case study approach. Data collection was conducted by in depth interview, focus group discussion, observation and document study. Research informants were mothers who have children below two years old and health education stakeholders. Data was analyzed using interactive analysis.Result: The promotion program for diarrhea prevention that has been conducted in Primary Health Care of Piyungan was not able to diminish various inappropriate perceptions and assumptions toward diarrhea. The community could not see the relation between diarrhea with environment and breastfeeding. Community's need toward diarrhea information was all materials related with diarrhea. The method to convey was through speech that used leaflet, folder and booklet. The information source that suitable to give information was health care provider in regulars meeting every month.Conclusion: the suitable health promotion for diarrhea is speech by health provider using leaflet, booklet and folder. Education material should be focused on diarrhea prevention, especially on the relationship between environment and breastfeeding and diarrhea incidents

Acceptability Notifikasi Wajib Tuberkulosis (TB) pada Dokter Praktik Mandiri dan Klinik Pratama Swasta di Kota Yogyakarta

Latar Belakang: Diperkirakan 68% kasus Tuberkulosis (TB) di Indonesia tidak dilaporkan atau tidak terdeteksi. TB merupakan penyakit yang harus dinotifikasi sejak dikeluarkannya Peraturan Menteri KesehatanNomor 67 Tahun 2016 tentang Penanggulangan Tuberkulosis. Berkaitan dengan notifikasi wajib kasus TB, dokter praktek mandiri dan klinik pratama swasta akan diwajibkan melaporkan kasus TB ke Puskesmas setempat. Pelibatan praktisi swasta memiliki dampak penting terhadap perbaikan program penemuan dan pengobatan TB dan pencegahan meluasnya kasus TB resisten obat. Kota Yogyakarta memiliki beban TB terbesar di DIY dan kepadatan penduduk yang tinggi dengan jumlah  praktisi swasta yang cukup besar. Belum terdapat penelitian yang menggali acceptability kebijakan notifikasi wajib TB pada dokter praktik mandiri dan klinik pratama swasta di Kota Yogyakarta.Tujuan: Mendeskripsikan acceptability kebijakan notifikasi wajib TB pada dokter praktik mandiri dan klinik pratama swasta di Kota Yogyakarta.Metode: Penelitian ini menggunakan rancangan kualitatif dengan metode deskriptif. Gambaran acceptability yang digunakan adalah acceptability prospektif dengan menggunakan kerangka Theorical Framework of Accceptability (TFA). Subjek penelitian adalah dokter praktik mandiri dan dokter klinik pratama swasta, beserta pimpinan klinik pratama swasta di Kota Yogyakarta, pemegang program TB Dinas Kesehatan Provinsi DIY dan Kota Yogyakarta, pemegang program TB Puskesmas, serta organisasi profesi (IDI). Metode pengumpulan data yang akan dilakukan adalah wawancara mendalam.Hasil: Gambaran acceptability (prospektif) kebijakan Notifikasi Wajib TB pada dokter praktik mandiri dan klinik pratama di Kota Yogyakarta dideskripsikan dalam sikap afektif, beban, etisitas, dan koherensi intervensi.Kesimpulan: Pendekatan awal yang tepat, pengenalan sikap afektif dan komunikasi berkelanjutan akan memperingan beban dan mengatasi masalah etisitas tentang notifikasi wajib TB. Selain itu pemahaman awal yang baik ditambah pemahaman lanjut yang komprehensif dan penguatan kapasitas menjadi modal penting bagi koherensi intervesi dalam acceptability notifikasi wajib TB pada praktisi swasta

Pengaruh ketersediaan layanan informasi pola konsumsi dan komplikasi gigi dan mulut terhadap perilaku pengelolaan penyakit pada penderita diabetes mellitus di Kota Yogyakarta

Disease management in people with diabetes melitus: access to information service consumption patterns and dental-mouth complicationsPurpose: This study aimed to determine the effect of the availability of information services related to diet and dental-mouth complications against diabetes melitus disease management.Methods: This research was a descriptive analytic study with a cross sectional design, using quantitative research methods. The population was all patients with diabetes mellitus who were recorded in Yogyakarta. Research sample counted 336 people at four health centers in Yogyakarta, namely Tegalrejo, Kotagede I, Mantrijeron, and Wirobrajan health centers.Results: This research indicated that there was no significant correlation between availability of consumption pattern information service and management behavior in diabetes melitus indicated by p>0.25 (p=0.763). There were significant correlations in the information of consumption pattern (p=0.003), information of oral dental complication (p=0.149), and family support (p=0.148) with management behavior in diabetes melitus indicated by p0.25 (p=0.763). Sedangkan informasi pola konsumsi (p=0,003), informasi komplikasi gigi mulut (p=0,149), dan dukungan keluarga (p=0.148) memiliki pengaruh terhadap perilaku pengelolaan pada penderita diabetes mellitus ditunjukkan dengan nilai p<0.25.Kesimpulan: Pelayanan Puskesmas terhadap pasien penderita diabetes di kota Yogyakarta secara umum sudah baik akan tetapi masih kurangnya informasi dan kepedulian terhadap kesehatan gigi dan mulut pada penderita diabetes. Perlu adanya kepedulian oleh Puskesmas terhadap kesehatan gigi dan mulut pada penderita diabetes mellitus. Selain itu perlu inovasi pada penyampaian informasi pada pasien, terutama pasien lama.

