Chronic obstructive pulmonary disease (COPD) is a major public health concern with psychosocial impacts, such as reduced resilience and depression. This study examined the moderating role of perceived social support on the relationship between resilience and depression among individuals diagnosed with COPD in South Tangerang, Indonesia. A quantitative cross-sectional study was conducted between January and February 2024 using self-administered questionnaires. Participants were adult patients with clinically diagnosed COPD, recruited from all public health centers (PHC) in South Tangerang. A total of 125 participants met the inclusion criteria and were included in the analysis. Participants had a mean age of 41.46 +/- 15.69 years, with a balanced distribution (51.2% male, 48.8% female). Descriptive analysis showed high resilience (mean = 29.27 +/- 7.20), very high social support (mean = 70.36 +/- 14.47), and depression scores (mean = 4.65 +/- 4.59) below the cutoff. Moderation regression analysis using Hayes' PROCESS Model 1 showed that resilience, with perceived social support as a moderator, explained 18% of the variance in depression scores (R-2 = 0.1807). These findings emphasized the importance of integrating psychosocial factors into COPD management. Strengthening resilience and social support within PHC settings may enhance mental health outcomes among COPD patients.
Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12-24-month age range. While the highest prevalence is in Eastern provinces (e.g., Central Papua, 39.4%), 51% of children with stunting were concentrated in five densely populated provinces (e.g., West and Central Java). The SEM consistently identified underweight (standardized coefficient: 0.69) and wasting (standardized coefficient: 0.57) as the strongest positive determinants of provincial stunting prevalence. Controlling acute malnutrition is essential; a 1% decrease in wasting is projected to reduce stunting prevalence by 1.2%. Furthermore, increasing coverage of key interventions, such as complete basic immunization and appropriate complementary feeding, is negatively associated with stunting, providing critical operational targets.
Musculoskeletal disorders (MSDs) are a leading cause of disability globally and are strongly influenced by occupational conditions. Evidence comparing MSD risk between formal and informal workers remains limited, particularly in developing countries. This study examined the association between individual and job-related factors with MSD symptoms among formal and informal workers in Indonesia. A cross-sectional study was conducted among 1,089 workers in North Sumatra Province, Indonesia, from August 2024 to December 2025. Participants were recruited using stratified convenience sampling from both the formal (office and health workers) and informal (drivers, traders, and farmers) sectors. MSD symptoms were assessed using the Nordic Body Map questionnaire and categorized into low, moderate, and high-risk levels. Independent variables included age, sex, work experience, and job type. Data were analyzed using Chi-square tests and multivariate logistic regression. Overall, 31.6% of workers reported moderate-to-high MSD symptoms. Informal workers had significantly higher odds of MSD symptoms (OR = 1.607; 95% CI: 1.20-2.10; p-value <0.001). Male workers were more likely to report MSD symptoms (OR = 3.65; 95% CI: 2.7-4.9; p-value <0.001). Longer work experience (>5 years) was associated with lower MSD risk (OR = 0.46; 95% CI: 0.34-0.63; p-value <0.001), while age was not a significant predictor. MSDs remain a substantial occupational health problem among Indonesian workers, particularly in the informal sector. Targeted ergonomic interventions and occupational health programs are needed to reduce disparities and improve workers' health in developing-country settings.
The rising prevalence of chronic diseases and disabilities, along with the aging of the population, has reduced individual independence and increased the demand for long-term care (LTC). This study aimed to assess the feasibility of integrating home healthcare services into Indonesia's National Health Insurance (NHI) scheme. A qualitative study using purposive sampling was conducted in Bandar Lampung, Yogyakarta, and Jakarta, Indonesia, selected based on disease burden, proportion of older adults, and regional development. Data was collected through in-depth interviews, focus group discussions, and observation between August and September 2024, involving 68 informants, including regulators, community members, and health facility staff. This study used content analysis with a scoring approach to synthesize informants' perspectives. Informants' statements were rated using a 1-10 scale to reflect perceived feasibility, with higher scores indicating greater feasibility. The overall feasibility score was high (8.10). Among the six aspects of feasibility, the operational aspect received the lowest feasibility score (7.87), mainly due to resource constraints, while the market aspect had the highest score (8.40). indicating a strong demand for home healthcare services. These findings suggested that integrating home healthcare services into LTC under the NHI scheme is feasible. However, policy efforts should prioritize strengthening operational capacity, workforce readiness, service delivery, and resource allocation to support effective implementation. This study highlights the importance of feasibility assessment as a critical step in developing new health programs.
Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent-child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline,1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, sociodemographic factors, and TPB-related changes in knowledge, attitude, subjective norm, control beliefs, perceived power, and perceived control. The conventional intervention produced significantly higher intention-to-change scores at 1 and 3 months, with moderate-to-large effects. In regression analyses (N = 209), Model 1 (type + demographics) significantly predicted change in intention (adjusted R-2 = .074), with only intervention type significant. Model 2 (adding TPB change scores) improved the fit (adjusted R-2 = .120; Delta R-2 = .069, p-value = .014), with perceived power positively and control beliefs inversely associated with change in intention; intervention type was no longer significant. Adolescents in the conventional group showed a larger and more sustained increase in intention to change their SRH behaviors than those in the web-based group, an effect that appeared to operate through changes in underlying psychosocial factors such as control beliefs and perceived power.
Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) are major contributors to healthcare-associated infection, yet data from primary care clinics remain limited. This study assessed environmental contamination in eight clinics in the Klang Valley, Malaysia, and evaluated associated environmental factors. Samples were collected from environmental surfaces and equipment in Medical Officer and Patient Treatment Rooms, then cultured and tested for antimicrobial susceptibility. Environmental parameters, including temperature, relative humidity, air movement, and room density, were measured. Data were analyzed using Kruskal-Wallis, Mann-Whitney, and multiple linear regression analyses. MRSA was detected on 19.8% of environmental surfaces (patient treatment beds (47.3%) and side tables (31.6%)), and 2.1% of equipment surfaces. No VRE was detected; however, Vancomycin-Sensitive Enterococcus was identified in several samples. Significant variation in MRSA contamination across sampling sites was observed (chi 2 = 25.664, p-value = 0.007). Regression analysis showed that room density (beta = -3.285, p-value = 0.006) and temperature (beta = -7.922, p-value = 0.012) were significant predictors of aerobic colony counts (R2 = 0.157). The detection of MRSA on high-touch surfaces highlights occupational exposure risks in PHC. Strengthened infection prevention and control measures, targeted cleaning strategies, and improved spatial management are urgently required to mitigate environmental transmission.
Hepatitis B remains a major public health problem in Indonesia. This study assessed the knowledge, attitudes, and practices (KAP) of hepatitis B patients in Jakarta to identify gaps in prevention and control and to explore relationships among KAP components. A cross-sectional study was conducted among 128 patients at a government hospital in South Jakarta, using a structured questionnaire that collected demographic information and assessed knowledge, attitudes, and practices regarding hepatitis B transmission and prevention. Despite moderate knowledge levels, major gaps remained. Only a small proportion (10.9%) correctly identified common symptoms, transmission routes (10.2%), and possible complications (18.8%). Misconceptions about transmission and vaccine safety were common, although attitudes toward early diagnosis and treatment were generally positive. Practices also fell within a moderate range; notably, 46.1% of respondents still shared personal items that could facilitate transmission. Higher education, vaccination, income, and awareness participation were associated with better knowledge, attitudes, and practices. There were positive correlations among knowledge, attitude, and practice scores, indicating that better knowledge may lead to improved behaviors. In conclusion, the study reveals persistent misconceptions and behaviors that continue to place hepatitis B patients at risk, despite generally positive attitudes toward care.
The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health workers' motivation was also associated with health services (T = 1.961; p-value = 0.050). Other variables, including health services, service targets toward the MSS, self-management, health behavioral skills, and family health services, showed positive but statistically no associations (p-value > 0.05). These results showed that improving the achievement of health targets and strengthening health workers' motivation could enhance the performance of PHCs in Yahukimo District, despite its geographical and structural limitations.
Paracetamol is a widely used over-the-counter medicine for self-medication and is often perceived as completely safe. However, inappropriate use may result in hepatotoxicity and other adverse effects, particularly at high doses. This study aimed to develop and validate a questionnaire to assess the general Indonesian population's knowledge, attitude, and practice (KAP) regarding paracetamol self-medication. The validation procedure consisted of three stages: content, face, and construct validation. Three experts assessed the relevance of the items using the Content Validity Index, and five respondents were interviewed to assess the linguistic clarity and comprehensibility of the questions. Construct validity and reliability were assessed in 30 participants using Pearson's correlation and Cronbach's alpha. All items obtained excellent relevance scores. The final questionnaire demonstrated acceptable validity and reliability after revising and removing two low-performing practice items (P3 and P4), with Pearson's correlation coefficients exceeding the r-table threshold (0.361) and Cronbach's alpha values of 0.766, 0.734, and 0.640 for the KAP domains, respectively. The final instrument, comprising 20 items (10 knowledge items, 6 attitude items, and 4 practice items), was deemed suitable for assessing public KAP regarding safe self-medication with paracetamol.
