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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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Delayed access to treatment and frequency of acute respiratory infection as risk factors of severe pneumonia among children aged 12-59 months in Denpasar, Bali Dewa Ayu Ketut Sri Abadi; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri; I Gusti Ayu Trisna Windiani
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p13

Abstract

Background and purpose: Period prevalence of pneumonia among children in Indonesia increased from 2.1 in 2007 to 2.7 per 1000 children in 2013. The highest incidence was found among children aged 12-23 months. This study aims to examine association between delayed access to health care facilities and severity of children pneumonia. Methods: A case control study was conducted in Denpasar City. A total of 132 children were recruited to participate in this study, consisted of 44 cases and 88 controls. Cases were selected from 161 children with severe pneumonia who registered at Pulmonology Department of Sanglah General Hospital between January 2015 and April 2016. Controls were selected from 261 children aged 12-59 months with mild pneumonia who visited out-patient service at all community health centres in Denpasar City between January 2015 and April 2016. Cases and controls were matched by sex. Data were collected by interview with the parents in their houses. Data were analysed using multivariate analysis with logistic regression. Results: Risk factors associated to severity of pneumonia among children aged 12-59 months were delayed access to treatment for more than three days (AOR=2.15;95%CI: 1.39-3.32), non-health care facilities at first episode of illness (AOR=4.02; 95%CI: 1.53-10.61) and frequent episodes of respiratory infections (>4 times) over the last 6 months (AOR=5.45; 95%CI: 2.13-13.96). Conclusion: Delayed access to treatment, did not access healthcare facilities at first episode of illness, and high frequency of acute respiratory infections are risk factors of severe pneumonia among children.
Sexual behaviours and sexual networks of men who have sex with men in Bali Ni Luh Dea Kumala Sari Karang; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p15

Abstract

Background and purpose: Transmission of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in Bali Province is increasing. This increased transmission is due to their sexual networks and behaviours. This study aims to examine sexual behaviours and sexual networks among MSM population in Bali Province. Methods: A descriptive cross-sectional study was conducted in Denpasar City and Badung District. A total of 130 MSM were recruited from Denpasar II Public Health Centre and Bali Medica Clinic – Badung District. Data were collected through interviews among MSM who visited both providers for STIs services from August to October 2015. Variables of this study included sociodemographic, sexual network (pattern and density), sexual activities in the last month, sexual role, condom/lubricant use, and history of previous STIs. Data were descriptively analysed. Results: As many as 53.1% respondents were aged <25 years, 90.8% were senior high school or higher degree graduates, 6.2% were married, 91.5% were employed, and 59.2% were having a regular partner. In the last month, as many as 70.8% respondents reported to have sex with first sexual partner, 52.3% with second sexual partners, and 45.6% with third sexual partners. Younger respondents tended to seek for younger sexual partners. The majority of respondents had had insertive sex, as many as 40.0% with their first partner, 44.6% with their second partner, and 43.2% with their third partner. About 20% of respondents were having high density sexual network and 71.5% of respondents were having concurrent sexual partnership. The consistent condom use within six months was 67.6% with the first partner, 72.8% with the second and the third partners. As many as 23% of respondents were diagnosed to have STIs. Conclusion: MSM population in Bali Province seem to have high risk sexual behaviours with great sexual network density, high concurrent sexual partnership, and selective mixing between older and younger MSM population.
Stigma and discrimination: Barrier for ending AIDS by 2030 and achieving the 90-90-90 targets by 2020 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.p01

Abstract

In order to be able to mirror the achievements of other countries towards 90-90-90, addressing stigma and discrimination towards key populations and people with HIV+ is crucial. Without these efforts ending the AIDS epidemic by 2030 will be challenging to realize and remain a lofty aspiration.
Factors affecting the use of electronic cigarettes in Udayana University students Luh Pitriyanti; Dewa Nyoman Wirawan; Komang Ayu Kartika Sari; I Made Ady Wirawan; Desak Putu Yuli Kurniati
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p03

