The Behavioral, Socioeconomic, and Environmental Factors Associated with Leprosy in Kediri, East Java: A Path Analysis Model

Background: Leprosy is a leading cause of preventable disability in many low and middle income countries, including Indonesia. It thereby poses a major public health challenge for the country. Leprosy can be so progressive that damages skin, nerve, extremity, and eye organs of the affected patients. Cumulative incidence of leprosy amounted to 200,000 cases worldwide, with the highest incidences occuring in India, Brazil, and Indonesia. This study aimed to examine thebehavioral, social economic, and environmental determinants of leprosy in Kediri, East Java, using a path analysis model. Subjects and Method: This was a case control study conducted at the Leprosy Hospital, Kediri, East Java, from November to December 2017. A total sample of 150 study subjects consisting of 75 leprosy patients and 75 non-diseased subjects were selected for this study by fixed disease sampling. The dependent variable was leprosy. The independent variables were personal hygiene, education, employment status, family income, dwelling density, humidity, and migration. Data on leprosy diagnosis was taken from medical record. The other data were collected by questionnaire. The data were analyzed by path analysis. Results: The risk of leprosy increased with poor personal hygiene (b= -1.20; 95% CI= -1.92 to -0.49; p= 0.001), high humidity (b= 0.73; 95%CI= 0.33 to 1.43; p= 0.040), and migration (b= 0.94; 95% CI= 0.14 to 1.74; p= 0.022). The risk of leprosy was indirectly affected by family income, dwelling density, education, and employment status. Conclusion: Poor personal hygiene, high humidity, and migration, directly affect the risk of leprosy. Education, employment status, family income, and dwelling density indirectly affect the risk of leprosy. Keywords: leprosy, social economic, environmental, personal hygien

Factors Associated with Years of Life with Disability in Patients with Leprosy: A Path Analysis Evidence from Kelet Hospital, Central Java

Background: Leprosy, also known as Hansen’s disease (HD), is a long-term infection by the bacterium Mycobacterium leprae or Mycobacterium lepromatosis. World Health Organization (WHO) reported that the number of leprosy casesin 2015 was 211,973 in 108 countries in the world. The number of leprosy cases in Indonesia ranks third after India and Brazil. There are 14,000 (8%) leprosy cases with disability. This study aimed to determine factors affecting disability and Years of Life with Disability (YLD) attributable to leprosy in patients with leprosy at Kelet Hospital, Central Java. Subjects and Method: This was a case control study conducted at Kelet Hospital, Central Java, from December 2017 to January 2018. A total sample of 140 leprosy patients was selected for this study using fixed disease sampling, consisting of 70 patients with disability and 70 patients without disability. The dependent variables were disability and YLD. The independent variables were age, education level, and self care. The data were collected by questionnaire and analyzed by path analysis. Results: Disability increases YLD (b= 0.37; 95% CI= 0.31 to 0.43; p<0.001). Disability increased with older age (b= 1.41; 95% CI= 0.38 to 2.43; p= 0.007) and decreased with better self care (b= -3.80; 95% CI= -4.90 to -2.71; p<0.001). Better self care increased with high education level (b= 1.96; 95% CI= 1.03 to 2.89; p<0.001). Conclusion: Older age increases the risk of disability, whereas self care decreases the risk of disability. Disability itself increases YLD. Higher education improves self care. Keywords: leprosy, disability, years of life with disability, determinan

Determinants of Safe Sex Behavior for Preventing Sexually Transmitted Infection in Female Sex Workers In Surakarta

