Faculty of Public Health Journal Universitas Indonesia
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Evaluasi Ekonomi Parsial antara Pemberian Terapi Rivaroxaban dan Terapi Kombinasi (Unfractionated Heparin + Warfarin) untuk Pengobatan Trombosis Vena Dalam pada Pasien Kanker di Rumah Sakit Kanker Dharmais
Get PDFAbstrak Berdasarkan penelitian sebelumnya, diketahui bahwa terapi rivaroxaban memiliki beberapa kelebihan dibandingkan dengan terapi kombinasi (UFH+warfarin) untuk pengobatan trombosis vena dalam (deep vein thrombosis/DVT). Akan tetapi, masih sedikit dokter di RS Kanker Dharmais yang memberikan terapi rivaroxaban untuk pengobatan DVT. Penelitian evaluasi ekonomi parsial ini bertujuan untuk menganalisis outcome dan besarnya biaya yang dibutuhkan dari perspektif rumah sakit antara pemberian terapi rivaroxaban dan terapi kombinasi (UFH+warfarin) untuk pengobatan DVT pada pasien kanker di Rumah Sakit Kanker Dharmais tahun 2016 – 2018. Desain penelitian ini adalah kohort retrospektif dengan unit analisis individu. Karena keterbatasan jumlah pasien yang mendapatkan terapi rivaroxaban selama 3 – 6 bulan, studi ini menganalisis biaya dan outcome dari pasien yang mendapatkan terapi selama 1 bulan. Outcome yang diukur adalah intermediate outcome, yang meliputi lama hari rawat, kesembuhan, dan kejadian perdarahan. Biaya dihitung berdasarkan biaya yang dibebankan kepada pasien (charge), yang meliputi biaya obat, pemeriksaan penunjang, tindakan, serta administrasi dan akomodasi. Hasil penelitian menunjukkan bahwa untuk outcome terapi rivaroxaban, sebagian besar pasien tidak mendapatkan perawatan rawat inap, 40% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi rivaroxaban adalah Rp 7.169.383,00 per pasien. Untuk outcome terapi kombinasi (UFH+warfarin), sebagian besar pasien memiliki lama hari rawat antara 8 – 14 hari, 46% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi kombinasi (UFH+warfarin) adalah Rp 11.878.813,00 per pasien.Abstract Based on previous studies, rivaroxaban therapy has several advantages compared to combination therapy (UFH+warfarin) for the treatment of deep vein thrombosis (DVT). However, the use of rivaroxaban in Dharmais Cancer Hospital is still low. This partial economic evaluation study aims to analyze cost and outcome of rivaroxaban therapy and combination therapy (UFH+warfarin) for DVT treatment in cancer patients at the Dharmais Cancer Hospital during 2016 – 2018. Data collection was done using cohort-retrospective and individual unit of analysis. Due to limited number of patient treated with rivaroxaban therapy within 3-6 months, we estimated the cost and outcome related to patients who were successfully treated in one month. The outcome was the intermediate outcome, i.e length of stay, recovery, and the occurrence of bleeding. The cost was calculated based on hospital perspective including drugs, laboratory tests, procedures, as well as the administrative and accommodation costs. The results showed that patients with rivaroxaban therapy were not admitted to inpatient care, 40% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of rivaroxaban therapy to reach the expected outcome was Rp 8,824,791.00. The study also showed that patients with combination therapy (UFH+warfarin) had a hospital length of stay between 8 to 14 days, 46% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of combination therapy (UFH+warfarin) to reach the expected outcome was Rp 13,201,698.00
Ex Ante Moral Hazard Pada Sistem Jaminan Kesehatan Nasional (JKN) di Indonesia
