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All Journal International Journal of Public Health Science (IJPHS) INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Journal of Public Health Research and Community Health Development (JPH RECODE) Public Health and Preventive Medicine Archive
Dewa Nyoman Wirawan
Department Of Community And Preventive Medicine Faculty Of Medicine Udayana University
Health Professions Medicine & Pharmacology Public Health

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Determinants of unmet needs for family planning in Indonesia: Secondary data analysis of the 2017 Indonesia Demographic and Health Survey Luh Nyoman Sumiati; Dewa Nyoman Wirawan; Luh Seri Ani
Public Health and Preventive Medicine Archive Vol. 7 No. 2 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i2.p03

Abstract

Background and purpose: Globally, the unmet need for family planning remains high. The proportion of unmet needs for family planning in Indonesia was found to have declined but was still higher than the set target. In the last 5 years there have been significant development in Indonesia including infrastructure, the national health insurance program and the increasing allocation of funds to all villages throughout Indonesia with a possible impact in decreasing the unmet need for family planning. This study aims to determine the factors associated with unmet needs for family planning in Indonesia. Methods: This study uses secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS) that was carried out in 34 provinces in Indonesia. The number of the analyzed samples was 26,479 of the total 2017 IDHS sample of 35,681 married women/living together with their partner aged between 15-49 years. The dependent variable is the unmet need for family planning, while the independent variables consist of four core variables namely individual, household, community and programmatic variables. Data analysis was performed with a binary logistic regression to obtain the adjusted odd ratio of each factor. Results: The proportion of unmet needs in this analysis was 14.3% (95%CI: 13.9-14.7%). Factors associated with unmet needs are maternal age 25-34 years (AOR=1.17; 95%CI: 1.01-1.36), 35-44 years (AOR=1.47; 95%CI: 1.24-1.74), ≥45 years (AOR=2.20; 95%CI: 1.81-2.68), age of last child ≥10 years (AOR=1.30; 95%CI: 1.16-1.45), number of living children <2 (AOR=1.66; 95%CI: 1.49-1.85), ideal number of children >2 (AOR=1.34; 95%CI: 1.24-1.44), have >1 son (AOR=1.12; 95% CI: 1.00-1.25), husband not working (AOR=1.89; 95%CI: 1.44-2.48), lack of knowledge about family planning methods (AOR=1.42; 95%CI: 1.24-1.63), not discussing family planning with partners (AOR=1.12; 95%CI: 1.03-1.21), living in urban area (AOR=1.24; 95%CI: 1.14-1.34) and regions with TFR >2.4 (AOR=1.59; 95%CI: 1.43-1.78). Conclusion: The proportion of unmet needs in Indonesia is still high and the dominant associated factor is the age of the mother ≥45 years. In order to decrease the family planning unmet needs, the intervention programs should be targeted to groups of women who are at risk of experiencing such unmet needs.
Sociodemographic factors and current contraceptive use among ever-married women of reproductive age: Analysis of the 2017 Indonesia Demographic and Health Survey data Ni Kadek Ayu Dwi Utami Ds; Dewa Nyoman Wirawan; Luh Seri Ani
Public Health and Preventive Medicine Archive Vol. 7 No. 2 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i2.p04

Abstract

Background and purpose: Globally, the number of new contraceptive users in mid-2017 was only around half of the target. According to the results of the Indonesian Demographic and Health Survey (IDHS), the use of all methods of contraception in Indonesia has increased but is still lower than the target. This study aims to determine the factors associated with the use of contraception in Indonesia. Methods: This study uses secondary data from the 2017 IDHS that was carried out in 34 provinces in Indonesia. The total sample was 35,681 of 49,627 women aged 15-49 years. The dependent variable was current contraceptive use. The independent variables consisted of socio-demographic and socio-economic factors, knowledge, discussion with husband, and access to health services. Data analysis was performed through a binary logistic regression test to obtain the adjusted odd ratio of each factor. Results: The proportion of current contraceptive use was found to be 63.6% (95%CI: 63.2-64.0%). Factors related to current contraceptive use were family planning information from health workers (AOR=1.67; 95%CI: 1.59-1.77), maternal age of 35-44 years (AOR=1.54; 95%CI: 1.42-1.66), maternal age of 25-34 years (AOR=1.37; 95%CI: 1.27-1.48), maternal age ≥45 years (AOR=0.75; 95%CI: 0.68-0.82), living in the Java-Bali region (AOR=1.28; 95%CI: 1.22-1.35), living in rural areas (AOR=1.07; 95%CI: 1.01-1.12), having more than two living children (AOR=1.52; 95%CI: 1.44-1.60), level of education not attending school until not graduating from high school (AOR=1,46; 95%CI: 1.35-1.59), high school graduation level (AOR=1.25; 95%CI: 1.16-1.35), not working status (AOR=1.08; 95%CI: 1.03-1.13), medium wealth index (AOR=1.07; 95%CI: 1.00-1.14) and good knowledge (AOR=1.17; 95%CI: 1.11-1.23). Conclusion: The proportion of current contraceptive use in couples of childbearing age in Indonesia has not reached the government target. Factors that were more likely to increase current contraceptive use were family planning information from health workers, age, region, number of living children, mothers’ education, and knowledge. The family planning program in Indonesia should therefore consider those factors to increase the current contraceptive use.
Continuation rates for injectable contraception and intra-uterine device (IUD) at Banyuning Village, Buleleng District Lina Anggaraeni Dwijayanti; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p02