Background: Sexually transmitted infection (STI) is a global issue because the gates HIV transmission. Female sex workers have a high risk of contracting and transmitting the STI and HIV/ AIDS because of unsafe sex behavior. This study aimed to analyze safe sex behavior determinants for preventing sexually transmitted infection in female sex workers in Surakarta. Subjects and Method: This was an analytic observational study with a cross-sectional design. The studywas conducted in Surakarta, from December2017 to January 2018. A sample of 105 female sex workers selected by fixed disease sampling. The dependent variable was safe sex behavior. The independent variables were perceived susceptibility, perceived seriousness, perceived benefit, perceived barriers, cues to action, self-efficacy, and perceived threat. The data were collected by questionnaire analyzed by path analysis. Results: Safe sex behaviour increased with perceived threat (b=0.19, SE=0.05, p=0.003), perceived benefit (b=0.29, SE= 0.05, p=0.002), and self-efficacy (b= 0.35, SE= 0.12, p<0.001). Safe sex behaviour decreased with perceived barrier b= -0.29, SE= 0.06, p= 0.002). Conclusion: Safe sex behavior is positively and directly affected by perceived threat, perceived benefit, and self efficacy. The safe sex behavior is negatively and directly affected by perceived barrier. Perceived barrier, perceived seriousness, and cues to action indirectly and positively affect on safe sex behavior. Keywords: Safe sex behavior, safe sex, STI, FS

Behavioral and Environmental Determinants of Leptospirosis: A New Evidence from Klaten, Central Java Using a Path Analysis Model

Background: Leptospirosis is a bacterial disease that affects both humans and animals. Humans become infected through direct contact with the urine of infected animals or with a urine-contaminated environment. The bacteria enter the body through cuts or abrasions on the skin, or through the mucous membranes of the mouth, nose and eyes. Person-to-person transmission is rare. Leptospirosis a global public health issue, with an estimated annual incidence of 0.1 to 1 case/100,000 population in moderate non-endemic area, and 10 to 100 cases/100,000 population in humid and tropical endemic areas. Indonesia is the third country in the world with the highest Leptospirosis-attributable mortality. Its fatality rate ranged from 2.5% to 16.45% with an average of 7.1%. This study aimed to analyze the risk factors of Leptospirosis in Klaten, Central Java. Subjects and Method: This was a case control study conducted in Klaten, Central Java, from October to November, 2017. A sample of 49 Leptospirosis cases and 101 non-diseased controls were selected for this study by fixed disease sampling. The independent variable were employment status, history of cuts, history of water excursion, use of personal protective equipment (PPE), house condition, environmental condition, presence of mouse or cattle, history of rain or flood. The dependent variable was Leptospirosis. The data were collected by questionnaire and analyzed by path analysis. Results: The determinants that increased the risk of Leptospirosis were history of cuts (b= 1.64; 95% CI= 0.40 to 2.87; p= 0.009), history of water excursion (b= 1.98; 95% CI = 0.52 to 3.43; p= 0.008), poor house condition (b= -1.92; 95% CI = -3.08 to -0.77; p= 0.001), and poor environmental condition (b= -2.35; 95% CI= -3.48 to -1.23; p<0.001). History of cuts increased with cattle-related work (b= 1.79; 95% CI = 0.86 to 2.72; p<0.001) and absence of PPE (b= -2.54; 95% CI= -3.49 to -1.60; p<0.001). Conclusion: The behavioral and environmental determinants that increase the risk of Leptospirosis are history of cuts, history of water excursion, poor house condition, and poor environmental condition. Keywords: determinants, behavioral, environmental, leptospirosi

The Relationship Between Maternal Education, Family Income, Parenting Style, and Language Development in Children Aged 3-4 Years in Boyolali, Central Java