Get PDFAbstrakPenelitian ini memberikan kontribusi berupa studi empiris ex ante moral hazard pada Sistem Jaminan Kesehatan Nasional (JKN) di Indonesia. Kami menemukan bahwa kepemilikan Program JKN memiliki hubungan negatif dengan aktivitas fisik dan hubungan positif dengan pengeluran rokok individu. Selanjutnya dengan menghitung efek marginal kami mendapatkan bahwa Program JKN mengurangi probabilitas individu untuk melakukan aktivitas fisik sebesar 2.7% dan mengurangi intensitas melakukan aktivitas fisik. Program JKN juga ditemukan berhubungan positif pengeluaran rokok individu bagi perokok. Hasil analisis menyatakan bahwa ada indikasi terjadinya ex ante moral hazard pada Program JKN karena terdapat hubungan yang positif antara kepemilikan JKN dan probabilitas individu melakukan perilaku kesehatan berisiko seperti aktivitas fisik dan perilaku merokok.Abstract This paper contributes to the empirical evidence of ex ante moral hazard on the National Health Insurance System (NHIS) in Indonesia. We find that JKN participation has a negative relationship with physical activity and positive relationship with smoking spending. Furthermore, by calculating marginal effect we obtained that JKN participation reduce the probability of physical activity by 2.7% and also reduce the intensity of individual physical activity. For the smoker, JKN Participation is expected increase in their spending for smoking. The result indicates that there is an evidence of ex ante moral hazard since there is a positive relationship between JKN participation and risky health behaviors such as physical activity and smoking behavior
Economic Burden Bore by Patients and Families because of stroke: Policy Assessment
Get PDFAbstractStroke to this day is still a disease that causes a high disability. In the future, it will require a prohibitive cost so that it has an impact on the socio-economic consequences for patients and their families. The price is prohibitive so that the impact on socioeconomic implications for patients and their families. Because of that, the purpose of the study is to estimate the cause of the cost that causes an economic burden from a stroke. The method that is used is a content analysis by doing a further literature review from various sources, from journal to textbook from a national level to international. Literature studies show that direct medical cost, which is rehabilitation, and nursing care cost is identified as the leading contributor to the high price of economic burden from a stroke. High costs incurred cause family to experience catastrophic financial disaster; it even impacts to drop welfare level. Social preventive action is needed to reduce the high prevalence of stroke to reduce the cost, to protect every household from financial disaster from a stroke
THE CORRELATION BETWEEN THE QUALITY OF WORK LIFE AGAINST THE PERFORMANCE OF THE EMPLOYEES OF OGAN ILIR DISTRICT GENERAL HOSIPTAL, SOUTH SUMATERA IN 2018
Get PDFAbstract. A favorable work environment will influence the quality of work life, would create quality human resources, and support the improvements in the quality of services. To discover the correlation betweem the quality of work life and the employees’ performance at Ogan Ilir District General Hospital, a study was performed in March-April 2018. The study was a cross sectional quantitative study on 315 civil servants and voluntary staff at the hospital. Univariate, bivariate, and multivariate analysis was performed using the chi-square and the double regression prediction/determinant model. We discovered that the quality of the work life at the hospital was lacking, particularly for pride in their place of work, employee involvement/participation, and the facilities provided to the employees. It was also discovered that of the 315 employees, 164 (51.1%) employees had low performance index and there was a significant correlation between the employee involvement/participation and the facilities provided to the employees with their performance. Therefore, the three components that was correlated strongly with employee performance was employee involvement/participation [Odds Ratio (OR): 2.190, Confidence Interval (CI): 95%, P <0.001], facilities provided (OR: 2.670; CI 95%, p < 0.000), and work safety (OR: 0.972, CI 95%, p = 0.911)
Associations of Dietary Diversity and Other Factors with Prevalence of Stunting among Children Aged 6-35 Months
