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Kata kunci: Jemaah haji, Pengendalian DM, Pembinaan Kesehatan Haji
This thesis discusses the influence of Hajj health development and guidance program on the success of DM control in pilgrims whose diagnosed Diabetes Mellitus. This research is quantitative research with cross sectional design. The results suggest that influence of Hajj Health Development was very important on the success of DM control, hajj pilgrims should be strived to follow all the activities of Hajj health Development so that the health status of Hajj can be increased to meet health requirements.
Key words: Hajj pilgrims, DM control, Hajj health development
Background: Digital transformation in the healthcare sector has become increasingly significant since the COVID-19 pandemic, driving the accelerated implementation of information technology, including Electronic Medical Records (RME). In Indonesia, the Ministry of Health has required all healthcare facilities, including Type C Private Hospitals, to implement RME. However, the successful implementation of RME depends not only on the existence of the system, but also on the hospital's level of digital maturity. Research Objective: This study aims to analyse the effect of digital maturity level on RME implementation in Type C Private Hospitals. Research Methodology: The research was conducted with a quantitative approach using a cross-sectional survey method of 202 health workers in Type C private hospitals. The research instrument refers to the Ministry of Health's Digital Maturity Index (DMI) with seven main dimensions, as well as five dimensions of RME implementation adapted from the Technology Acceptance Model (TAM). Data were analysed using PLS-SEM to test the validity, reliability, and relationship between variables. Research Results: The results showed that the level of digital maturity significantly influenced the success of RME implementation, with the dimensions of ‘Data Utilisation’ and ‘Availability of RME Features in health services’ being the dominant factors. This research provides a practical contribution in developing strategies to strengthen hospital digitalisation and provides input for policy makers in supporting effective and sustainable digital transformation
Kata kunci: Hipertensi, wanita, obesitas
Hypertension is an important public health challenge because it has a strong effect with cardiovascular disease and premature death. The number of hypertension increases from year to year. At the same risk factors, women are more susceptible to hypertension. Many factor that influence of hypertension, one of them is obesity. This study aims to determine the effect of obesity to hypertension in adult women (21-40 years old) in Indonesia, 2014. This study uses secondary data of Indonesian Family Life Survey (IFLS 5, 2014) with cross sectional study design. The number of samples is 6,861 people. The results of this study indicate that 6,861 of women aged 21-40 years old are 11.98% (95%CI: 10,76-12,01) hypertension, 24.78% (95%CI: 23,6-25,37) obesity. The results of multivariate analysis, there is no covariate variable that becomes confounding variable in influence of obesity to hypertension in this research, odds ratio influence obesity to hypertension is 3,29. This means that women with obesity have risk 3,29 to be hypertension. Health Office needs to improve the early detection program of hypertension, especially in obese women with aged 21-40 years olds. The society must apply a healthy lifestyle by maintaining food intake.
Key words: Hypertension,women, obesity
Data and information have an important role in the decision-making process. In the health sector, data utilization is used to estimate the burden of a disease including its determinants. Tuberculosis (TB) remains a global health problem that infects 10.6 million people worldwide in 2021, where Indonesia is the second highest contributor to caseload after India. The province with the highest number of TB case findings in Indonesia in the last 5 years is West Java Province. To find out the spatial model of risk factors that have an effect on each district/city, an analysis was carried out using a spatial approach using secondary data. The results of this study indicate that there is a positive spatial autocorrelation that has a significant effect on the number of TB cases in West Java Province, which means that the distribution of cases forms a clustered pattern and adjacent areas tend to affect the surrounding area. The districts/cities that have become hotspot areas and are priority areas for intervention in handling TB cases in West Java Province are Bekasi Regency, Bogor Regency, Karawang Regency, Purwakarta Regency, Sukabumi Regency, Bekasi City, Bogor City and Depok City. Spatial analysis found risk factors that had different effects in each district/city area, namely the poor population, temperature and altitude, so that the forms of health interventions carried out were also different. Utilization of data with this spatial approach is expected to be able to support decision-making support related to health intervention programs and policies that are specific to the area so that they are right on target and able to reduce the number of TB cases in West Java Province.