Background: Early childhood is a unique period where development proccess such as language development occurs rapidly. Speech and language disorders are two among the most common problems in children. The first years of life form critical period in children's life. Maximum brain plasticity occurs during the initial years of life and continues to develop for a few years with slower pace. Sensorik experience, stimulation, and language exposure during this period determine the synaptogenesis, myelinisation, and synaptic relation. National Center for Health Statistics (NCHS) reported that speech disorder ocurred approximately 0.9% in children under five, and 1.94% in children aged 5-14 years old. The purpose of this study was to determine the relationship between maternal education, family income, parenting style, and language development in children aged 3-4 years.Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted at Kindergarten Nogosari Sub-district, Boyolali, Central Java. A sample of children aged 3-4 years old were selected for this study. The dependent variable was language development. The independent variables were maternal education, family income, and parenting style. The data were analyzed by multiple logistic regression. Results: Maternal education ≥ high school (OR= 25.74; 95% CI= 1.80 to 367.62; p= 0.017), family income ≥ minimum regional wage (OR= 32.98; 95% CI= 2.93 to 370.52; p= 0.005), and democratic parenting style (OR= 20.19; 95% CI= 1.83 to 222.82; p= 0.014), had positive and statistically significant relationships with language development in children aged 3-4 years old.Conclusion: Maternal education ≥ high school, family income ≥ minimum regional wage, and democratic parenting style, have positive and statistically significant relationships with language development in children aged 3-4 years old.Keywords: maternal education, family income, parenting style, child language developmentCorrespondence: Muryanti. School of Health Polytechnics, Poltekkes Surakarta. Email: [email protected] Journal of Medicine (2016), 1(2): 100-107https://doi.org/10.26911/theijmed.2016.01.02.0

Association Between Self-Esteem, Self-Efficacy, Peers, Parental Controls and Sexual Behavior in Adolescentsat High School, Surakarta

Background: Sexual behavior among teenagers is worrying. It is influenced of permissive attitude shift, causing violation of norms, ethics in society. One factor is the opening of information about sex freely circulating in the community. In Surakarta adolescent at high school never did kiss the lips of 10.53%, a kiss in 5.6%, 4.23% masturbation and sexual intercourse 3.09%. This study aimed to determine the association of self-esteem, self-efficacy, peers, parents, with premarital sexual behavior in adolescent high school in Surakarta.Subjects and Method: This was an observational analytic study with cross sectional design. A total sample of 113 respondents was taken by using proportional random sampling. The population was in ten high schools of 1663 subjects in Surakarta. Data analysis used linear regression.Results: There is a relationship of self-esteem with premarital sexual behavior (b1= -0.202; 95% CI= -0.39 to -0.01; p= 0.036) were significantly higher self-esteem then reduce premarital sexual behavior. There is a relationship of self-efficacy with premarital sexual behavior (b2= -0.168; 95% CI= -0.33 to -0.01; p= 0.041) were significantly higher self-efficacy students then reduce premarital sexual behavior. There are peer relationships with premarital sexual behavior (b3= -0.271; 95% CI= -0.51 to -0.04; p= 0.024) were significantly better peer support and will reduce premarital sexual behavior. There is a parental relationship with premarital sexual behavior (b4= -0.236; 95% CI= -0.44 to -0.03; p= 0.025), the better the more parental supervision reduce premarital sexual behavior. There is a relationship of self-esteem, self-efficacy, peers, parents with premarital sexual behavior (F = 10.053; 95% CI= 24.16 to 43.61; p <0.001; R 2 = 24.4%)Conclusion: Self-esteem, self-efficacy, peers, and parents are associated with premarital sexual behavior in adolescents of 24.4%. Seventy six point six percent is influenced by other variables outside the research model.Keywords: Self-esteem, Self Efficacy, Peers, Parents Supervision, Premarital sex behaviorCorrespondence: Winarni. School of Public Health, Sebelas Maret University, Surakarta.Journal of Health Promotion and Behavior (2016), 1(1): 46-53https://doi.org/10.26911/thejhpb.2016.01.01.0

The Effectiveness of Mosquito Breeding Site Eradication and Role of Wiggler Controller Toward Countermeasure Effort of Dengue Hemorrhagic Fever in Klaten, Central Java

