Jurnal Kesehatan Masyarakat starting in 2024 migrates from OJS 2 to OJS 3 to better secure from various unwanted things, including journal hacking and so on. To submit, the author please visit the new website page of our journal at the link https://journal.unnes.ac.id/journals/kemas MIGRATION OFFICIAL STATEMENT HERE KEMAS: Jurnal Kesehatan Masyarakat [P-ISSN 1858-1196 | E-ISSN 2355-3596] publised by Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK). KEMAS publishes the article based on research or equivalent to research results in public health or other disciplines related to public health that has not been loaded/published by other media. The journal contains articles about epidemiology and biostatistics, health policy and administration, public health nutrition, environmental health, occupational health and safety, health promotion, reproductive health, maternal and child health, and other related articles in public health. The journal can be used by health practitioners, health caregivers, teachers, medical students, and people who are interested in public health issues. The journal was first published in July 2005. Since 2022, the journal were published quarterly a year in July, October, January, and April. Starting October 2022, articles in KEMAS Journal have been accepted for indexing to Scopus. Accreditation Certificate: 2014-2019, 2018-2023 Indexing GARUDA SINTA DIMENSIONS DOAJ SCOPUS SCIMAGOJR
Universitas Negeri Semarang in collaboration with Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI Tingkat Pusat) and Jejaring Nasional Pendidikan Kesehatan (JNPK)
Integrated Situational Analysis of Chronic Energy Deficiency to Inform A Community-Based Mentoring Model in Indonesia
Maternal malnutrition in Central Lombok remains a challenge. This study aimed to identify multilevel determinants of chronic energy deficiency among pregnant women through an integrated situational analysis using a mixed-methods approach to inform a community-based mentoring model in Indonesia. A sequential exploratory mixedmethods design was conducted in 2025 at the district health office and five community health centers. The qualitative phase used purposive sampling of stakeholders and cadres, while the quantitative phase included 206 pregnant women with mid-upper arm circumference (MUAC) <23.5 cm selected through cluster random sampling. The dependent variable was MUAC status, with independent variables including maternal characteristics, dietary intake, food taboos, antenatal care (ANC), iron–folate supplementation, mentoring exposure, knowledge, and attitudes. Data were analyzed using contingency coefficients and multiple logistic regression. Food taboos were reported by 43.2% and were significantly associated with MUAC (p=0.023). Energy and protein inadequacy were 91.3% and 84.0%, respectively. ANC attendance (94.7%) and iron–folate use (91.3%) were high. High-risk maternal age increased the odds of lower MUAC (OR=2.364; 95% CI:1.208–4.629), while higher education decreased the odds (OR=0.528; 95% CI:0.279–0.998). Mentoring exposure (OR=2.636; 95% CI:1.238–5.612) and parity (OR=1.610; 95% CI:1.122–2.310) were also significant. These findings inform community-based mentoring models focusing on dietary behavior and social context.
Copyright (c) 2026 Jurnal Kesehatan Masyarakat
Pesticide Exposure and Oxidative Stress Biomarkers Among West Java Applicators
Pesticide exposure may induce oxidative stress, which subsequently contributes to the onset of chronic diseases. This study aimed to evaluate the association between pesticide exposure intensity and oxidative stress among pesticide applicators using urinary malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) as biomarkers. A total of 74 vegetable farmers who had actively applied pesticides for at least one year were included in this cross-sectional study. The cumulative exposure level (CEL) of pesticides was estimated using a validated quantitative method. Urinary MDA and 8-OHdG were analyzed at an accredited testing laboratory. The Mann-Whitney U test was used to assess differences in MDA and 8-OHdG levels in the study population by individual and occupational characteristics. The mean age was 51.2 years (SD 11.3). Pesticide applicators were exposed to multiple pesticide classes, and the use of complete PPE was low. Higher cumulative pesticide exposure (CEL) was associated with increased oxidative stress, reflected by elevated urinary MDA and 8-OHdG, with different biomarkers capturing distinct exposure dimensions. This finding shows the need for comprehensive preventive strategies that focus on reducing exposure intensity through safer work practices, complemented by the appropriate use of personal protective equipment and ongoing education.
Agrochemical toxicity, Malondialdehyde, Oxidative stress, Occupational exposure, 8-hydroxy-2'-deoxyguanosine
Vitamin D Deficiency in Elderly Postmenopausal Women: The Role of Sunlight, Diet, and Vitamin D Status
In Indonesia, the prevalence of vitamin D deficiency, especially in the geriatric female population. Vitamin D is crucial for postmenopausal (elderly) women to maintain bone density, prevent osteoporosis, and reduce the risk of falls due to muscle weakness. The study objective was to determine the influence of sunlight, dietary supplement intake, and physical activity on the risk of Vitamin D deficiency in elderly postmenopausal women. This study used a cross-sectional design and will be conducted from October-November 2024 at a nursing home in Surabaya. The respondent were elderly postmenopausal women (>60 years) who live in a nursing home in Surabaya, with no comorbidities that affect the ability to eat and do physical activities. The sampling technique in the study was purposive sampling. Their correlations were determined using the Spearman correlation test to identify the correlation between sun exposure, diet, and vitamin D status with vitamin D level. The average age of respondents was 63.47±73.25 years in 57 respondents. The average vitamin D level was 19.4667±6.67 ng/mL. Higher sun exposure leads to higher blood vitamin D levels. For dietary, indicating a significant relationship between higher egg and/or vitamin D supplement intake and increased blood vitamin D levels. Most respondents didn’t have low risk of vitamin D deficiency and vitamin D level insufficiency was 29 people (50.88%). There was a significant relationship between sun exposure frequency, diet of egg, vitamin D supplements, and vitamin D status variable and vitamin D levels.