Abstract

Background and purpose: Surveys on the proportion of contraception uptake have been regularly conducted in Indonesia, including Bali Province. However, very limited studies have explored contraceptive continuation rates. This study aims to examine continuation rates for injectable contraception and IUD including its determinants. Methods: A cross-sectional survey was conducted in Buleleng District. A total of 100 reproductive age women who ever used or currently using injectable contraception or IUD were recruited to participate in the study. One village at Buleleng District was purposively selected and samples were selected from all registered reproductive age couples at the village using a systematic random sampling method. Data were collected through home interviews and were analysed using survival analysis to calculate contraceptive continuation rates. Multivariate analysis were performed using cox regression to identify factors associated to continuation rates for injectable contraception and IUD. Analysis was done using STATA SE 12.1. Results: The one year continuation rate for IUD for first child was 84.62% whereas for injectable contraception was 71.03%. When sex variable of the child was applied, the one year continuation rate for IUD for first child was higher among those who have male child (81.82%) than female child (66.67%). Similarly, the one year continuation rate for injectable contraception was higher among those who have male child (79.10%) than female child (57.58%). The one year contraceptive continuation rate is also higher for the second child than the first one (79.56 vs 71.03 for injectable and 87.88 vs 84.62 for IUD). The multivariate analysis showed that perceived quality of family planning services was associated to contraceptive continuation rates (AHR=2.54; 95%CI: 1.22-5.29). Conclusions: The continuation rate for IUD was higher than injectable contraception. Higher contraceptive continuation rate was found among those who have male children. The contraceptive continuation rate was associated with perceived quality of family planning services. Interventions to improve the quality of family planning services are warranted.
Predictors of treatment interruption among tuberculosis patients in public health centres in Bali, Indonesia Putu Ika Farmani; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri; I Wayan Gede Artawan Eka Putra
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p11

Abstract

Background and purpose: Tuberculosis treatment interruption (TB TI) is one factor that leads to treatment failure, tuberculosis (TB) drug resistance and drop out. The purpose of this study is to identify the incidence and the predictors of TB TI in public health centres (PHCs) in Bali. Methods: A retrospective longitudinal study was conducted using secondary data of 644 cohorts of TB patients on the first regiment who enrolled in 11 PHCs in Denpasar Bali during 2011-2012. Information from TB program officers in PHCs was also obtained to determine the differences within the practical implementation of TB treatment. Data were analysed using Kaplan Meier and Cox Proportional Hazard Regression. Results: The study revealed that 378 patients experienced TB TI with the total events of 535. The incidence rate of TB TI event was 5.1 per 1.000 person days and the median time was 56 days (IQR: 56-57). Predictors of the TB TI were male (AHR=1.22; 95% CI: 1.02-1.45; p=0.027) and a more flexible schedule to take the medicine (AHR=1.47; 95%CI: 1.22-1.76; p<0.0001). Conclusions: The implementation of fixed schedule and shortened time lapse for patients to take TB drug will enable more close contact between patients and health providers. Intensive adherence counselling especially tailored for male patients is also required.
Differences in post-placental intra uterine device acceptance with and without couples counseling in private practice midwifery clinics, West Denpasar Putu Ayu Ratna Darmayanti; Dewa Nyoman Wirawan; Komang Ayu Kartika Sari; Mangku Karmaya; Ni Luh Putu Suariyani
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p02