Penerimaan remaja putri terhadap tablet tambah darah di Kota Yogyakarta

Acceptance of adolescent girls on iron tablets in Yogyakarta, IndonesiaBackground: Supplementation of iron tablets is one of the efforts to combat anemia in adolescent girls taken by the government. However, compliance with iron tablet consumption still tends to be low. Objective: This study aims to determine the acceptance of adolescent girls to iron tablets in Yogyakarta. Methods: This study is a sequential explanatory mixed method. The investigation was conducted from January to April 2018. The subjects of the study were girls in junior high and high school of Yogyakarta, as many as 211 people with criteria 12-18 years; FGD/in-depth interview respondents were 32 students, four teachers/UKS officer, two Puskesmas officers, and one health program holder. Results: Of 204 subjects who received iron tablets, only 133 subjects (65.20%) consumed iron tablets, and 71 subjects (34.80%) did not. The organoleptic perception of subjects consisting of flavor, aroma, and color indicates they like iron tablets, but some also do not want them because they smell fishy. Side effects of iron tablets, such as nausea, heartburn, constipation, and dizziness, are the reasons the subject does not consume or spend the iron tablets given. In addition to the encouragement or support of parents, teachers or officers of UKS, and health workers, it is a factor that affects the acceptance of subjects against iron tablets. Conclusion: Factors influencing the acceptance of adolescent girls to iron tablets are a factor in self and factors from outside (parents, teachers, and health workers). Therefore, increasing the consumption of iron tablets requires young women's self-awareness, motivation, and support from various parties to obtain information related to the iron tablet, such as socializatio

Faktor-Faktor Yang Memengaruhi Efektivitas Peran Dinas Kesehatan Kota Sungai Penuh dalam Mengimplementasikan Peraturan Daerah Nomor 1 Tahun 2015 tentang Kawasan Tanpa Rokok

Latar belakang: Epidemik tembakau merupakan salah satu ancaman kesehatan masyarakat terbesar di dunia dan telah membunuh sekitar 8 juta orang setiap tahun, 1,2 juta kematian diakibatkan oleh paparan asap rokok orang lain yang disebabkan karena penyakit kardiovaskular dan gangguan pernapasan. Persentase penduduk Kota Sungai Penuh pada tahun 2019 yang merokok tembakau dalam 1 bulan terakhir tiap hari sebesar 24,08% merupakan salah satu yang tertinggi menurut di Provinsi Jambi. Salah satu upaya mengurangi paparan asap rokok, Pemerintah Kota Sungai Penuh mengeluarkan Peraturan Daerah Nomor 1 Tahun 2015 Tentang KTR. Meski Kota Sungai Penuh sudah memiliki peraturan daerah tentang kawasan tanpa rokok, fakta di lapangan menunjukkan bahwa masih ditemukannya beberpa puntung rokok dan bungkus rokok di kawasan yang sudah ditetapkan sebagai KTR.Tujuan: Untuk mengetahui dan menganalisis faktor-faktor apa saja yang paling mempengaruhi efektivitas peranan Dinas Kesehatan Kota Sungai Penuh dalam mengimplementasi upaya penegakan Peraturan Daerah Kota Sungai Penuh Nomor 1 Tahun 2015 Tentang KTR.Metode: Penelitian ini menggunakan metode penelitian kualitatif dengan pendekatan case study. Pendekatan case study dipilih karena peneliti ingin menggali informasi apa yang bisa dipelajari atau ditarik dari sebuah kasus, seperti kasus kecendrungan meninggkatnya konsumsi rokok di wilayah Kota Sungai Penuh.Hasil: Hasil penelitian menunjukkan belum maksimal dan efektifnya pelaksanaan kebijakan KTR yang dilakukan oleh pelaksana kebijakan sehingga dapat menyebabkan ketidaktahuan dan mengakibatkan masih adanya temuan pelanggaran di kawasan tanpa rokok. Terkait masalah anggaran yang terbilang rendah, perlu adanya penambahan anggaran sehinnga dapat membangun ruang khusus merokok di semua delapan tatanan kawasan tanpa rokok. Selain itu masyarakat telah menerima adanya implementasi kebijakan KTR, namun belum semua masyarakat mengetahui keijakan tersebut dan memiliki kesadaran untuk tidak merokok di kawasan-kawasan yang telah ditetapkan sebagai kawasan tanpa rokok.Kesimpulan: Efektivitas dari implementasi Peraturan Daerah No. 1 Tahun 2015 tentang KTR di Kota Sungai Penuh sejauh ini masih belum berjalan secara maksimal dengan berbagai kendala dalam konteks implementasinya.Kata Kunci : Efektivitas, Implementasi, Kebijakan Kawasan Tanpa Roko

