Unnes Journal of Public Health 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/ujph MIGRATION OFFICIAL STATEMENT HERE Unnes Journal of Public Health is published by Universitas Negeri Semarang (UNNES) in cooperation with the Association of Indonesian Public Health Experts (Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI)). Unnes Journal of Public Health contains articles about health epidemiology, biostatistics, health administration, public health nutrition, environmental health, occupational health and safety, health promotion, reproductive health, maternal and child health, health management, health economics, traditional medicine/treatment for preventive or first aid purposes, public health law/ethics and other related health articles, especially in low-income and middle-income countries. The journal can be used by health practitioners, health caregivers, teachers, students, and people who interested in health issues. Indexing GARUDA SINTA DIMENSIONS DOAJ SCOPUS SCIMAGOJR
Universitas Negeri Semarang (UNNES) in cooperation with the Association of Indonesian Public Health Experts (Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI))
Adolescent Attitudes and Multilevel Influences on Risky Sexual Behavior Prevention in a Semi-Urban Border Province of Northern Thailand: The Roles of School, Family, and Community
Adolescents in semi-urban border areas face sociocultural barriers that may limit effective sexual risk prevention. This study examined adolescents’ attitudes toward risky sexual behavior and assessed whether perceived support from school, family, and community (SFC) systems was associated with these attitudes in a northern Thai province. A cross-sectional survey was conducted among 297 junior high school students aged 12–15 years. in Mae Hong Son Province. A self-administered questionnaire assessed preventive attitudes and perceived support from SFC. Descriptive statistics, Pearson correlations, and multiple regression analyses were performed using SPSS version 22. Preventive attitudes were low to moderate (M = 2.10, SD = 0.35). Perceived school (M = 3.49), family (M = 3.33), and community (M = 2.96) support was moderate. SFC variables were moderately intercorrelated (r = 0.43–0.59, p < .001), but showed weak, non-significant associations with preventive attitudes (r = .05–.11, p > .05). Regression analysis indicated no significant association (F(3, 293) = 1.11, p = .35; R² = .01). Perceived school, family, and community support was not significantly associated with adolescents’ preventive attitudes. Additional youth-centered and culturally responsive strategies may be needed to strengthen sexual health promotion in border settings.
adolescent attitudes; risky sexual behavior; school–family–community; sexual health; Thailand
Copyright (c) 2026 Unnes Journal of Public Health
WASH Determinants of Stunting among Toddlers in Jayapura, Papua: Evidence from a Multivariate Analysis
Stunting has severe consequences, including impaired growth, cognitive deficits, reduced productivity, and increased susceptibility to disease. This study aimed to examine the determinants of stunting, emphasizing water, sanitation, and hygiene (WASH) practices. A case-control design involving toddlers aged 25–59 months in Jayapura City from May to August 2023 was applied. Three hundred twenty-six children were recruited using consecutive sampling, with a 1:1 ratio of cases and controls. Inclusion criteria were residence within the public health center catchment area and parental consent to participate. Controls were selected after matching for age, sex, and ethnicity within the same neighborhood as cases. Data were collected through structured questionnaires and analyzed using multivariate logistic regression. The prevalence of stunting was 50%. Significant associations were observed between stunting and household factors, including drinking water and food management, access to clean water, latrine conditions, liquid waste disposal, and solid waste management. Among these, drinking water and food management practices emerged as the most dominant determinant, indicated by the highest adjusted odds ratio (AOR). These findings underscore the critical role of WASH practices in reducing the burden of stunting in Papua.
Effect of Perceived Stress Factors on Cortisol Level Among Industrial Workers
This cross-sectional study to evaluate the effect of perceived stress and hormone change will help the workers to better understand the way to manage and reduce stress. The aim of this study was to explore the relationship between occupational stress symptoms, perceived stress level, and cortisol level in industrial workers. The study was conducted with 137 workers from the automotive parts manufacturing industry. The levels of perceived stress were assessed by a stress assessment instrument, and the stress symptoms were assessed by questionnaires; samples of urine were collected for the determination of urinary cortisol levels through an enzymatic immunoassay. The study results found that a sleep problem was a risk factor for increased stress symptoms (11.48; 95% CI, 1.37–26.24). The cortisol level of workers with elevated perceived stress was higher than that of office workers (control group). The office workers and operation workers groups had cortisol levels of 126.4 ng/mL and 187.8 ng/mL, respectively. Increased perceived stress could lead to an increase in hypertension incidence. High cortisol could increase the risk of many stress symptoms. Our findings indicate that stress substantially contributes to symptom occurrence, with increased cortisol levels appearing to be a more influential factor than changes in health-related behaviors.
