Suparmi Suparmi’s research while affiliated with Badan Standardisasi Nasional and other places

Introduction Infectious diseases remain public health issues in Indonesia. However, there remains a knowledge gap on whether breastfeeding can prevent infectious diseases in young children. This study examined the relationship between current breastfeeding and child infections in Indonesia. Methods Data were derived from the 2017 Indonesia Demographic and Health Survey by including 5158 children aged 6–23 months. The dependent variables were diarrhea, fever, and acute respiratory infection (ARI). The main exposure of interest was the current breastfeeding status. Covariates included factors at the child, maternal, household, health care, and community levels. Results Around 20%, 38%, and 4% of children experienced diarrhea, fever, and ARI, respectively. Current breastfeeding status was protective against diarrhea (adjusted odds ratio [AOR] = 0.74, 95% confidence interval [CI] = 0.61–0.89) but not related to fever (AOR = 0.95, 95% CI = 0.82–1.11) and ARI (AOR = 1.01, 95% CI = 0.70–1.47). Other factors related to diarrhea included female children, older maternal age, maternal higher education, improved drinking water source, and living in Sulawesi. Living in Sumatera and Sulawesi were linked to fever. Higher birth orders and improved toilet facilities were associated with ARI. Conclusion The findings indicate different levels of factors affecting child infections. Thus, integrating breastfeeding promotions with water, hygiene, and sanitation interventions may help prevent infectious diseases in young children.

Penanganan penyakit yang seharusnya dapat tuntas ditangani di puskesmas menjadi sangat penting terkait pembayaran Kapitasi Berbasis Pemenuhan Komitmen Pelayanan (KBPKP) dan salah satu indikatornya adalah Rujukan Rawat Jalan Kasus Non Spesialistik (RRNS). Tujuan penelitian ini mengidentifikasi kemampuan puskesmas dalam penanganan penyakit-penyakit yang ditetapkan dalam Kepmenkes nomor 514 tahun 2015. Penelitian ini menggunakan data Riset Fasilitas Kesehatan (Rifaskes) tahun 2019 dengan jumlah observasi sebanyak 9831 Puskesmas. Analisis dilakukan dengan membandingkan kesesuaian ketersediaan alat, laboratorium, serta obat-obatan dengan ketetapan yang ada. Kesiapan puskesmas dalam pemenuhan ketuntasan penanganan penyakit berbeda menurut aspek geografis, status akreditasi dan pengelolaan keuangannya. Puskesmas yang berada di Pulau Jawa, berstatus terakreditasi, dan memiliki pola pengelolaan keuangan Badan Layanan Umum Daerah (BLUD) memiliki kesiapan penanganan penyakit yang lebih baik. Pemenuhan ketuntasan penyakit masih mengalami kendala dalam hal ketersediaan dan kecukupan peralatan, pemeriksaan penunjang, dan obat-obatan di puskesmas. Oleh sebab itu, perlu dilakukan sinkronisasi dan penguatan regulasi penetapan jenis penyakit yang harus dapat ditangani secara tuntas di puskesmas; meninjau kembali jenis penyakit yang dapat ditangani; serta melengkapi syarat minimal ketersediaan alat, kemampuan laboratorium, dan ketersediaan obat-obatan.

This study aimed to analyze drinking water types and their relationship with diarrheal disease in adults. Cross-sectional study design was selected for this study and data were retrieved from 2018 Basic Health Research (Riskesdas) in 34 provinces in Indonesia. The sample of this study included household members with a total of 495,239 respondents. Data were analyzed using multinomial regression statistical methods to observe the relationship between drinking water types and other risk factors of diarrhea. The results of the analysis showed that the case of diarrhea in adults was at 6.3%. Respondents who consumed bottled water had a 1.2 times risk of not experiencing diarrhea compared to those who consume unimproved drinking water after controlled with defecation behaviour (OR= 1.20; 95% CI: 1.20 to 1.21; P< 0.005). Respondents who consumed refill drinking water had the same likelihood of not having diarrhea as those who consumed unimproved drinking water (OR= 0.99; 95% CI: 0.98 to 0.99; P< 0.05). Consumption of bottled drinking water is safer than refill drinking water in relation to the prevalence of diarrhea. Therefore, it is important to treat drinking water properly prior to consuming refill drinking water.