Get PDFAbstractPrevalence of stunting among under five children in Indonesia is still considered as a public health problem. Dietary diversity, one of the important assessments in infant and child feeding practice, is one of important determinants of stunting. This study is aimed to examine associations between dietary diversity with other factors with prevalence of stunting in Babakan Madang District, Bogor Regency in 2019. A cross-sectional design study was performed in this study during April-June in 2019. A total of 149 children’s height aged 635 months was measured and defined based on WHO growth standards. Dietary diversity scores were collected from 24-hour food recall based on 7 food groups. Results showed that the prevalence of stunting in this study was 32.2% and 31.5% of them had low dietary diversity. There was association between dietary diversity and minimum acceptable diet with stunting (p-value = 0.033 and 0.013). Therefore, interventions should be taken by improving dietary diversity to reduce the burden and prevalence of stunting in both household and community level.AbstrakPrevalensi stunting pada balita di Indonesia masih merupakan masalah kesehatan masyarakat. Keragaman pola makan sebagai salah satu asesmen penting dalam praktik pemberian makan bayi dan anak, merupakan salah satu determinan penting untuk stunting. Penelitian ini bertujuan untuk mengetahui hubungan antara keragaman pola makan dan faktor lain terhadap prevalensi stunting di Kecamatan Babakan Madang Kabupaten Bogor tahun 2019. Studi cross sectional dilakukan pada penelitian ini selama bulan April -Juni tahun 2019. Sebanyak 149 anak usia 6-35 bulan diukur tinggi badannya dan didefinisikan menggunakan standar pertumbuhan tinggi badan menurut usia dari WHO. Skor keragaman pangan dikumpulkan dari Food Recall 24 jam berdasarkan 7 kelompok pangan. Hasil penelitian menunjukkan prevalensi stunting pada penelitian ini sebesar 32,2% dan sebanyak 31.5%-nya memiliki keragaman pola makan rendah. Terdapat hubungan antara keragaman diet dan asupan minimum yang dapat diterima dengan stunting (p value = 0.033 dan 0.013). Dengan demikian, intervensi harus dilakukan dengan meningkatkan k eragaman pangan untuk mengurangi beban dan prevalensi stunting baik di tingkat rumah tangga ma upun masyarakat
Hubungan Wilayah Tempat Tinggal dengan Pemberian ASI Ekslusif pada Anak 0-5 Bulan di Indonesia (Analisis Data Survei Demografi Kesehatan Indonesia) Tahun 2017
Get PDFASI ekslusif dapat mencegah morbiditas dan mortalitas pada anak. Wilayah tempat tinggal perkotaan dan pedesaan memiliki keterkaitan dengan praktek pemberian ASI ekslusif. Penelitian ini bertujuan untuk menganalisis hubungan antara wilayah tempat tinggal dengan praktek pemberian ASI ekslusif pada anak 0-5 bulan di Indonesia. Desain studi penelitian yaitu cross sectional menggunakan data sekunder Survei Demografi Kesehatan Indonesia. Penelitian ini dilaksanakan diseluruh provinsi di Indonesia. Variabel dalam penelitian ini terdiri dari ASI ekslusif sebagai variabel dependen, wilayah tempat tinggal sebagai variabel independen dan variabel perancu yang terdiri dari umur ibu, pendidikan ibu, paritas, kondisi depresi ibu, status bekerja, status ekonomi, status pernikahan, inisiasi menyusui dini, jenis persalinan, tempat bersalin, antenatal care dan berat lahir anak. Teknik sampling menggunakan total sampling dengan jumlah sampel 1.266. SPSS 16 digunakan sebagai software statistik pada penelitian. Data dianalisis menggunakan regresi logistik dan prevalence odds ratio. Hasil penelitian menunjukkan prevalensi ASI ekslusif 67,1% dan 37,9% tidak ASI ekslusif. Prevalensi wilayah tempat tinggal pedesaan 53,5% dan perkotaan 46,5%. Terdapat hubungan wilayah tempat tinggal dengan pemberian ASI ekslusif POR 1,298 (95%CI 1,023 – 1,646). Ibu yang tinggal diperkotaan memiliki peluang yang lebih tinggi untuk tidak memberikan ASI ekslusif dibandingkan ibu yang tinggal dipedesaan, setelah dikontrol dengan variabel status bekerja, inisiasi menyusui dini dan status pernikahan
Traveler’s Infections: Understanding SARS-CoV-2 as a Potential Agent