occupational stress; perceive stress; stress symptoms; cortisol level
Mortality Risk Factors Among Indonesians with Tuberculosis: An Analysis of a National Health Insurance Data
Tuberculosis (TB) significantly contributes to global mortality; thus, identifying mortality risks is crucial for effective disease management. This study aims to explore the risks of mortality among Indonesians with TB. This case-control study analyzed Indonesian health insurance data (2015-2022), employing propensity score matching (1:4 ratio) and Cox modeling to assess the relationship between mortality and demographics/comorbidities. Mortality was treated as a binary (death or survived) and a multistate outcome (including death within two months, death afterward, and survived). The analysis included 60,472 subjects and 1,777 deaths, revealing that most demographics had no correlation with mortality, except for marital status. Being married was protective against mortality after two months (Hazard Ratio [HR] 0.65, 95% Confidence Interval [CI]: 0.45-0.93). Anemia increased mortality risk over time (HR 3.62 within the first two months; 9.19 thereafter). Cancer and heart failure heightened mortality risk early on, while HIV affected later stages. Interestingly, some chronic conditions may provide protective effects. Access to healthcare through universal health coverage (UHC) may help reduce mortality risks. The study emphasizes critical management periods for TB in patients with specific conditions and highlights the importance of UHC in mitigating sociodemographic disparities to improve health outcomes.
risk factors; mortality; tuberculosis; health policy
Revealing the Hidden Burden and Risk Factors of Mental Health Disorders
Mental health diseases are a major issue in Indonesia, as evidenced by mental–emotional disorders rising from 6.1% in 2018 to 9.8% in 2021, the reported prevalence of depression being that of up to 6.6%. However, even though national-level data are available, evidence from the specific region regarding the prevalence and risk factors in Bogor is still scant. Including used dataThis study: 2017-2018 NCD Bogor City Knowledge Risk Factor Cohort. The aims were to assess the prevalence of mental health disorders and associated factors and risk profile for each factor. 3,784 people participated. Bivariate and logistic regression analyses were used to identify risk factors. In Bogor City, the prevalence of MHD is reported at 21.4%. Multivariable analysis revealed factors associated with the outcome: below-median income (less than Rp. 3,557.146) (aOR=1.801; p=0.001), age 26-45 (aOR=1.328; p=0.001), male (aOR=1.731; p=0.001), and incomplete elementary education (aOR=1.919; p=0.006). In contrast, completion of only elementary education (aOR = 2.064; p = 0.019), heart disease (aOR = 1.773; p = 0.017), and heavy physical activity (aOR = 1.561; p = 0.001) were found to significantly influence the risk of mental health disorders (MHD) (p = 0.002). Overall, Bogor City exhibits a high prevalence of MHD, with multiple demographic and health-related risk factors contributing to this condition, including low income, age 26–45, male gender, incomplete elementary education, lack of health insurance, comorbid heart disease, and engagement in heavy physical activity.
mental health disorders; risk factors; Bogor
Artificial Intelligence and Regional Health Vulnerabilities: A Bibliometric Review of Global Trends in Non-Communicable Disease Research
Non-communicable diseases (NCDs), including cardiovascular disease, diabetes, cancer, and chronic respiratory conditions, are the leading causes of death worldwide. These diseases are driven by socioeconomic disparities, unhealthy lifestyles, and environmental factors. AI can improve NCD vulnerability mapping through the use of big data and risk prediction, but faces data and access barriers in developing countries. This study explores how AI can be leveraged to more effectively map regional NCD vulnerability. This study seeks to analyze global research trends in the application of Artificial Intelligence (AI) to map regional vulnerability to non-communicable diseases (NCDs). This study uses a bibliometric analysis of Scopus-indexed, peer-reviewed articles (2006–2025) on AI and NCD vulnerability, processed with Excel and VOSviewer. A total of 3,626 articles were analyzed, showing a sharp rise in AI–NCD research since 2007, peaking in 2024 with 723 publications and 35,148 citations. Frequent keywords included “machine learning”, “COVID-19”, “mental health”, “diabetes”, and “artificial intelligence”. The field is marked by strong international collaboration, led by the US, China, and the UK, with over 96% of studies involving multi-country co-authorship. AI shows strong potential for mapping regional NCD vulnerability, improving early detection, and enhancing predictive risk assessment to strengthen national health policies.
Non-communicable diseases; regional vulnerability; artificial intelligence; bibliometric analysis
Analysis of Bay Leaf Tea Blend Made from Bay Leave (Syzygium polyanthum), Turmeric (Curcuma Longa L.), and Cinnamon (Burmese cinnamon) for Preventing Degenerative Diseases in the Community
Antioxidants act as free radical stabilizers to reduce oxidative stress, which in the long term can cause degenerative diseases. The development of functional drinks in the form of tea made from local ingredients such as bay leaves, turmeric, and cinnamon is expected to play a significant role in reducing the prevalence of degenerative diseases. This study aims to determine the best formulation of tea blend made from bay leaves, turmeric, and cinnamon based on physicochemical properties and consumer acceptance. It was conducted using an experimental method with a Completely Randomized Design (CRD). Three formulations with different ratios of bay leaves, turmeric, and cinnamon, namely F1 (50:25:25), F2 (37.5:25:37.5), and F3 (25:20:55), were tested for water content using the gravimetric method, pH using a pH meter, antioxidant activity using the DPPH method, and hedonic acceptance tests. The hedonic test was conducted with 100 untrained panelists. The best functional tea blend for the prevention of degenerative diseases was F3, which contained the highest content of cinnamon (55%) with moderate antioxidant activity.