Utilization of Oral Hyperglycemic Drugs Among Type 2 Diabetes Patients in Indonesia’s Major Maize-Producing Region
Diabetes Mellitus (Diabetes) is a degenerative and chronic disease caused by impaired carbohydrate metabolism due to insulin hormone insufficiency. Data from the Gorontalo Provincial Health Department in 2023 showed that there were 18.299 cases of diabetes mellitus diagnosed. The study aimed to analyze the use of oral hyperglycemic drugs in patients with type 2 diabetes mellitus in Bone Bolango Regency, Gorontalo Province. This research is a quantitative study with an observational analytical approach using a cross-sectional design. The population of this study was diabetic patients who were using oral hyperglycemic drugs in the Kabila Health Center area, with 126 people selected using the total sampling method. The data on gender, age, income, health worker support, and family support were analyzed using binary logistic regression. The results showed a significant difference between income (P = 0.013) and health worker support (P = 0.022) with compliance. In contrast, the gender (P = 0.333) and family support (P = 0.070) did not significantly differ in compliance. Each category that had significant differences was subjected to multivariate analysis. The results showed no difference in compliance based on gender (P = 0.235), 2). However, there was a difference in compliance based on age (P = 0.022) and income level (P = 0.020). The variable explaining the dependent variable was only 19.5%, and the rest was described by other variables outside the research model (80.5%). The statistical analysis concluded that 1) gender variables (Sig 0.333) and family support (0.070) did not have a significant effect on compliance, 2) income variables (0.013) and health worker support (0.022) had a significant effect on compliance.
Empowerment Scale for Pregnant Adolescents: Psychometric Testing on Antenatal Care and Birth Attendant Choices
Inability of pregnant adolescents to make decisions regarding antenatal care and the choice of birth attendants increases the risk of maternal and childbirth complications. This study aimed to develop and validate an empowerment measurement instrument based on the Cattaneo and Chapman framework. A quantitative approach was applied in three community health centers (Puskesmas) in Cimahi City, known for high adolescent pregnancy rates. Data were collected by three community volunteers who distributed questionnaires directly and via Google Forms. Instrument validity was examined through a readability test with 10 adolescents and face validity by four experts. Thirty pregnant adolescents participated. Reliability was tested using Cronbach’s alpha. The empowerment construct produced 40 statements; the Item-Total Correlation test revealed one invalid self-efficacy item, two knowledge items, two skill items, one action item, and three impact items. The overall Cronbach’s alpha was 0.92, with subscales: meaningful goals (0.84), self-efficacy (0.58), knowledge (0.70), skills (0.52), action (0.77), and impact (0.83). This study concludes that the empowerment instrument is valid and reliable, and further research is recommended to revalidate it through content validity and factor analysis with larger samples
adolescent pregnancy; antenatal care; birth attendants; empowerment; psychometric testing
Photoprotection Practice and Skin Health Habits on the Incidence of Pigmentation
The skin is susceptible to intrinsic and extrinsic factors — including sun exposure, diet, and lifestyle which can disrupt homeostasis and induce pigmentation. This pilot study evaluated photoprotective behaviors and skin health habits and their association with pigmentation incidence among medical students at Sam Ratulangi University, Indonesia (February–April 2024). Using a self-administered questionnaire, 94 valid respondents were included (mean age 21.4 ± 1.7 years; response rate 37.6%). Pigmentation was reported by 34.0% of respondents, predominantly female (59.8%). Associated factors included irregular sunscreen use, history of sunburn, passive smoking, prolonged sun exposure, poor dietary habits, insufficient sleep, limited exercise, and elevated stress. Statistically significant associations (P < 0.05) were identified for daily sunscreen use, sunscreen use during outdoor activities, history of sunburn, and daily stress. Although pigmentation incidence was relatively low, concerning gaps in photoprotective and skin health behaviors were observed. As future healthcare providers, medical students represent a critical target population. Early education on sun-related damage, photoprotection, and skin health habits is recommended to improve knowledge, attitudes, and practices in this group.
Work-Environment Predictors of Burnout Among Psychiatric Nurses in Indonesia
Healthcare professionals, particularly nurses, operate in demanding environments that require advanced expertise and considerable responsibility. Nurses frequently encounter heavy workloads, increasing their susceptibility to burnout. This risk is heightened among psychiatric nurses, who routinely care for patients with mental disorders and must address complex emotional challenges. In the present study, 22.22% of participating nurses reported experiencing burnout as a result of aggressive patient behavior. Methods: This cross-sectional study involved 180 nurses selected through stratified random sampling from outpatient, inpatient, emergency, and Intensive Psychiatric Care Unit (IPCU) settings at Dr. Radjiman Wediodiningrat Psychiatric Hospital. Environmental factors were assessed using the Copenhagen Psychosocial Questionnaire III, while burnout was measured with the Maslach Burnout Inventory. Data analysis was conducted using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to examine the association between environmental factors and burnout. Results: A statistically significant negative association was identified between environmental factors and burnout among nurses (path coefficient = -0.355, p-value < 0.05). The most influential environmental indicators included community relationships, work values, and perceived fairness. Higher levels of these indicators corresponded with lower levels of burnout. Conclusion: Environmental factors, especially community relationships, work values, and fairness, play a critical role in reducing burnout among psychiatric hospital nurses. Interventions focused on these factors may enhance nurse well-being and improve the quality of care.