Get PDFCoronavirus disease 2019 (COVID-19) has become a major, global, public health challenge. More than 1,051,635 confirmed cases (and counting) have been reported worldwide, thus far, and both local and international travelers are considered to represent populations at high risk of acquiring the infection. Many factors are involved in the spread of this viral agent, including travel to and from endemic areas, a history of contact with a traveler from an endemic country, the virus infection rate at the destination, individual health, and inadequate prevention and control measures. COVID-19 symptoms range from fever and cough to difficulty breathing, and more severe cases can present with pneumonia and multi-organ failure. The virus is thought to be transmitted through large respiratory droplets, generated by coughing or sneezing and transmitted through close contact with infected persons or contaminated surfaces. Diagnostic strategies include the assays for the detection of antiviral antibodies, multiplex nucleic acid amplification, and microarray-based assays. Currently, no approved antiviral therapy or vaccine exists to treat or prevent the infection. Public health measures, such as quarantine, have been enforced, to slow the community spread of the virus, by governments, worldwide. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have recommended COVID-19 infection screening be performed at airports, for all travelers, before traveling to endemic countries and the restriction of travel to countries more than one thousand cases of infection. In response to the global outbreak, this review examines COVID-19 as a potential traveler’s infection
Local Initiatives In Preventing Coronavirus Based On Health Policy Perceptive
Get PDFAbstract. World Health Organization (WHO) has declared Coronavirus 2019-2020 as a Public Health Emergency of International Concern (PHEIC). Local transmission of this disease occurs in almost every country around the world. Likewise, in Indonesia, Covid-19 cases have spread to all 34 provinces. This study aims to analyze the local initiative in handling Covid-19 based on the public health perspective in Indonesia. It is based on time, the form of activity, the type of response, and the contribution of local initiatives. This study used secondary data from various media sources and articles on the Covid-19 pandemic in Indonesia and community assistance as the keywords. The study used 31 news found in media sources from 34 provinces in Indonesia. Handling Covid-19 has become a concern for the government and the public. The government is implementing physical distancing as a way to handle Coronavirus. For the local community, it is in the form of local initiatives by educating the community, fulfilling PPE, supporting infrastructure facilities, crowdfunding carried out personally or in groups, and doing prevention by wearing masks and doing self-quarantine. Various elements of society have played a role and participated in the movement to eradicate the Coronavirus. Cross-sectoral coordination needs to be intensified for the implementation of comprehensive efforts
Model Spasial Faktor Risiko Kejadian Berat Bayi Lahir Rendah di Provinsi Jawa Barat: Analisis Data SDKI Tahun 2012
Get PDFBerat badan lahir rendah merupakan salah satu penyebab meningkatnya kematian neonatus di beberapa negara berkembang. Selain itu, dapat memengaruhi perkembangan anak di masa dewasa. Tujuan dari penelitian ini adalah untuk mengetahui faktor risiko kejadian BBLR melalui pendekatan spasial di provinsi Jawa Barat. Penelitian ini dilakukan melalui pendekatan kuantitatif dengan desain studi cross sectional dan menggunakan data SDKI 2012. Sampel penelitian ini berjumlah 753 individu dari 24 kabupaten/kota di Provinsi Jawa Barat. Variabel dependen pada penelitian ini adalah Berat badan lahir rendah yang didefinisikan sebagai kondisi bayi saat lahir <2500 g. Faktor risiko kejadian berat lahir rendah yang diteliti adalah kunjungan antenatal care, status merokok pada ibu, pendidikan ibu, status ekonomi, pekerjaan, konsumsi zat besi dan komplikasi