3/30/2021 Editorial Team | INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD)
About Journal
Indonesian Journal of health sciences research and development is a double-blind peer-reviewed international journal. The frequency is monthly from 2019. It deals with all aspects of health sciences including Community Medicine, Public Health, Epidemiology, Occupational Health, Environmental Hazards, Clinical Research, and Public Health Laws, pharmacology biotechnology, health instruments, nursing, clinical psychology and covers all medical specialties concerned with research and development for the masses. The journal strongly encourages reports of research carried out within the Indonesian continent and South East Asia.
Editorial Team
Chief of Editor : DrPH. Tasnim, SKM, MPH
Managing editor : 1. La Djabo Buton, SKM, M.Kes
2. Azlimin, SKM, MM
3. Noviati, SKM.,MPH
4. Muhammad Isrul, S.Si., M.Si, Apt
5. La Ode Hamrin, S.Si., M.T
6. Tiara Mayang Pratiwi Lio, S.Ked., M.Si
7. Putu Suri, A.Md.Keb, SKM, M.Kes
8. Lisnawati, S.Kpe, Ns., M.Kep
9. Iksan, SKM.,M.Kes
10. Jamal Buton, SKM
https://ijhsrd.com/index.php/ijhsrd/about/editorialTeam 1/4 3/30/2021 Editorial Team | INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD) Editorial Board : 1. Ass. Prof. Lillian Mwanri (Australia)
2. Ass. Prof. Gouranga Dasvarma (Australia)
3. Prof. Dr. Rusli Bin Nordin (Malaysia)
4. Prof. Dr. Abdul Rachman Ayub (Malaysia)
5. DrPH. Tasnim, SKM, MPH (Indonesia)
6. Dr. Astha Sharma Pokharel (Nepal, India)
7. Dr. Vikram Nirajan (Ireland, India)
8. Dr. Ayesha AlRifai (Palestine)
9. Ass. Prof. Dr. Roy Rillera Marzo (Malaysia)
10. Fairuz Fadzilah Rahim (Malaysia)
(/index.php/ijhsrd/about/submissions)
Editorial Team (/index.php/ijhsrd/about/editorialTeam)
Peer Reviewers (/index.php/ijhsrd/reviewers)
Peer Review Process (/index.php/ijhsrd/review)
Focus and Scope (/index.php/ijhsrd/focusandscope)
Publication Ethics (/index.php/ijhsrd/ethic )
Online Submission (/index.php/ijhsrd/about/submissions)
Online Submission Guidelines (https://drive.google.com/open? id=1VPoaMbjwQ6pfDoGN9ngjKaMp-byyrRgc)
https://ijhsrd.com/index.php/ijhsrd/about/editorialTeam 2/4 3/30/2021 Editorial Team | INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD)
Plagiarism Check (/index.php/ijhsrd/plagiarism )
Article Processing Charge (/index.php/ijhsrd/apcs )
Open Access Statement (/index.php/ijhsrd/openaccess )
License Term (/index.php/ijhsrd/licence)
Statistics (https://statcounter.com/p12104385/?guest=1)
Template (https://drive.google.com/open? id=1Gi9fldp8iYF42T_CUxlESIfjJe_LuOB1)
Cover letter and statement (https://drive.google.com/open? id=1SsGrdMikdelO5Uq85PzmEh66CsOx9TzO)
History Jurnal (/index.php/ijhsrd/history)
Information
For Readers (https://ijhsrd.com/index.php/ijhsrd/information/readers)
For Authors (https://ijhsrd.com/index.php/ijhsrd/information/authors)
For Librarians (https://ijhsrd.com/index.php/ijhsrd/information/librarians)
Current Issue
(https://ijhsrd.com/index.php/ijhsrd/gateway/plugin/WebFeedGatewayPlugin/atom)
https://ijhsrd.com/index.php/ijhsrd/about/editorialTeam 3/4 3/30/2021 Editorial Team | INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD)
(https://ijhsrd.com/index.php/ijhsrd/gateway/plugin/WebFeedGatewayPlugin/rss2)
(https://ijhsrd.com/index.php/ijhsrd/gateway/plugin/WebFeedGatewayPlugin/rss)
Address
Jl. Jend.A.H Nasution No.G-37 Kambu, Kendari, Sulawesi Tenggara, Indonesia
Contact Info
+62822 3765 8472 [email protected] [email protected]
© 2019 {International Journal Health Science Research Development}, All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-ShareAlike 4.0 International License Licensed under (https://creativecommons.org/licenses/by-sa/4.0/) a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/). . Site using OJS 3 PKP optimized (https://ijhsrd.com/index.php/ijhsrd/about/aboutThisPublishingSystem)
https://ijhsrd.com/index.php/ijhsrd/about/editorialTeam 4/4 e-ISSN: 2715-4718 DOI: 10.36566/ijhsrd/Vol3.Iss1/X https://ijhsrd.com/index.php/ijhsrd
CONTENTS
Volume 3, Issue 1 March 2021
1. THE EFFECT OF GIVING CUCUMBER (Cucumis sativus) TO DECREASE HEMOGLOBIN TROMBOSITE AND IMPROVEMEN IN PRE-ECLAMMED PATIENTS AT DEWI SARTIKA HOSPITAL ...... 1 Novia Sarmiati, Erwin Azizi Jayadipraja, La Banudi
2. THE APPLICATION OF JOB SAFETY ANALYSIS (JSA) METHOD IN IDENTIFYING THE RISK OF WORK ACCIDENTS IN CHARGED MANPOWER IN BUNGKUTOKO PORT, KENDARI CITY...... 8 Muh. Yamin Samma, Erwin Azizi Jayadipraja, Azis Harun
3. FACTORS RELATING TO THE QUALITY OF HUMAN RESOURCES IN BAHTERAMAS REGIONAL PUBLIC HOSPITAL SOUTHEAST SULAWESI PROVINCE...... 18 Putri Suchi Tulhikma Sarewo,Tasnim Tasnim,La Ode Kamalia
4. FACTORS RELATED TO EMPLOYEE SATISFACTION IN THE HOSPITAL PUBLIC SERVICE AGENCY OF KONAWE DISTRICT...... 24 Alisia Witanti, La Ode Saafi, La Ode Kamalia
5. THE IMPACT OF DEMOGRAPHY AND PERCEPTION ON MALE CONTRACEPTIVE USE IN INDONESIA...... 31 Yunita Amraeni, SudijantoKamso
6. GIVING RED RICE (ORIZA NIVARA) TO CHANGE GLUCOSE LEVELS IN DIABETES MELLITUS PATIENTS IN KENDARI CITY...... 38 Laode Ardiansyah, Nawawi
7. PROVISION OF SUPPLEMENTARY FOOD FOR SASIGO AND BISCUIT IN INCREASING THE WEIGHT OF CHILDREN: A COMPARATIVE STUDY IN NAMBO PRIMARY HEALTH CARE IN KENDARI CITY...... 45 Mariyatni Rasyid, Timbul Supodo, La Banudi
8. THE EFFECTIVENESS OF THE BARK DREDGING OF THE JAVA WOOD TREE (LANNEA COROMANDELICA) ON THE DIABETIC ULCER HEALING PROCESS...... 55 Dwi Wulandari Ningtias Purnama, Wa Ode Rahmadania
9. WASTE UTILIZATION TRAINING ABOUT STYROFOAM BECOME A BATAKO IN THE SCAVENGER WASTE COMMUNITY IN PALOPO CITY.. 61 Indra Amanah, Miftahul Jannah, Ishak
ii
e-ISSN: 2715-4718 DOI: 10.36566/ijhsrd/Vol3.Iss1/X https://ijhsrd.com/index.php/ijhsrd
10. THE RELATIONSHIP BETWEEN POTENTIAL OF VACCINE AND IMMUNIZATION SERVICES WITH QUALITY OF MEASLES VACCINE IN KONAWE KEPULAUAN DISTRICT...... 65 Afiat, Timbul Supodo, Sunarsih
11. THE EFFECT OF LEAFLET AND VIDEO METHODS OF HEALTH COUNSELING ABOUT INNECTICIDED GAMBUS IN MABODO PRIMARY HEALTH CARE...... 71 Zanuma, Timbul Supodo, Sanihu Munir, Anry Hariadhin Depu
12. THE RELATIONSHIP BETWEEN COMPETENCY AND SERVICE OFFICERS ON THE ACHIEVEMENT OF EXCLUSIVE BREASTFEEDING TARGETS IN KENDARI CITY HEALTH DEPARTMENT...... 79 Asmawati, Tasnim Tasnim, Sunarsih
13. COMPARATIVE STUDY OF KNOWLEDGE AND SOCIAL ENVIRONMENT FOR ADOLESCENTS WHICH INFORMATION PROGRAMS AND TEENCES COUNSELING EARLY MARRIAGE IN STATE HIGH SCHOOLS IN KONAWE KEPULAUAN DISTRICT...... 85 Jumriah Abdullah, Tasnim Tasnim, La Banudi
14. THE RELATIONSHIP BETWEEN STIGMA AND JOB AND MARRIED ACCESSIBILITY IN HIV- AIDS PATIENTS IN KENDARI CITY...... 91 Sri Zul Atmi, Tasnim Tasnim, Azis Harun.
