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The forming of indicators for monitoring the quality improvement and patient safety continuity post-accreditation of primary health care: action research in Jember District
No full textTujuan: Mengembangkan indikator pemantauan keberlanjutan peningkatan mutu dan keselamatan (PMKP) pasca akreditasi Puskesmas di Kabupaten Jember. Metode: Penelitian ini menggunakan rancangan penelitian action research. Subyek penelitian adalah Tim Pendamping Akreditasi Puskesmas dan Tim Mutu Puskesmas di Kabupaten Jember. Pengumpulan data dilakukan dengan analisis hasil wawancara mendalam untuk mengidentifikasi komponen indikator, telaah pustaka (guidelines) dan lokakarya untuk menyusun daftar indikator potensial, analisis uji coba, serta lokakarya akhir untuk menetapkan indikator. Hasil: Keterbatasan sumber daya manusia akibat perubahan struktur organisasi menjadi kendala utama dalam proses pemantauan PMKP pasca akreditasi sehingga dibutuhkan instrumen yang memudahkan prosesnya berupa indikator. Penyusunan indikator melewati proses kajian pustaka, seleksi dan konsensus awal, uji coba, evaluasi hasil uji coba, hingga dirumuskan 18 indikator pemantauan keberlanjutan PMKP pasca akreditasi Puskesmas di Kabupaten Jember (8 indikator pada komponen structure dan 10 indikator pada komponen process). Kesimpulan: Implementasi indikator pemantauan keberlanjutan PMKP pasca akreditasi Puskesmas di Kabupaten Jember perlu didukung dengan penetapan kebijakan, pembenahan sistem informasi, serta revitalisasi peran Dinas Kesehatan sebagai pendamping akreditasi Puskesmas.Purpose: Developing indicators for monitoring the Quality Improvement and Patient Safety (QIPS) continuity post-accreditation of primary health care center (Puskesmas). Method: This research using an action research design. The research subjects are the Puskesmas Accreditation Assistance Team and the Puskesmas Quality Team in Jember District. Data collection is done by analyzing the in-depth interviews to identify the indicator components, literature and guideline review also workshop to compile a list of potential indicators, analysis of trials, and the final workshop to set the indicators. Results: The absence of post-accreditation monitoring instruments become a major obstacle in the post-accreditation QIPS monitoring process, so some instruments in the form of indicators are needed to facilitate the process. The development of indicators went through the process of literature review, selection and initial consensus, trials, evaluation of trial results, until 18 indicators were formulated (8 indicators of structure component and 10 indicators of process component). Conclusions: The implementation of indicators for monitoring the QIPS continuity post-accreditation of Puskesmas needs to be supported by the policies, revamping the information system, and revitalizing the role of the District Health Office as Puskesmas accreditation assistant
Implementing One Health (OH) Guideline for Effective Cross-Sectoral Collaboration: Enablers and Challenges for Neglected Zoonoses and Emerging Infectious Diseases (EIDs) Control in Kulonprogo District, Yogyakarta Province, Indonesia
No full textZoonoses are communicable diseases that transmissible between animals to humans, and vice versa. There are approximately 75% of emerging infectious diseases (EIDs) that originated from the animal. It has been an evidence-based practice for decades that One Health (OH) approach which integrates humans, animals and environmental health could provide earlier windows opportunity for better zoonoses control. We used a qualitative method using document review and semi-structured depth interviews to understand the barriers and enablers for implementing OH guidelines from Coordinating Ministry for Human Development and Cultural Affairs for cross-sectoral collaboration in Kulon Progo district, Yogyakarta Province, Indonesia. Totally, 13 participants were interviewed, who came from different backgrounds and expertise, including animal, public and environmental health, social science, governance, and disaster response. The document review shows precedent of cross-sectoral collaboration between public and animal health on national level that was initiated in 1972. Based on the recent trend of the public health problems in Kulon Progo, there are significantly lingering and/or increasing number of infectious diseases, both from public and animal health. Those diseases are leptospirosis, scabies, and helminthiasis (ancylostomiasis and ascariasis). All of those diseases are zoonotic and the last