functional beverage; antioxidant activity; bay leaf; turmeric; cinnamon
Osmoregulatory Pattern and Larval Density of Culex spp. in Coastal Aquatic Ecosystem: Implications for Vector Control Strategies in Lymphatic Filariasis Elimination
Lymphatic filariasis in coastal regions is prone to transmission due to the environmental factors that enable the reproduction of Culex spp. Therefore, this study aims to examine the relationship between Culex spp. larval osmoregulation patterns with coastal ecosystem properties, and the impact on the larval density and control of vectors. Sampling was conducted in the field across different aquatic environments. Larval density was quantified, and environmental salinity was measured with a refractometer, while larval hemolymph and water osmolarity were analyzed using an automatic osmometer. The results showed that larvae demonstrated different osmoregulatory patterns, including iso-osmotic, iso-hyperosmotic, and iso-hypoosmotic. Significant differences in larval densities were observed among these patterns, with the highest density found in iso-hyperosmotic conditions (p=0.034), typically in low-salinity waters (0–1‰). Field analysis also showed that areas affected by occasional tidal flooding had significantly higher larval densities compared to unaffected areas (p=0.008). Multivariate analysis indicated that larval iso-hyperosmotic conditions, occasional tidal flooding, and damaged mangrove collectively increased larval density (p<0.0001). Therefore, effective Culex spp. larvae control in coastal regions should focus on micro-hydrological management through the elimination of unintended puddles and habitat modification, such as mosquito ditching, to support the sustainability of lymphatic filariasis elimination.
culex larvae; osmoregulatory pattern; tidal flooding; vector control; lymphatic filariasis
Wealth Index Association with Elective or Choice of Pre-Labor Caesarean Section among Thai Women
The prevalence of caesarean section in Thailand is increasing every year along with the growing capability of women to work. This study examined the correlation between wealth index and caesarean section decision (decided in advance or after labour). This study used secondary data from the Multiple Indicator Cluster Survey (MICS) Thailand in 2022. The sample consisted of women who had at least one child. The dependent variable is the caesarean section decision, and the main independent variable is the wealth index. The data was analyzed for univariate, bivariate (t-test and Chi-square), and multivariate (binary logistic regression). The findings revealed that around 70% of women decided to deliver by caesarean section in advance (not after labour). The multivariate analysis found the richest women were 2.88 times more likely to decide to deliver by caesarean section in advance compared to lower wealth index quantiles. This study contributed to the current phenomenon that the richest women tend to deliver by caesarean section as an elevated social status compared to vaginal birth.
caesarean section; Thai women; wealth index; MICS Thailand
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Health Education to Improve Maternal Awareness on Soy-Based Infant Formula for Individuals with Cow’s Milk Allergy in Indonesia
Background: Cow’s milk allergy is relatively common among Indonesian infants who are not exclusively breastfed. Despite extensive hydrolyzed formula and amino acid-based formula are the recommended nutrition for infants with moderate-tosevere illness, not all parents could provide those specialized formulas, presumably due to the high cost, low availability and poor palatability. In that case, soy-based infant formula could be an alternative nutrition. However, it was unknown whether Indonesian mothers were aware on that alternative nutrition. Objective: We therefore assessed the knowledge levels of mothers who participated in an online platform of PrimaKu on the usefulness of soy-based infant formula to support growth and development of children with cow’s milk allergy. Methods: The study subjects appeared to have sufficient levels of knowledge on the usefulness of soy-based infant formula for children with cow’s milk allergy. Results: In addition, by increasing their knowledge on iron and fiber fortification in soy-based infant formula, e.g., through regular academic presentations, mothers could be more selective in choosing alternative nutrition for children with cow’s milk allergy. Conclusion: Our study suggested that Indonesian mothers who were active in the online platform of Primaku had sufficient levels of knowledge on the usefulness of soy-based protein for managing children with cow’s milk allergy.
cow’s milk allergy; soy-based infant formula; indonesia
Pre-marital Sex Behavior and Marriage Plans among Papuan and non-Papuan High School Students
Early marriage is a persistent public health issue in Papua, shaped by cultural norms, socio-economic conditions, and adolescent sexual behaviors. This study examines factors influencing marriage plans among Papuan and non-Papuan adolescents. A cross-sectional study using primary data was conducted in five Senior High Schools (SMA) spread across Jayapura City and Regency. The sample consisted of students aged between 15 and 17 years, totaling 237 people, using an accidental sampling technique. The data were analyzed using a logistic regression model of the risk factor in STATA 16. Results: The proportion of students who had a plan to marry at the ideal age in both Papuan and non-Papuan tribes was 78.4% and 76.9%, the behavior of having sex before marriage was a factor that supported Papuan students to plan marriage (AOR:0.35; 95%CI:0.11-1. 07) after controlling for gender, while non-Papuan students who did not have sex before marriage had a 2.41 times greater chance of being able to plan to marry at the ideal age (AOR:2.42, 95%CI:1.04-5.56) after controlling for the variable of residence. Conclusion: Not having sex before marriage is one of the steps for adolescents to be able to plan their future, including marriage.