kehamilan. Analisis penelitian ini adalah analisis prediksi menggunakan regresi logistik dan analisis spasial menggunakan Geographically Weighted Regression. Hasil penelitian ini menunjukkan bahwa variabel kunjungan antenatal care, status merokok pada ibu dan komplikasi kehamilan membentuk model prediksi. Sementara itu, pada analisis spasial, Model global spasial yang terbentuk adaalah variabel konsumsi zat besi, sedangkan variabel kunjungan antenatal care, status merokok pada ibu, pendidikan ibu, status ekonomi, pekerjaan, dan komplikasi kehamilan merupakan model spasial lokal wilayah. Suplementasi besi merupakan salah satu intervensi yang dapat di lakukan secara global di seluruh provinsi Jawa Barat untuk menurunkan kejadian berat bayi lahir rendah. Pemerataan pembinaan kesehatan ibu hamil perlu ditingkatkan di wilayah dengan kejadian faktor risiko BBLR yang cukup tinggi
Factors Associated with Minimum Dietary Diversity among Breas tfed Children Aged 6-23 Months in Indonesia (Analysis of Indonesia DHS 2017)
Get PDFAbstractPoor comp lementary feeding practices can lead to malnutrition in infants and young children . Minimum dietary diversity (MDD) is one of the determinants of children’s nutritional status and has been found to predict stunting. This study examined factors associated with MDD achievement among breastfed children aged 6-23 months based on Indonesia’s Demographic and Health Survey 2017. This study us ed chi-square and multiple logistic regression to analyze the data. Among 2,976 children only around 53% children met MDD recommendation. Multivariate analysis found that the diversity of diet is better among older children than younger children. Children aged 18-23 months have possibility of 5.7 times higher to achieve MDD than children aged 6-11 months and 1.3 times higher than children aged 12-17 months . Children of wealthier family (3 rd quintile and above), those delivered by trained healt h personnel, children of higher mothers’ education, working mothers, fathers’ involve in child care , ANC visit >= 4 times, and parents reside in u rban areas have possibility of having higher MDD achievement significantly than the other groups . The low MDD achievement among children aged 6-11 months warrant the importance of prioritizing effort on this age group because this is a period where a child grows rapidly and potentially expose to infection as a result of un -hygienic food preparation , and will affect the child’s growth later on .AbstrakPraktik MP-ASI yang buruk dapat menyebabkan kekurangan gizi pada anak -anak.a Ragam Asupan Minimal ( MDD) merupakan salah satu penentu status gizi anak dan dapat memprediksi terjadinya stunting . Penelitian ini membahas mengenai faktor -faktor yang berhubungan dengan capaian MDD pada anak yang diberi ASI usia 6 -23 bulan berdasarkan data SDKI tahun 2017 . Penelitian ini menggunakan uji Chi -square dan uji regresi logistik ganda untuk menganalisis data. Dari 2 ,976 anak usia 6 -23 bulan yang diberi ASI di Indonesia tahun 201 7, h anya sekitar 5 3 % anak yang telah mencapai MDD. Hasil analisis multivariat menunjukkan ba hwa capaian MDD lebih baik pada anak yang berusia lebih tua. Anak umur 18 -23 bulan mempunyai kemungkinan sebesar 5.7 kalinya untuk mencapai MDD dan anak umur 12 -17 bulan sebesar 1.3 kalinya, dibandingkan dengan bayi umur 6 -11 bulan. Anak yan g berasal da ri keluarga lebih mampu (kuintil 3 atau lebih), yg lahir ditolong tenaga kesehatan terlatih, anak dari ibu yang berpendidikan lebih tinggi, ibu yang bekerja, ayah yang berperan dalam mengurus anak, ibu yang melakukan kunjungan ANC > 4 kali dan orang tua t inggal di perkotaan, mempunyai kemungk inan lebih besar secara bermakna untuk mencapai MDD sesuai anjuran . Rendanhya capaian MDD pada bayi 6 -11 bulan menunjukkan pentingnya memberikan perhatian pada kelopmpok ini karena merupakan kelompok yang masih tumbuh dengan cepat dan mulai terpapar dengan kemungkinan terjadiya infeksi akibat penyiapan makanan yang tidak hygienis, dan akan berpengaruh terhadap pertumbuhan selanjutnya