Large-scale tobacco marketing on social media has resulted in widespread population-level exposure, particularly in Indonesia, which faces growing challenges in digital public health. This study aimed to assess the associations between platform type and marketing tactics and identify correlations of user engagement. An analytical cross-sectional study was conducted using secondary data from the Tobacco Enforcement and Reporting Movement (TERM), collected from January 2022 to August 2023. A total of 21,255 tobacco marketing posts from social media were analyzed. Platform-tactic associations were examined using Chi-square tests, and multivariable Poisson regression was used to identify factors associated with user engagement. The findings indicated that Instagram (66.8%) and Facebook (24.0%) accounted for the majority of tobacco marketing content. Community-based marketing was the most prevalent tactic (64.7%), followed by direct advertising (20.1%). Bivariate analysis demonstrated a significant association between social media platforms and marketing tactics (p-value <0.001). The Poisson regression model was statistically significant (p-value <0.001). Engagement varied substantially by platform. Compared to YouTube, TikTok demonstrated markedly higher engagement (OR = 35.8), followed by Instagram (OR = 1.88). Corporate social responsibility (OR = 2.39) and community-based marketing (OR = 1.70) were associated with higher engagement. Tobacco promotion on Indonesian social media employs platform-specific strategies to increase exposure and normalize consumption narratives. These patterns underscore substantial digital public health concerns and suggest that enforcement of digital TAPS remains inadequate. Therefore, relevant ministries should strengthen TAPS enforcement and expand targeted digital health education initiatives.
Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three years after the primary treatment. Survival outcomes were analyzed using the Kaplan-Meier curve and Cox proportional hazards model. The overall 3-year DFS rate was 41.6%. Patients treated by GO specialists had a higher DFS rate (54.3%) than those treated in hospitals without GO services (24.5%). Multivariate analysis showed a higher recurrence risk in patients treated without GO services (HR 2.75; 95% CI: 1.32-5.74). This study's findings highlight the potential clinical benefits of facilitating early access to specialized GO care for patients with EOC.
Irritant contact dermatitis is a common condition among farmers, but its underlying causes remain poorly understood. This study aimed to identify factors associated with irritant contact dermatitis among horticulture farmers in Semarang District, Indonesia. A cross-sectional survey was conducted among 427 farmers using a validated, reliable structured questionnaire. The results indicated complaints of dermatitis related to contact with irritants. Data were analyzed using the Chi-square test and logistic regression. Analysis revealed that sex, personal hygiene habits, education level, and the number of pesticide types used were significantly associated with irritant contact dermatitis. Female farmers were less likely to develop irritant contact dermatitis. Conversely, farmers with poor personal hygiene habits or lower levels of education were more likely to develop the condition. Farmers who used fewer types of pesticides had a lower risk of irritant contact dermatitis than those who used a greater variety. In conclusion, irritant contact dermatitis among farmers is influenced by both work-related exposures and hygiene practices. Improving personal hygiene habits and limiting the use of multiple pesticide types may help prevent irritant contact dermatitis under typical farming conditions.
Achieving and sustaining low disease activity (LDA) and remission in rheumatoid arthritis (RA) remains challenging. This study examined the rates and predictors of LDA/remission and sustained LDA/remission in an Indonesian RA cohort. A retrospective study of newly diagnosed adult patients attending a rheumatology clinic in 2020-2021 was conducted. Patients were followed for 12 months to evaluate achievement of LDA/remission, defined as DAS28-ESR <= 3.2, and those meeting the target were observed for an additional 12 months to evaluate sustained LDA/remission. Cox regression was used to identify predictors of time to LDA/remission and loss of LDA/remission. Of 166 participants, 91 (54.8%) achieved LDA/remission, with a median time of 10 months. Among these, 39 (41.8%) maintained LDA/remission for 12 months. The median time to loss of LDA/remission was also 10 months. In multivariate analysis, no baseline variables (age, sex, rheumatoid factor (RF) positivity, disease activity, obesity, or disease duration) predicted achieving or sustaining LDA/remission. In this Indonesian cohort, over half of patients reached LDA/remission within 12 months. However, fewer than half sustained it over the following year, highlighting the need for ongoing monitoring and timely treatment adjustments, even after remission is achieved.