Child, Parental, and Household Factors on Inactivated Poliovirus Vaccine Use
Although the immunization program requires OPV vaccine for every infant, outbreaks of polio and Acute Flaccid Paralysis (AFP) still occur frequently, triggering a rapid response of mass immunization. The vaccine of Inactivated Polio Virus (IPV) was added to prevent wild poliovirus which causes paralysis, but its effectiveness has not been optimal. The study purpose was to analyse the effect of child characteristics, perceptions, parental hygiene practices, and house's physical conditions on the IPV vaccination utilization. This study was quantitative survey with a cross-sectional approach. The population was all children aged <7 years in Central Java Province. A sample of 1,069 children was obtained through convenience sampling from 15 districts/cities serving as RCA locus for 2024 Polio SubPIN activities. Data collection was conducted through observations using the KIA Handbook, home visits, and interviews using a questionnaire. Data was analysed using descriptive, bivariate, and multivariate. The results showed that 85.9% of children utilized 4-doses OPV vaccination completely and 83.6% utilized the first dose of IPV vaccination. It was proven that OPV immunization status, parental hygiene practices, and house's physical condition were associated with IPV vaccine utilization, both partially and simultaneously. The effect of three variables was 27%, with OPV immunization status being the main predictor. There was a 3.54-fold increase in IPV utilization if OPV status was complete, followed by parental hygiene (OR=2.02) and the house's physical condition (OR=1.56). More intensive socialization regarding IPV vaccination is needed through personal communication interventions that can also motivate parents. Strengthening the vaccination service system by providing vaccine stocks and cold chains as needed, regulatory support, and effective IEC are key factors in the success of IPV vaccination
Prenatal And Postnatal Risk Factors Associated with Stunting in Children Aged 0-24 Months Banyumas Regency Indonesia
Stunting remains a serious public health challenge in Indonesia. The prevalence of stunting in Banyumas Regency reached 20.9% in 2023. Determinants of stunting are related to many factors, both prenatal and postnatal. The purpose of this study was to analyze the risk factors for stunting in children aged 0-24 months during the prenatal and postnatal periods in Banyumas Regency in 2024. This is an observational cross-sectional study that included 100 children aged 0–24 months selected through cluster random sampling. Data analysis included univariate, bivariate with chi-square, and multivariate with multiple logistic regression. The results showed that prenatal factors associated with stunting were maternal MUAC (p=0.029), gestational weight gain (p=0.031), and postnatal factors were maternal nutritional knowledge (p=0.03), parental diet (p=0.042), and child factors were gender (p=0.034), birth weight (p=0.001), and protein adequacy (p=0.04). Multivariate analysis revealed that factors influencing stunting included maternal MUAC, gestational weight gain, parental diet, and birth weight. The most influential factor was birth weight (p=0.00; OR=12.5, meaning that babies with low birth weight are 12.5 times more likely to be stunted. The results of this study emphasize and then develop appropriate interventions during the prenatal and postnatal periods to reduce stunting.
Risk Factors; Prenatal; Postnatal; Stunting; Children Aged 0–24 Months
Dose-Response Moringa Oleifera Extracts on Lactation Outcomes In Breastfeeding Women
Introduction: Herbal galactagogues such as Moringa oleifera are traditionally used to enhance breast milk production. However, evidence regarding optimal dosage is limited. This study aimed to evaluate the effects of three different doses of Moringa oleifera extract (250 mg, 650 mg, and 800 mg) on breast milk production in breastfeeding mothers. Methods: a quasi-experimental pretest posttest was conducted among 89 postpartum women from three Primary Health Centre areas in Semarang, Central Java, Indonesia. Participants received 250 mg (n=28), 650 mg (n=30), or 800 mg (n=31) of Moringa oleifera extract once daily for 14 days. Outcomes were infant weight gain, bowel movement frequency, and urination frequency. Data were collected from October 2024 to March 2025 and analysed using paired t tests and Kruskal-Wallis tests (p<0.05). Results: All dosage groups showed improvements in indicators of breast milk production. No statistically significant differences were observed between groups (p>0,05). The 650 mg group recorded the highest mean infant weight gain, whereas the 250 mg group showed the greatest increases in bowel movements and urination frequency. Conclusions: Moringa oleifera extract at 250, 650, and 800 mg/day over 14 days supported breast-milk production. Further studies are needed to clarify the dose response relationship.