15. RISK OF ENVIRONMENTAL HEALTH RISK PARAMETERS NO2 AND COMPLAINTS OF RESPIRATION ON PUBLIC TRANSPORTATION DRIVERS (NEW CAMPUS-CITY) IN KENDARI CITY...... 97 Asri Manafia, Erwin Azizi Jayadipraja, Ridwan Adi Surya
16. THE RELATIONSHIP BETWEEN BENEFITS AND CONSTRAINTS THE FEELING WITH THE HABIT OF SMOKING HEALTH PERSONNEL IN LATAMBAGA SUB-DISTRICT KOLAKA DISTRICT...... 108 Martina Pingak, Tasnim Tasnim, Herianto Wahab
17. RELATIONSHIP BETWEEN INCOME LEVEL, PERCEPTION OF HEALTH SERVICES AND CADRES’S ACTIVITY WITH COMPLIANCE WITH PAYMENT OF INDEPENDENT NATIONAL HEALTH ASSURANCE IN KOLAKA DISTRICT...... 115 Jumiati Bandu, La Ode Kamalia, Erwin Azizi Jayadipraja
18. ANALYSIS OF THE INFLUENCE OF HEALTH EDUCATION TO IMPROVE MOTHER'S KNOWLEDGE IN PREVENTING STUNTING IN MASOLAKA RAYA SUB-DISTRICT, BOMBANA DISTRICT...... 129 Yulfiah Suleman, Tasnim Tasnim, Herianto Wahab
19. THE RELATIONSHIP A BETWEEN LEADERSHIP STYLE AND WORKING CONDITIONS WITH NURSES 'WORKING SATISFACTION IN INPATIENT ROOMS, BAHTERAMAS HOSPITAL...... 136 Nur Ardiana, La Ode Saafi, Tasnim Tasnim
iii
e-ISSN: 2715-4718 DOI: 10.36566/ijhsrd/Vol3.Iss1/X https://ijhsrd.com/index.php/ijhsrd
20. EXPERIENCE AND TRAINING RELATE TO PERFORMANCE CLEAN AND HEALTHY LIVING BEHAVIOR IN CADRE IN THE WORKING AREA OF POASIA PRIMARY HEALTH CARE, KENDARI CITY...... 143 Hasmariana, La Ode Saafi, Tasnim Tasnim, Anry Hariadhin Depu.
21. RISK FACTORS PULMONARYTUBERCULOSIS IN POASIA HEALTH CENTRES IN THE COASTAL REGION OF KENDARI CITY...... 149 Ifon, Timbul Supodo, Sunarsih, H. Sanihu Munir, Abd Aziz Harun
22. ANALYSIS OF SMOKING HABITS AND MONOXIDE CARBON CONTENTS IN HOME WITH CARBOXIHEMOGLOBINE (COHb) IN ACTIVE SMOKING IN III ENVIRONMENT, KEMARAYA, KENDARI CITY...... 159 Sari Arie Lestari B, Titi Saparina L, Leniarti Ali
23. THE RELATIONSHIP BETWEEN DEMOGRAPHIC FACTORS AND INDIVIDUAL PERCEPTION ABOUT COVID-19 VACCINES...... 167 Tasnim Tasnim
24. THE IMPLEMENTATION AND HUMAN RIGHT LAW OF POLICY ABOUT STUNTING PREVENTIONIN COVID -19 ERA IN KENDARI...... 176 Yunita Amraeni,Toto Surianto, M. Nirwan
25. THE RELATIONSHIP BETWEEN HUSBAND SUPPORT AND MIDWIFE ROLE WITH POST PARTUM CONTRACEPTION IN KONAWE KEPULAUAN DISTRICT...... 182 Dian Wulandari, Sunarsih, Akbar Torontju
26. THE RISK FACTORS OF RESIDENTIAL DENSITY AND HABITS OF WASHING THE CURTAINS TO POSITIVE LUNG TUBERCOLOSIS PREVALENCE IN BOMBANA DISTRICT...... 188 Eka Januati, Timbul Supodo, Sunarsih
27. HEALTH RISKS OF SULFUR DIOXIDE (S02) TAXATION IN COMMUNITIES IN RESIDENTIAL SURROUNDING INDUSTRY PT. DIAN SWASTATIKA SENTOSA POWER IN KONAWE SELATAN DISTRICT...... 195 Ikhsan Dwianto, Sunarsih, Erwin Azizi Jayadipraja
28. A STUDY ABOUT THE HEALTH REFERENCE INFORMATION SYSTEM IN THE CASE OF NON SPECIALISTICS IN KENDARI CITY PRIMARY HEALTH CARE...... 205 Sartini Risky, Abdul Azis Harun, Anry Hariadhin Depu
29. THE CORRELATION BETWEEN INDIVIDUAL CHARACTERISTICS AND SMEAR-POSITIVE PULMONARY TUBERCULOSIS IN PUUWATU HEALTH CENTER, KENDARI CITY...... 223 Fitri Rachmillah Fadmi, La Djabo Buton
iv
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718
Research Article Open Access
THE EFFECT OF GIVING CUCUMBER (Cucumis sativus) TO DECREASE HEMOGLOBIN TROMBOSITE AND IMPROVEMEN IN PRE-ECLAMMED PATIENTS AT DEWI SARTIKA HOSPITAL
Novia Sarmiati1, Erwin Azizi Jayadipraja2, Labanudi3
1,2,3Magister of Public Health Study Program, College of Health Sciences Mandala Waluya Kendari, Southeast Sulawesi, Indonesia
Corresponding Author : Novia Sarmiati Email : [email protected]
Abstract
Background : According to the World Health Organization (WHO) every day in 2015, around 830 women die from complications during pregnancy and child birth. Globally, maternal mortality in the world was 303,000 in 2015. The maternal mortality rate (MMR) in Indonesia based on the Indonesian Health Demographic Survey (IDHS) in 2012 was around 359 / 100,000 live births, this figure increased compared to 2007, which was around 228 / 100,000 live births. Based on Dewi Sartika General Hospital’s data with preeclampsia cases for the last three years. In 2017, the number of births in 1855 who experienced preeclampsia were 305 cases. In 2018, the number of births in 1822 who experienced preeclampsia was 334 cases. In 2019, the number of deliveries in 2007 who experienced preeclampsia was 377 cases. For 2020 January to June number of deliveries695 the incidence of preeclampsia was 164 cases. Methods: This study used a quasi-experimental method with a pre-test-post-test control group design. The population in this study was 164 preeclampsia patients from August to October 2020. Result: The wilcoxon test showed p value was 0.0000 < α = 0.05 on decreased hemoglobin and increased platelets Conclusion: There was an effect of cucumber on decreasing hemoglobin and increasing platelets in pre-eclampsia patients at DewiSartika General Hospital.