Abstract

Background and purpose: Electronic cigarettes (e-cigarettes) have been marketable since 2003 and first became for sale in Indonesia in 2010. Users tend to be predominately young people. The purpose of this study is to determine the proportion, characteristics and factors that influence the use of e-cigarettes among university students. Methods: This study used a cross sectional survey with 351 undergraduate students from a variety of study programs at Udayana University. Students were selected by multistage random sampling. In the first step, 10 out of 47 study programs at Udayana University were chosen randomly. Students who responded by filling out online questionnaires were included in this study. Data collection was conducted using questionnaires with the Survey Monkey Application. Analysis with logistic regression was applied to determine the factors influencing e-cigarettes use. Results: The proportion of university students who used tobacco cigarettes was 14.53%. The number of respondents who reported had ever used e-cigarettes was 61 (17.38%, 95%CI: 13.46%-21.3%) and 25 of them (40.98%) were current smokers. As many as 88.52% of respondents who had ever used e-cigarettes were male and 11.48% were female. Students who had ever used e-cigarettes in the campus area were 22 (36.07%). The reasons of using e-cigarettes included a desire to stop using tobacco cigarettes (29.51%), the fact that e-cigarettes are considered safer (26.23%), are considered “cool” (22.95%) and other reasons (26.23%). Multivariate analysis showed that the variables found to be associated with the use of e-cigarettes were gender (AOR=14.72; 95%CI: 4.34-49.87), a history of smoking tobacco cigarettes (AOR=42.16; 95%CI: 13.56-131.08), a history of consuming alcoholic beverages (AOR=5.72; 95%CI: 2.04-16.04) and coming from a smoking household (AOR=3.87; 95%CI: 1.33-11.21). Conclusion: The proportion of university students who had ever used e-cigarettes was found to be higher than tobacco cigarettes users. In addition, use was found to be greater among male students than females. Influencing factors associated with the use of e-cigarettes are gender, a history of tobacco smoking, a history of consuming alcoholic beverages and coming from a smoking household. There is a need for prevention efforts including education and regulations to reduce the use of e-cigarettes among students as well as community in general.
Relationship between maternal perception and full immunization coverage among children aged 1-3 years in Kalibagor Village, Situbondo District Ifa Nurhasanah; Desak Putu Yuli Kurniati; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p05

Abstract

Background and purpose: Full immunization coverage in Indonesia and East Java Province is reported to remain below the target of Universal Child Immunization. The purpose of the study was to determine the association between maternal perception and full immunization coverage among children aged 1-3 years. Methods: A cross-sectional study was conducted with mothers who had children under 3 years in Kalibagor Village, Situbondo District, East Java Province. A total of 116 respondents were selected using systematic random sampling from 133 mothers of children aged 1-3 years. Listing of all mothers was conducted through home visits one month before data collection. Data collection was conducted by interview at respondents' house in October-May 2018. Data collected included sociodemographic characteristics, knowledge on immunization, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, information on immunization, and support from community leader, health provider and peer. Data analysis with logistic regression was conducted to determine the relationship between maternal perception with full immunization coverage. Results: This study showed that 79.3% of respondents reported to have provided full immunization to their children. The results of multivariate analysis showed that full immunization was related to the mother's perception on the benefits of immunization (AOR=59.75; 95%CI: 4.60-775.86), self-efficacy (AOR=6.25; 95%CI: 1.84-21.35) and knowledge on immunization (AOR=7.77; 95%CI: 1.92-31.49). Conclusion: Maternal perceptions on immunization’s benefits, selfefficacy and knowledge are related to the full immunization coverage in children. Education about the benefits of immunization needs to be prioritized in an effort to increase full immunization coverage in children.
Incidence of dengue fever, climate and vector density in Denpasar Irma Rubianti; Dewa Nyoman Wirawan; Anak Agung Sagung Sawitri2
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p07