planning married; intercouse; child marriage
Establish The Policy Target to Reduce Stunting Among Indonesian Toddlers with Single Mothers
Single mothers bear two significant burdens: domestic responsibilities and earning an income. The role of a mother determines the nutritional status of a toddler. Until now, policies about stunting have not focused on specific target areas. The study aims to establish a policy target for reducing stunting among Indonesian toddlers with single mothers. The cross-sectional study examined 5,387 toddlers. Eight independent factors were considered: place of residence, mother’s age, occupation, education, socioeconomic status, antenatal care (ANC), children’s age, and sex. A binary logistic regression test was used for data analysis. 20.0% of Indonesian toddlers who had single mothers were stunted. Rural youths were 1.171 times more likely to be stunted (95%CI 1.149-1.192). All maternal ages were more likely to have stunted kids than ≥45. Lower education increases the risk of stunted toddlers. Unemployed mothers were 1.170 times more likely to have stunted kids (95%CI 1.148-1.192). The wealthier the household, the less likely the under-fives are to be stunted. Mothers without ANC were 1.194 times more likely to have stunted toddlers (95%CI 1.116-1.278). Toddlers were more likely than infants (0-11 months) to be stunted, and girls had a higher risk of stunting. The policy targeted rural areas, low-income families with young, uneducated, unemployed mothers, no ANC, older toddlers, and girls.
health policy; nutritional status; public health nutrition; single mother; stunting
Birth Interval and Twins Birth on Maternal Mortality in Indonesia: Cross-Sectional Study
Maternal mortality is a global-scaled health problem to indicate how good a health system is in a region. Indonesia reached 305 per 100.000 live birth as per 2017. That rate is still far from SDGs 2030 which suggests that every country has accomplished 70 per 100.000 livebirth. There are factor risks that caused maternal mortality. Those factors can be divided into individual character-related factors, socioeconomy-related factors, and healthcare-related factors. This study is an analytical study using cross-sectional design data from the DHS program 2017. Data were analyzed using bivariate analysis and multivariate analysis to fiigure out which variables that associate with maternal mortality. Preceding birth interval, succeeding birth interval, and twin birth status are the three main factor risks that associate with maternal mortality. It is recommended that Indonesian family needs to participate in family planning, including birth control in order to control the factor risks of maternal mortality.
determinants; maternal mortality; birth interval; twin birth
Dietary Quality and Body Composition on Lipid Profile in Endurance Athletes Aged 13-18 Years in Central Java Province
Diet quality and body composition are critical determinants of lipid metabolism and cardiovascular health in adolescent athletes. However, the relationship between these factors and lipid profiles in this population remains underexplored. This study aimed to examine the association between anthropometric indicators, diet quality, and lipid profile parameters in adolescent athletes. A cross-sectional study was conducted on 72 adolescent athletes. Univariate analysis described participants’ characteristics, including anthropometric measures, diet quality using the Alternative Healthy Eating Index (AHEI), blood pressure, lipid profiles, and physical activity levels. Data normality was tested using the Kolmogorov–Smirnov test. Pearson or Spearman correlation tests were applied for bivariate analysis, and logistic regression was used for multivariate analysis. Statistical significance was set at p < 0.05. Participants had a mean BMI of 21.9 ± 2.1 kg/m², body fat percentage of 19.3 ± 5.5%, and AHEI score of 51.1 ± 10.6, indicating moderate diet quality. Most lipid parameters were within normal ranges. Bivariate analysis revealed no significant associations between BMI, waist circumference, or AHEI score with lipid parameters. Waist-to-hip ratio was positively associated with HDL (p = 0.017). Body fat percentage showed significant associations with total cholesterol (p = 0.001), HDL (p = 0.001), LDL (p = 0.007), and triglycerides (p = 0.010). Multivariate analysis confirmed body fat percentage as the strongest predictor of lipid profile alterations. Body fat percentage is a more sensitive indicator of lipid metabolism changes than BMI in adolescent athletes.
adolescent athletes; body composition; diet quality; lipid profile
Factors Associated with the Quality of Life of People Living in Saltwater Intrusion Areas
Saltwater intrusion adversely affects both agriculture and mental health, yet its impact on quality of life (QoL) is underexplored. To understand the profound implications of saltwater intrusion on mental health and quality of life (QoL), especially when combined with other stress factors. The study aims to explore this underexplored relationship in saltwater intrusion-affected zones of Thailand. We investigated the QoL of 417 Thai agriculturists in saltwater-affected areas using the WHOQOL-BREF survey and multiple linear regression. Results indicated that a majority, 61.63%, experienced a moderate QoL, and a significant 83.69% reported tasting salinity in their water. A key finding was that individuals aware of their water’s salinity had notably lower QoL scores. Influential factors on QoL included gender, age, household size, education, and occupation. Specifically, the detection of salinity in drinking water was linked to a 3.16-point reduction in QoL scores (Adjusted Mean Difference: -3.16, 95% CI: -5.08 to -1.25). Furthermore, those with an awareness of water salinity saw an additional QoL decrease of 4.40 points (Adjusted Mean Difference: -4.40, 95% CI: -6.84 to -1.96). The findings underscore the urgency for targeted government interventions to address the repercussions of saltwater intrusion. Strategies including the implementation of real-time alert systems and the establishment of protected freshwater reserves are vital for preserving agricultural productivity, ensuring water security, and enhancing the well-being of affected communities.