Cervical cancer is a common gynecological malignancy, particularly in developing countries, where it coexists with renal impairment in over one-third of patients. This disease typically presents acutely and progresses rapidly. Consequently, kidney replacement therapy, including hemodialysis (HD), is commonly required. To assess survival rates and associated factors, this retrospective cohort study analyzed the medical records of 252 cervical cancer patients who began HD across a three-month follow-up period. Kaplan-Meier analysis indicated a median short-term survival duration of 71.5 days (range: 7-90), with 1-, 2-, and 3month survival rates of 56%, 51%, and 49%, respectively. Multivariate Cox regression identified post-HD systolic blood pressure <110 mmHg (hazard ratio [HR] 3.354; 95%confidence interval [CI]: 2.346-4.795; p-value <0.001) and interdialytic weight gain >= 5%(HR 1.685; 95%CI: 1.125-2.521; p-value <0.011) as significant predictors of decreased survival. Other variables, including age, urea, albumin, vascular access, baseline creatinine, and cancer stage, were not significantly associated with short-term survival. These findings underscore the critical role of salt and fluid management, adherence to dietary and dialysis regimens, and close monitoring of weight in improving outcomes. Interventions targeting modifiable factors may improve the survival of cervical cancer patients who require HD. Such approaches, therefore, warrant further investigation.
Patients with human immunodeficiency virus (HIV) are required to take antiretroviral therapy (ART) to suppress the virus. However, suboptimal adherence remains a critical barrier that can lead to treatment failure and persistent transmission risks. This study aimed to identify factors associated with ART adherence in patients with HIV. This quantitative study with a cross-sectional design consisted of patients with HIV aged >18 years who received care at the voluntary counseling and testing clinic of a public hospital in Jakarta, Indonesia. Purposive sampling was used. This study used HIV care and ART overview forms as instruments. Data were analyzed using multiple logistic regression. The results showed that among 266 patients with HIV, 213 (80.1%) reported adherence to ART. This study found that age >= 44 years (adjusted FOR 2.631; 95% CI 1.059-6.533), higher education level (adjusted FOR 4.407; 95% CI 1.948-9.973), and CD4 count >= 200 (adjusted FOR 2.593; 95%CI 1.219-5.517) were associated with higher adherence. Conversely, patients with an ART duration of 1-5 years (adjusted FOR, 0.259; 95% CI, 0.100-0.673) and those who had never experienced drug side effects (adjusted FOR, 0.108; 95% CI, 0.014-0.860) were less likely to be adherent. The dominant factor was the experience of drug side effects, suggesting that adherence should be enhanced through proactive counseling.
Hypertension remains a major public health challenge among the elderly in low-and middle-income countries. This cross-sectional study examined demographic and metabolic factors associated with hypertension among the elderly living in urban and rural areas of West and Central Java Provinces, Indonesia. This study included 1,920 adults aged >= 60 years who had resided in the study areas for at least six months, were able to communicate effectively, and provided informed consent. Data were collected between March and August 2023 using stratified multistage random sampling, structured questionnaires, and biochemical measurements. Multivariable logistic regression revealed distinct patterns of association across settings. In urban areas, hypertension was associated with older age (AOR =1.366; 95% CI: 1.043-1.789), female sex (AOR=1.681;95%CI: 1.198-2.359), central obesity based on waist circumference (AOR=2.031; 95% CI:1.477-2.793), and abnormal blood glucose levels (AOR=2.821; 95% CI: 1.754-4.536). In rural areas, hypertension was associated with older age (AOR=1.613; 95% CI: 1.228-2.119), lower education level (AOR=0.686; 95%CI:0.507-0.928), central obesity (AOR = 1.613; 95% CI: 1.204-2.161), and blood glucose levels (AOR=1.503; 95% CI: 0.978-2.310). These findings highlighted that while metabolic markers, such as waist circumference and blood glucose, were universal predictors, demographic factors, such as sex and education level, varied by environment. Consequently, public health interventions must adopt tailored, context-specific approaches to manage hypertension in urban and rural Indonesian communities effectively.