Fenomena sosial unik pada perokok wanita di kabupaten Lebong Bengkulu Indonesia

Tujuan: Penelitian ini bertujuan mengetahui penyebab dan proses perilaku merokok yang dilakukan oleh perokok wanita di Kabupaten Lebong, Provinsi Bengkulu. Metode: Penelitian fenomenologi dengan subjek penelitian wanita yang merokok dan tinggal di Kelurahan Tes, Kabupaten Lebong, Provinsi Bengkulu. Metode pengumpulan data yang dilakukan adalah wawancara mendalam dan observasi pada 15 wanita perokok. Keabsahan data dilakukan dengan wawancara mendalam kepada 2 orang tenaga promosi kesehatan puskesmas, dan kepada 4 orang suami wanita perokok. Hasil: Penyebab perilaku merokok pada wanita adalah karena meniru teman, pengaruh ibu yang juga perokok, dan keinginan mencium aroma asap rokok saat hamil. Perilaku merokok wanita terus berlanjut karena mereka merasa puas bila merokok setelah sudah makan, terutama saat merokok bersama saat makan gaji dan uleak. Jika mereka tidak merokok, mereka merasa kepala pening, mulut terasa pahit dan lidah terasa tebal. Selain itu, wanita perokok mendapat dukungan dari suami. Penelitian juga menemukan belum pernah dilakukan edukasi kesehatan tentang bahaya merokok terhadap kesehatan untuk para wanita di Kelurahan Tes. Kesimpulan: Perlu ada edukasi kesehatan tentang bahaya merokok terhadap kesehatan wanita. Perlu program layanan konseling untuk membantu perokok wanita untuk berhenti merokok dan mencegah wanita untuk tidak merokok.Unique social features of female smokers in Lebong district of Bengkulu IndonesiaPurposeThis study aimed to determine the cause and process of women’s smoking behavior.MethodThis research was a phenomenological study involving 15 women who smoke and live in Tes village, Lebong District of Bengkulu. Data collection was conducted through in-depth interviews and participant observation. The triangulation of data was reached through in-depth interviews on two public health center staff, and four husbands of the participants.ResultsResults showed that imitating friends, having smoking mothers, financial independency, increased sensitivity and desire for cigarette smoke smell when pregnant were the reasons women wanted to smoke. Also, they enjoy cigarette smoking after meals and smoked as part of their culture (smoke on the day received salary and celebrations day “uleak”). If they were not smoking they got headaches, bitter mouth and tongue felt thick, and felt support from husbands towards smoking behavior. The study also found that there was not any education about the impacts of smoking.ConclusionIt is indispensable to do health education about the negative impacts of smoking on health for women which requires a special program to help women smokers to stop smoking and prevent non-smoking women from starting smoking, such as quit smoking counseling services.

Health promotion through youth empowerment to prevent and control smoking behavior: a conceptual paper

Purpose This paper aimed to review globally the empowerment programs for the prevention and control of smoking behavior among youths, to examine the role of empowerment in health promotion, to explore the stages of health promotion through community empowerment strategies including planning, implementation and evaluation. Finally, this paper will develop a model of youth empowerment to prevent and control smoking behavior that reflects theory and experience drawn from the literature. Design/methodology/approach This review synthesized articles on community empowerment and health promotion, youth empowerment programs for tobacco prevention and control globally from books and electronic databases from the Universitas Gadjah Mada (UGM) library in the publication period 2000–2020. Relevant literature was selected and critically reviewed which reflected the role empowerment in health promotion, stage of community empowerment strategy as described by Laverack and youth empowerment concept in tobacco control as described by Holden. Findings Documents that specifically discuss empowerment programs for smoking prevention and control are still limited. The findings document that youth empowerment in tobacco control do not fully integrate the theory empowerment as described by Laverack and Holden. This paper provides information about the stages of youth empowerment, and a conceptual framework of youth empowerment for the prevention and control of smoking behavior. Youth empowerment is done through the direct involvement of youth in programs starting from program design, planning, implementation and evaluation. Indicators of the success of the empowerment process are reflected in the increase in the empowerment domain. Meanwhile, the output of empowerment can be seen from the individual- or group-level changes. Originality/value This paper proposes a model of youth empowerment for the prevention and control of smoking behavior among youths based on theory and experience in the field