Key words: cucumber, preeclampsia, hemoglobin, platelets
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 1
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION 2007 who experienced preeclampsia was 377 Preeclampsia is a pregnancy-specific cases. For 2020 January to June number of syndrome with decreased organ perfusion deliveries695the incidence of preeclampsia resulting in vascular vasospasm and was 164 cases. The high number of endothelial activation(1). As much as 3.9% childbirth visits at Dewi Sartika General of all pregnant women in the world have Hospital is because Dewi Sartika Hospital preeclampsia(2). One of the complications in has a strategic location on the border of pregnancy is preeclampsia which causes Konsel with Kendari besides that Dewi serious illness, long-term disability, and Sartika General Hospital also collaborates death to the mother, foetus and neonate(3). with 4 cities / districts for health assurance Preeclampsia is called a "disease of (BPJS of indonesian term) (8). theories" because there are several theories Preeclampsia cases can be caused in that can explain these conditions. The various diseases. The cause of preeclampsia theories include: placental implantation is placental ischemia, in addition there are theory, immunological maladaptation, other factors that cause preeclampsia, namely genetics, endothelial dysfunction, nutrition primigravida, maternal age <20 years or> 35 and hormones. Recently, endothelial and years, family history of preeclampsia, placental factors are considered important in multiple pregnancies, diabetes and the pathogenesis of preeclampsia, but many obesity(9). other unknown factors have been Laboratory tests such as routine blood recognized(4). In preeclampsia there is no tests can help early detection of preeclampsia invasion of trophoblast cells in the muscle so that action and prevention can be taken layer of the spiral artery and surrounding immediately. Research(10), explained that matrix tissue which can result in decreased pre-chlamydial patients experienced an placental perfusion and continued placental increase in haemoglobin and a decrease in hypoxia and ischemia. Ischemia in the platelets. The increase in hemoglobin is placenta results in disruption of blood flow caused by haematological abnormalities and to the fetus(5). impaired heme degradation. The presence of Data from the Southeast Sulawesi endothelial damage causes haematological Provincial Health Office, in 2017 the number abnormalities by leaking between the gaps in of preeclampsia cases was 12.6%. in 2018 the endothelial cells, then resulting in a the number of preeclampsia cases was 17.8% decrease in plasma volume intravascular and in 2019 the number of preeclampsia leading to hemo concentration. These results cases was 21.3% (Dinkes Sultra, 2019). Data are consistent with (11) who revealed that in from the Health Counselling Office in 2017 pre-eclampsia, loss of serum protein and were 19.4% of preeclampsia cases, 17.42% increased capillary endothelial permeability of preeclampsia cases in 2018 and 21.4% of causes a decrease in intravascular volume. preeclampsia cases in 2019(6).Whereas for Hemo concentration will cause a state of the Kendari City area, based on data in 2017, thrombocytopenia and an increase in there were 24.5% of Preeclampsia cases, erythrocyte production, so that haemoglobin 19.4% of Preeclampsia cases in 2018 and levels are also high. 26.1% of Preeclampsia cases in 2019 (7). Data from Dewi Sartika General METHOD Hospital with preeclampsia cases for the last This study used a quasi-experimental three years. In 2017, the number of births in type with a pre-test-post-test control group 1855 who experienced preeclampsia were method design(1). The research period was 305 cases. In 2018 the number of births in conducted for 3 months starting from August 1822 who experienced preeclampsia was 334 to October 2020. The population in this cases. In 2019 the number of deliveries in study was 164 people, with a sample size of
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 2
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 116 people in all preeclampsia patients from hemoglobin, namely 3.33 g / dL was higher August to October 2020 as many as 164 than the control group, the decrease in mean people. The questionnaire was used as a data hemoglobin was 2.71 g / dL. After testing collection method(2). the data analysis using the wilcoxon test (α 0.05) in the cucumber group obtained p RESULT 0.000 which means there is the effect of Table 1.shows that from116 giving cucumber (Cucumis sativus) on respondents, most are in the age category 31- reducing hemoglobin in preeclampsia 35 years as many as 59 respondents (50.9%) patientsatDewiSartika and the smallest is the age category 20-25 Hospital.Whileaverage Platelets that is years as many 13 respondents (11.2%). 218 with standard deviation 16.8, after Table 2.Itshows from 116 respondents, giving the intervention there was an increase most are respondents with blood pressure in the mean Platelets that is 261 by standard 150/90 mmHg namely 51 respondents 14.7and the control group before giving the (44.0%) and the smallest is the respondent intervention mean Platelets that is 224 with with blood pressure 170/100 mmHg as many standard deviation 13.1, after giving the as 2 respondents (1.7%). intervention there was an increase in the Table 3.Itshows that in the cucumber mean platelets that is 257 by standard group before the intervention, the mean 14.8This means that the cucumber group had hemoglobin was 17.48 g / dL with a standard an average increase platelets that is 43 higher deviation1.48, after the intervention, the than the control group mean Platelets that is mean hemoglobin decreased, namely 14.15 g 33. After testing the data analysis using the / dL by standard 0.97 and the control group testwilcoxon test (α 0.05) in the cucumber before giving the intervention mean group obtained p 0.000 which means there is haemoglobin ie18.04 g / dL with standard the effect of giving cucumber (Cucumis deviation 1.16, after the intervention, the sativus) against increased platelets in mean haemoglobin decreased, namely 15.33 preeclampsia patientsat DewiSartika g / dL by standard 0.71, This means that the Hospital. cucumber group decreased the mean
Table 1 Distribution of Respondents by Age at Dewi Sartika Hospital
No. Age n % 1 20-25 years 13 11.2 2 26-30 Years 21 18.1 3 31-35 Years 59 50.9 4 36-40 Years 23 19.8 Amount 116 100
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 3
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Blood Pressure Distribution of Respondents at Dewi Sartika Hospital
No. Blood pressure n % 1 140/90 mmHg 34 29.3 2 150/90 mmHg 51 44.0 3 160/90 mmHg 5 4,3 4 170/90 mmHg 9 7,8 5 140/100 mmHg 8 6.9 6 150/100 mmHg 4 3,4 7 160/100 mmHg 3 2,6 8 170/100 mmHg 2 1.7 Amount 116 100
Table 3 Influence Giving Cucumber (Cucumis sativus) Against Decrease Haemoglobin and Increased Platelets in Preeclampsia Patients At Dewi Sartika Hospital GivingCucumber Control
Pre Post Delta p Pre Post Delta P Variable ∆ value ∆ Value Mean + Mean + Mean + Mean + SD SD SD SD
17.48 + 14.15 + 18.04 15.33 + 3.33 0,000 2.71 0,000 Hemoglobin 1.48 0.97 +1.16 0.71
218 + 261 + 257 + 43 0,000 224 +13.1 33 0,000 Platelets 16.8 14.7 14.8
Table 4 Influence Giving Cucumber (Cucumis sativus) Against Decrease Haemoglobin in Preeclampsia Patients at Dewi Sartika Hospital (Anova test) Group Homogeneity p value Mean Cucumber (Cucumis sativus) 14,152 0.622 0,000 Control 15,338
DISCUSSION sativus) on reducing hemoglobin in preeclampsia patients at Dewi Sartika There is an effect of giving cucumber to Hospital. decrease hemoglobin in preeclampsia Empirically there is a significant effect patients. of giving cucumber juice on reducing blood The results of data analysis using the pressure and improving haemoglobin, this is test wilcoxon test (α = 0.05) in the cucumber possible because cucumbers contain group obtained p = 0.000 which means there potassium, magnesium and phosphorus, is the effect of giving cucumber (Cucumis Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 4