Background: Countermeasure of Dengue Hemorrhagic Fever (DHF) is more prioritizing in preventive activities such as implementing mosquito breeding site eradication or PSN through 3M plus by involving the society and facilitating the establishment of wiggler controllers or Jumantik. Role of wiggler controllers is very important especially in initial vigilance system moreover in the outbreaks of DHF because of their function in monitoring the wigglers' position and hampering the initial development of DHF transmitter vector. The activeness of wiggler controllers in monitoring their environment is expected to decrease the number of DHF cases. This study was aimed to investigate analyzing the effectiveness of mosquito breeding site eradication and the roles of wiggler controllers or Jumantik in prevention and countermeasure efforts of DHF.Subject and Methods: This was a qualitative study with case design. This was conducted in Juwiring, Ngawen, North Klaten community health center in Klaten, Central Java were selected by Purposive Sampling. The data was collected with observation, document analysis, and in-depth interview. The data validity included a triangulation, methodological triangulation, and theory triangulation. The data was analyzed with data collection, data reduction, data presentation, and drawing the conclusion were included in the data analysis of this research.Results: Several obstacle factors were people's behavior which was not routinely doing the eradication of mosquito breeding site or PSN, lack of knowledge about PSN, lack of health workers especially in PSN program and the role of public figure was not maximum yet. Those could be seen from the outcome of PSN program which was divided by the output of PSN. Morbidity rate of DHF and mortality rate of DHF in Klaten District were still high and did not achieve the national target yet. Then, people's knowledge about PSN program was quite good, people's behavior was also good especially to the implementation of PSN program although some of them behaved poorly, their reliance and trust were good especially to the implementation of PSN program, then, there were no contradictions between society values and PSN Program. Health facilities and infrastructures were adequate to perform individual health effort in promotive, preventive, curative, or rehabilitative which were done by the government, regency government, or the society especially to encourage the implementation of PSN program. Amount of health officers for the implementation of PSN Program was not ideal yet, especially for Epidemiology officers and Health Promotion officers. Public and government supports were quite good in the implementation of PSN Program. Attitude and behavior of public figures, religious leaders, and also health officers were quite good. Although some of public figures did not give their full support. Government policy in encouraging the implementation of PSN Program itself was quite good. That was proven by publishing Region Regulation No. 03 of 2010 and Regent Regulation No. 05 of 2013 about prevention and disease control from animal sources, but its implementations were not maximum and binding yet. The role of wiggler controllers in decreasing the rate of DHF cases could be optimized by specific commitment from the policy makers, started from the highest to the lowest in order to build better initial vigilance system. Operational fund for the wiggler controllers (Jumantik) in Klaten District was not ideal yet, so, commonly they spent their own money for the operational fund when they did their job.Conclusion: The effectiveness of PSN Program in Klaten District to overcome DHF was effective enough. The role of predisposition factor toward mosquito breeding site eradication or PSN in order to overcome DHF in Klaten District was became the booster of the implementation of mosquito breeding site eradication program (PSN). Enabling Factors are enormously important in implementing the PSN Program in the public. The encourage factor on PSN program was not maximum yet, especially in the implementation of Region Regulations and Regent Regulations particularly about Prevention and Disease Control from Animal Source. The roles of wiggler controllers in the countermeasure of DHF in Klaten District was very important especially for the initial vigilance of DHF because its functions were used to monitor their existences and also hamper the initial development of DHF transmitter vectorKey words: mosquito breeding site eradication, DHF, the role of wiggler controllersCorrespondence : Riska Chandra Pradana. Dr. R Soeprapto Cepu Hospital. Email: [email protected] of Epidemiology and Public Health (2016), 1(1): 37-48https://doi.org/10.26911/jepublichealth.2016.01.01.0

Path Analysis on Factors Associated with the Risk of Scabies Among Students at Darussalam Islamic Boarding School, Blokagung, Banyuwangi, Indonesia