Implementasi Kebijakan JKN oleh Pemberi Pelayanan Kesehatan di Kabupaten Kepulauan Anambas

ABSTRACTBackground: On January 1st, 2014, the implementation of NHI started in Indonesia as well as in the district of Anambas Islands accordance with the mandate of Law No. 24 in 2014. NHI policy is a top-down policy that must be implemented. On the process of implementation, the health service providers in the RSL, as the main reference in Anambas Islands, have some problems due to the characteristics’ differences of regional and limitations the District of Anambas Islands as the border areas, islands and separated-areas (DTPK). In the context of health, rural and remote areas is often associated with a state of limited public transport, poor road infrastructure, long distances to health service facilities and difficulties in recruiting and retaining health personnel. As a result there is a significant impact on the provision of adequate health care. The availability of resources is inadequate in every health facility in Anambas Islands is also an obstacle for the implementation of NHI any existing health facilities in the District of Anambas Islands must qualify credensialing set by BPJS Health.The Objective: To analyze the implementation of NHI policy by the health service providers in the District of Anambas Islands.Method: This research is using the descriptive research with qualitative methods using a single case study, design to analyze the implementation of the NHI policy established by the health service providers in Anambas Islands, which is focused on resources, bureaucratic structure and disposition.Result: Implementation of policy NHI by health care providers both in health centers and hospitals are still many have constraints such as limited power specialist, especially in hospitals, general practitioners definitive still lacking in some health facilities, the limited infrastructure in health centers and hospitals that cause will not want the patient should be referred. This adds to the burden of transportation costs to society as ocean freight rates are quite expensive though some things can be addressed as a problem of information and improvement of bureaucratic structures, but it can not prevent the public to be referred.Conclusion: The implementation of NHI policy does not match held in Anambas Islands as the border areas, islands and separated-areas area because of the benefits received by the community of NHI be limited due to so many constraints faced by health care providers. Keywords : Implementation of policy, the National Health Insurance, health service providers.ABSTRAKLatar belakang : Dengan diberlakukannya UU Nomor 24 Tahun 2014 maka pada tanggal 01 Januari 2014 Jaminan Kesehatan Nasional dimulai di Indonesia, demikian juga halnya di Kabupaten Kepulauan Anambas. Kabupaten Kepulauan Anambas merupakan kabupaten yang dikategorikan sebagai daerah DTPK. Dalam konteks kesehatan, daerah pedesaan dan terpencil sering dikaitkan dengan keadaan transportasi umum yang terbatas, infrastruktur jalan yang buruk, jarak yang jauh ke fasilitas pelayanan kesehatan dan kesulitan dalam merekrut dan mempertahankan tenaga kesehatan. Akibatnya ada dampak yang signifikan untuk penyediaan pelayanan kesehatan yang memadai. Ketersediaan sumber daya yang tidak memadai pada setiap fasilitas kesehatan di Kabupaten Kepulauan Anambas juga menjadi kendala karena dalam pelaksanaan JKN setiap fasilitas kesehatan yang ada di Kabupaten Kepulauan Anambas harus memenuhi syarat kredensialing yang telah ditetapkan oleh BPJS Kesehatan.Tujuan: Menganalisis implementasi kebijakan JKN oleh pemberi pelayanan kesehatan di Kabupaten Kepulauan Anambas.Metode: Penelitian ini merupakan jenis penelitian deskriptif dengan metode kualitatif menggunakan rancangan studi kasus tunggal terjalin untuk menganalisis implementasi kebijakan JKN oleh pemberi pelayanan kesehatan di Kabupaten Kepulauan Anambas, yang difokuskan pada sumber daya, struktur birokrasi dan disposisi.Hasil: Implementasi kebijakan JKN oleh pemberi pelayanan kesehatan baik di puskesmas maupun rumah sakit masih banyak mengalami kendala seperti terbatasnya tenaga spesialistik khususnya yang ada di rumah sakit, dokter umum yang definitif masih kurang di beberapa fasilitas kesehatan, keterbatasan prasarana di puskesmas dan rumah sakit yang menyebabkan mau tidak mau pasien harus dirujuk. Hal ini menambah beban biaya transportasi bagi masyarakat karena tarif angkutan laut yang cukup mahal walaupun beberapa hal dapat dibenahi seperti masalah informasi dan perbaikan struktur birokrasi namun hal tersebut tidak dapat mencegah masyarakat untuk dirujuk.Kesimpulan: Implementasi kebijakan JKN tidak cocok dilaksanakan di Kabupaten Kepulauan Anambas sebagai daerah DTPK karena manfaat yang diterima masyarakat dari JKN menjadi terbatas disebabkan begitu banyak kendala yang dihadapi oleh pemberi pelayanan kesehatan. Kata Kunci : Implementasi kebijakan, Jaminan Kesehatan Nasional, pemberi pelayanan kesehata