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 where these minerals can effectively treat There is an effect of giving cucumber on hypertension (3). the increase in platelets in Preeclampsia Potassium content has been widely patients at Dewi Sartika Hospital. studied in relation to blood pressure The results of data analysis using the regulation. States several mechanisms by Wilcoxon test (α = 0.05) in the cucumber which potassium can lower blood pressure as group obtained p = 0,000 which means that follows potassium can lower blood pressure there is an effect of giving cucumber by causing a vasodilating effect, causing a (Cucumis sativus) on the increase in platelets decrease in total peripheral retention and in preeclampsia patients at RSU Dewi increasing cardiac output. Consumption of a Sartika. lot of potassium will increase the Platelets are small fragments that come concentration in the intracellular fluid so that from the cytoplasm. Disc-shaped and it tends to draw fluid from the extracellular contains granules. There are 250,000- part and reduce blood pressure (4). 400,000 pieces of blood in every mm3 of The results showed giving Cucumber human blood. The life span of platelets is 10 (Cucumis sativus) experienced an days (7). Platelets are produced in the bone improvement in the mean haemoglobin in marrow by fragmentation of the cytoplasm the cucumber group before the intervention of megakaryocytic. Megakaryocyte- was given the mean haemoglobin was 17.48 megakaryoblast precursors arise by the g / dL with a standard deviation of 1.48, after process of differentiation from hemopoietic the intervention there was a decrease in the stem cells. Megakaryocyte maturation by mean haemoglobin which was 14.15 g / dL endomitotic nucleus replication process. with a standard of 0, 97 and the control Cytoplasmic volume can increase when the group before giving the intervention the nucleus is doubled. The cytoplasm will then mean haemoglobin was 18.04 g / dL with a become granular and then the platelets are standard deviation of 1.16, after the released. Each megakaryocytic is capable of intervention there was a decrease in the mean producing 4000 platelets. The time interval haemoglobin which was 15.33 g / dL with a from stem cell differentiation to platelet standard of 0.71, meaning that the cucumber production is about 10 days in humans (8). group had a decrease in mean haemoglobin. The results showed that the namely 3.33 g / dL, which was higher than administration of cucumber (Cucumis the control group, the decrease in mean sativus) experienced an improvement in the haemoglobin was 2.71 g / dL. trambocyte rate of the respondents, which The results of this study are in line was proven before the intervention, the mean with research(5)explain cucumber juice of platelets was 218 with a standard which can affect blood pressure. This occurs deviation of 16.8, after the intervention there because the content in cucumbers, namely was an increase in the mean of platelets, potassium, magnesium, and phosphorus, namely 261 with a standard of 14.7 and the causes inhibition of the Renin Angiotensin control group before giving intervention that System and will also cause vasodilatation of is 224 with a standard deviation of 13.1, after peripheral blood vessels. Research(6)explain the intervention, there was an increase in the Consumption of 150 ml of cucumber juice mean platelet count, namely 257 with a for 7 days can significantly reduce systolic standard of 14.8, meaning that the cucumber and diastolic blood pressure in hypertensive group had an increase in the mean platelet men and women. count, which was 43 higher than the control group with a mean of 33. The results of research conducted by (9), proved that consuming a combination of pumpkin can effectively reduce blood
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 5
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 pressure in patients with hypertension and 7. Kendari City Health Office. Health improve trambocytes. And in accordance Profile 2019. with research (10), it proves that there is an 8. Dewi Sartika Hospital. Preeclampsia effect of giving pumpkin stew on Case Data. Southeast Sulawesi2020. trambocytes in people with hypertension. 9. Wagiyo N, Kp S, Kep M, Mat S, Putrono SK. Antenatal, Intranatal and Newborn Nursing Care Physiology and CONCLUSION Pathology: Publisher Andi; 2016. There is an effect of cucumber 10. Tiaranissa A, WB SC, Sriwahyuni E. administration on decreasing haemoglobin Profile of Hemoglobin Levels in Severe and increasing platelets in preeclampsia Pre-Eclamptic Women Compared to patients at Dewi Sartika General Hospital. Normal Pregnant Women. FKUB Health The hospital is expected to be able to use this Magazine. 2016; 1 (3): 171-7. therapy as a non-pharmacological basic 11. Anasari T. The Effect of Hemoglobin therapy to reduce haemoglobin and increase and Hematocrit Levels on Eclampsia in platelets in preeclampsia patients. Pregnant Women with Severe Pre- Eclampsia at Rsud Margono Soekadjo . Purwokerto in 2013. Midwife Prada: REFERENCES Journal of Midwifery Publication Akbid 1. Yuliana M, Jatmiko SW. Differences in YLPP Purwokerto. 2015; 6 (1). Hemoglobin, Hematocrit and Platelet 12. Mackey A, Gass SM. Second language Levels between Preeclamptic and Non- research: Methodology and design: Preeclamptic Patients: Muhammadiyah Routledge; 2015. University of Surakarta; 2019. 13. Sugiyono. Nonparametric Statistics for 2. Siska S. The Relationship between Research. 2015. Nutritional Status and Soil Transmitted 14. Anggraeny O, Ariestiningsih AD. Helminth Infection with Ferritin and Preconception Nutrition, Pregnant and Hemoglobin Levels for Pregnant Breastfeeding Women: Universitas Women Supplemented with Iron 90 Brawijaya Press; 2017. Tablets in the Work Area of Puskesmas 15. Prakoso Imammudin W, Soviana E, Gz Lubuk Buaya Padang City 2015: S, Gizi M. Relationship between ANDALAS UNIVERSITY; 2017. Potassium Intake and Blood Pressure in 3. Bastian MD, Rahfiludin Z, Mawarni A. the Elderly at Ngudi Waras Elderly Risk Factors Cause of Anemia Incidence Posyandu in Blulukan Village, in Pregnant Women at Kedawung Public Colomadu District, Karanganyar Health Center, Cirebon Regency, 2015: Regency: Muhammadiyah University of DIPONEGORO UNIVERSITY Surakarta; 2016. SEMARANG; 2016. 16. Tjiptaningrum A. Benefits of Cucumber 4. Poppy S. Overview of Perinatal Juice (Cucumis sativus L.) as Therapy Outcomes in Preeclampsia-Eclampsia for Hypertension. Majority Journal. Mothers at Dr. M. Djamil Padang: 2016; 5 (1): 112-6. Andalas University; 2016. 17. Lebalado LP, Mulyati T. Effect of 5. Zahra F. Relationship between Cucumber Juice (Cucumis sativus L.) on preeclampsia and low birth weight in Systolic and Diastolic Blood Pressure in Bengkalis Hospital. THESIS-2014. Patients with Hypertension: Diponegoro 2020. University; 2014. 6. Southeast Sulawesi Health Office. 18. Hendrayati TD. The Effect of Centella Health Profile. Southeast Sulawesi2019. asiatica (L.) Urban Leaf Decoction on the Number of Blood Pieces (Platelets)
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 6
Sarmiati, N., E.A. Jayadipraja, & Labanudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/42 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 in Mice (Mus Musculus L.) and Their Use as Popular Scientific Work. 2015. 19. Al-Qaim FF, Abdullah MP, Othman MR, Mussa ZH, Zakaria Z, Latip J, et al. Investigation of the environmental transport of human pharmaceuticals to surface water: A case study of persistence of pharmaceuticals in effluent of sewage treatment plants and hospitals in Malaysia. Journal of the Brazilian Chemical Society. 2015; 26 (6): 1124-35. 20. Budiana N. Miracle fruit spilling disease: Group Self-Help Spreader; 2013. 21. Rusiani H, Pujianto A. Description of Types and Frequency of Food Consumption in Elderly with Hypertension: Faculty of Medicine; 2017.