Background: Scabies is an infectious disease that is particularly important in populations with low socioeconomic level in developing countries. Scabies is not life-threatening so usually get treatment is low. But actually the chronic and severe scabies can cause dangerous complications. This study aimed to analyze factors associated the students with scabies disease.Subjects and Methods: This was an observational analytical study with cross-sectional design. This was conducted at Darussalam Islamic Boarding School of Blokagung Banyuwangi, Indonesia in March 23 to April 30,2016. A total of 90 samples were amounted 30 students with scabies and 60 had not scabies. Data collection was using questionnaire. Data analysis used STATA 13.Results: Four variables associated with scabies was associated indirectly obtained between knowledge and myth was negative amounting to the value of -1.88 (p < 0.001) path coefficient between knowledge and healthy behaviors is positive that amounting to 1.68 with value (p = 0.016), the path coefficient between myth - 2:39 (p = 0.038), the path coefficient between allowance to health behaviors positive value that is equal to 2:00 (p = 0.026), the path coefficient between health behavior with scabies is negative in the amount - 3:43 (p < 0.001).Conclusion: The level of knowledge, myths, pocket money indirectly related to the incidence of scabies through healthy behaviors. It is expected to reduce disease scabies students can change the behavior of health to be good.Keywords: scabies, level of knowledge, myths, pocket moneyCorrespondence: Febrika Devi Nanda. Bakti Indonesia University, Banyuwangi. Email: [email protected] of Epidemiology and Public Health (2016), 1(1): 18-26https://doi.org/10.26911/jepublichealth.2016.01.01.0

Path Analysis on Factors Associated Withthe Incidence of Diarrhea in Infants Aged 6-12 MonthsatKaranganyar Community Health Center,inPurbalingga, Indonesia

Background: A diarrheal disease is an endemic disease and has outbreak potential in Indonesia. In Indonesia (2012) the number of pain diarrhea on toddler reached 900 per 1,000 inhabitants. This study aimed to determine the factors associated to the incidence of diarrhea in infant aged 6-12 months. Subjects and Method: This was an observational analytic study with cross sectional design. This was conducted in Karanganyar Community Health Center, Purbalingga, Indonesia, in April-Mei 2016. A total of 100 subjects was selected Fixed Disease. The data was using the questionnaire. The data analysis used path analysis.Results: There was a direct correlation between breast feeding, nutritional status, personal hygiene of mothers and infants, and the availability of basic sanitation with the incidence of diarrhea, and statistically significant (b= 2.62; 95% CI= 1.00 to 4.24; p= 0.001), (b= 3.37; 95% CI = 0.61 to 6.12; p=0.017), (b=3.70; 95% CI=2.07 to 5.33; p<0.001), (b=3.00; 95% CI=0.69 to 5.32; p=0.011). There is a positive correlation between indirect breast feeding with the incidence of diarrhea through nutritional status, culture with the incidence of diarrhea through breast feeding, culture with the incidence of diarrhea through the facility's individual mothers and babies, the availability of basic sanitation with diarrhea through individual facility's mothers and babies, statistically significant (b=0.91; 95%CI =-0.28 to2.11;p=0.135), (b=1.83; 95% CI=0.95 to 2.22; p<0.001), (b=1.40; 95% CI=0.46 to 2.25; p=0.003), (b=1.10; 95% CI= -0.10 to 2.22; p=0.076).Conclusion: There is a direct correlation between breast feeding, nutritional status, personal hygiene of mothers and infants, and the availability of basic sanitation with the incidence of diarrhea. There is indirect correlation between breast milk with the incidence of diar­rhea through nutritional status, culture, personal of mother and infants, the availability of basic sani­tation with diarrhea through individual facility's mother and the baby.Keywords: nutritional status, culture, human breast milk, sanitation, individual hygiene, diarrheaCorrespondence: Norma Arista Narzah.Community Health Center, Karanganyar, Purbalingga, Indonesia. Email: [email protected]. Journal of Maternal and Child Health (2016), 1(1): 13-18https://doi.org/10.26911/thejmch.2016.01.01.0