ABSTRAK Nama : Noerfitri Program Studi : Ilmu Kesehatan Masyarakat Judul : Analisis Survival Pengaruh Rujuk Balik dan Tipe Pasien Terhadap Kejadian Lost to Follow-up pada Pasien Multidrug-Resistant Tuberculosis di Indonesia Tahun 2014-2015 Pembimbing : R. Sutiawan, S.Kom, M.Si Tingginya angka insidens TB MDR di Indonesia, dibarengi dengan tingginya tingkat Lost to Follow-up (LTFU) pada pengobatan pasien TB MDR. Pasien TB resisten obat memiliki kemungkinan LTFU lebih besar dibandingkan pasien TB sensitif obat dikarenakan durasi pengobatan yang lebih lama. Selain itu, pasien TB MDR yang tidak melanjutkan pengobatannya sampai tuntas memiliki peningkatan risiko kematian akibat TB. Studi ini bertujuan untuk mengetahui pengaruh rujuk balik dan tipe pasien terhadap kejadian LTFU pada pasien Multidrug-Resistant Tuberculosis (TB MDR) di Indonesia. Studi dilakukan pada Mei-Juni 2018 di Subdit TB – Direktorat P2PML, Ditjen P2P Kementerian Kesehatan RI. Desain studi yang digunakan adalah desain studi kohort retrospektif. Jumlah sampel pada studi ini adalah 961 pasien. Sampel diambil secara total sampling. Berdasarkan status rujuk baliknya, 86,3% pasien dilakukan rujuk balik dan 13,97% pasien tidak dirujuk balik. Berdasarkan kategori tipe pasien, 35,17% kasus kambuh, 5,52% pasien baru, 13,94% pasien pernah LTFU, 23,10% kasus gagal pengobatan kategori 1, 20,29% kasus gagal pengobatan kategori 2, 1,9% lain-lain (pasien tidak diketahui riwayat pengobatan TB sebelumnya). Dari studi ini, diketahui bahwa proporsi kejadian LTFU sebesar 28,40% dengan kumulatif hazard LTFU sebesar sebesar 1,12 selama 39 bulan pengamatan, sehingga didapatkan hazard rate sebesar 2,88/100 orang-bulan. Hasil analisis multivariabel dengan regresi cox time-dependent menunjukkan bahwa rujuk balik menurunkan peluang terjadinya LTFU sebesar 46% (HR 0,54; 95% CI 0,35-0,84) pada kondisi variabel tipe pasien dan umur sama (adjusted). Untuk tipe pasien, tipe pernah LTFU, gagal pengobatan kategori 2 dan tidak diketahui riwayat pengobatan TB sebelumnya meningkatkan peluang terjadinya LTFU masing-masing sebesar 50% (HR 2,02; 95% CI 1,18-3,45), 53% (HR 2,13; 95% CI 1,240-3,66), dan 74% (HR 3,80; 95% CI 1,54-9,36) dibandingkan dengan tipe pasien kambuh (baseline) pada kondisi variabel rujuk balik, jenis kelamin, dan umur sama (adjusted). Pada laki-laki, efek tipe gagal pengobatan kategori 2 lebih rendah 0,26 kali dibandingkan dengan pasien wanita dengan tipe gagal pengobatan kategori 2. Petugas kesehatan perlu meluangkan waktu yang lebih banyak untuk memberikan komunikasi, informasi, dan edukasi mengenai pengobatan TB serta mengenai manfaat rujuk balik kepada pasien TB MDR. Risiko LTFU meningkat pada pasien yang bertipe pernah LTFU, gagal pengobatan kategori 2, dan tidak diketahui riwayat pengobatan TB sebelumnya dibandingkan pasien dengan tipe kambuh, karena tipe kambuh sudah teruji kepatuhannya terhadap pengobatan sebelumnya. Perlunya skrinning tipe pasien dengan baik untuk mengidentifikasi risiko LTFU berdasarkan tipe pasien sejak awal pasien memulai pengobatan. Kata kunci: LTFU, rujuk balik, tipe pasien, TB MDR
ABSTRACT Name : Noerfitri Study Program : Public Health Title : Survival Analysis of Influence of Decentralization and Type of Patient on Lost to follow-up in Multidrug-Resistant Tuberculosis Patients in Indonesia 2014-2015 Supervisor : R. Sutiawan, S.Kom, M.Si The high incidence rate of MDR-TB in Indonesia is accompanied by high rate of lost to follow-up (LTFU) in the treatment of MDR-TB patients. Drug resistant TB patients have a greater risk of LTFU than drug-sensitive TB patients due to longer treatment duration. In addition, MDR-TB patients who did not continue treatment completely had an increased risk of dying from TB. The aims of this study were to determine the decentralization influence and patient type on the incidence of LTFU in MultidrugResistant Tuberculosis (MDR-TB) patients in Indonesia. This study was conducted in May-June 2018 at Subdirectorate of TB - Directorate of Prevention and Communicable Disease Control, Directorate General of Prevention and Disease Control - Ministry of Health of the Republic of Indonesia. The study design was retrospective cohort. The number of samples in this study was 961 patients. Samples were taken in total sampling. Based on the decentralization status, 86.3% of patients were decentralized. Based on the type of patient category, 35.17% of relapse, 5.52% of new, 13.94% of after LTFU, 23.10% of failure category 1, 20.29% of failure category 2, 1.9 % of other patients (unknown history of previous TB treatment). The proportion of incidence of LTFU is 28.40% with cumulative hazard of LTFU equal to 1.12 during 39 months of observation, so hazard rate is 2.88 / 100 person-month. In multivariable analysis with cox regression time-dependent revealed that decentralization reduced the probability of LTFU up to 46% (HR 0.54, 95% CI 0.35-0.84) after controlled by type of patient and age. For patient type, treatment