Factors Associated with Falciparum Malaria in Lembata, East Nusa Tenggara

Background: Lembata district, East Nusa Tenggara, is a malaria endemic area. In 2016, as many as 27,976 clinical suspect cases were reported. As many as 6,562 malaria cases were confirmed, of which 444 were Plasmodium falciparum cases, 6,116 were Plasmodium vivax cases, and 2 mixed cases. Annual Parasite Incidence (API) was 46.60 new cases per thousand populations. This study aimed to determine the factors associated with Falciparum malaria in Lembata, East Nusa Tenggara. Subjects and Method: This was a case control study carried out in Lembata, East Nusa Tenggara. A sample of 226 people was selected for this study, consisting of 113 Falciparum malaria cases and 113 controls. The dependent variable was Falciparum malaria. The independent variables were age, fever, convulsion, and diarrhea. Malaria case was diagnosed by anamnesis, clinical and laboratory examinations. The other data were collected by questionnaire, interview, and observation. The data were analyzed by a multiple logistic regression. Results: Falciparum malaria was associated with younger age (OR= 2.88; 95% CI= 1.47 to 5.07; p< 0.001), high fever (OR= 5.88; 95% CI= 4.21 to 7.45; p= 0.001), convulsion (OR= 4.90; 95% CI= 2.09 to 7.63; p<0.001), and diarrhea (OR= 3.76; 95% CI= 1.16 to 8.75; p= 0.023). Conclusion: Falciparum malaria is associated with younger age, high fever, convulsion, and diarrhea. Keywords: malaria, Falciparum, fever, convulsion, diarrhe

SOCIO-CULTURAL AND HEALTH TECHNICAL FACTORS AFFECTING REFERRAL SYSTEM IN EAST FLORES, EAST NUSA TENGGARA

BACKGROUND: An effective referral system ensures a close relationship between all levels of the health technical and helps to ensure people receive the best possible care closest to home. A good referral system can help to ensure: (1) Clients receive optimal care at the appropriate level and not unnecessarily costly; (2) Hospital facilities are used optimally and cost-effectively; (3) Clients who most need specialist service can accessing them in a timely way; (4) Primary health services are well utilized and their reputation is enhanced. This study aimed to determine socio-cultural and health technical factors affecting referral system in East Flores, East Nusa Tenggara. SUBJECT AND METHODS: This was a cross sectional study conducted in East Flores, East Nusa Tenggara. A sample of 22 community health center, district hospital, and district health office in East Flores, East Nusa Tenggara, was selected for this study. The dependent variable was referral system. The independent variables were socio-cultural and health technical factors. Base on factor analysis, the socio-cultural factors consisted of several important indicators: (1) Referral pattern; (2) Referral culture; (3) Geographical condition; (4) Transportation; and (5) Cost. The health technical factors consisted of several important indicators: (1) Referral criteria; (2) Referral capacity; and (3) Referral model. The data were collected by a questionnaire, interview, and document review. The data was analyzed by a multiple linier regression. RESULTS: Both socio-cultural factors (b=0.95; p=0.041) and health technical factors (b=0.99; p=0.037) had positive relationship with referral system. CONCLUSION: Both socio-cultural factors and health technical factors are important determinants for referral system. If referral system is to be improved, then several indicators that shape both socio-cultural factors and health technical factors must be enhanced. Keywords: referral system, socio-cultural factors, health technical factor

Factors Affecting Maternal Mortality in an Alert Village in South Timor Tengah, East Nusa Tenggara

Background: Maternal mortality may be attributable to direct or indirect causes, such as social, cultural, economic, and geographical factors. The purpose of this study was to determine factors affecting the risk of maternal mortality in an alert village in South Timor Tengah, East Nusa Tenggara. Subjects and Method: This was a case control study conducted at a Community Health Center, in an alert village, South Timor Tengah, East Nusa Tenggara. A sample of 167 postpartum women, consisting of 35 dead postpartum women (represented by their families) and 132 alive postpartum women, were selected for this study. The independent variables were age, antenatal care visit, unskilled birth attendant, access transportation, and social support. The dependent variable was maternal death. The data were collected from medical and obstetric record and questionnaire. The data were analysis by multiple logistic regression. Results: Risk of maternal mortality increased by birth delivery at home (OR = 18.00; 95% CI= 5.00 to 74.00; p = 0.001), unskilled birth attendant (OR = 43.50; 95% CI= 4.40 to 363.50; p=0.001), antenatal care visit <4 (OR = 50.09; 95% CI = 5.96 to 420.40; p = 0.001), maternal age <20 years or ≥35 years (OR = 3.29; 95% CI = 1.10 to 9.05; p = 0.032), poor access to transportation (OR= 4.50; 95% CI= 1.10 to 18.50; p=0.028), weak familly support (OR = 3.05, 95% CI = 1.05 to 8.84, p = 0.037), and weak emotional support (OR = 11.00; 95% CI = 3.2 to 36.70; p = 0.001). Conclusion: Risk of maternal mortality increased by birth delivery at home, unskilled birth attendant, antenatal care visit <4, maternal age <20 years or ≥35 years, poor access to transportation, weak familly support, and weak emotional support. Keywords: Maternal mortality, unskilled birth attendant, antenatal care, maternal age, transportation, familly support, emotional suppor

Health Services, Maternal Intrinsic and Socio-Cultural Factors and Perinatal Mortality

