Clinical Outcomes of Geriatric Care in Cipto Mangunkusumo Hospital, Before and After the Implementation of National Health Insurance Program

Background: the National Health Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of geriatric patient care, such as improved functional status and quality of life have not been evaluated. Prolonged hospitalization and re-hospitalization are potentially affecting the efficiency care of this vulnarable group. This study aimed to identify the differences of functional status improvement, quality of life improvement, length of stay, and hospitalization of geriatric patients admitted to CMH between prior to and after NHI implementation.Methods: a cohort study with historical control was conducted among geriatric patients admitted to Acute Geriatric Ward CMH Hospital on two periods of time: January-December 2013 (pre-NHI implementation) and June 2014-May 2015 (after NHI implementation). Patients who died within 24 hours of hospital admission, those with APPACHE II score >24, advance stage cancer, transfer to other wards before they were discharged or have incomplete record were excluded from the study. Data on demographical and clinical characteristics, functional status, quality of life, length of stay, and re-hospitalization were taken from patient’s medical record. The differences of studied outcomes were analyzed using t-test or Mann-Whitney test.Results: there were 102 subjects in pre-NHI and 135 subjects in NHI groups included in the study. Median lengths of stay were not different between two groups (12.5 days in pre-NHI and 10 days in NHI groups, p=0.087), although the proportion of patients with in-hospital stay less than 14 days was higher in NHI group. The difference of functional status of discharged patients in pre-NHI and NHI groups were 3 and 3 (p=0.149) respectively, whereas for health-related quality of life, although NHI group in the beginning showed a lower quality of life compared to the pre-NHI (0.163 [0.480] vs. 0.243 [0.550]; p=0.012). However, after incorporating comprehensive geriatric assessment (CGA) the quality of life improved significantly by the end of in-hospital care in both groups. Re-hospitalization incidence in NHI group was lower compared to pre-NHI (7 [5.2%] vs. 13 [12.7%]; p=0.038).Conclusion: our study shows that there was  no  significant difference regarding length of stay, functional status, and health-related quality of life between prior to and after national health insurance implementation on admitted geriatric patients. Rehospitalization incidence showed better results in NHI group and hence NHI implementation is favored

Fenomena Sosial Unik pada Perokok Wanita di Kabupaten Lebong Bengkulu Indonesia

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

The Political Economy of Non-Traditional Security: Explaining the Governance of Avian Influenza in Indonesia

Given the common association of non-traditional security (NTS) problems with globalisation, surprisingly little attention has been paid to how the political economy context of given NTS issues shape how they are securitised and managed in practice. We argue that security and its governance are always highly contested because different modes of security governance invariably privilege particular interests and normative agendas in state and society, which relate directly to the political economy. Drawing on critical political geography, we argue that, because NTS issues are perceived as at least potentially transnational, their securitisation often involves strategic attempts by actors and coalitions to ‘rescale’ their governance beyond the national political and institutional arenas, into new, expert-dominated modes of governance. Such efforts are often resisted by other coalitions, for which this rescaling is deleterious. As evidenced by a case study of avian influenza in Indonesia, particular governance outcomes depend upon the nature of the coalitions assembled for and against rescaling in specific situations, while these coalitions’ make-up and relative strength is shaped by the political economy of the industries that rescaling would affect, viewed against the broader backdrop of state-society relations

Faktor Determinan Penolakan Imunisasi di Desa Bonjor Kabupaten Temanggung

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

Clinical Outcomes of Geriatric Care in Cipto Mangunkusumo Hospital, Before and After the Implementation of National Health Insurance Program

Background: the National Health Insurance (NIH/JKN) has been enacted since January 2014. Various outcomes of geriatric patient care, such as improved functional status and quality of life have not been evaluated. Prolonged hospitalization and re-hospitalization are potentially affecting the efficiency care of this vulnarable group. This study aimed to identify the differences of functional status improvement, quality of life improvement, length of stay, and hospitalization of geriatric patients admitted to CMH between prior to and after NHI implementation. Methods: a cohort study with historical control was conducted among geriatric patients admitted to Acute Geriatric Ward CMH Hospital on two periods of time: January-December 2013 (pre-NHI implementation) and June 2014-May 2015 (after NHI implementation). Patients who died within 24 hours of hospital admission, those with APPACHE II score >24, advance stage cancer, transfer to other wards before they were discharged or have incomplete record were excluded from the study. Data on demographical and clinical characteristics, functional status, quality of life, length of stay, and re-hospitalization were taken from patient’s medical record. The differences of studied outcomes were analyzed using t-test or Mann-Whitney test. Results: there were 102 subjects in pre-NHI and 135 subjects in NHI groups included in the study. Median lengths of stay were not different between two groups (12.5 days in pre-NHI and 10 days in NHI groups, p=0.087), although the proportion of patients with in-hospital stay less than 14 days was higher in NHI group. The difference of functional status of discharged patients in pre-NHI and NHI groups were 3 and 3 (p=0.149) respectively, whereas for health-related quality of life, although NHI group in the beginning showed a lower quality of life compared to the pre-NHI (0.163 [0.480] vs. 0.243 [0.550]; p=0.012). However, after incorporating comprehensive geriatric assessment (CGA) the quality of life improved significantly by the end of in-hospital care in both groups. Re-hospitalization incidence in NHI group was lower compared to pre-NHI (7 [5.2%] vs. 13 [12.7%]; p=0.038). Conclusion: our study shows that there was  no  significant difference regarding length of stay, functional status, and health-related quality of life between prior to and after national health insurance implementation on admitted geriatric patients. Rehospitalization incidence showed better results in NHI group and hence NHI implementation is favored