moringa oleifera, galactagogue, breastfeeding women
Distribution, Severity, and Root Causes of Traffic Accidents in a Logistics Company
Traffic accidents are the main issue in logistics and transportation, causing health and economic losses, including lowering productivity. The study aimed: 1) to investigate the distribution of accidents, 2) to examine the category and severity of accidents based on operational type, and 3) to evaluate the root cause of accidents in logistics/goods transportation. This quantitative study was conducted in Indonesia using the data from Logistics Corporation from 2022 to 2023. The variable consists of operational type, accident category, severity, and root cause. This study was analysed using descriptive and inferential statistics. The chi-square was used to examine the statistical test, with the alpha set at 5%. The analysis was performed in Stata Ver 13 (College Station, TX, USA). A total of 288 accidents were reported during 2022-2023, with the accidents being highly distributed on Java (50%) and Sumatra (44.79%). The Accident category noted that collisions with objects, hits, and single-vehicle accidents are prevalent. The accident severity is as follows: minor severity (83.33%) and higher minor severity (16.67%). The statistical test also exhibits a significant on accident severity between last mile and long haul (p value < 0.05). According to operational type, long-haul operations have high accident intensity, while last-mile operations have severe accidents. The root cause of the accident is caused by third-party error (32.98%), followed by driver behavior (30.56%), driver competence (13.88%), and driver distraction (6.59%). The company should establish regulations, standard operating procedures (SOPs), work shift schedules, and vehicle maintenance protocols, and ensure their implementation. Additionally, measuring stress levels and work-related fatigue among drivers should be conducted to help prevent accidents.
Custom-Made Foot Insoles on Dynamic Balance in Children with Flexible Flat Feet: A Community-Based Study
Flexible flat feet in children are common in community and school-aged populations and may be associated with altered lower-limb biomechanics, impaired postural control, and reduced dynamic balance, potentially affecting mobility, participation, and safety in daily activities. Although custom-made foot insoles are widely prescribed, evidence regarding their functional effects on dynamic balance in community-based pediatric settings remains limited. This study aimed to evaluate the effects of custom-made foot insoles on dynamic balance among children with flexible flat feet in a community-based rehabilitation context. A pre–post intervention study was conducted involving 40 children (mean age 10.05 ± 1.04 years). Dynamic balance was assessed using the Balance Beam Test before and after the intervention. Changes in balance performance were analyzed using the Wilcoxon signed-rank test, with effect size calculated using Cohen’s d. Dynamic balance scores improved significantly after insole use (Z = −3.995, p < 0.001), with a large effect size (d = 0.81). Greater improvements were observed in children with lower baseline balance. These findings support the potential role of custom-made foot insoles within community-based rehabilitation strategies to enhance functional balance and promote safe participation among children.
Natural Disasters and Maternal-Neonatal Health Services: Systematic Review of Services Disruption and Recovery
Sudden-onset natural disasters rapidly disrupted essential maternal and neonatal health (MNH) services across the disaster cycle. This systematic review synthesized how such events affected the disruption and recovery of antenatal care (ANC), facility delivery, and emergency obstetric and neonatal care (EmONC), as well as postnatal/neonatal care, and identified the main health-system pathways involved. Searches of Scopus, ScienceDirect, and PubMed (November–December 2025) included English-language, open-access articles published between 2021 and 2026. Eligible quantitative, qualitative, and mixed-methods studies examined sudden-onset disasters and reported disruption and/or recovery of essential MNH services. Using PRISMA procedures, PEO-based criteria, and the MMAT 2018 quality appraisal, seven studies were included, primarily focusing on floods and cyclones in South Asia, Sub-Saharan Africa, and the Caribbean islands. Disasters generated acute shocks to service delivery, workforce, supplies, referral and transport, and information and coordination, leading to declines in ANC, facility delivery/EmONC, and PNC/neonatal care. Recovery ranged from return to near baseline within about three months to prolonged and uneven restoration, with poorer, marginalized, and remote groups being consistently more affected. The findings highlighted predictable but inequitable system pathways, supporting the integration of MISP-aligned preparedness, protection of ANC/PNC platforms, securing EmONC referral and transport, strengthening supply chains, and improving routine information systems to sustain continuity and accelerate recovery.
Early Breastfeeding Initiation Among Indonesian Women Aged 15–49: Evidence from the 2023 Health Survey
Early Breastfeeding Initiation (EBI) achievement globally has only reached 48%, with the target is 70% by 2030. Thus, there is still a 22% gap from the expected target. Although national coverage targets have been achieved in Indonesia, there are still some disparities in maternal characteristics, socioeconomic conditions, and access to maternal health services suggest the presence of underlying determinants that have not been fully explored at the national level. This study aimed to identify factors associated with the practice of EIBF among women of reproductive age in Indonesia. This study uses secondary data of individuals and toddlers SKI 2023 obtained from the Data Center of the Ministry of Health of the Republic of Indonesia, using 14,030 respondents’ data, who were selected based on the completeness of the data and did not have damaged data on the research variables. Chi-Square test was used with a significance level of α = 0.05 and a 95% confidence interval (CI 95%), while multivariate analysis was carried out using the Backward Likelihood Ratio (Backward LR) logistic regression test. The results of the study showed that the type of residential area (PR = 1.044; 95% CI = 1.013-1.077), maternal education level (PR = 0.920; 95% CI = 0.892-0.948), economic status (PR = 0.935; 95% CI = 0.906-0.964), parity (PR = 1.068; 95% CI = 1.024-1.114), ANC frequency (PR=0.958; 95% CI= 0.929-0.989), delivery method (PR=1.597; 95% CI= 1.597-1.745), place of delivery (OR= 1.167; 95% CI=1.021-1.335), and birth weight (PR= 1.265; 95% CI= 1.188-1.348) were associated with EBI practices in WUS in Indonesia. While maternal employment status was not associated with EBI practices in WUS in Indonesia. The variables of place of delivery and birth weight were proven to be confounded by the parity variable. The Indonesian Ministry of Health’s Data Center is advised to add data related to the mother’s age at birth. Women of childbearing age are advised to give birth in health facilities because they have a greater opportunity to practice EBI.