This study question was how significant the determination of health services, maternal intrinsic risk factors and socio-cultural factors on perinatal mortality. Its objective was to construct a model of perinatal mortality pattern by case-control design. The case population was all mothers with perinatal mortality. The sample-size was 35 by simple random sampling with case-control ratio of 1:1 (35:35). The data analysis applied Bivariate using Chi Square Test and Multivariate using Logistic Regression Test. The Bivariate Analysis Results found the risk-variables on Perinatal Mortality were Birth Attendant (OR=2.1; 1.63-2.7; 95%CI), Health Financing (OR=7.1; 1.82-27.8; 95% CI), Maternal Disease History (OR=8; 2.05-31.16; 95%CI), Perinatal History (OR=6.47; 2.26-18.55; 95%CI) and Custom (OR=2.17; 1.67-2.82; 95%CI). Multivariat Analysis found three consistent risk variables on Perinatal Mortality i.e.: Health Financing (p=0.016; OR=6.8; 95% CI), Maternal Disease History (p=0.006; OR=8.41; 95%CI) and Perinatal History (p=0.021; OR=4.3; 95%CI). It concluded that the most significant determinant on Perinatal Mortality was Maternal Disease History

Knowledge, Preventive Practice, and The Risk of Dengue Hemorrhagic Fever in Kupang, East Nusa Tenggara

Background: Dengue/dengue hemorrhagic fever (DHF) has been one of the most important resurgent tropical diseases in the past 17 years. Its incidence in East Nusa Tenggara has been increasing from 2011 to 2013. This study aimed to investigate the associations between knowledge, preventive practice, and the risk of dengue hemorrhagic fever in Kupang, East Nusa Tenggara. Subjects and Method: This was a case-control study conducted at 8 Puskesmas (Community Health Center) in Kupang, East Nusa Tenggara, Indonesia, from March to May 2016. A total of 72 subjects were selected for this study by fixed disease sampling, consisting of 36 DHF cases and 36 controls. The dependent variable was DHF. The independent variables were knowledge on DHF and DHF preventive practice including draining, hoarding and burying. The data were collected by questionnaire and interview. The data were analyzed by multiple logistic regression. Results: Poor knowledge on DHF (OR= 4.85; 95% CI= 1.62 to 14.49; p= 0.005) and poor DHF preventive practice (OR= 4.72; 95% CI= 1.60 to 13.91; p= 0.005) were associated with an increased risk of DHF. Conclusion: Poor knowledge of DHF and poor DHF preventive practice are associated with an increased risk of DHF. Keywords: knowledge, preventive practice, dengue hemorrhagic fever

Pemanfaatan Voluntary Counseling And Testing oleh Ibu Rumah Tangga Terinfeksi HIV/AIDS

Human Immunodeficiency Virus - Acquired Immuno Deficiency Syndrome (HIV-AIDS) merupakan penyakit menular yang jumlah penderitanya terus bertambah. Ibu rumah tangga merupakan penderita HIV/AIDS terbanyak di Kabupaten Belu. Pemanfaatan Voluntary Counseling and Testing (VCT) yang rendah oleh orang dengan HIV/AIDS (odha) termasuk ibu rumah tangga terinfeksi HIV/AIDS menyebabkan penyebaran HIV/AIDS sulit dikendalikan. Tujuan penelitian ini adalah untuk menganalisis hubungan umur, tingkat pendidikan, persepsi tentang penyakit, persepsi tentang pelayanan kesehatan, pekerjaan suami, pendapatan keluarga, keterjangkauan, persepsi keparahan penyakit dan persepsi stigma diri sendiri dengan pemanfaatan VCT oleh ibu rumah tangga terinfeksi HIV di Kabupaten Belu. Jenis penelitian yang digunakan adalah kuantitatif, disain cross sectional. Jumlah sampel adalah 90 orang yang merupakan total populasi. Penelitian dilakukan di Kabupaten Belu pada bulan Januari sampai Juli 2015. Analisa data secara deskriptif dan bivariat. Hasil analisis bivariat dengan uji chisquaremenunjukkan adanya hubungan pendidikan (p=0,040), persepsi tentang penyakit (p=0,0001), persepsi tentang pelayanan kesehatan (p=0,0001), pendapatan keluarga (p=0,016), pekerjaan suami (0,037), keterjangkauan (p=0,038), persepsi keparahan penyakit (p=0,0001) dan persepsi stigma diri sendiri (p=0,0001) dengan pemanfaatan VCT. Persepsi tentang penyakit dan pelayanan kesehatan perlu ditingkatkan dengan memperluas penyebaran informasi tentang penyakit HIV/AIDS dan manfaat VCT

Factors Associated with The Use of Antenatal Care in East Sumba, East Nusa Tenggara

Background: Antenatal care (ANC) is very important to pregnant women as it helps prevent mother and child mortality, prevent complications, helps foster a good relationship between the husband and wife, mother and child and father. Good antenatal care includes regular screening which can detect and prevent early complications such as hypertension and pregnancy diabetes; both of which can dramatically affect the fetus. Early detection means regular monitoring and treatment. This study aimed to analyze factors associated with the use of ANC in East Sumba, East Nusa Tenggara. Subjects and Method: This was an cross sectional study conducted in East Sumba, East Nusa Tenggara. A sample of 254 pregnant women were selected for this study by simple random sampling. The dependent variable was use of ANC. The independent variables were being a housewife, receiving husband's support, and social support. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results: The use of ANC was associated with being a housewife (b= 0.88; 95% CI= 1.30 to 4.48; p= 0.005), receiving husband's support (b= 0.72; 95% CI= 0.25 to 0.95; p= 0.035), and social support (b= 1.52; 95% CI= 0.10 to 0.51; p<0.001). Conclusion: The use of ANC is associated with being a housewife, receiving husband's support and social support. Keywords: housewife, husband's support, social support, antenatal care, utilizatio