two are neglected, which included in neglected tropical diseases (NTDs) by WHO. There are enablers that emerge for implementing OH, including strong commitment, political will, program flexibility, good governance, system support, and thinking. The challenges/barriers that emerge including silo mentality, lack of cross-sectoral communication and coordination, conflict of interest, regulation, political will, siloed education, and funding. The necessary feasible intervention at the district level is to formalize a working group and/or committee for outbreak preparedness. Cross-sectoral meeting for joint-program and funding allocation are crucial for better planning, execution, and program evaluation to tackle zoonotic diseases (both NTDs and EIDs)
Risk Model for Third Hand Smoke Against Health Problems in Children in Palembang City
No full textIntroduction The cigarette smoke residue left on home furnishings, clothes and on smokers' bodies is known to have an impact on health, especially toddlers and children. In the long term this exposure triggers the incidence of cancer. Purpose This study aims to determine the risk of third hand smoke in children under five to their health problems in Palembang. Method This study used a cross sectional design in Palembang. The sample amounted to 180 toddlers who were selected using the cluster sampling method. The analysis performed was univariate, bivariate and multivariate analysis of risk factor models. Results Based on the analysis, it is known that respondents who are classified as Third Hand Smoke (THS) have a risk of 2.905 (1,341-6,296) times for experiencing health problems than those who are not classified as THS. After controlling for socio-economic variables, smoker status, gender, child's age, father's attitude, the risk of THS against health problems increased from 8,752 (2,656-28,843). Discussion It is necessary to educate the public, especially fathers, about the dangers of exposure to cigarette smoke residues for children's health problems.Keywords : Third Hand Smoke, Smoker Father, smoke residue, Health ProblemsIntroduction The cigarette smoke residue left on home furnishings, clothes and on smokers' bodies is known to have an impact on health, especially toddlers and children. In the long term this exposure triggers the incidence of cancer. Purpose This study aims to determine the risk of third hand smoke in children under five to their health problems in Palembang. Method This study used a cross sectional design in Palembang. The sample amounted to 180 toddlers who were selected using the cluster sampling method. The analysis performed was univariate, bivariate and multivariate analysis of risk factor models. Results Based on the analysis, it is known that respondents who are classified as Third Hand Smoke (THS) have a risk of 2.905 (1,341-6,296) times for experiencing health problems than those who are not classified as THS. After controlling for socio-economic variables, smoker status, gender, child's age, father's attitude, the risk of THS against health problems increased from 8,752 (2,656-28,843). Discussion It is necessary to educate the public, especially fathers, about the dangers of exposure to cigarette smoke residues for children's health problems.Keywords: Third Hand Smoke, Smoker Father, smoke residue, Health Problem
Bacteriological quality of drinking water and public health inspection of refill depots: finding workable strategies to control the quality
Full text linkPurpose: Water refill depots have increased in all areas of Indonesia. Many studies have reported concerns about the bacteriological quality of drinking water at refill depots. However, limited studies have focused on ensuring the safety and quality of drinking water in refill depots, particularly for small-scale depots. This paper examines water microbiological quality at the refill depots and their depot production inspections from the local public health authority.Method: This survey used 60% of depots (47 out of 77 depots in the district) from April 4th to May 31st, 2016, in the North Luwu District of Central Sulawesi. Water samples were taken for E. coli and coliform examination. In-depth interviews were conducted with environmental health officers at the local health authority, depot owners, and workers.Results: Almost half of the total depots (49%) failed to meet the hygiene standard. Site observation found that depots were with poor sanitation and poor water handling. Depot owners found the cost of two times a year of the bacteriological examination was too expensive, including the transportation cost of water samples to the available closest laboratory in the provincial capital.Conclusion: Depots with non-standard bacteriological quality were still high. Supervision of the depot by the district health office was very loose. Efforts to advocate the district health office to take a more assertive position are critical. Community organizations and refill water depot associations should be involved so that public health interests get attention from the local government