Monitoring and Managing Stress during Pregnancy with the ‘Smart Mother’ Information System for Early Detection
Psychological adjustment during pregnancy plays a vital role in maintaining maternal mental health and supporting fetal well-being. This study developed and evaluated Smart Mother, a smartphone based application designed for early detection and management of stress among pregnant women. The system was developed using the System Development Life Cycle (SDLC) framework and tested through a randomized controlled trial following CONSORT guidelines. A pretest–posttest design was conducted with 120 pregnant women randomly assigned to an intervention group (n = 60) and a control group (n = 60) from March to October 2023. The intervention group utilized the Smart Mother application, which integrates stress screening and self management features, while the control group received conventional printed educational materials. Statistical analysis using the Wilcoxon signed-rank test, Mann–Whitney U-test, and multivariate analysis showed a significantly greater reduction in stress scores in the intervention group compared with the control group (7.19 ± 5.8 vs. 5.87 ± 4.2; p< 0.01). Evaluation based on the Technology Acceptance Model (TAM) demonstrated high usability, with an average score of 4.26 (85.2%). These findings suggest that Smart Mother is an effective digital tool for improving stress monitoring and management during pregnancy and supports more comprehensive antenatal mental health care.
Pregnant women, stress, early detection, information systems, Smart Mother
Uncovering Early Risk Factors of Diabetic Peripheral Neuropathy: Insights from Primary Health Care Facilities
Diabetic Peripheral Neuropathy (DPN) is a progressive and frequently underdiagnosed complication of type 2 diabetes mellitus. Limited early screening based on clinical risk factors in primary healthcare settings in Indonesia contributes to delayed diagnosis, increasing the likelihood of advanced neuropathy, foot ulceration, and lower-limb amputation. This study aimed to identify respondent characteristics and analyze risk factors associated with DPN among individuals with T2DM. A quantitative cross-sectional study was conducted among 162 patients with T2DM in the Bogor Primary Healthcare area. The Michigan Neuropathy Screening Instrument (MNSI) was used to assess neuropathic symptoms, and a physical foot examination was performed. Data were analyzed using Chi-square tests and binary logistic regression. The majority of respondents were aged 35–60 years (56.2%), female (69.1%), and had a duration of diabetes mellitus (DM) of <5 years (71.6%). 75.3% of respondents showed signs of Neuropathy, with the most common symptoms being dry and cracked skin on the feet (93.1%), muscle cramps (75.9%), and numbness (74.1%). No active ulcers were found (0%), and none had a previous diagnosis of Neuropathy. Bivariate analysis showed that age (p=0.004), duration of diabetes mellitus (p=0.030), and random blood sugar (p=0.000) were significantly associated with NPD. Logistic regression identified hyperglycemia (AOR=6.50; 95% CI = 2.65–15.85) and age ≥35 years (AOR=2.16; 95% CI 1.12–4.28) as independent predictors of NPD (Nagelkerke R²=0.27). Peripheral Neuropathy was highly prevalent even among patients with a short diabetes duration and had not been clinically diagnosed previously.
The Role of Treatment Supporters in Addressing Adverse Effects of Anti-Tubercolusis Treatment: Cross-Sectional Study in Timor Leste
Tuberculosis (TB) remains a critical health challenge in Timor-Leste, as one of the 30 countries with the highest TB burden globally. The involvement of Treatment Supporters or Pengawas Minum Obat (PMO) has been widely implemented to address these challenges. Purpose: This study aims to examine the relationship between the presence of active PMO and the incidence of OAT adverse effects among TB patients in Timor Leste. Methods: A descriptive-correlational study was conducted from July to November 2023. A total of 69 pulmonary TB patients who had completed the intensive treatment phase were selected through purposive sampling. Data were collected using a validated questionnaire; analysis was conducted using a chi-square test via SPSS version 26. Results: Among 69 respondents, 10 (14.5%) reported adverse effects, while 59 (85.5%) did not. The most common symptoms included reddish urine (97.1%), loss of appetite (91.3%), and joint pain (34.8%). A significant correlation was found between active PMO presence and absence of reported adverse effects (p < 0.001). Conclusion: The presence of active PMO significantly influences the perception and reporting of OAT adverse effects among TB patients. Strengthening the training and involvement of PMO in TB programs can enhance patient adherence and improve treatment outcomes.
Segmenting Women’s Motivational Profiles in mHealth Adoption for Reproductive Health: A Cluster Analysis
While mHealth has the potential to improve access to reproductive health services, its adoption remains uneven in Indonesia. This study aimed to segment women of reproductive age based on motivational and contextual profiles related to mHealth use, rather than to identify causal determinants. A cross-sectional survey was conducted in 2025 among 350 Indonesian women aged 18–45 years. Guided by the Health Belief Model (HBM) and UTAUT2, k-means cluster analysis was used to identify user segments. Differences in motivational constructs were examined using t-tests, while contextual characteristics were assessed using chi-square tests. Two clusters emerged: highly motivated users (n = 222) and less motivated users (n = 128). The highly motivated group reported significantly higher self-efficacy (M = 4.71 vs. 3.66), perceived benefits (4.82 vs. 3.86), effort expectancy (4.78 vs. 3.86), and trust in technology (Δ = 0.96; all p < .001). Moderate differences were observed for perceived susceptibility, while perceived barriers were not significant. Significant group differences were also found for income, perceived health literacy, prior use of reproductive health services, and intention to adopt mHealth (p < .05). These findings highlight distinct readiness-based user segments, supporting segmentation-driven digital health interventions.