BACKGROUND: Inadequate antenatal care (ANC) has been identified as a risk factor for poor pregnancy outcomes in low-income nations. The World Health Organization recommends adequate ANC for a minimum of eight visits. While universal health coverage has been implemented since 2014, Indonesia as fourth largest populous country encounters challenge on socioeconomic disparities. AIM: This study aims to explore the socioeconomic difference of adequate ANC in Indonesia. METHODS: Data from the Indonesia Demographic and Health Survey 2017 was used for the analysis and includes 15,313 mothers age 15–49 who had a last live birth in the 5 years preceding the survey. Multivariate logistic regression was employed to assess correlation between socioeconomic status and adequate ANC. RESULTS: About 20.8% of mothers had adequate ANC and the proportion ranging between 11.4% in the poorest group and 34.5% in the richest group. Poorest (adjusted odds ratio [AOR]: 0.68; 95% CI: 0.54–0.86) and poorer (AOR 0.79; 95% CI: 0.64–0.97) mothers are less likely to have adequate ANC compared to the richest mothers. In addition, mothers who lived in Java-Bali region, had better knowledge on danger sign of pregnancy, exposed to internet every day, health insurance ownerships, and having ANC at health facilities were more likely to have adequate ANC. CONCLUSION: Socioeconomic status was significantly associated with adequate ANC, where inequality was profound among poor mothers. Therefore, specific intervention to expand universal health coverage for poor mothers is essential to reduce socioeconomic disparities.

Background: The Indonesian maternal and neonatal mortality rates remain some of the highest in Southeast Asia. Aims: This study aims to assess and compare district-level innovations that address maternal and neonatal mortality. Methods: This was a qualitative study conducted via four focus group discussions in eight selected districts in November 2021. Data obtained were analyzed using the WHO health system building blocks framework. Results: The study found high variation in districts’ innovations ranging from expansion of service for maternity waiting homes to periodical obstetrician visits at Puskesmas. A majority of districts use a local approach as the basis for innovation. Some innovations are modifications of the national program or initiated purely by District Health Offices, Puskesmas, and the community. Many interventions are based on multisectoral commitment, community participation, and targeting to strengthen health service delivery. Leadership and health financing also have an influence on the implementation of these innovations. Conclusion: The multitude of innovations reflects a high variation in barriers to reducing maternal and neonatal mortality that need to be addressed at the district level. A routine forum to share districts’ best practices is warranted. Additionally, family-based surveillance for neonatal danger signs, monitoring for pregnant women and neonates via WhatsApp, and zoning systems for referrals to healthcare facilities in larger districts are innovations identified in this study that have potential to be replicated in other districts or expanded nationally.

Background Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030. Methods We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations. Findings Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3–63·7) to 69·4 years (67·2–71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5–66·8) to 73·5 years (71·6–75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90–77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7–81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9–68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7–67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019. Interpretation Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country. Funding The Bill & Melinda Gates Foundation and the Government of Indonesia. Translation For the Bahasa Indonesia translation of the abstract see Supplementary Materials section.

Currently, One of the Ministry of Health’s programs to improve maternity and child health is through the Assistance to Pregnant Women Program. Furthermore, as an evaluation material for the implementation of them conducted by students and health cadres, the unit cost information needed in the Assistance to Pregnant Women Program. This study aims to analyze the unit costs of the Assistance to Pregnant Women Program using the Activity-Based Costing (ABC) method. Qualitative research with a descriptive-analytic approach. This approach describes and interprets investment, operational, and maintenance costs that are directly related to the assistance to Pregnant Women Program. This research was performed in two districts, specifi cally Lebak District, which represented areas with diffi cult access and Surabaya City, which represented areas with easy access. The results showed that the unit cost of the assistance to pregnant women program in the City of Surabaya was IDR. 3,027,750.00, and the District of Lebak was IDR. 2,907,250.00. These unit costs can be used as a recommendation for the District Health Offi ces and other districts. Abstrak Salah satu Program Kementerian Kesehatan untuk meningkatkan Kesehatan Ibu dan Anak adalah melalui Program Pendampingan Ibu Hamil. Sebagai bahan evaluasi pelaksanaan Program Pendampingan Ibu Hamil yang dilakukan oleh mahasiswa dan kader, maka diperlukan informasi biaya satuan yang dibutuhkan dalam Program Pendampingan Ibu Hamil. Penelitian ini bertujuan untuk menganalisis biaya satuan Program Pendampingan Ibu Hamil menggunakan metode Activity Based Costing (ABC). Merupakan penelitian kualitatif dengan pendekatan deskriptif analitik. Pendekatan ini menguraikan dan menginterpretasikan biaya investasi, operasional dan pemeliharaan yang terkait langsung dengan Program Pendampingan Ibu Hamil. Penelitian ini dilakukan di dua Kabupaten yaitu Kabupaten Lebak yang mewakili daerah dengan akses sulit dan Kota Surabaya yang mewakili daerah dengan akses mudah. Hasil penelitian menunjukkan bahwa biaya satuan program pendampingan ibu hamil di Kota Surabaya sebesar Rp 3.027.750,00 dan Kabupaten Lebak sebesar Rp2.907.250,00. Biaya satuan tersebut dapat menjadi bahan rujukan Dinas Kesehatan dan daerah lain dalam mengalokasikan pelaksanaan Program Pendampingan Ibu Hamil.