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 7
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718
Research Article Open Access
THE APPLICATION OF JOB SAFETY ANALYSIS (JSA) METHOD IN IDENTIFYING THE RISK OF WORK ACCIDENTS IN CHARGED MANPOWER IN BUNGKUTOKO PORT, KENDARI CITY
Muh. Yamin Samma1, Erwin Azizi Jayadipraja2,Azis Harun3
1,2,3Magister of Public Health Study Program, College of Health Sciences Mandala Waluya Kendari, Southeast Sulawesi, Indonesia
Corresponding Author : Muh. Yamin Samma Email : [email protected]
Abstract
Background : Data from the Ministry of Manpower of the Republic of Indonesia that the number of work accidents in Indonesia in 2016 was 101,368, in 2017 there were 123,041 cases, in 2018 there were 173,415 cases. At the end of September 2019 there were 130,923 cases and there were 6 people who died every day. On September 2019, the sectors that contributed to the relatively large number of work accidents were the processing industry with 50,358 (38.46%) cases, trade of 9,559 (7.30%) cases, transportation and warehousing 2,694 (2.06%) cases, and the rest 68,312 (52.18%) cases from other sectors. The same thing was reported by the Social Security Administration for Employment that there was an increase in work accidents by 40%, from 157,313 in 2018 to 173,105 cases in 2019.
Methods: This research is quantitative research with a descriptive analytic research design and applied observational analytic approach. The population of all loading and unloading workers was 150 people divi ded into 3 teams, where each team consisted of 50 TKBM members of Bungkutoko Port, Kendari City. Result: This study found 3 work stages with the highest RPN value, namely, wrong in the lifting position in the stevedore of work process at the time workers lift goods and put them into the net, as well as in the cargodore of work process when workers stack goods on the truck with a value of 288, stumbling (cargo) which occurs in the stevedoring work process where The worker on the truck directs the crane and the net into the truck body with an RPN value of 192, and pinched by a lifting tool in the cargodor e of work process when workers remove goods from the sling on the truck / remove the sling, with a value of RPN 144. Conclusion: There were 3 loading and unloading work processes, namely, stevedoring, cargodoring,
and delivery with each work stage having potential hazards, the impact of hazards, and control efforts, and the person in charge of control efforts.
Key words: work accident, stevedoring, cargodoring, delivery
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 8
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION Sulawesi Province, has a land area of 70,700 Occupational Safety and Health is a m2, 18,236 m2 of landfill, 1200 m2 of science to anticipate, recognise, evaluate and warehouse, and 388 m2 of office. control hazards that arise in the workplace Meanwhile, the sea side has a dock area of which can have an impact on the health and 4,000 m2, -8 Mlws depth, 1,648 m2 Trestle, well-being of workers, as well as the impacts and 1,200 m2 Causeway. With these that may be felt by the surrounding facilities, Bungkutoko Port can be berthed by community and the general environment(1). ships weighing 6,000 DWT. In future As industrialization and globalization development, Bungkutoko Port is not only a develop as well as advances in science and container port, but also serves as a technology, occupational safety and health multipurpose port. The port is also one of the are also growing. Law Number 1 of 1970 ports that is busy with ships carrying concerning safety as the legal basis for passengers and shipping goods between implementing Occupational Safety and islands, the number of loading and unloading Health in Indonesia has been strengthened by workers is around 150 people, divided into 3 the issuance of Law Number 36 of 2009 teams(5). concerning Health where in articles 164-165 At a glance, it can be seen that there concerning occupational health it is stated are many potential hazards of potential that all workplaces are required to implement hazards that threaten every work process occupational health efforts both in the sector. carried out by workers that can result in formal and informal including the State Civil accidents, material loss for workers and the Apparatus, INA and Police(2). company, death, decreased quality and Data from the Ministry of Manpower quantity of production, as well as hazards to of the Republic of Indonesia states that the the surrounding environment(6). The number of work accidents in Indonesia in operation of lifting and transportation aids 2016 was 101,368, in 2017 there were such as Rubber Tyred Gantry Cranes (TGC) 123,041 cases, in 2018 there were 173,415 and cranes for loading and unloading cases, and at the end of September 2019 activities at Bungkutoko Port has resulted in there were 130,923 cases, and there were 6 many workers experiencing injuries, such as people who died every day. As of September being pinched and hit by tools and cargo. 2019, the sectors that contributed to the Based on an interview with one of the relatively large number of work accidents managers of the Tunas Bangsa Mandiri were the processing industry with 50,358 TKBM at Bungkutoko Port, he said that in (38.46%) cases, trade of 9,559 (7.30%) the last 3 (three) years from 2017 to 2019 cases, transportation and warehousing 2,694 several physical complaints that loading and (2.06%) cases, and the rest 68,312 (52.18%) unloading workers often complained about cases from other sectors(3). every day were low back pain, back pain, The same thing was reported by the pain / neck tension, shoulder pain and Social Security Administering Body for sprains, hand pain, and other health Employment that there was an increase in problems, such as coughing and dizziness. In work accidents by 40%, from 157,313 in 2019 to 2020 there were 3 (three) serious 2018 to 173,105 cases in 2019. BPJS work accidents, namely 1 person was injured Ketenagakerjaan data from Southeast / scratched by cargo, 5 people tripped over Sulawesi Province recorded an increase in cargo, 1 person fell from the transport truck cases from 2017 which only 23 (8.21%) and suffered a fracture. The three cases of cases, in 2018 84 (30%) cases and in 2019 accidents have been handled well, the jumped sharply to 173 (61.79%) cases(4). workers received medical care, however, Bungkutoko Port, which is located in there are also some who only undergo Abeli District, Kendari City, Southeast traditional healers or massage treatments. It
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 8
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 was further explained that all loading and shows that 14 people aged 21-28 years unloading workers were provided with health (23.3%), 19 respondents aged 29-36 years insurance in the form of a Jamsostek card (31.7%), 37 respondents aged -44 years as and collaborated with BPJS employment. many as 14 people (23.3%), and respondents Occupational accidents and health problems aged 45-52 years as many as 13 people are still frequently experienced by workers, (21.7%) (Table 2). but these incidents are not well documented Table 2 and because workers consider them to be Frequency Distribution Based on the Age occupational risks for them. of TKBM at the Port Bungkutoko, Kendari City METHOD Age n % This research is a type of quantitative 21-28 years 14 23.3 research, using a cross-sectional design(7). 29-36 years 19 31.7 37-44 years 14 23.3 The research approach used was 45-52 years 13 21.7 observational. The population is all loading Total 60 100 and unloading workers as many as 150 people who are divided into 3 teams, where The frequency distribution of TKBM each team consists of 50 TKBM members of at Bungkutoko Port, Kendari City based on Bungkutoko Port, Kendari City. In this tenure shows that 32 respondents with a study, the researchers took a sample of 20 service period of <2 years (53.3%) and a people from each team, so that the total service period of> 2 years (46.7%) (Table sample size was 60 people. The data were 3). collected by using purposive sampling Table 3 method(8). TKBM Frequency Distribution at Bungkutoko Port, Kendari City Based on RESULT the Service Period Years of n % The number of lift and transport service equipment at Bungkutoko Kendari Port, <2 Years 32 53.3 there are 6 lift and transport aircraft used > 2 Years 28 46.7 including 1 unit of reach stacker, 1 unit of 32 Total 60 100 ton forklifts, 2 units of 7 ton forklifts, 1 unit of 5 ton forklifts, and mobile cranes. 