PENGELOLAAN KESEHATAN REPRODUKSI PENGUNGSI PASCA GEMPA DI KABUPATEN LOMBOK TIMUR
No full textBackground: MISP (minimum initial service package) is a guideline for post-disaster reproductive health services. After the earthquake in East Lombok Regency, reproductive health services, according to the MISP standards, need to be seen. Suppose the condition does not comply with the standard. In that case, it will cause many pregnant and lactating women and infants and toddlers to be threatened with the quality of their health and safety. It will have an impact on increased maternal and infant mortality rates.Purpose: Describe the management of reproductive health in pregnant women, women giving birth / postpartum mothers with newborns among IDP victims of the earthquake disaster in East Lombok Regency.Research Methods: This research is a qualitative study with a case study design. In-depth interviews were conducted with 21 informants consisting of 6 stakeholders from the East Lombok District Health Office, four service providers, nine service recipients, and two cross-sectoral. Secondary data and document studies were also used as data sources.Result: Most informants have never heard of the term MISP, and the management of IDPs' reproductive health after the earthquake was not well organized. The organizational structure for managing the district-level health care program, both during the emergency response and rehabilitation phase, has not yet been formed. However, health workers' types of service activities such as midwives, nurses, and doctors from unaffected puskesmas are still running. These activities include ANC, delivery assistance, high-risk detection, and case referral. Family planning services and contraceptives, and the need for romance tents are not provided. As a result, there was an increase in mothers and neonates' high-risk cases and an increase in pregnant women K1 during the rehabilitation period. Provision of the "Kespro" tent for delivery services, pregnant women, and maternity services is available in collaboration with overseas organizations, but there is only one for the entire district. Apart from limited facilities and logistics and sanitation, officers are also less sensitive to other basic needs.Conclusion: There is a gap between the services provided and the minimum initial service package, which is the standard for reproductive health services in crisis times. Preparation of the local government through the relevant regional apparatus organizations is required to immediately prepare a Disaster Management Plan at all stages, starting from comprehensive mitigation, contingency, emergency response, and rehabilitation plan. Latar Belakang: PPAM (paket pelayanan awal minimum) adalah pedoman pelayanan kesehatan reproduksi pasca bencana. Pasca gempa di Kabupaten Lombok Timur pelayanan kesehatan reproduksi yang sesuai standar PPAM perlu untuk dilihat. Apabila kondisi tidak sesuai standar terus terjadi maka kelompok ibu hamil dan menyusui serta bayi dan balita yang jumlahnya cukup banyak terancam kualitas kesehatan dan keselamatannya dan akan bisa berdampak pada peningkatan angka kematian ibu dan bayi.Tujuan: Menggambarkan pengelolaan kesehatan reproduksi pada ibu hamil, ibu bersalin/ibu nifas bayi baru lahir pada pengungsi korban bencana gempa di Kabupaten Lombok Timur.Metode Penelitian: Penelitian ini adalah penelitian kualitatif dengan rancangan studi kasus. Wawancara mendalam dilakukan terhadap 21 informan yang terdiri dari 6 stakeholder Dinas Kesehatan Kabupaten Lombok Timur, 4 pemberi layanan, 9 penerima layanan, dan 2 lintas sektoral. Data sekunder dan studi dokumen juga digunakan sebagai sumber data.Hasil: Sebagaian besar informan belum pernah mendengar istilah PPAM; dan pengelolaan kesehatan reproduksi pengungsi pasca gempa belum terorganisasi dengan baik. Struktur organisasi pengelolaan kespro tingkat kabupaten baik dalam masa tanggap darurat dan fase rehabilitasi belum terbentuk. Namun, jenis kegiatan pelayanan yang diberikan oleh tenaga kesehatan seperti bidan, perawat dan dokter dari puskesmas yang tidak terdampak tetap berjalan. Kegiatan tersebut