Strengthening Community Readiness for a Possible Avian Influenza Resurgence
Avian influenza (AI) continues to pose a significant zoonotic threat in communities where close contact between humans and poultry is common. In 2024–2025, several areas, including Semarang City, Klaten, Temanggung, and Purworejo, reported simultaneous poultry deaths that were subsequently confirmed as AI through laboratory testing. This study aimed to develop and evaluate a community-based educational model to enhance readiness for a potential AI resurgence in Semarang City. A research and development (R&D) approach was employed using the ADDIE framework, encompassing needs analysis, model development, expert validation, pilot testing, and refinement. A mixed methods approach assessed knowledge, attitudes, practices, self-efficacy, and health commitment, complemented by qualitative feedback from community cadres and local leaders. Independent t-tests compared pre- and post-intervention results between intervention and control groups. The intervention included a validated educational module, cadre capacity strengthening, and community-based surveillance components. The intervention group demonstrated statistically significant improvements across all assessed variables (p = 0.000), whereas the control group exhibited no significant changes (p > 0.05). The community-based educational model, known as KONMABUR (Komunitas Masyarakat Anti Flu Burung), proved effective in enhancing community preparedness for AI and shows potential for broader application in the prevention of other zoonotic diseases.
Hematological Profile and Air Quality: A Case Study in Belendung Subdistrict, Benda, Tangerang
Cities with high population density, high traffic volume of public and private transportation, and significant industrial operations in areas surrounding airports constitute a combination that worsens air pollution. Exposure to pollutants could impact the hematological system. The aim of this study is to determine air pollution exposures in Belendung Subdistrict, Benda District, Tangerang. This study served as a preliminary step or pilot study, conducted within a 4.6 km radius of the airport, and located near some industries in the area, using a cross-sectional and purposive method. SO₂, CO, NO₂, Ox as O₃, NMHC, TSP, Pb, PM2.5, and PM10 levels were measured as air pollution variables. These parameters were assessed on the 3rd and 5th days before blood sampling. Neutrophils, eosinophils, monocytes, basophils, lymphocytes, CRP, leukocytes, hemoglobin, erythrocytes, hematocrit, platelets, MCV, MCH, MCHC, and ESR were measured from 12 male and 12 female respondents. The results showed that the air quality ranged within the standard threshold except for PM10, and most residents have normal biomarkers in the blood. This indicated that PM10 merely activates basic immune responses in the body. The observed inflammation provides a correlation between MCH and MCV, with a value of 0.905.
Smoking Behavior and Workplace Health Promotion Among Municipal Employees: A Study of Greater Amman Municipality Staff in Jordan
This study explores how common smoking is among employees of the Greater Amman Municipality (GAM) in Jordan. It looks at patterns and reasons behind smoking within the context of both national and global efforts to create smoke-free public spaces. We used a cross-sectional design and a structured electronic questionnaire to gather data on tobacco use, demographics, job stress, quitting behavior, and knowledge of available support services. The results show that 36% of GAM employees smoke, with traditional cigarette use being the most common type. Smoking behavior is notably linked to factors like how long employees have worked there, their stress levels, and how young they started smoking. Although 53% of smokers tried to quit, only 32% of those who knew about cessation clinics actually used them. Almost 70% of respondents reported being exposed to second-hand smoke, even though 66% thought GAM was a smoke-free environment. These findings emphasize how workplace culture, psychological stress, and gaps in enforcement contribute to ongoing smoking habits. The study highlights the urgent need for health promotion strategies that include support for quitting, mental health resources, and effective policy actions focused on municipal workers. It adds to the existing literature on occupational health in urban areas of the Middle East and backs national tobacco control efforts aimed at cutting down smoking in public sector workplaces.
Smoking behavior; Workplace health promotion; Municipal employees; Second-hand smoke; Cessation programs
Integrating Multiple Micronutrient Supplementation into Antenatal Care in Rural Indonesia
The This study evaluated the effectiveness of Multiple Micronutrient Supplementation (MMS) compared to Iron–Folic Acid (IFA) in improving maternal nutritional out comes in Indonesia. Maternal undernutrition and anemia contribute to low birth weight and stunting, while antenatal programs largely rely on IFA. This quasi-experimental pre–post parallel-group study was conducted in 2025 in Grobogan District, Central Java, who involved 60 pregnant women who were randomly assigned to MMS (n = 30) or IFA (n = 30). Maternal nutritional status was assessed through changes in body weight, mid-upper arm circumference (MUAC), and hemoglobin levels. Ethical approval was obtained (No. 48/Kom.etik/VI/2025). Data were analyzed using paired t-tests or Wilcoxon tests for within-group comparisons and independent t-tests or Mann–Whitney tests for between-group differences. Both groups showed significant weight gain (MMS: +2.93 kg; IFA: +3.47 kg; p < 0.05), with no significant difference between groups (p = 0.363). MUAC increased significantly in the IFA group (+0.96 cm; p = 0.018) but not in the MMS group. Hemoglobin increased significantly in the IFA group (+1.02 g/dL; p = 0.008), whereas MMS showed a non-significant decline. These findings indicate that although both supplements improved maternal weight, IFA was more effective in increasing hemoglobin.
