Estimasi Pengaruh Vaksin DPT pada Kematian Anak: Analisis Diskritif Data Surveilan Demografi dan Kesehatan di Kabupaten Purworejo

Background: Recent controversial reports suggest that recipients of one dose of DTP vaccine have higher mortality than children who have received no DTP vaccine. Those reports were mainly derived from African countries where mortality and malnutrion were higher than Indonesia.Objectives: To describe specific and non-specific effects of DTP vaccination on child mortality age 1-24 months under routine vaccination program in Indonesia.Methods: During period of January 1 1995 to August 31, 2001 our longitudinal surveillance data at Purworejo district provided information on 5647 children below 24 months of age who received DTP and other vaccinations. The main outcome measure was all-cause mortality. Vaccination status on DTP, BCG, and measles were collected every 90 days and recorded its time at vaccination. Confounding factors associated with mortality were also collected. This first report used descriptive analysis and a survival curve (Kaplan-Meier) to examine the differential of mortality according to sex of the children and among vaccinated and non-vaccinated children with DTP, BCG, and measles vaccines. The second report will use survival analysis to estimate specific and non-sprecific effects of DTP by considering time at vaccination and other counfounding factors.Results: There is no sex differential of mortality among children in Purworejo. A probability of dying was lower in the children vaccinated with DTP vaccine compared with those not vaccinated DTP. Simmilarly, vaccinated children with BCG and measles have lower mortality compared to unvaccinated children. There is strong indication that BCG and measles have stronger protected effects to risk of dying than DTP.Conclusion: The study showed lower mortality among children who received DTP, BCG, and measles vaccines compared those unvaccinated. There were not enough evidences to change current vaccination policy because DTP was not associated with any harmful effect among girls

Estimasi Pengaruh Vaksin DPT pada Kematian Anak: Analisis Multivariabel Data Survailan Demografi dan Kesehatan di Kabupaten Purworejo

Background: Recent controversial reports suggest that recipients of one dose of DTP vaccines had higher mortality than children who had received no DTP vaccine. We reanalyzed data on vaccination and child survival collected from demographic and health surveillance to challenge previous findings.Objectives: To estimate specific and non-specific effects of DTP vaccination on child mortality age 1-24 months under routine vaccination program in Indonesia.Methods: A longitudinal surveillance data provided information on 5647 children below 24 months of age who received DTP and other vaccinations. The main outcome measure was all-cause mortality. Background factors associated with mortality were collected, such as: sex, birth order, dead sibling, mother's education and family size. We assessed DTP vaccinations as an independent factor with other variables in Cox's regression models with time dependent covariates.Results: There is no sex differential of mortality among children in Purworejo even after considering other factors using Cox regression analysis. Mortality was lower in the group vaccinated with DTP vaccine compared with those not vaccinated, the relative risk of mortality (RR) being 0.56 with 95% confidence interval (CI) is 0.453–0.690. After controlling for the background factors, recipient of DPT vaccines continued to have a lower mortality with RR=0.74 (95% CI: 0.586–0.925). BCG and measles vaccines have stronger non-specific effects compared to effects of DTP vaccines.Conclusion: Through specific effect against targeted diseases and a non-specific benefit against others illnesses, the study showed reduced mortality among children who received DTP vaccine. There is no reason to change current vaccination policy because DTP was not associated with any harmful effect among girls

Vaksin Rotavirus: Apakah Sudah Waktunya Dimasukkan dalam Program Imunisasi Nasional di Indonesia?

Background: Two rotavirus vaccines have been availablefor use. The objectives of the study to examine disease burdenof diare rotavirus and the cost and effectiveness of a rotavirusvaccination program in Indonesia.Material and Methods: Data on direct and indirect costs ofchildren with rotavirus diarrhea were established in PurworejoDistrict and Yogyakarta city. It was extrapolated to nationalestimates on the basis of the projected birth cohort in 2007and diarrhea morbiditity rate at national level. The main outcomemeasures were economic burden and cost-effectiveness ratio(Rupiah per DALY averted).Results: The disease burden is equivalent to an economicburden of an estimated Rp390.4 billion in medical direct costs,Rp 67.3 bilion in nonmedical direct costs, and 70.4 billion rupiahin indirect costs. From the health care system and communityperspectives, universal vaccination of infants at a cost of lessthan US $12,7 for a vaccine dose would be a cost-effective ofpublic health intervention.Conclusions and Recommendation: In Indonesia, rotavirusvaccination would reduce the morbidity burden of rotavirusinfection, but would not be cost-effective unless the price ofvaccine decreased considerably. At the current price ofvaccine, universal vaccination program for rotavirus wouldnot be recommended.Keywords: burden of disease, rotavirus diarrhea vaccine,cost-effectivenes

Pengaruh Kontrasepsi Hormonal Dan Non Hormonal Terhadap Lamanya Menyusui Di Indonesia (Analisis Data Sdki Tahun 2007)