Abstract

Background and purpose: The post-placental intra uterine device (IUD) program is one intervention to increase IUD uptake however the acceptance remains low. Contraceptive counseling during pregnancy is expected to increase IUD uptake. The primary objective of this study is to determine the efficacy of counseling by involving the husband in order to improve post-placental IUD uptake. The secondary objective is to compare knowledge and perceptions of IUD before and after intervention. Methods: A randomized controlled trial was conducted with 58 pregnant women at 37-40 weeks’ gestation in three private midwifery clinics in Denpasar, Bali. Subjects were divided into two groups: 29 intervention groups that were given couples counseling and 29 control groups that were given counseling without involving husbands. Base line interview was conducted during enrollment and follow up interview was carried out immediately after delivery. Results: Acceptance of post-placental IUD was found in 21 women (72.41%) in the intervention group and 10 women (34.48%) in the control group (RR=2.2; 95%CI: 1.23-3.84). The mean difference in pretest and post-test scores of knowledge, perceptions of susceptibility and benefits were found to be higher in the intervention group but not statistically significant. The result of multivariate analysis indicated that the variables influencing post-placental IUD acceptance were the child’s gender (AOR=45.9, 95%CI: 4.53-465.25), couples counseling with husband (AOR=17.4, 95%CI: 2.55-119.56) and maternal education (AOR=7.1; 95%CI: 1.17-43.40). Conclusions: Couples counseling was found to increase postplacental IUD uptake. In addition, post-placental IUD acceptance is also influenced by the child’s gender and maternal education levels. To increase uptake of post-placental IUDs there is a need for upscalling of couples counseling at the time of antenatal care.
Determinants of long-acting contraceptives use among reproductive-age couples in Tanjung Karang Public Health Centre Mataram City, West Nusa Tenggara Widya Aryati; Dewa Nyoman Wirawan; Komang Ayu Kartika Sari; Anak Agung Sagung Sawitri
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p03

Abstract

Background and purpose: The national family planning program prioritises the use of long-acting contraceptives which include intrauterine devices (IUD), tubectomy, vasectomy, and implant. However, the coverage of long-acting contraceptives in Indonesia remains low. This study aims to identify the determinants of longacting contraceptives uptake among reproductive-age couples in Tanjung Karang Public Health Centre (PHC) Mataram City. Methods: A cross-sectional study was conducted involving 169 reproductive age couples in Tanjung Karang PHC in 2016. Samples were selected from six sub-villages (dusun) in two villages using systematic random sampling. We selected 85 samples from coastal and 84 samples from non-coastal areas. Data on sociodemographic characteristics, perception, husband support, access to service, and information regarding long-acting contraceptives were collected through home interview. Analysis with logistic regression was applied to determine the factors influencing long-acting contraceptives uptake. Results: The majority of respondents aged 20–35 years-old, and most of them have a lower level of education and knowledge regarding longacting contraceptives. Among all current users, as many as 37.0% use long-acting contraceptive methods. The respondents refused to use long-acting contraceptives due to prohibited by the husband (92.8%) and desire to have more children (38.7%). Multivariate analysis using logistic regression showed that the uptake of long-acting contraceptives was significantly associated with area of residence (noncoastal) with an adjusted odds ratio (AOR)=2.89 (95%CI; 1.39-6.01), employment status with AOR=0.40 (95%CI; 0.18-0.90), income at minimum wages and above with AOR=2.47 (95%CI; 1.16-5.26), and husband support with AOR=2.19 (95%CI; 1.18-3.41). Conclusions: The use of long-acting contraceptives are associated with husband support, living in non-coastal areas, and having a higherincome. Ongoing support from the husband, especially among those who live in coastal areas and from the lower socioeconomic background, is required to improve the coverage of long-acting contraceptives.
Nutritional status and associated factors in under-five children in Lembar Village West Lombok, Indonesia Widya Dwijayanti; Dewa Nyoman Wirawan; Luh Seri Ani; Ni Wayan Arya Utami
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p04