adalah ANC, pertolongan persalinan, deteksi resiko tinggi, dan rujukan kasus. Pelayanan KB dan alat kontrasepsi serta kebutuhan tenda asmara tidak diberikan. Akibatnya, terjadi peningkatan kasus resiko tinggi ibu dan neonatal, serta terjadi peningkatan bumil K1 pada masa rehabilitasi. Penyediaan tenda kespro untuk pelayanan persalinan, ibu hamil dan maternitas tersedia atas kerja sama dengan organisasi luar negeri, namun hanya ada satu untuk seluruh kabupaten. Selain fasilitas dan logistik serta sanitasi yang terbatas, petugas juga kurang peka terhadap kebutuhan dasar lain.Kesimpulan: Terjadi kesenjangan pelayanan yang diberikan dengan paket pelayanan awal minimum yang merupakan standar pelayanan kesehatan reproduksi pada saat krisis. Diperlukan persiapan pemerintah daerah melalui organisasi perangkat daerah terkait untuk segera menyusun Disaster Management Plan pada semua tahap mulai dari rencana mitigasi, kontingensi, tanggap darurat maupun rehabilitasi yang komprehensif
Food poisoning outbreak caused by diarrhoeal Bacillus Cereus: a retrospective study
Full text linkPurpose: This study aimed to investigate the causative agents, source of food poisoning, and mode of food poisoning transmission in Tegalkenongo Village.Method: A retrospective cohort study was used in the epidemiological investigation for one week from 13 May 2019 – 20 May 2019. Results: Based on the investigation, Of the 303 villagers involved in the event, 188 villagers were ill with the median age of cases was 38 years old, the average incubation period was 8 hours, and the predominant symptoms were diarrhea (93.62%), nausea (84.57%), and abdominal cramps (64.89%). The contaminated chicken satay was determined as the source of contamination with an adjusted Risk Ratio (aRR) was 4.36; 95% CI 1.1538, 16.5285. Initial epidemiological features and cultures from food items served in the event and stool sample of one patient suggested that the causative agent was Bacillus Cereus which was supported by Klebsiella Pneumoniae. Conclusion: Based on the field investigation result related to symptoms and incubation period and laboratory identification, we conclude that the causative agent was diarrhoeal B. cereus
Aedes sp Larvae resistance to malathion: public health implication
No full textAbstractPurposes: Dengue is emerging as a serious public health problem globally. The primary strategy to control dengue is by reducing the vector population using insecticides. Malathion has been massively used since the 1990s in dengue control programs. As there is no effective dengue drug or safe vaccine available, vector control remains the most effective intervention to reduce incidence and prevent transmission and outbreak. This study determined resistance status to malathion of Aedes sp larvae from Jalan Gedang Village, Bengkulu City (dengue endemic areas). Methods: This study used experimental with post-control only design. Aedes sp eggs were collected by ovitraps and colonized to larvae stage. Susceptibility test of larvae to the malathion was estimated using standard WHO. Results: Mortality of larvae Aedes sp after 24 hours with multiple concentration of malathion indicative of highly resistant (p=0.001). Conclusions: Continued testing to insecticide resistance in dengue vector is important to prevention of increased incidence of dengue. In order to reduce the development of insecticidal resistance, it recommended insecticides of different chemical structures be applied in rotation.Purposes: Dengue is emerging as a global public health problem. The primary strategy to control dengue is by reducing the vector population using insecticides. The massive use of malathion in dengue control programs has been since the 1990s. As there is no effective dengue drug or safe vaccine available, vector control remains the most effective intervention to reduce the incidence and prevent transmission and outbreak. This study determined resistance status to Aedes sp larvae's malathionfrom a dengue-endemic area of Bengkulu. Methods: This experimental study used a post-control only design. Aedes sp eggs were collected by ovitraps and colonized to larvae stage. Susceptibility test of larvae to the malathion was estimated using standard WHO. Results: Mortality of larvae Aedes sp after 24 hours with multiple concentrations of malathion indicative of highly resistant (p=0.001). Conclusions: Continued testing of insecticide resistance in dengue vectors is vital to preventing dengue hemorrhagic fever. To prevent resistance, it recommended insecticides of different chemical structures be applied in rotation.