Intensifying heat waves disrupt learning environments in the Philippines, particularly in rural areas where schools often lack adaptive infrastructure. Many rural classrooms are built with heat-retaining materials, such as concrete, which trap excessive heat, leading to indoor temperatures exceeding safe comfort levels. These conditions lead to dehydration, fatigue, and reduced cognitive function, directly impairing students' focus and academic performance. Schoolchildren are particularly vulnerable due to their developing thermoregulatory systems, higher metabolic demands, and potential preexisting health conditions. These risks are further amplified in rural communities with limited access to cooling, healthcare, and adaptive resources. These challenges require practical, context-specific interventions. Schools can adopt energy-efficient designs, improved ventilation, and passive cooling techniques to create safer indoor environments while reducing environmental and financial costs. Adjusting school schedules during periods of extreme heat can minimize exposure while minimizing disruption to education. Moreover, heat-health education programs can raise awareness and promote adaptive behaviors among students and families, thereby enhancing community resilience. Integrating climate change and heatwave preparedness into the curricula of the Commission on Higher Education and the Department of Education can equip learners with essential coping skills. Meanwhile, simple measures such as hydration protocols, shaded rest areas, and proper ventilation offer immediate protection for schoolchildren's health and learning outcomes.
Hemophilia A is a rare bleeding disorder caused by a deficiency of clotting factor VIII, leading to recurrent bleeds, joint damage, and disability. Low-dose prophylaxis has been shown to achieve better clinical outcomes than on-demand treatment in reducing bleeding frequency. However, in Indonesia, access and affordability remain key challenges. This study aimed to develop a conceptual model for conducting a health economic evaluation of low-dose prophylaxis treatment for children with severe hemophilia A in Indonesia. This study followed the ISPOR-SMDM Modeling guidelines, outlining two-stage processes: conceptualization of the clinical problem and model development. A systematic literature review was conducted to identify relevant clinical and economic evidence on low-dose prophylaxis and on-demand treatment in pediatric hemophilia A. Indonesian clinical guidelines and expert input from two hematologists were incorporated to contextualize the model. Thirteen studies (three clinical and ten economic evaluations) consistently reported improved outcomes with low-dose prophylaxis. Most models applied health state transitions involving bleeding episodes, joint damage, complications, and death. Based on this review and discussion, the conceptual model was established to support the cost-effectiveness analysis of low-dose prophylaxis. A rigorous conceptual model serves as the key foundational step in developing a valid, health economic model for the Indonesian setting.
Working mothers in Indonesia may influence complementary feeding practices, particularly their ability to ensure that their infants properly meet the minimum acceptable diet (MAD). In this cross-sectional study, an online survey was distributed through various online platforms where participants were recruited using convenience sampling. The questionnaire covered sociodemographic factors, workplace policies, and infant and young child feeding (IYCF) practices. Descriptive and logistic regression analyses were conducted. A total of 394 working mothers participated, of which over 90% of the respondents reported meeting minimum dietary diversity, minimum milk frequency, minimum milk feeding frequency, and MAD indicators as assessed with a standardized questionnaire based on the WHO's IYCF assessment. Multivariate analysis identified two workplace policy variables significantly associated with meeting MAD requirements: physical facility support (AOR: 2.99; 95% CI [1.03, 8.70]; p-value <0.05) and workplace flexibility scores (AOR: 0.18; 95%CI [0.05, 0.65]; p-value <0.05). These findings highlighted the importance of having supportive workplace environments that enable working mothers to ensure that their infants meet MAD requirements. Additionally, the negative association between workplace flexibility and meeting MAD requirements may have been due to the homogeneity of this study's subjects' characteristics.
The prevalence of human immunodeficiency virus is high among female sex workers (FSWs) in Indonesia, underscoring the need for integrated prevention strategies supported by strong government policies. This study aimed to investigate FSWs' willingness to participate in a pre-exposure prophylaxis (PrEP) program. This qualitative study employed semi-structured interviews with 20 participants residing in Pangkal Pinang City, Indonesia (4 stakeholders and 16 FSWs), recruited through purposive sampling. Data were collected from July to September 2024. This non-probability sampling method was adopted due to the focus on specific study objectives and a targeted population. The analysis of the interviews revealed three theme clusters comprising eight themes. The identified clusters were government policy, knowledge of effectiveness and willingness to follow PrEP, and readiness for side effects and long-term compliance. Improving health services in areas where FSWs are concentrated is crucial for facilitating easier access with lower transportation costs. Furthermore, supporting the privacy of FSWs is crucial, and the cost of health screening before PrEP initiation should be waived to eliminate financial barriers and encourage participation in the PrEP program.