Barriers and gaps in utilization and coverage of mass drug administration program against soil-transmitted helminth infection in Bangladesh: An implementation research

Background: Bangladesh has implemented school-based mass drug administration (MDA) bi-annually since 2008 aimed to control soil-transmitted helminth (STH) infection. Despite several rounds of MDA, the government is still facing challenges to achieve the target coverage and utilization of the intervention. This study was done to explore and explain the barriers and gaps that hinder the utilization and coverage of MDA for STH. Methods: This research was a mixed method study, was conducted in two selected districts of Bangladesh. A total of 160 questionnaire surveys, 12 in-depth interviews, 8 focus group discussion, and 2 key-informant interviews were done among 238 study participants which included school-age children with relevant parents, school teachers, health workers, community leaders and MDA program managers. Descriptive statistical analysis was used to analyze the quantitative data while thematic analysis was applied for the qualitative data. Results: It was revealed that the participants have positive attitudes towards MDA but they pointed out the limitations in reaching all target population especially non-school going children. The level of knowledge regarding STH and MDA were found different among the study population. The evaluated coverage of MDA was also found lower than that reported. Some major barriers associated with MDA coverage found in this study were drug distribution policy, accessibility to schools, poor record keeping, follow-up, and information dissemination. Inadequate information about population dynamics and rumors about side effects of MDA drugs adversely affected the compliance of the intervention. Insufficient training of drug distributors and poor motivation among stakeholders also added to the barriers. Conclusion: There is the need to re-strategize drug distributing methods and create effective policies to include all targeted population. Use of local channels for community sensitization, adding local distribution points, regular monitoring and follow-up and promotion of health education can possibly enhance both treatment coverage and program infrastructure. Keywords: Barriers, Utilization, Coverage, Mass drug administration, Soil-transmitted helmint

Kebiasaan Merokok Keluarga Serumah dan Kejadian Pneumonia Balita di Bantul

Latar belakang: Salah satu permasalahan kesehatan yang terjadi di Indonesia adalah kematian anak sebelum mencapai usia 5 tahun. Diantara 5 kematian Balita, 1 diantaranya disebabkan oleh pneumonia. Salah satu faktor resiko kejadian pneumonia pada Balita adalah adanya polusi udara yang terdapat di dalam rumah. Polusi udara tersebut dapat disebabkan oleh adanya kebiasaan merokok yang dilakukan oleh keluarga yang serumah dengan Balita. Penelitian ini bertujuan untuk menganalisis hubungan kebiasaan merokok keluarga serumah dengan kejadian pneumonia pada Balita di Kabupaten Bantul.Metode: Penelitian ini adalah penelitian observasional analitik dengan menggunakan pendekatan case control study untuk membandingkan antara kelompok Balita yang menderita penyakit pneumonia (kasus) dengan kelompok Balita yang tidak menderita pneumonia (kontrol). Jumlah sampel dalam penelitian ini adalah 80 orang Balita pada kelompok kasus dan 80 orang Balita pada kelompok kontrol. Pengambilan sampel dilakukan dengan cara non probability sampling.Hasil: Terdapat hubungan antara kebiasaan merokok keluarga serumah dengan kejadian pneumonia pada Balita di Kabupaten Bantul (OR= 2,31; 95% CI: 1,13-4,69; p= 0,03). Selain itu, ditemukan adanya variabel lain yang memiliki hubungan dengan kejadian pneumonia pada Balita di Kabupaten Bantul yakni penggunaan obat nyamuk bakar (OR=3,33; 95% CI: 1,18-9,39; p= 0,02), status gizi Balita (OR= 3,20; 95% CI: 1,19-8,61; p= 0,02) dan kepadatan hunian (OR=2,49; 95% CI: 1,15-8,61; p= 0,02). Sedangkan pada variabel pendidikan ibu, status imunisasi, penghasilan orangtua, riwayat pemberian ASI eksklusif, riwayat pemberian vitamin A, jenis bahan bakar rumah tangga, lokasi dapur, jenis dinding rumah dan aktivitas membakar sampah tidak memiliki hubungan dengan kejadian pneumonia di Kabupaten Bantul (p value >0,05).Kesimpulan: Kebiasaan merokok keluarga serumah, penggunaan obat nyamuk bakar, status gizi dan kepadatan hunian merupakan faktor risiko yang berhubungan dengan kejadian pneumonia di Kabupaten Bantul sehingga perlu dilakukan promosi kesehatan pada rumah tangga tentang dampak kebiasaan merokok keluarga terhadap Balita, terutama pada rumah tangga yang padat penghuni, perlu dilakukan pengawasan terhadap anggota keluarga yang memiliki kebiaasaan merokok agar tidak melakukan aktivitas merokok di dalam rumah terutama pada keluarga yang memiliki Balita dan melakukan perbaikan status gizi