Abstract

Background and purpose: Until 2009, Denpasar consistently had the highest rates of dengue fever in Bali. However, from 2010 onwards, dengue rates in Denpasar have declined and in 2017 ranked 7th for incidences of dengue fever in Bali. This study aims to determine the trend and the difference of dengue fever incidence rates, vector density and climate for the period 2007-2017. Methods: This study employed a secondary analysis of dengue fever incidence rates, climate data and vector density from 2007 to 2017. Data on dengue fever incidence, vector density and the number of field workers (known as juru pemantau jentik or jumantik) were obtained from the Denpasar City Health Office. Climate data for 2007-2017 were obtained from the Bali Province Meteorological, Climatological and Geophysical Agency. The data were analyzed by comparing the dengue fever incidence rates, climate data, and vector-density data of the period 2007-2012 and 2013-2017. Results: Incidences of dengue fever in Denpasar have declined since 2013. Climate-related variables found to differ significantly were air temperature, humidity, wind speed and sunlight duration. Air temperature (p=0.03) and wind speed (p<0.01) were significantly higher in 2013-2017 compared to the period of 2007-2012. Humidity and sunlight duration were significantly lower (p<0.01) in 2013-2107 compared to the period of 2007-2012. Rainfall was lower in 2013-2017 compared to the period of 2007-2012, however, the difference was not significant (p=0.57). The proportion of larva-free households was significantly higher (p<0.01) in 2013-2017 (96.9%) compared to the period of 2009-2012 (95.3%). The data of house index (HI), container index (CI) and Breteau index (BI) cannot be compared between these two periods because they are only available for 2013-2017. Conclusion: There has been a decrease in the incidence of dengue fever in Denpasar from 2013-2017 compared to 2007-2012. This is likely to be related to the performance of jumantik in the implementation of vector control programme (VCP) in Denpasar.
Meningkatkan Daya Saing Tenaga Kesehatan dalam Era Masyarakat ASEAN Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 3 No. 1 (2015)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2015.v3.i1.p01

Abstract

Selain regulasi dan kebijakan yang telah dikembangkan oleh pemerintah pusat, peran pemerintah provinsi/kab/kota dan lembaga pendidikan juga amat penting untuk meningkatkan daya saing tenaga kesehatan. Pertama, mengembangkan sistem pemantauan (surveilans) tenaga kerja asing di wilayahnya masing-masing, bekerja sama dengan instansi terkait terutama pihak imigrasi. Walaupun telah ada Undang-undang Tentang Pendayagunaan Tenaga Kesehatan Warga Negara Asing di Indonesia, kemungkinan masuknya tenaga kesehatan asing secara ilegal masih amat memungkinkan. Kedua, pemerintah provinsi/kab/kota terutama dinas kesehatan bekerja sama dengan instansi terkait, juga perlu memantau dengan ketat standar mutu lulusan lembaga pendidikan kesehatan di daerahnya masing-masing agar sesuai dengan standar kompetensi yang telah ditetapkan. Hal ini sesuai dengan tanggung jawab dan kewenangan pemerintah provinsi/kab/kota yang diatur dalam Pasal 6 dan 7 Undang-Undang Republik Indonesia Nomor 36 Tahun 2014.5 Ketiga, untuk meningkatkan kesempatan tenaga kesehatan bekerja di luar negeri, pemerintah daerah, terutama dinas tenaga kerja perlu menjalin hubungan dengan para konsulat negara sahabat yang ada di daerahnya masing-masing dan dengan Pelaksana Penempatan Tenaga Kerja Indonesia Swasta (PPTKIS). Hal ini sejalan dengan Rencana Pengembangan Tenaga Kesehatan Kementerian Kesehatan Tahun 2011-2025.8 Keempat, pemerintah provinsi/kab/kota terutama dinas kesehatan perlu menjalin hubungan dan melakukan sosialisasi dengan lembaga pendidikan kesehatan di wilayahnya masing-masing tentang standar dan kualifikasi tenaga kesehatan di negara-negara ASEAN. Hal ini sejalan dengan tujuan ASEAN MRA on Nursing Services yaitu tentang butir exchange information and expertise on standards and qualifications. Kelima, pemerintah provinsi/kab/kota serta semua lembaga pendidikan bidang kesehatan perlu menjalin hubungan dengan negara-negara ASEAN dalam upaya untuk meningkatkan kapasitas tenaga kesehatan dimana hal ini sejalan dengan tujuan ASEAN MRA yaitu tentang tujuan provide opportunities for capacity building and training of nurses. Keenam, semua lembaga pendidikan bidang kesehatan harus meningkatkan kompetensi dan kemampuan Bahasa Inggris atau bahasa asing lainnya bagi para mahasiswanya.
Workload Analysis of Doctors at Puskesmas Using Workload Indicators of Staffing Need in Denpasar Anak Agung Ngurah Gede Dharmayuda; Luh Putu Lila Wulandari; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 3 No. 1 (2015)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2015.v3.i1.p04