Determination of Safe Concentration of Non-Carcinogenic Toluene in Surabaya Printing
No full textAims: The research objective is to determine the safe concentration of non-carcinogenic toluene in Surabaya printing. Methods and Material: The research design used was observational analytic, cross sectional research design with a quantitative approach. The research location is a printing press in Surabaya. Total population was 37 workers, the study sample was taken using the accidental sampling method with a total sample of 30 respondents. The formula for determining the concentration of toluene non carcinogen intake is (CxRxtExfExDt): (Wbx30x365). Results: The concentration value of toluene exposure is greater than the standard set by labor regulations No. 5 of 2018 by 0.2 ppm. A total of 10% of workers falls under normal category, 73% above normal category and 27% below normal category. Conclusions: The concentration of toluene exposure in Surabaya printing area is above normal with a concentration of 0.2 ppm and this is considered normal
Studi Kasus Analisa Beban Kerja Pelayanan Gizi Menurut Patton dan Sawicki di UPT Puskesmas Beji Kota Depok Provinsi Jawa Barat Tahun 2019
No full textPurpose: To analyze the workload of nutrition service in Beji Puskesmas UPT, Depok City, West Java Province in 2019. Method: A qualitative study, through in-depth interviews with the Head of Puskesmas, the Head of Administration, Quality Control and Nutritionist. Results: Nutrition counseling services in the building cannot be done every day during Puskesmas working hours because nutrition workers have to conduct regular monthly visits to 32 integrated community health service posts (posyandu). Even so, the scheduled staff cannot visit all posyandu within 1 month due to limited time and energy. Thus, the distribution and monitoring of supplementary feeding (PMT) is assisted by community health workers (CHW). There are two different recording and reporting applications, namely Community Based Nutrition Recording and Reporting (e-PPGBM) from the Ministry of Health and local applications from the Depok City Health Office. Inadequate computer equipment, infrastructure, and internet facilities, as well as incomplete population data, were highly time-and-energy consuming. Another increase in workload is the non-cooperation of families with malnourished children which often refused to be referred to the TFC (Therapeutic Feeding Center). Conclusion: Nutrition service efforts both inside the building and outside the building are less optimal because nutrition services are only carried out by a nutrition officer. Nutrition service, especially outside the building, must empower CHWs in order to increase the scope of nutrition services.Latar belakang: Tujuan: Untuk menganalisa upaya pelayanan gizi yang ada di UPT Puskesmas Beji Kota Depok Provinsi Jawa Barat Tahun 2019.Metode: Penelitian ini menggunakan metode penelitian kualitatif, melalui wawacara mendalam pada 4 orang yaitu Kepala Puskesmas, Kepala Tata Usaha, Penanggung Jawab Mutu dan Tenaga Gizi.Hasil: Berdasarkan wawancara yang dilakukan terhadap petugas gizi UPT Puskesmas Beji Kota Depok diperoleh informasi pelayanan konseling gizi di dalam gedung tidak dapat dilakukan setiap hari pada saat jam kerja Puskesmas dikarenakan petugas gizi melakukan kunjungan rutin tiap bulan terjadwal ke 32 posyandu. Walaupun terjadwal petugas tidak dapat melakukan kunjungan ke seluruh posyandu dalam 1 bulan. Dikarenakan terbatasnya waktu dan tenaga mendistribusikan Pemberian