Latar Belakang : Tujuan global untuk meningkatkan kesehatan dan mutu makanan bayi secara optimal, maka semua ibu memberikan (Air Susu Ibu) ASI esklusif dan semua bayi diberi ASI esklusif sejak lahir sampai berusia 6 bulan. Data SDKI menunjukkan bahwa pemberian ASI eksklusifpada bayi kurang dari 6 bulan 40% turun 32% di Indonesia dan di seluruh dunia 38%, median lamanya menyusui yaitu 22 bulan, tahun 2007 yaitu 23,7 bulan . Pemakaian menurut alat dan cara KB menunjukkan peningkatan dari 50% pada tahun 1991 menjadi 61% pada SDKI tahun 2007, terjadi Perubahan pemakaian alat/cara KB moderen. Pemakaian pil 15% wanita berstatus dan pemakaian kontrasepsi suntik meningkat. Kebutuhan wanita akan kontrasepsi selama menyusui adalah kontrasepsi yang aman digunakan selama menyusui, namun metode kontrasepsi hormonal kombinasi terutama yang mengandung estrogen dan progesteron dapat mengganggu laktasi dengan menghambat proklatin sehingga mengurangi produksi ASI.Tujuan : Untuk mendapatkan gambaran tentang pengaruh kontrasepsi hormonal dan non hormonal terhadap lamanya menyusui di Indonesia.Metode: Menggunakan data SDKI tahun 2007, jenis penelitian observational dengan rancangan kohort retrospektif. Sampel penelitian adalah wanita berumur 15-49 tahun yang memenuhi kriteriainklusi dan eksklusi yang berjumlah: 10738 pada SDKI 2007 menggunakan kontrasepsi hormonal dan kontrasepsi non hormonal sebagai variabel bebas dan lamanya menyusui sebagai variabel terikat.Analisis data menggunakan analysis survival, dimana besar pengaruh penggunaan kontrasepsi hormonal dan non hormonal terhadap lamanya menyusui diperoleh dengan menggunakan Cox propotional hazard model.Hasil Penelitian : Berdasarkan SDKI 2007, penggunaan kontrasepsi pil tidak signifikan terhadap durasi menyusui HR=0,99 CI=(0,89-1,12, suntik/susuk tidak signifikan terhadap durasi menyusui.HR=0,90 CI=(0,82-0,99). Lama memakai alat kontrasepsi pada 0-6 bulan signifikan terhadap durasi menyusui HR=2,86 CI=(2,20-3,31). Dan lama memakai alat kontrasepsi pada 7-12 bulan signifikanterhadap durasi menyusui HR=1,77 CI=(1,32-2,28).Simpulan : Durasi masih menyusui pada penggunaan kontrasepsi lebih cepat menyapih pada pil dibanding dengan suntik/susuk, waktu lama memakai alat kontrasepsi lebih cepat menyapih pada 0-6bulan dibandingkan dengan lama menyusui 7-12 bulan dan 13-24 bulan

Peran Sumber Layanan dan Jenis Provider terhadap Diskontinuitas Kontrasepsi: Analisis Data Survei Demografi Kesehatan Indonesia 2012

Effects of health facility ownership and type of providers on contraception discontinuation: an analysis of 2012 Indonesian demographic health surveyPurposeThis study aimed to examine the role of source of family planning services and types of providers on the discontinuity pattern of modern contraceptive use in women of childbearing age.MethodsThis study analyzed the longitudinal data using secondary data of the IDHS 2012. The sample criteria were: women ever married, aged 15-49, who have ever used modern contraception (pills, injections, IUDs and implants). Stratified Cox models were used to assess the effect of predictors toward contraceptive discontinuation.ResultsKaplan-Meier curves showed higher discontinuity in the short-term contraceptive methods such as injections and pills. Multivariable analysis showed the influence of method source to discontinuation after controlling for other factors, namely age, number of children, education level and place of residence. The risk of discontinuation was greater in government source than private, with HR 1.14 95% CI (1.06 to 1.23). Sub-sample analysis of private services showed a greater chance of discontinuity in physician, with HR 1.28 95% CI (1.06 to 1.54).ConclusionContraceptive discontinuation rate was lower among women using private source and midwives. Women with older age had greater number of children, and the factor of low education levels also was associated with longer duration of contraceptive use

Jarak Penggunaan Alat Kontrasepsi Setelah Melahirkan terhadap Kegagalan Kontrasepsi di Indonesia: Analisis Survei Demografi dan Kesehatan Indonesia 2012

Contraceptive use after childbirth and contraception failure: an analysis of Indonesia Demographic Health Survey 2012PurposeThis research aimed to evaluate the use of contraception after childbirth with contraception failure. MethodsThis research was an observational study using IDHS 2012 with a retrospective cohort design. Married women who got pregnant while using contraceptives were the unit of analysis. Statistical analysis used survival analysis with stratified Cox Regression methods.ResultsAnalysis showed a higher failure rate in the traditional contraceptive methods such as coitus interruptus and periodic abstinence. The failure rate of the contraceptive method implant in Indonesia was higher by 10 times the global failure rate. Women who had used contraceptive for 33-48 weeks and >48 weeks after childbirth had higher risk of pregnancy with contraceptive failure (respectively HR=1.25; 95% CI: 0.63-2.47 and 1.91; 95% CI: 1-3.67), respectively. Other factors influencing the contraceptive failure were age and met or unmet needs.ConclusionContraceptive use after childbirth is associated with contraceptive failure among woman of childbearing age in Indonesia. Providers of contraceptive implants may introduce additional variations of implantable contraceptives in Indonesia and are supported by qualified health personnel

Determinan Abortus di Indonesia

Abortion has become a main problem in public health because of its impact on maternal morbidity and mortality. There is no comprehensive data on abortion in Indonesia. So far, data were based on survey with limited coverage. Unsafe abortion is responsible to 11 percent of maternal mortality in Indonesia. This research objective is to determine factors related to abortion in Indonesia. The study was an observational method with cross sectional design. Thesedata are gathered from Indonesian Demography and Health Survey 2002–2003. Data analysis used univariate, bivariate and multivariate analysis with logistic regression. The risk of an abortion increased in line with the increasing of maternal age. Women with 0-2 parity have higher risk than multiparity (OR=5.2, IK95%=3.49-7.89). Employed women have higher risk than unemployed (OR=2.7, IK95%=2.10-3.58). The risk of abortion increased among women married at 30 years old or over (OR=1.8, IK95%=1.30-2.48). There is no significant association between history of abortion, education, socioeconomic and risk of abortion