saltwater intrusion; quality of life; water quality; agriculture; mitigation strategies
Association Between Heat Stress Exposure, Physical Activity, and Nutritional Status with Occupational Fatigue: Pilot Study
Global economic losses from workplace heat and reduced labor productivity are projected to reach nearly US$2 trillion by 2030. The rubber processing industry is particularly vulnerable to heat exposure. This study aimed to describe worker sociodemographic characteristics and assess the relationship between perceived heat stress, nutritional status, physical activity, and occupational fatigue among employees at PT. X in Jambi Province. A cross-sectional design with purposive sampling involved 74 workers across three production areas. Fatigue was measured using the Swedish Occupational Fatigue Inventory (SOFI), while perceived heat stress was assessed with the Heat Stress Perception Index (HSSI). Data were analyzed with univariate and multivariate methods, including multiple linear regression. Participants had a mean age of 34.03 years, BMI of 25.88, and oxygen saturation of 98.01%. The mean heat stress perception score was 50.31, and occupational fatigue averaged 40.55. Lack of energy was the most reported fatigue dimension (mean = 49.23), whereas lack of motivation was the least (mean = 29.92). Regression analysis identified gender (p = 0.003), physical activity (p = 0.031), and perceived heat stress (p = 0.035) as significant predictors. These findings highlight the need for targeted occupational health interventions to mitigate fatigue in the rubber processing industry
worker health; urine specific gravity; occupational fatigue; heat stress; multiple linear regression
Factors of Diabetic Retinopathy among Type 2 Diabetes Mellitus Patients in Central Java Province, Indonesia
One of the microvascular complications of type 2 diabetes mellitus is diabetic retinopathy. The prevalence of diabetes mellitus in Central Java Province in 2022 by 10% increased to 12.52% in the third quarter of 2023. This prevalence rate has not reached the SDG's target, namely there is no increase in diabetes prevalence by 0%. The purpose of this study is to analyze factors associated the incidence of diabetic retinopathy in type 2 DM patients at Central Java Provincial Hospital in 2023. This research is quantitative research with a nested case control study design, using electronic medical record data from the Central Java Provincial Hospital in 2023. The variables in this study were gender, age, education level, employment status, marital status, health insurance status, BMI, DM diet, duration of DM, hypertension, other diseases, current blood glucose, and HbA1c. The analysis used was univariate, bivariate, and multivariate analysis (logistic regression). The results showed that there was association between age ≥70 years (p=0.006), DM diet (p<0.0001, OR=20.914), duration of DM (p=0.003, OR=3.010), hypertension (p=0.013, OR=2.619), other diseases including cataracts (p=0.040, OR=9.00), glaucoma (p=0.007), CHD (p=0.040, OR=9.00), and cardiomegaly (p=0.016), current blood glucose (p=0.045, OR=2.478), and HbA1c (p<0.0001, OR=6.152). DM diet is the most dominant factor associated with diabetic retinopathy in type 2 DM patients.
Sarcopenia in Indonesian Community-Dwelling Elderly: The Prevalence and Influencing Factors within the Primary Care Setting
Determining the prevalence of sarcopenia and identifying associated factors can aid in early detection and treatment among community-dwelling elderly. This study aims to estimate the prevalence of sarcopenia and identify associated factors. This cross-sectional study was conducted in the elderly community within the two areas of Public Health Center, Semarang, Indonesia, through random sampling. Sarcopenia was defined based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Data on socio-demographics, clinical, and functional status were collected and associated factors analyzed using multivariable logistic regression. Of the 153 participants, the prevalence of severe sarcopenia was 50.33%, and overall sarcopenia prevalence was 44.44%. Elderly individuals with severe sarcopenia had a mean age of 69.45, with a higher occurrence in women (79.2%) compared to men. Age (p=0.003; APR: 1.105; 95% CI: 1.035-1.180), toilet type (p=0.002; APR: 4.194; 95% CI: 1.677-10.493), and being female (p=0.049; APR: 2.341; 95% CI: 1.003-5.460) were identified as risk factors for severe sarcopenia. The prevalence of severe sarcopenia is elevated among community-dwelling elderly. Sarcopenia was defined as low muscle mass with low handgrip strength and/or low gait speed. Routine check-ups are needed to detect sarcopenia and its risk factors in primary health care to enable early intervention for sarcopenia in the elderly.
Access to Sanitation and Its Impact on Stunting in Toddlers in EastNusa Tenggara, Indonesia
Background: Stunting is still one of the focuses of health problems in the world. Stunting is caused by many factors, including access to sanitation. Inadequate access to sanitation can cause infectious diseases that impair nutritional absorption in toddlers during digestion, leading to stunting. Objective: This study examines the connection between sanitation access and stunting in East Nusa Tenggara Province along with its confounding variables consisting of access to drinking water, toddler age, gender, and residence. Method: The study design was cross-sectional with a sample size of 4,224 children aged 0-59 months analyzed from the 2023 Indonesian Health Survey (IHS) data. Data were analyzed using univariate, bivariate (ChiSquare test), and multivariate (multiple logistic regression analyses with a risk factor model). Results: Studies showed households with inadequate sanitation access can increase the risk of stunting by 1.56 compared to those with adequate sanitation access. Other factors significantly associated with stunting included toddler age, gender, and residence. The problem of access to sanitation is related to residence and defecation behavior. Conclusion: Increasing indiscriminate defecation behavior can increase exposure to pathogens from feces which can cause diseases such as diarrhea, resulting in malnutrition and stunted growth. To reduce stunting in East Nusa Tenggara Province, the government is suggested to enhance programs to expand access to sanitation, especially in rural areas.