Comparative Impact of Black Coffee and Milk Coffee on Prediabetes in Obese Adults
Obesity is a major risk factor for metabolic diseases such as diabetes mellitus, hypertension, and cardiovascular disorders, primarily through the mechanism of insulin resistance. One contributing factor to obesity is the increasing consumption of sugar sweetened beverages, including milk coffee. However, coffee also contains bioactive compounds with potential protective effects. This study aimed to compare the effects of pure black coffee and milk coffee consumption on prediabetes status and fat mass among obese individuals. An analytical observational study with a cross sectional design was conducted in Medan City from December 2024 to February 2025 involving 82 obese participants aged 19–45 years. Coffee intake was assessed using a Food Frequency Questionnaire (FFQ), fasting blood glucose levels were measured using spectrophotometry, and fat mass was evaluated with a Body Composition Analyzer. Data were analyzed using a chi-square test with a significance level of p < 0.05. Results showed no significant difference in prediabetes incidence between black coffee and milk coffee consumers (p = 0.925). Similarly, fat mass did not differ significantly between groups (31.1 ± 7.4 vs. 31.7 ± 7.3). In conclusion, consumption of black coffee or coffee with milk showed no significant effect on prediabetes incidence or fat mass among obese individuals.
Nutritional Determinants and Molecular Insights into Anemia among Boarding School Adolescents
Introduction: Anemia remains a significant public health problem among adolescents in developing countries such as Indonesia. Female adolescents are more vulnerable due to menstrual blood loss and increased iron needs during growth, while dietary diversity and beverage habits may further influence anemia risk. Aim: This study aimed to analyze factors associated with anemia, including gender, diet quality, and tea or coffee consumption, and to explore their molecular relevance using a bioinformatics approach. Methods: A cross-sectional study was conducted among 199 adolescents (105 males, 94 females) aged 12–17 years in a boarding school in Malang, Indonesia. Data collection included hemoglobin measurement, anthropometric assessment, and a Food Frequency Questionnaire (FFQ). Statistical analysis was performed using Chi-square and logistic regression, while bioinformatics analysis employed STRING, Cytoscape, and ShinyGO to identify key genes and pathways. Results: Female gender (AOR = 6.595; p < 0.001), adequate diet (AOR = 0.184; p = 0.012), and tea/coffee intake (AOR = 7.532; p < 0.001) were significant predictors of anemia. Bioinformatics analysis identified SLC11A2, TFRC, and HAMP as key genes regulating ferroptosis and mineral absorption pathways. Conclusions: Gender, dietary quality, and tea or coffee consumption significantly influence anemia in adolescents.
Complications among Postpartum Mothers in Indonesia
The postpartum period, also known as the postpartum period, begins immediately after the birth of the neonate and placenta and ends at 6–8 weeks. Maternal mortality in Indonesia was caused by bleeding in 30.5%, infection in 22.5%, gestosis in 17.5%, and anesthesia in 2.0%. The purpose of this study is to analyze the risk factors that affect the incidence of complications in postpartum mothers in the working area of the Grobogan Health Center in 2025. This research is quantitative with a case control study design,using data from the Grobogan Health Center in 2025. The analysis used was univariate, bivariate (chi-square test), and multivariate analysis (logistic regression). The results showed that there was a relationship between maternal education (p=0.011, OR=1.83), employment status (p<0.0001, OR=2.52), gestational age (p<0.0001, OR=3.02), parity status (p=0.034, OR=1.24), BMI (p<0.0001, OR=9.09), childbirth distance (p<0.0001,OR=13.38), hypertension (p=0.006, OR=2.4), diet (p<0.0001, OR=5.797) and exposure to cigarette smoke (p<0.0001, OR=3.50), history of psychological disorders (p=0.007,OR=0.158), and LBW (p<0.0001, OR=2.443). The results of this study are expected to increase postpartum mothers’ awareness of the importance of recognizing and managing risk factors that may lead to complications, thereby encouraging healthy behaviors and informed decision-making during the postpartum period.
Pharmacists’ Knowledge, Attitudes, and Practices Regarding Nano-Pharmaceutical Availability in Hospitals
The medical application of nanomaterials with dimensions extending below 100 nm defines nanomedicine. The discipline provides solutions to multiple existing barriers in medical diagnosis and treatment management. Nanopharmaceutical knowledge from pharmacists will increase drug availability in the market while enhancing patient compliance to medication protocols. The research aimed to determine if nano pharmaceutical medications existed in Sulaymaniyah hospitals while evaluating pharmacist knowledge about these medications. This study used a questionnaire with a cross-sectional design to determine the availability of nanopharmaceutical medicines. It also examines knowing these nanopharmaceutical drugs among pharmacists based on questionnaires from previous studies on pharmaceutical formulations and nanoformulations. In addition, it tests the variables by Prism—GraphPad. The study collected one hundred surveys from pharmacists of many hospitals in the Sulaymaniyah city in Iraq. According to the findings, twelve are available in hospitals, with different frequencies with Rapamune being number one, with a 72% availability rate. Furthermore, the respondents showed that they know more about pharmaceutical formulations than nano-formulations. There were no enough nano-pharmaceutical drugs in Sulaimaniyah hospitals because there are no diverse nano-pharmaceutical formulations. Nanopharmaceuticals should be better understood by pharmacists by including nanomedicine courses in undergraduate pharmacy curricula.