30 tons Worksheet Job Safety Analysis (JSA) as much as 1 unit (Table 1). The Stevedoring Work Process at Table 1 Bungkutoko Port, Kendari City, there are 4 Frequency Distribution of the Number of work stages, namely, workers enter the barge Lift and Transport Equipment at / hold, workers lift goods and enter into the Bungkutoko Port, Kendari City net, lifting goods in the net using a crane to a Type of Aircraft and Number of transport truck, and The worker on the truck Transport Tools (unit) directs the crane and the net into the truck's Reach Stacker 1 body, with 19 potential hazards that can lead Forklift 32 tons 1 to work accidents (Table 4).. Efforts to Forklift 7 tons 2 control are attempted by the person in Forklift 5 tons 1 charge, in this case the TKBM manager, Mobile Crane 30 Tons 1 Total 6 field supervisors, port K3 staff and TKBM foremen to minimize the potential risk of The frequency distribution of TKBM work accidents. at Bungkutoko Port, Kendari City by age
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 9
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Job Safety Analysis Worksheet (JSA) Stevedoring Work Process at Bungkutoko Harbor, Kendari City Work Stage Potential hazard Potential Risks Control Responsible 1. Workers enter Dropped into the Wounds, fractures Need caution and the barge / hold hold put up warning signs Fall into the sea Drowning, death Need caution and put up traffic warning signs Slip Wounds, injuries Use complete PPE, namely a helmet, vest, safety shoes, and gloves Stumble Wounds, fractures Use complete PPE, namely a helmet, vest, safety shoes, and gloves 2. Workers lift Sun exposure Dehydration, Using complete goods and put fatigue PPE, namely them in the net helmets, vests, safety shoes and gloves, as well as setting rest hours and providing drinking water at work for workers. Exposure to dust Respiratory Use complete PPE, disorders, eye namely helmets, TKBM managers, irritation vests, safety shoes, field supervisors, and masks. port K3 staff, Stuck by goods Injuries, broken Use complete PPE, foremen bones namely a helmet, vest, safety shoes, and gloves Got hit by a tool Wounds, injuries, Use complete PPE, fractures namely a helmet, vest, safety shoes, and gloves Fatigue Error in lifting Rest hour setting Wrong lifting Back pain, joint Adjusting the rest position injuries time, stretching after working for a long time, increasing knowledge of ergonomics of correct lifting procedures and positions. 3. Lifting goods Stuck by goods Injuries, broken Use complete PPE, in the net using bones namely a helmet, a crane to the vest, safety shoes, transport truck and gloves Got hit by a tool Wounds, injuries, Use complete PPE, fractures namely a helmet,
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 10
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 vest, safety shoes, and gloves Exposure to dust Respiratory Use complete PPE, disorders, eye namely helmets, irritation vests, safety shoes, and masks. The sling broke Injuries, broken Use complete PPE, bones, death namely a helmet, vest, safety shoes, and gloves 4. The worker on The sling broke Injuries, broken Use complete PPE, the truck bones, death namely a helmet, directs the vest, safety shoes, crane and net and gloves into the truck Stuck by goods Injuries, broken Improve work body. bones concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Sandwiched in Wounds, fractures Improve work the back of a concentration truck (focus), wear PPE, namely helmets, vests, safety shoes, gloves Slip Wounds, injuries Improve work concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Stumble Wounds, injuries Improve work concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves
Job Safety Analysis Worksheet(JSA) The Cargodoring Work Process at Bungkutoko Port, Kendari City, there are 2 work stages, namely, Removing goods from the sling on the truck / removing the slings and arranging the goods on the truck, with 11 potential hazards that can risk causing work accidents. Efforts to control are attempted by the person in charge, in this case the TKBM manager, field supervisors, port K3 staff and TKBM foremen to minimize the potential risk of work accidents (Table 5).
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 11
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 5 Worksheet Job Safety Analysis (JSA) Cargodoring Work Process at Bungkutoko Port, Kendari City Potential Potential Work Stage Control Responsible hazard Risks 1. Unload the goods Slip Wounds, Improve work from the slings on the fractures concentration (focus), truck / remove the wear PPE, namely slings helmets, vests, safety shoes, gloves Stuck by goods Dead Improve work concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Clamped in the Wounds, Improve work lift fractures concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Stumble Wounds, Improve work injuries concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Sun exposure Dehydration, Using complete PPE, fatigue namely helmets, vests, safety shoes and gloves, as well as setting rest hours and providing TKBM drinking water at work managers, field for workers. supervisors, Exposure to dust Respiratory Use complete PPE, port K3 staff, disorders, namely helmets, vests, foremen eye irritation safety shoes, gloves, and masks 2. Stacking goods on Dust exposure Respiratory Use complete PPE, the truck. disorders, namely helmets, vests, eye irritation safety shoes, gloves, and masks Fell Wounds, Improve work injuries concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Stuck by goods Wounds, Improve work fractures concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Sun exposure Dehydration, Using complete PPE, fatigue namely helmets, vests, safety shoes and gloves, as well as setting rest hours and providing drinking water at work for workers. Wrong lifting Back pain, Adjusting the rest time, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 12
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 position joint injuries stretching after working for a long time, increasing knowledge of ergonomics of correct lifting procedures and positions.
Worksheet Job Safety Analysis (JSA) The Delivery Work Process at Bungkutoko Port, Kendari City, there is 1 work stage, namely, Moving goods from a warehouse or accumulation field onto trucks, with 5 potential hazards that can risk causing work accidents. Efforts to control are attempted by the person in charge, in this case the TKBM manager, field supervisors, port K3 staff and TKBM foremen to minimize the potential risk of work accidents (Table 6).. Table 6 Worksheet Job Safety Analysis (JSA) Delivery Work Process at the Port Bungkutoko, Kendari City Work Stage Potential hazard Potential Risks Control Responsible Moving goods Stuck by goods Broken bones, Improve work from the death concentration (focus), warehouse or wear PPE, namely yard onto helmets, vests, safety trucks shoes, gloves Stumble Wounds, fractures Improve work concentration (focus), wear PPE, namely helmets, vests, safety shoes, gloves Pinched Wounds, injuries Improve work concentration (focus), TKBM managers, wear PPE, namely field supervisors, helmets, vests, safety shoes, gloves port K3 staff, Sun exposure Dehydration, Using complete PPE, foremen fatigue namely helmets, vests, safety shoes and gloves, as well as setting rest hours and providing drinking water at work for workers. Exposure to dust Respiratory Use complete PPE, disorders, eye namely helmets, irrigation vests, safety shoes, gloves, and masks
Hazard identification during the loading and unloading process shows that the stevedoring section identified 60 hazards (100%), 60 hazards (100%) identified in the cargodoring section and 60 hazards (100%) in the delivery section (Table 7)..