Budget Policy and Revenue in Indonesian Community Healthcare Centers
The primary sources of revenue of community healthcare centers (CHCs, puskesmas) are capitation fees and public funds; only a minority are able to generate other revenues. Several factors contribute to this issue, chiefly ineffective management and inadequate budget policy. Consequently, CHCs provide poor quality of care, pushing patients away and lowering revenue. This study examined the effect of budget policy on the revenue of CHCs across Aceh, Indonesia. Quantitative data were collected from 375 managers in 102 inpatient CHCs in Aceh, Indonesia, using questionnaires, while qualitative data were gathered through interviews with 21 managers from 21 CHCs. Quantitative data were analyzed using linear regression, while qualitative data using thematic analysis. Budget policy was found to have a significant positive effect on revenue of inpatient CHCs, B = 0.567, t = 5.776, p < 0.001. The qualitative findings showed that CHCs were unable to generate sufficient revenue due to the convoluted process for imbursement of non-capitation fees, costs outweighing fees, gap between accreditation and practice, lack of entrepreneurial mindset, inadequate equipment and facilities, dependence on the Social Security Agency (BPJS), and insufficient human resources. These issues were driven in part by a non-participative budgeting process, rigid allocation and use of budget, and incoherent budget policy. Coherent budget policy at the policymaker and managerial levels is therefore necessary to promote revenue generation in inpatient CHCs. Budget policy must consider services, program, and activities that can satisfy the needs of society implemented by the management of CHCs. Patients and society should be involved in budget formulation and allocation (i.e., participatory budgeting). Internal budgets should be allocated by technocratic management and oriented towards revenue generation within the limits permitted by relevant regulations. Management must also become more entrepreneurial to “make do” with budget shortcomings and improve revenue.
budget policy; community health centers; Indonesia; revenue
Prevalence of Fear of Falling and Its Association with Frailty Among Community-Dwelling Older Adults in Northern Thailand
Frailty in the elderly population is a known risk factor for common geriatric syndromes, contributing significantly to adverse health outcomes. Therefore, we examined the relationship between prevalence of fear of falling and frailty among older adults. A cross-sectional design was employed, and data were collected through in-person interviews conducted between April and May 2024. Participants were selected through simple random sampling from a total of 409 individuals aged 60 years or older, who were included in the analysis. The fear of falling (FOF) was evaluated using the Short Falls Efficacy Scale International (Short FES-I). Frailty was evaluated using the Thai version of the Simple Frailty Questionnaire (T-FRAIL). The mean age was 69.5 years, and 58.7% were female. The prevalence rates were 47.4% for non-frailty, 39.1% for pre-frailty, and 13.4% for frailty among older adults. Multinomial logistic regression analysis revealed that pre-frail adults had significantly higher odds of high FOF (OR: 5.27; 95% CI: 3.16-8.80, p-value < 0.001), whereas frail adults had significantly higher odds of moderate FOF (OR: 4.37; 95% CI: 1.55-12.32, p-value = 0.005) and high FOF (OR: 17.36; 95% CI: 6.79-44.39, p-value < 0.001) compared to a reference group of non-frail participants. Preventing frailty and pre-frailty among older adults could involve interventions that target various risk factors, such as demographic characteristics, and FOF.
Unlocking the Link: Sleep Deprivation and Cognitive Performance in Working-age Women - A Systematic Review
Background: Sleep deprivation is a prevalent issue among working women, often resulting from a combination of professional, familial, as well as societal demands. Objective: This systematic review aims to summarize the body of research on the effects of sleep deprivation on cognitive function, focusing on working women in particular. Method: A comprehensive search was conducted across several databases to locate pertinent studies released between January 2014 and January 2024. Research has examined the relationship between sleep deprivation and executive function, memory, attention, and decision-making, among other cognitive abilities. The chosen studies' methodological quality was assessed, and relevant data were located and compiled. Results: The results indicate that sleep deprivation has a major negative impact on working women's cognitive function, with deficiencies noted in a number of domains. Age, workload, and family obligations may also increase these effects. Conclusion: To develop targeted therapies that can lessen the detrimental impacts of sleep deprivation and improve the wellbeing of women in the profession, a thorough understanding of how sleep deprivation affects cognitive performance is crucial.
Sleep deprivation, cognitive performance, working women.