Makanan Tambahan (PMT) bagi Balita gizi kurang dan gizi buruk serta PMT bagi ibu hamil KEK dan memantau balita gizi kurang dan gizi buruk di wilayah Kecamatan Beji yang padat penduduk, sehingga pendistribusian dan pemantauannya dibantu oleh kader. Adanya dua aplikasi pencatatan dan pelaporan yang berbeda yaitu Pencatatan dan Pelaporan Gizi Berbasis Masyarakat (e-PPGBM) dari Kementerian Kesehatan dan aplikasi lokal dari Dinas Kesehatan Kota Depok, sehingga menyita waktu dan tenaga. Sarana dan prasarana perangkat komputer dan fasilitas internet yang tidak memadai serta tidak lengkapnya data penduduk berupa Nomor Induk Kependudukan (NIK) dan nomor Hand phone (HP) yang merupakan variabel yang harus dimasukkan pada saat input data menggunakan aplikasi e-PPGBM dari Kementerian Kesehatan menyebabkan waktu dan tenaga menjadi tersita banyak. Kendala lain tidak kooperatifnya keluarga yang memiliki balita gizi buruk dan sering menolak dirujuk ke Puskesmas TFC (Therapeutic Feeding Center), sehingga menambah beban kerja petugas gizi untuk melakukan pelayanan gizi rawat jalan dengan pemberian konsultasi diit dan Pemberian Makanan Tambahan (PMT) sesuai dengan Tata Laksana Gizi Buruk serta Audit Kasus Gizi Buruk untuk dilaporkan ke Dinas Kesehatan Kota Depok.Kesimpulan: Upaya pelayanan gizi baik di dalam gedung dan di luar gedung kurang optimal karena pelayanan gizi hanya dilakukan oleh petugas gizi, sehingga agar pelayanan gizi di luar gedung berjalan optimal petugas mesti memberdayakan kader masyarakat dalam rangka meningkatkan pelayanan gizi.Kata kunci: beban kerja, pemberdayaan, kader, pelayanan giz
Sunat: Pengetahuan dan Sikap Orang Tua
No full textPurpose: This study finds out whether the parents have a good knowledge about circumcision and the relationship between knowledge and behavior of parents towards determining circumcision actions in mass circumcision held at Headquarters of Kopassus Group 1, Serang, Banten on 24-27 October 2018. Method: This is a cross-sectional analytical research, in which researchers use questionnaires as the primary data. The research samples were taken using purposive sampling from 224 respondents.Results: The results showed that 68.8% of respondents had sufficient knowledge of circumcision and 31.3% of respondents had less. 37.1% of the respondents had consistent behavior towards time of the circumcision and 62.9% of the respondents was not. Conclusion: There is no significant relationship between parents' knowledge and behavior towards time of the circumcision with a value of p = 0.75. Tujuan: Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan orang tua mengenai sirkumsisi serta hubungan pengetahuan dan sikap orang tua terhadap penentuan waktu untuk dilakukan sirkumsisi. Penelitian dilakukan pada orang tua peserta bakti sosial sunatan massal yang diselenggarakan di Markas Kopassus Grup 1, Serang, Banten pada 24-27 Oktober 2018. Metode: Penelitian analitik dengan disain penelitian cross sectional. Peneliti menggunakan kuesioner. Sampel penelitian ini diambil dengan menggunakan purposive sampling sebanyak 224 responden. Hasil: Hasil penelitian menunjukkan sebanyak 68,8% responden memiliki pengetahuan cukup mengenai sirkumsisi dan 31,3% responden memiliki pengetahuan kurang. 37,1% responden memiliki sikap yang sesuai terhadap waktu untuk melakukan sirkumsisi dan 62,9% responden tidak sesuai. Kesimpulan: Tidak ada hubungan signifikan antara pengetahuan mengenai sirkumsisi dan sikap orang tua terhadap waktu untuk melakukan sirkumsisi dengan nilai p=0,75