Abstract

Background and purpose: Studies on determinants of nutritional status in under-five children in Indonesia have been widely explored. However, most studies utilised only one out of three nutritional status indicators–weight/age, height/age, or weight/height. These studies also show inconsistent results. This present study aims to examine nutritional status in under-five children by using all three indicators and associated factors which include mother’s characteristics, nutrition intake, and child’s history of infectious diseases. Methods: A cross-sectional study was conducted with a total sample of 100 under-five children who were randomly selected. Data on the mother’s characteristics, nutrition intake, and child’s history of infectious diseases were collected through structured interview with the mother, while data on nutritional status were obtained through measurements. Data were analysed using logistic regression to identify association between the nutritional status of under-five children with the mother’s characteristics, nutrition intake, and child’s history of infectious diseases. Results: There was no association between the nutritional status of under-five children based on weight/age, height/age, and weight/ height with the mother’s characteristics and nutrition intake. However, there was an association between the nutritional status of under-five children and child’s history of infectious diseases with an adjusted odd ratio (AOR)=41.0 (95% CI: 12.10-139.14) for weight/age, AOR=3.52 (95%CI: 1.53-8.05) for height/age, and AOR=10.69 (95%CI: 1.31-87.11) for weight/height. Conclusions: Child’s history of infectious diseases is the only determinant associated with nutritional status in under-five children based on weight/ age, height/age, and weight/height. Prevention measures are required to prevent infection among children by improving environmental hygiene as well as providing prompt treatment for infectious diseases especially diarrhoea and upper-respiratory tract infection.
The determinants of early breast cancer detection via breast self-examination (BSE) in Denpasar, Bali Ni Made Ari Febriyanti; Dinar Lubis; Dewa Nyoman Wirawan; Ni Luh Putu Suariyani; Mangku Karmaya
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p07

Abstract

Background and purpose: Breast cancer is the leading cause of death in females, followed by colorectal cancer. Early detection of breast cancer can be done through breast self-examination (BSE). BSE behaviour is influenced by an individual’s level of knowledge and perceptions of the procedure. This study examines the determinants of BSE behaviour in married women aged 15-49 in six villages in the working area of Puskesmas (public health centre) II in West Denpasar, Bali, Indonesia. Methods: A cross-sectional survey was employed with 180 respondents selected by multistage random sampling. Data were collected using standardised questionnaire carried out from November-December 2016. Multiple poisson regression was used to identify the determinants of the BSE behaviours. Results: The proportion of respondents who performed BSE in the three months prior to interview is 55.6%, and, of these, 50.0% reported performing BSE regularly. Multivariate analysis shows the significant determinants of BSE are: high-school and above (APR=2.03; 95%CI:1.41 to 2.92); having a good knowledge of BSE (APR=1.41; 95%CI:1.09 to 1.82); perceived benefits (APR=2, 24; 95%CI:1.53-3.29); perceived low barrier (APR=1.63; 95%CI: 1.16-2.29); and high self-efficacy (APR=1.50;95%CI:1.16-1.95). Conclusions: Level of education, good knowledge of BSE, perceived benefits, perceived low barriers, and high level of self-efficacy are the significant determinants of BSE practice. These findings suggest that education on BSE should be enhanced, particularly for women with lower levels of education.
Emotional support is the only social support associated with the quality of life of people living with HIV Ni Wayan Sri Rahayuni; Ketut Tuti Parwati Merati; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 7 No. 1 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i1.p08

Abstract

Background and purpose: The quality of life of people living with HIV is influenced by many factors, one of which is social support. Social support consists of four elements, namely information, instrumental, emotional and appraisal supports. Publication on the association between the quality of life of people living with HIV and the four elements of social support shows inconsistent results. The purpose of this study is to determine the association between the four elements of social support and the quality of life of people living with HIV. Methods: A cross-sectional survey was carried out at the WM Medika Clinic, Kerti Praja Foundation, Denpasar, Bali. Samples were people living with HIV who came to the clinic between July-August 2018 to take antiretroviral (ARV) drugs. The total number of samples was 92 patients selected through the convenience sampling. Data was collected by conducting individual interviews and consisted of respondent characteristics, quality of life, information, instrumental, emotional and appraisal supports. Data were analyzed using logistic regression to determine the association between social support and quality of life of people living with HIV. Results: Emotional support was the only element of social support found to be significantly associated with quality of life of people living with HIV with AOR=4.918 (95%CI: 1.268-19.082). Whereas the other three elements were not found to be related to the quality of life of people living with HIV, these were instrumental support (AOR=0.865; 95%CI: 0.228-3.278); information support (AOR=0.949; 95%CI: 0.248-3.637); and appraisal support (AOR=0.317; 95%CI: 0.095- 1.057). Conclusion: The quality of life of people living with HIV is found to be related to emotional support and is not found to be related to information, instrumental and appraisal supports. Emotional support needs to be addressed in order to further improve the quality of life of people living with HIV.
Association between physical activity, fiber and salt intake with hypertension in adolescents with obesity Ni Luh Putu Sudiasih; Dewa Nyoman Wirawan; I Gusti Lanang Sidiartha
Public Health and Preventive Medicine Archive Vol. 7 No. 1 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i1.p11