Physical Environmental Factors and Maternal Behavioral Characteristics in Toddlers ARI
ISPA frequently occurs in toddlers, particularly in the North Putussibau area, which reports the highest cases. This research studies the association between physical environmental factors and behaviors with ISPA incidence among toddlers at the North Putussibau Community Health Center. Using a case control design, 64 participants were equally separated into patient and comparison categories. Data were examined applying the χ2 analysis, with significance assessed correlations were among ISPA incidence and dampness (p = 0.023), lighting (p = 0.024), floor type (p = 0.000), residential density (p = 0.048), use of mosquito repellent (p = 0.003), exposure to smoke (p = 0.023), mothers not covering their mouths when coughing (p = 0.007), delayed toddler care (p = 0.003), and mothers not wearing masks when ill (p = 0.024). No significant links were observed with ventilation, wall or roof type, open windows, mothers not washing hands after coughing, or burning trash near the house. These results suggest that both the home environment and maternal behaviors influence the occurrence of sudden breathing illnesses in the young.
Integrated Socio Epidemiological Model for Leptospirosis Control in Tidal Flood Prone Areas
The Elderly populations in tidal flood-prone areas face heightened vulnerability to leptospirosis due to environmental hazards, recurrent inundations, and psychosocial stressors. This study analyzed an integrated socio-epidemiological model that accommodates a community-based intervention, targeting perceived stress, self-efficacy, and clean and healthy living behavior (PHBS), along with a system dynamics simulation to forecast leptospirosis incidence. This quasi-experimental study design was implemented with 70 participants (35 intervention and 35 control). The participants reside in flood-affected villages of Demak Regency, Indonesia, in 2024 (Purwosari, Sriwulan). Perceived stress (PSS-10), self-efficacy, and PHBS scores were measured at pre- and postintervention. Statistical analyses included Mann-Whitney, Wilcoxon, and paired t-tests. Delta scores were integrated into a stock-flow model (PowerSim Studio 10) incorporating behavioral and environmental risk variables to simulate leptospirosis cases for 2024–2029. The in- tervention group demonstrated significant improvements in self-efficacy (Δ=+5.69±8.17,p<0.001) and PHBS (Δ=+9.37±4.59, p<0.001), alongside a non-significant but clinically relevant reduction in perceived stress (Δ=-7.20±8.33, p=0.733 vs control). The dynamic model projected a 25–30% reduction in leptospirosis cases over five years with intervention, compared to a ≤5% decline without behavioral programs. Visual validation indicated alignment between simulated and real incidence trends (2020–2024). Integrating psychosocial behavioral interventions with dynamic modeling provides a reliable framework for leptospirosis control in flood-prone populations.
Work Productivity through Low Back Pain among Garbage Truck Drivers in Makassar
Abstract. Background: Low back pain is a Musculoskeletal disorder characterized by pain in the lumbar area and is commonly experienced by workers who perform repetitive physical activities, sit for long periods, or are exposed to vibration, such as truck drivers. This condition can interfere with comfort, concentration and physical ability in carrying out tasks. As a result, Low back pain has the potential to reduce work productivity, which refers to an individual’s ability to complete tasks effectively and efficiently according to predetermined targets. Objective: To analyze the direct and indirect effects of age, duration of work, years of service, delivery frequency, BMI, vibration and working posture on work productivity through Low back pain among garbage truck drivers at the Antang Landfill. Methods: This research used a quantitative study with a cross-sectional approach and a sample size of 140 respondents obtained through purposive sampling. Data were collected using questionnaires and analyzed with SPSS. Results: Confidence Interval 95% (0,05). Indirect effects on work productivity through Low back pain were significantly shown by age (p=0.019), BMI (p=0.000), years of service (p=0.009), duration of work (p=0.009), working posture (p=0.004), delivery frequency (p=0.024) and vibration (p=0.028). Conclusion: Age, duration of work, years of service, BMI, delivery frequency, working posture and vibration have both direct and indirect effects on work productivity through Low back pain as an intervening variable.
Low back pain; Work Productivity; Ergonomics; Garbage Truck Drivers
The Effect of Clinical Supervision by Ophthalmologists on the Severity of Diabetic Retinopathy in Kapuas District
Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM) and a leading cause of blindness among productive-age adults. Globally, the prevalence of DR reaches 34.6%, while in Indonesia it is 43.1%, making it the second most common diabetes complication after nephropathy. In Kapuas District, the 2022 data reported 5,390 DM patients and 56 DR cases, with a growing trend each year, particularly in areas with limited health services. This study, conducted in 2025, aimed to analyze the effect of clinical supervision by ophthalmologists on DR severity in relation to treatment duration, age, and healthcare access distance. A quasi-experimental design with a pre-test and post-test approach was applied to 52 non-proliferative DR patients divided into intervention (clinical supervision) and control groups. Results showed that clinical supervision effectively maintained mild DR conditions (p=1.000), while the non-supervised group exhibited increased severity (p=0.025). Longer treatment duration correlated with stable DR (p=0.000), age influenced severe DR (p=0.033), and healthcare distance affected moderate DR (p=0.045). Clinical supervision by ophthalmologists effectively slows DR progression, particularly among productive-age patients and those with limited access to eye care services.