Experiences of Working with Parents with Mental Disabilities in Private Education Institutions: A Qualitative Focus Group Study
The purpose of this study is to understand the experiences of parents with intellectual disabilities employees whom working in official private education institutions and the contribution to the scientific field. A qualitative method was used in this research. The study adopted a phenomenological design, highlighting the exploratory nature of qualitative research. Six focus groups were formed in this study. -These six focus group sessions were conducted, with total of 36 participants. Coding analyses were done using the MAXQDA 2022 program. Then,content analyses from the focus groups were conducted focusing to answer the research questions.This study recommended that counseling services should be provided specifically to intellectually disabled parents, focusing particularly specific on the social work profession. In addition, this study recommended for competent authorities to conduct further close monitoring and case follow-ups for involved families to observe the ongoing situations between parents and children.
experiences; intellectual disabilities; private education institution; parents; social work needs
The Relationship Between Burnout and Violence Tendencies of Caregivers of Patients with Schizophrenia
The importance of family has increased with the adoption of the community-based approach in the treatment of patients with schizophrenia and returning them to their social environments. Schizophrenia is a chronic mental illness, that affects not only the individual but also the family’s life because 10% of suffered individuals with illness need such long-term care and needed support from their families. This study aims to examine the relationship between burnout and violent tendencies among caregivers of schizophrenia patients. The study was a correlational and cross-sectional survey and followed quantitative methodology. The population consisted of 60 caregivers who took primary responsibility and spent the most time with patients diagnosed with “schizophrenia” according to DSM-V-TR diagnostic criteria, who were registered in a health center. In line with the purpose of the research, data collection tools are the Personal Information Form, Maslach Burnout Scale, and Violence Tendency Scale. The study found that there was a positive significant relationship between burnout and violence tendency among caregivers (r=0.539; p=0.000<0.05). In other words, burnout of caregivers increases violence tendency. In addition, the sub-dimensions of burnout significantly affected the propensity to violence (F=8,657; p=0.000<0.05). The severity of illness in schizophrenia patients impairs their caregivers’ mental health. Families caring for persons with schizophrenia have difficulty tolerating them if the families have a feeling of burnout. Dissemination of psychosocial practices among caregivers of schizophrenia patients in adjunct to treatment will help families reduce their level of burnout and depression.
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Exclusive Breastfeeding as the Foundation for Complementary Feeding: A 2022 Analysis of Nutrition Status Survey (NSS) Lampung Province, Lampung
In Indonesia, supplemental foods are provided to almost 40% of newborns before they are six months old. This study aimed to identify the factors influencing complementary feeding practices in Lampung Province. A cross-sectional design was used, drawing on secondary data from the 2022 Nutrition Status Survey (NSS) of Lampung Province. Data were collected from all districts and cities in the province, consisting of 13 districts and 2 cities, and included children aged 6–23 months. The final sample comprised 2,310 respondents. Data collection involved interviews, anthropometric assessments and physical checks using household and individual questions carried out by qualified local enumerators. The physical examinations assessed nutritional status, including breastfeeding and complementary feeding practices. Anthropometric measurements included body weight, length/height, and mid-upper arm circumference. Multivariate logistic regression was used for data analysis. The results showed that the variable most strongly associated with complementary feeding practices was breastfeeding history (p = 0.001; OR = 2.244; 95% CI: 1.377–3.658). These findings highlight the importance of optimising exclusive breastfeeding up to six months of age, as it supports infants in developing preferences for a wider variety of foods.
complementary feeding; exclusive breastfeeding; nutrition; breast milk
The Effect of Being Faithful, Condom Use, no Drug Behavior on the Incidence of Sexually Transmitted Infections (STIs) in Unmarried Men Who Have Sex with Men (MSM) in Indonesia
Background: “BCD” habits can help homosexual people and men who have sex with men (MSM) prevent the transmission of sexually transmitted infections (STIs) and safeguard their partners. Objective: The purpose of this study was to investigate how BCD behaviour affects the prevalence of STIs among Indonesian MSM. Methods: a cross-sectional study was conducted in 24 provinces in Indonesia from April to May 2023. The study population comprised MSM who had ever engaged in sexual intercourse, either occasionally, once, or frequently, totaling 6,000 individuals. A sample of 3,515 participants was selected using the Respondent Driven Sampling (RDS) method. Integrated Biological and Behavior Survey (STBP) 2018-2019 data was utilized. The data was analyzed using multivariate analyses with STATA 14 software. Results: after controlling for the variables of pieces of information exposure and vaginal intercourse, the following behaviors were found to have a significant influence of the occurrence of STIs among MSM (p-value:0.050; AOR:1,62 with 95% CI:0.96-2.73), condom use (p-value:0.050; AOR:0.37 with 95% CI:0.14- 1.00), no drug use (p-value:0.040; AOR:1,67 with 95% CI:1.02-2.75). Conclusion: promoting faithful behavior towards a steady partner, consistent condom use during sexual activity, and refraining from injections and drug use can effectively reduce the transmission of STIs among MSM.