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 13
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 7 Hazards Identification During the Loading and Unloading Process at Bungkutoko Port Kendari City uses the Job Safety Analysis (JSA)method Loading and Unloading Process Hazard Stevedoring Cargodoring Delivery Identification n % n % n % There is 60 100 60 100 60 100 There is no 0 0 0 0 0 0
Total 60 100 60 100 60 100 DISCUSSION unloading activities, both multipurpose ports Identification of the hazards of work and container ports. accidents using the JSA method for The following are the stages in making loading and unloading workers at JSA loading and unloading activities at the Bungkutoko Port, Kendari City port of Bungkutoko, Kendari City: a) JSA is a technique that focuses on the Determine the type of job and the name of stages of work as a way to identify hazards the worker. In this case the loading and before unwanted events occur(9). This unloading activities carried out by TKBM at technique focuses more on the interaction Bungkutoko Port consist of 3 types of work between workers, job tasks, equipment and processes, namely: stevedoring, cargodoring, the work environment. Once it is known the and delivery; b)Determine the work stages of hazards present at the work stage, efforts are each work process. In the stevedoring work made to eliminate or reduce the hazard risk process there are 4 work stages, namely: to an acceptable level. JSA is very important workers enter the barge / hold, workers lift to be able to determine and establish work goods and put them into the net, lifting goods procedures appropriately so that occupational in the net using a crane to the transport truck, accidents and occupational diseases can be and workers on the truck directing the crane prevented when workers carry out a good and the net into the truck bag room. In the work procedure. cargodoring work process, there are 2 work JSA is a procedure used to review a stages, namely: removing the goods from the method or way of working and determine sling on the truck / removing the slings and hazards that may have previously been arranging the goods on the truck. Whereas in overlooked in the laying of a factory or the delivery work process, there is only a job building on the design of machines, work of moving goods from the warehouse or tools, materials, work environment, and storage field onto trucks. c) Determine the process (10). JSA is an analysis of work potential hazards of each stage of work. In safety in an activity in the form of safe work this case, the hazard is a potential that can recommendations based on the potential cause work accidents to TKBM. In general, hazards that may arise in each sequence of there are types of occupational accident work steps(11). hazards in the loading and unloading In the loading and unloading process at activities carried out by TKBM, namely: Bungkutoko port, there are 3 main activities, falling, slipping, tripping, being hit by namely stevedoring, cargodoring, and objects, being hit by tools, exposed to delivery which are carried out for 8 hours sunlight, exposure to dust, fatigue, incorrect every day. This activity is a loading and lifting positions, broken slings, and being unloading activity which is generally carried pinched by tools. out at every seaport that serves loading and In the stevedoring work process, based
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 14
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 on table 4 of the Job Safety Analysis (JSA) include slipping, being hit by objects, being worksheet, the stevedoring work process at pinched by lifting equipment, tripping, Bungkutoko Port, Kendari City,there are 19 exposure to sunlight, exposure to dust, potential hazards. Common potential hazards falling, and wrong lifting positions that can cause work accidents include falling This is confirmed by research (15), into a hold, falling into the sea, slipping, against the loading and unloading workers at tripping, exposure to sunlight, exposure to Teluk Nibung Janjung Balai Asahan Port, dust, being hit by objects, being hit by tools, stated that in the cargodoring work process fatigue, incorrect lifting positions, broken there are 9 hazards that can cause accidents slings, and being caught in the tub. truck. consisting of 5 physical hazards, namely This is confirmed by research(12), At direct exposure to sunlight, wheelbarrows the Port of Tanjung Perak, Surabaya, it was sliding without control, scattered piles of stated that the hazards identified in the goods, fall because they are entangled in manual loading and unloading work of ropes that are scattered in the warehouse, the porters at Kalimas Terminal, Tanjung Perak uneven floor of the warehouse can cause Port, Surabaya were 46 potential hazards, the workers to trip. Workers lift and arrange highest risk value from the risk analysis was goods repeatedly when arranging goods, 15, namely the danger of falling and being workers often do this by bending so that in hit. this condition workers are at risk of The results of this study are in line with experiencing low back pain. The potential the research(13),regarding the Loading and for these hazards is in line with research Unloading Workers (TKBM) at the Port of by(16), unnatural work postures and Tanjung Emas in Semarang, occupational slouching overly cause musculoskeletal safety and health risks that are often complaints. experienced by workers at the port include The results of this study are in line with muscle or musculoskeletal disorders due to the research (17),regarding the Loading and non-ergonomic conditions, injuries due to Unloading Workers (TKBM) at the Port of collisions, falls, slips, fractures, and even Tanjung Emas in Semarang, occupational died from being crushed by a load. Data on safety and health risks that are often occupational accidents (including deaths) that experienced by workers at the port include occurred on loading and unloading Workers muscle or musculoskeletal disorders due to (TKBM) at Tanjung Emas Port Semarang in non-ergonomic conditions, injuries due to 2011 were 14 people, 2012 were 19 people, collisions, falls, slips, fractures, and even 2013 were 22 people, in 2015 were 6 people, died from being crushed by a load. and in 2016 were January to April as many as In the delivery work process, based on 12 people. table 6, the Worksheet Job Safety Analysis Other research results, namely research (JSA) for the delivery work process at (14), shows that most of the workers on the Bungkutoko Port, Kendari City, there is 1 stevedoring and receiving port of Tapaktuan job activity and 5 potential hazards were Aceh are exhausted. One of the factors that found. Potential hazards that can cause work can affect fatigue includes the opportunity to accidents, namely falling objects, tripping, change attitudes or work positions, clothing, pinching, exposure to sunlight, and exposure shoes, floor conditions and work shifts. to dust. In the cargodoring work process, based This is confirmed by research(18), on on table 5, the Job Safety Analysis (JSA) the loading and unloading workers at Teluk worksheet for the cargodoring work process Nibung Port, Tanjung Balai Asahan, stated at Bungkutoko Port, Kendari City, there are that in the delivery work process there were 9 11 potential hazards. Common potential potential hazards that could cause accidents hazards that can cause work accidents consisting of 6 potential physical hazards,
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 15
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 namely, being pinched and the danger of (supervisors), TKBM Foremen. Supervisors falling goods from goods carried by workers. or workers, both of them work together in a) Determine the risk of each hazard that has implementing the JSA that has been created. been identified. Risk is the result of danger if In general, the supervisor is responsible for it causes an accident. There are various types making the JSA, documenting the JSA form, of risks from hazards at each stage of the providing training to all TKBM as stated on loading and unloading process carried out by the JSA form and enforcing safe and efficient TKBM ranging from minor risks, such as work procedures. d)JSA form that has been injuries, injuries, dehydration, fatigue, approved by the supervisor with the signature respiratory problems / irritation, lumbago, and full name of the supervisor. The form is joint injuries, wounds, fractures to the proof of commitment and guidance in heaviest risks such as , drowning and wounds ensuring that the form covers all stages of which can cause death. This is confirmed by work to be carried out in the field. e)The JSA research(19), regarding the Loading and form then received approval from the Safety Unloading Workers (TKBM) at the Port of Manager, evidenced by the signature and Tanjung Emas in Semarang, occupational clear name of the Safety Manager as the party safety and health risks that are often responsible for ensuring that everything experienced by workers at the port include written in the JSA form has met the safety muscle or musculoskeletal disorders due to aspects of the work. f)Each TKBM team non-ergonomic conditions, injuries due to member puts a signature on the JSA form, so collisions, falls, slips, fractures, and even that all team members are aware of it and as died from being crushed by a load. evidence that the JSA form has been b)Determine the most effective control socialized to all team members. g)The JSA measures to reduce the risk of each potential Form is complete and must be documented hazard at the stage of work. There are various and disseminated to related parties. risk control efforts including: need to be careful warning and put up warning signs, . use complete PPE, namely helmets, vests, REFERENCES safety shoes, gloves, and masks, regulating 1. Van Daele J. The International Labor rest periods, stretching after working for a Organization (ILO) in past and present long time, increasing knowledge about research. International Review of Social ergonomics of proper lifting procedures and History. 2008; 53 (3): 485-511. positions, as well as increasing concentration 2. Nazirah R, Yuswardi Y. Nurse Behavior (focus) at work. in the Implementation of Occupational This is confirmed by research Health and Safety Management (K3) in (20),states that the design of Aceh. Idea nursing journal. 2017; 8 (3). recommendations or proposed improvements 3. Khairunnisa K. Report on Field Work is carried out based on the hazards that occur. Practices (PKL) at the Ministry of It aims to find a solution for all problems Manpower of the Republic of Indonesia. from existing hazard sources. With the 2019. proposed improvement, the Bungkutoko Port 4. BPJS of Employment. BPJS and TKBM Management can reduce the Ketenagakerjaan Data for Southeast accident rate and prevent similar accidents Sulawesi Province 2019. from before. c)Determine the party who is 5. Tunas Bangsa Mandiri Cooperative. responsible and committed to carrying out Profile of Bungkutoko Port, located in such control efforts. Some parties who are Abeli District, Kendari City, Southeast competent in the loading and unloading Sulawesi Province 2019. process at the port are TKBM Managers, 6. Faniah AM, Suwaji MK. Factors Field Supervisors, Port K3 staff Related To Compliance With The Use