Abstract

Background and purpose: Ratio of health staff instead of workload have been used to determine quota of staff at primary health centers. There is no study assessing workload of functional medical doctors (general practitioners) at primary health centers in Bali. The objectives of this study were to describe functional medical doctors workload, the number and distribution which is needed in primary health centers in Denpasar. Methods: Descriptive cross-sectional study was conducted among functional medical doctors at 11 primary health centers across Denpasar. Data were collected by interview and participatory observation to the study participants. Data was analyzed using WISN English Version 1.1.132.0 software. Results: Among 34 study participants, majority were female (73.5%), aged 35-44 years (61.8%), working as a government employee (97.1%), with tenure of 6-10 years (55.9%) and almost all of them (95.6%) had additional duties besides providing medical care to patients. Results indicated that workload of functional medical doctors at primary health centers was high with WISN ratio 0.5-0.9 compared to the ideal ratio=1. Based on workload analysis, shortages of functional medical doctors was found in all primary health centers in Denpasar. Conclusion: When using the ratio of functional medical doctors per population, the number was sufficient. However, when using workload analysis indicated shortage.
Risk Factors of Moderate and Severe Malnutrition in Under Five Children at East Nusa Tenggara Kadek Dwi Ariesthi; Kadek Tresna Adhi; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 3 No. 1 (2015)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2015.v3.i1.p05

Abstract

Background and purpose: East Nusa Tenggara is the province with the prevalence of moderate and severe malnutrition second highest in Indonesia, amounting to 29.4%. The aim of this study was to identify risk factors of moderate and severe malnutrition among under five children at East Nusa Tenggara. Methods: A case control study was carried out at North Kodi Subdistrict, Southwest Sumba District, East Nusa Tenggara, consisted of 38 moderate and severe malnutrition under five children as cases and 76 healthy under five children as controls. Independent variables were maternal and child factors, feeding and health care practises and sanitation. Data were collected by conducting interviews and analysed using Stata SE 12.1. Bivariate analysis was done to calculate crude odd ratio and logistic regression was done to calculate adjusted odd ratio. Results: Bivariate analysis showed that family income, frequency of illness, mother’s knowledge, frequency of visiting health care centres, number of children , and quality of drinking water supply were risk factors of moderate and severe malnutrition among under five children. Multivariate analysis showed that significant risk factors were frequency of illness (adjusted OR=35,4; 95%CI:4,8–256,8), family income (adjusted OR=14.8; 95%CI: 2.1-100.9), mother’s knowledge (adjusted OR=9.8; 95%CI: 1.4-66.1), frequency of visiting posyandu (adjusted OR=9.0; 95%CI: 1.6-50.7) and source of drinking water (adjusted OR=7.1; 95%CI: 1.1-45.5). Conclusion: Frequency of illness, family income, mother’s knowledge, frequency of visiting posyandu and source of drinking water were predominate risk factors of moderate and severe malnutrition at North Kodi Sub-district, Southwest Sumba, East Nusa Tenggara.
The Difference of Patient Satisfaction Between ISO and Non ISO Health Centers in Denpasar A.A.A.A. Candrawati; I Ketut Suarjana; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 3 No. 1 (2015)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2015.v3.i1.p06

Abstract

Background and purpose: ISO has been implemented to improve quality of care and patient satisfaction in four health centers in Denpasar. An assessment of the quality of services has been conducted, but there has been no assessment of patient satisfaction. This study determined differences of patient satisfaction between ISO and non- ISO centers and related factors. Methods: The study design was cross-sectional sample survey of 298 respondents; 149 attending ISO clinics and 149 non-ISO clinics. Data were collected using self-administered questionnaires and analyzed with chi square test and logistic regression methods as well as quadrant analysis. Results: Satisfaction was significantly higher (p=0.001) among ISO health centers (98.66%) compared to non-ISO (87.25%). Satisfaction levels were significantly higher (p=0.001) among ISO health centers specifically for sub item reliability (97.99% vs 81.21%), responsiveness (97.32% vs 82.52%), assurance (98.66% vs 84.56%), empathy (97.32% vs 77.18%) and physical appearance (97.32% vs 83.8%). Multivariate analysis indicated that factors associated with patients satisfaction were ISO status (adjusted OR=16.56; 95%CI: 3.87-70.95) and health insurance membership (adjusted OR=3.76; 95%CI: 1.38-10.23). Quadrant analysis indicated that sub item politeness, carelessness and untidiness were priority area for improvement among ISO health centers. Conclusion: Patient satisfaction was significantly higher among ISO health centers. Study findings indicated that sub-items politeness, apparent carelessness and untidiness still to be improved among ISO health centers.
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