Abstract

Background and purpose: There are indications that the prevalence of obesity among adolescents is increasing which is one of the main factors of hypertension. This study aims to determine the association between hypertension among obese adolescents with physical activity, fiber and salt intake. Methods: This study used a cross-sectional design among obese adolescents aged 12-15 years. The study was conducted at six public/ private middle schools in the North Denpasar Sub-district, Denpasar City, Bali Province. The samples of 203 children were selected from the results of obesity screening conducted by North Denpasar III Public Health Center (PHC). Data collection was conducted over July-September 2018 with data included social demographics, body weight and height, blood pressure, consumption frequency of vegetables, fruits and high salt content foods, and physical activity carried out in the past week. Data analysis with logistic regression was conducted to determine the association between physical activity, fiber and salt intake with hypertension among obeseadolescents. Results: This study found that of 203 respondents, 14.8% had hypertension. Multivariate analysis showed that hypertension in obese adolescents was associated with salt intake ≥1500 mg/day with adjusted odd ratio (AOR) of 5.19 (95%CI: 2.20-12.22), inadequate physical activity (AOR=5.87; 95%CI: 1.19-29.00) and inadequate fiber intake (AOR=2.43; 95%CI: 0.27-21.76). Conclusion: Salt intake ≥1500 mg/day and inadequate physical activity are associated with hypertension among obese adolescents. A reduction in the consumption of processed foods that are high in salt and increasing physical activity would improve adolescent health.
Co-Authors A.A.A.A. Candrawati Anak Agung Gede Agung Anak Agung Ngurah Gede Dharmayuda Brad Otto Claire Ryan Desak Nyoman Purniati Desak Nyoman Widyanthini Desak Putu Yulita Kurniati Dewa Ayu Ketut Sri Abadi Dewa Suyetna Dewi, Desak Made Sintha Kurnia Dinar Lubis Dinar Lubis Emily Rowe Emily Rowe Fonny Silfanus Gusti Ayu Satriani I Gusti Agung Trisna Windiani I Gusti Lanang Sidiartha I Ketut Duara I Ketut Subrata I Made Ady Wirawan I Made Bakta I Nyoman Sudiatmika I Nyoman Sutarsa I Putu Adiartha Griadhi I Wayan Gede Artawan Eka Putra I.N. Adnyana Surapathi Ida Ayu Dwi Astuti Minaka Ida Ayu Putri Widhiastuti Ifa Nurhasanah Irma Rubianti Jacinta dos Santos Guterres K Tangking Widarsa Kadek Dwi Ariesthi Kadek Tresna Adhi Kenyem Subagia Ketut Suarjana Ketut Tuti Parwati Merati Komang Ayu Kartika Sari Lina Anggaraeni Dwijayanti Lisa Sutiasih Luh Nyoman Sumiati Luh Pitriyanti Luh Putu Lila Wulandari Luh Putu Sri Armini Luh Putu Wulandari Luh Seri Ani Made Pasek Kardiwinata Made Suarjaya Mangku Karmaya Mangku Karmaya Musrifa Ni Kadek Ayu Dwi Utami Ds Ni Kadek Ethi Yudiastuti Ni Ketut Arniti Ni Luh Astri Indraswari Ni Luh Dea Kumala Sari Karang Ni Luh Putu Suariyani Ni Luh Putu Sudiasih Ni Made Ari Febriyanti Ni Putu Diwyami Ni Wayan Arya Utami, Ni Wayan Arya Ni Wayan Sri Rahayuni Nyoman Suardani Pande Putu Januraga Putri Pidari Putu Ayu Merry Antarina Putu Ayu Ratna Darmayanti Putu Ika Farmani Putu Sri Utami Putu Sukma Megaputri Rini Hendari Rizki Yulia Purwitaningtyas Sawitri, Anak Agung Sagung Shannon Turnbul Sri Juharni Vennesa Vitari Maureen Susanto Widya Aryati Widya Dwijayanti