after LTFU, failure category 2 and unknown history of previous TB treatment increased the probability of LTFU by 50% (HR 2,02; 95% CI 1,18-3,45), 53% (HR 2,13; 95% CI 1,240-3,66), and 74% (HR 3,80; 95% CI 1,54-9,36) consecutively compared with the type of relapse patients (baseline) after controlled by the decentralization, gender, and age. In male patients with failure treatment category 2, the effect was 0.26 times lower compared with failure category 2 in female patients. Health workers need to spend more time in communicating, informing and educating about TB treatment and the benefits of decentralization to MDR-TB patients. The risk of LTFU increased in type of patient after LTFU, treatment failure category 2, and unknown history of previous TB treatment compared with patients with relapse types. The need for good patient type screening to identify the risk of LTFU by type of patient from the initial of treatment. Keywords: LTFU, decentralization, type of patient, MDR-TB
Kematian ibu merupakan salah satu permasalahan kesehatan yang masih terjadi. AKI Indonesia pada tahun 2020 mencapai 189 per 100.000 kelahiran hidup yang masih di atas target SDGs 2030. Dan Jawa Timur merupakan provinsi yang memiliki kasus kematian ibu cukup tinggi di Indonesia. Berbagai faktor dapat berpengaruh terhadap kejadian kematian ibu, baik dari faktor kesehatan maupun non kesehatan. Pendekatan spasial pada penelitian ini bertujuan untuk melihat pengaruh faktor secara lokal di antarwilayah dan antarwaktu. Dalam penelitian ini, digunakan data sekunder berupa agregat dari publikasi profil kesehatan Jawa Timur dan BPS Jawa Timur, dengan variabel dependen kematian ibu, serta independen Rata-Rata Lama Sekolah (RLS), usia kawin, penduduk miskin, rasio tenaga kesehatan, rasio puskesmas, persalinan di fasyankes, dan ANC dari tahun 2021 – 2023. Juga terdapat atribut spasial berupa ketinggian wilayah dan kerapatan jalan serta peta digital. Metode yang digunakan adalah pemetaan faktor risiko dengan overlay serta statistik spasial dengan Geographically Weighted Regression. Didapatkan faktor risiko determinan kematian ibu cenderung sedang dan tinggi di tahun 2021, 2022, dan 2023. Juga didapatkan kejadian kematian ibu terjadi autokorelasi global dengan pola berkelompok. Dan secara autokorelasi lokal, terdapat beberapa wilayah signifikan di setiap tahun. Sedangkan untuk hasil GWR, didapatkan variabel signifikan lokal di tahun 2021 adalah ANC di seluruh wilayah, dan 2022 tidak ada variabel signifikan, sedangkan 2023 beberapa wilayah signifikan dengan rasio tenaga kesehatan dan persalinan di fasyankes, dan beberapa tidak signifikan. Dan untuk model dari nilai R2 bervariasi, meskipun cenderung meningkat dari tahun 2021 ke 2023. Dari hasil penelitian ini diharapkan dapat menjadi bahan perencanaan bagi program kesehatan ibu dan anak di Jawa Timur, agar dapat fokus ke wilayah prioritas intervensi. Kata kunci: kematian ibu, spasial, sosial-ekonomi, layanan kesehatan
Maternal mortality remains a significant health issue. Indonesia’s maternal mortality rate (MMR) in 2020 reached 189 per 100,00 0 live births, still above the 2030 SDGs target. East Java is one of the provinces with the highest maternal mortality rates in Indonesia. Various factors can influence maternal mortality rates, both health-related and non- health-related. The spatial approach in study aims to examine the local influences of these factors across regions and over time. In this study, secondary data in the form of aggregates from East Java health profile publications and the East Java Central Statistics Agency (BPS) were used, with the dependent variable being maternal mortality and the independent variables being Average Years of Schooling (RLS), age at marriage, poor population, health worker ration, health center ratio, deliveries in health facilities, and ANC from 2021 – 2023. Spatial attributes include elevation, road density, and digital maps. The methods used include risk factors mapping with overlay and spatial statistics using Geographically Weighted Regression (GWR). The results indicate that risk factors for maternal mortality tend to be moderate to high ini 2021, 2022, and 2023. Additionally, maternal mortality events exhibit global autocorrelation with a clustered pattern. In terms of local autocorrelation, there were several significant regions in each year. For the GWR results, the significant local variable in 2021 was ANC across all regions, while in 2022 there were no significant variables, and in 2023, some regions were significant with the ratio of healthcare workers and births in healthcare facilities, while others were not significant. The R2 values of the models varied, though they tended to increase from 2021 to 2023. The findings of this study are expected to serve as a basis for planning maternal and child health programs in East Java, enabling a focus on priority intervention areas. Key words: maternal mortality, spatial, social-economic, health services