Healthy Lifestyle Components and Mental Health among Undergraduate Students
Background: Mental health issues among undergraduates have gained attention in recent years due to their rising incidence. Healthy lifestyle components like sleep quality, diet, physical activity, substance abuse, and social support may affect mental health. Thus, recognizing the most important components of a healthy lifestyle allows relevant parties to execute suitable treatments. Objective: This study aims to identify predictors of a healthy lifestyle on mental health. A cross-sectional study was carried out on a randomly selected sample of 180 undergraduate students aged 18 to 30. Significant predictors of healthy lifestyle components were identified using AHLQ and DASS 21 instruments. Methods: This research is quantitative research with a nested case-control study design, using electronic medical record (EMR) data from the Central Java Provincial Hospital in 2023. The variables in this study were gender, age, education level, employment status, marital status, health insurance status, BMI, DM diet, duration of DM, hypertension, other diseases, current blood glucose, and HbA1c. The analysis used was univariate, bivariate, and multivariate analysis (logistic regression). Results: The findings indicate a significant relationship between a healthy diet and mental health, and a healthy diet contributes 25% of variances, while 29% of mental health variance was attributed to the combination of a healthy diet and PA. Furthermore, 31% of mental health variance is attributed to sleep quality variables, and a combination of healthy diet, PA, sleep quality, and substance abuse contributes to 34% of mental health variance. Conclusion: This study provides insights to stakeholders in terms of incorporating healthy lifestyle components in mental health intervention strategies for undergraduate students. It was concluded that such interventions should focus on promoting a healthy diet since it is the most significant measure of good mental health.
Mental Health; Healthy Lifestyle; Depression; Anxiety; Stress
Environmental Health Risk Assessment of Consumption of Foodstuffs Containing Organophosphate Residues among Farmers
The use of pesticides in the agricultural sector results in contamination of foodstuffs by pesticide residues, thus becoming a source of exposure to the body and resulting in health problems. The purpose of this study was to analyse the health risks due to the consumption of foodstuffs containing organophosphate residues in farmers. The design of this study was cross-sectional, employing the Environmental Health Risk Assessment (EHRA). The study population was farmers in the North Dempo District of Pagar Alam. A total of 117 farmers were sampled randomly. Environmental samples consisted of five red chilies and five tomatoes, which were selected purposively. Organophosphate residues were quantified using liquid Chromatography Tandem Mass Spectrometry. Body weight was measured using calibrated body scales. Activity pattern data were collected through interviews using a questionnaire. Data analysis was conducted using the EHRA formulas. The results demonstrated the presence of Chlorpyriphos in red chillies at a concentration of 3,05 mg/kg, while Profenofos was found at 0.0731 mg/kg and 0.0118 mg/kg. The presence of Chlorpyriphos in tomatoes samples at a concentration of 0.4439 mg/kg, while Profenofos was found at 0.0112 mg/kg and 0.2043 mg/kg. The risk quotient for consumption of red chillies containing Chlorpyriphos was found to be 0.0447, while that for Profenofos was 0.2476. The risk quotient for consumption of tomatoes containing Chlorpyriphos was found to be 0.0302, while that for Profenofos was 2.92. It can be concluded that respondents were at non-carcinogenic health risk due to consumption of tomatoes containing Profenofos.
A Systematic Approach Utilizing the System Engineering Initiative for Patient Safety 2.0 Model to Mitigate Fatigue in ER
The study focuses on addressing fatigue among healthcare workers in Emergency Room (ER), vital in delivering health services but prone to worker fatigue. Using objective measures like cardiovascular load (%CVL) and Bourdon Wiersma test, it evaluates physical and mental fatigue. Leveraging the System Engineering Initiative for Patient Safety 2.0 (SEIPS 2.0) model, it comprehensively analyzes factors affecting fatigue. Data collection includes surveys and statistical analysis through Structural Equation Modeling-Partial Least Squares (SEM-PLS). Results show all workers experience fatigue, with physical fatigue affected by age and gender, and mental fatigue influenced by workload. The outer model analysis confirms convergent and discriminant validity, and reliability of the constructs. The inner model analysis reveals the work system significantly affects fatigue, while the process does not. The study emphasizes the importance of addressing fatigue to improve worker well-being and enhance patient care in ER, providing actionable insights for healthcare organizations.
Development of a Mobile App for Smoking Cessation: a Qualitative Study
Smoking is a public health concern in Indonesia. A challenge facing Indonesian healthcare system is that the use rate of in-person smoking cessation counseling is low due to smokers’ concerns about their privacy. This challenge has limited the ability of Indonesian health researchers and policy makers to develop and implement evidence-based practices to prevent smoking. The development of digital technologies in Indonesia has offered various opportunities to address this issue. Mobile devices are ubiquitous in Indonesia and have the potential to deliver counseling services for smokers. This study was part of the Mobile Application System for Smoking Cessation program and aimed to investigate the culturally-tailored features of mobile apps to prevent smoking in Indonesia. Data were collected through structured interviews and Focus Group Discussions (FGDs) among Indonesian policy makers and experts from universities and NGOs. We also reviewed relevant documents recommended by participants. We found that to develop a culturally-tailored mobile app for smoking cessation in Indonesia, it is important to understand smokers’ characteristics, smoking status, smoking behavior, and level of motivation to quitting smoking. We also found that following the World Health Organization’s 5A (Ask, Assess, Advise, Assist, Arrange) and 5R (Relevance, Risk, Reward, Roadblocks, Repetition) strategies is a key to improve the feasibility and acceptability of a smoking-cessation mobile app. App-based interventions need to be integrated with the practices performed by counselors and health workers and should be easily accessed by smokers.