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 16
Samma, M.Y., E.A. Jayadipraja, & A. Harun. DOI: 10.36566/ijhsrd/Vol3.Iss1/46 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Of Apd Earplugs And Gloves In Repair 15. Saragih¹ WL, Mahyuni EL, Lubis AM. Unit Workers AT PT. Kai Daop VI Assessment of Work Accident Risk in Yogyakarta Dipo Solo Racing: Loading and Unloading Workers at Muhammadiyah University Surakarta; Teluk Nibung Port, Tanjung Balai 2016. Asahan in 2015. University of North 7. Mackey A, Gass SM. Second language Sumatra; 2015. research: Methodology and design: 16. Utami U, Karimuna SR, Jufri NN. Routledge; 2015. Relationship of Length of Work, Work 8. Sugiyono. Nonparametric Statistics for Attitude and Workload with Research. 2015. Musculoskeletal Disorders (MSDs) on 9. Simanjuntak RA, Abdullah R. Overview Rice Farmers in Ahuhu Village, Meluhu of Systems and Performance District, Konawe Regency in 2017. Management of Underground Mine (Public Health Student Scientific Safety & Health CV. Tahiti Coal, Journal). 2017; 2 (6). Talawi, Sawahlunto, West Sumatra. 17. Prasetio DB, Aryani I, Meikawati W. Mine Development. 2018; 3 (4): 1536- Risk Assessment of Loading and 45. Unloading Work at Nusantara Tanjung 10. Ilmansyah Y, Mahbubah NA, Emas Port, Semarang. 2016. Widyaningrum D. Implementation of 18. Ramisdar IO. Analysis of Work Job Safety Analysis as an Effort to Accident Risk in the Loading and Prevent Work Accidents and Improve Unloading Process Using the Job Safety Work Safety at Pt Shell Indonesia. Analysis (JSA) Method and the Hazard Proficiency. 2020; 8 (1): 15-22. and Operability Study (HAZOPs) at PT 11. Widiantoro O, Kusnan K, Suparji S, Pelindo IV (Persero) Makassar Rijanto T. Differences in Learning Container Terminal: Alauddin Makassar Outcomes Using Direct Learning Islamic State University; 2019. Models Viewed from Spatial Ability: 19. Kurniawan Y, Kurniawan B, Ekawati E. Study At Basic Survey Working Lesson Knowledge Relationship, Fatigue, in the Engineering Surveying. Physical Workload, Body Posture at International Journal for Educational and Work, and Attitudes of Using Apd with Vocational Studies. 2020; 2 (4). Occupational Accidents (Studies on 12. Husna FA. Compliance with the use of Manual Lifting Activities in the personal protective equipment for Fertilizer Packaging Unit of Tanjung loading and unloading workers (TKBM) Emas Port Semarang) Journal of Public of ships at Belawan Harbor, the working Health (e-Journal). 2018; 6 (4): 393-401. area of the Class 1 Port Health Office 20. Restuputri DP, Sari RPD. Work accident (KKP) in Medan. 2019. analysis using the Hazard and 13. Aryani I. Risk assessment on log loading Operability Study (HAZOP) method. and unloading work (Study at the Deep Industrial Engineering Scientific Port of Tanjung Emas in Semarang): Journal. 2015; 14 (1): 24-35. UNIMUS; 2016. 14. Medianto D. Factors Associated with Work Fatigue in the Loading and Unloading Workers (TKBM) at the Port of Tanjung Emas, Semarang (Study on TKBM Workers in the Fertilizer Packing Unit): Muhammadiyah University of Semarang; 2017.
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 17
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718
Research Article Open Access
FACTORS RELATING TO THE QUALITY OF HUMAN RESOURCES IN BAHTERAMAS REGIONAL PUBLIC HOSPITAL SOUTHEAST SULAWESI PROVINCE
Putri Suchi Tulhikma Sarewo1*,Tasnim Tasnim2,La Ode Kamalia3
1,2,3Magister of Public Health Study Program, Universitas Mandala Waluya, in Kendari, Southeast Sulawesi Province, Indonesia
Corresponding Author : Putri Suchi Tulhikma Sarewo Email : [email protected]
Abstract
Background : Based on the data of the achievement of minimum service standards at Bahteramas Hospital shows that several programs have not reached the specified Minimum Service Standards. For examples, the availability of facilities and operating equipment (34.37%), customer satisfaction (74.04%) from the standard ≥80%, time provision of medical records (30 minutes) from standard 10 minutes, completeness of informed concent (67.75%) of ≥80%. Observing the development of human resources at the Bahteramas Hospital has not been carried out optimally, for example, such as a standardized selection and recruitment process, support for facilities, infrastructure and technology, individual commitment to organization, leadership commitment and employee work relations themselves. The purpose of this research is to analyze factors related to the quality of human resources at the Bahteramas Regional General Hospital, Southeast Sulawesi Province. Methods: Quantitative research used a cross sectional study design.The population in this study was
around 981 people. The number of samples in this study were 277 people. The sample was determined by simple random sampling technique. The data were obtained using the chi square test. Result: The results using the chi square statistical test showed that the value of X2 = 22,378> 3,841, the value of the training variable (X2=18,658> X2 table3,841), the value of the individual commitment variable (38,863> 3,841), the value of the reward variable (X2=51,784> X2 table =3,841), the value of the skill variable (X2=94,713> X2table= 3,841). Conclusion: There is a relationship between selection and the quality of human resources. There is a relationship between training and the quality of human resources. There is a relationship between individual commitment and the quality of human resources. There is a relationship between reward and the quality of human resources. There is a relationship between skills and the quality of human resources.
Key words : Human_resources, Training, Individual, Commitment, Reward
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 18
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION Thus, based on data showing that in the The intense competition from private Bahteramas Hospital, there are still some and even foreign public hospitals is a result SPM that are not in accordance with of the pressure of globalization(1). standards, meaning that employee Nowadays, people place very strict demands performance has not been carried out on the owners of health service facilities that optimally according to predetermined all community needs must be able to be standards(9). served quickly and with quality(2). Facing Observing the development of human this, health workers, both medical and non- resources at the Bahteramas Hospital has not medical personnel, must provide services been carried out optimally, for example, such that provide satisfaction to customers, be as standardized selection and recruitment able to provide innovative services and processes, support for facilities, develop themselves(3). infrastructure and technology, individual According to Notoatmodjo, he commitment to organization, leadership explained that even though he received commitment and employee work relations support with adequate infrastructure and themselves. Starting from the phenomenon financial resources, without having great on the background that has been stated human resources, the goals of an above, so the author has conducted a study organization would be difficult to achieve with the title of "factors related to the quality properly. This shows that human resources of human resources at the Bahteramas have a central role in the development of an Regional General Hospital, Southeast organization(4). Sulawesi Province". Organization is a means of activities for people to achieve common goals(5). In METHOD this activity forum, every person or This study used quantitative research employee must have high ability to carry out methods using a cross sectional study their respective duties, powers and design(10). This research was conducted responsibilities in accordance with their from 25 August to 25 September 2020. The position(6). Therefore, the development of population in this study were all employees Human Resources owned by an institution at the Bahtteramas Hospital for the period of must be carried out optimally, so that Human February 2020, totaling 981 people. While Resources can work optimally to jointly the sample was 277 people. Determination of achieve goals in accordance with the vision the sample using simple random and mission of the organization(7). sampling(11). To reveal the phenomena that occur in the Bahteramas Regional Hospital related RESULT to the development of Human Resources Table 1. Shows that of the 277 which is an important and urgent aspect to be respondents in the age group, the largest studied in order to provide a solution. Based number is in the 30-37 year old group of 118 on data on the achievement of minimum people (42.6%) and the least is in the 46-35 service standards at Bahteramas Hospital, it year group, which amounts to 26 people shows that some programs have not reached (9.4%). the specified Minimum Service Standards, Table 2.Shows that the results of the namely the availability of operating facilities Chi-square statistical test performed obtained and equipment (34.37), customer satisfaction the value of X2 count> X2 table (22.378> (74.04%) from the standard ≥80%, Time of 3.841). So, this means that there is a provision of medical records (30 minutes) relationship between the selection process from standard 10 minutes, completeness of and the quality of human resources at the informed concent (67.75%) of ≥80%(8).
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 19
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Bahteramas Regional General Hospital, 3,841). So, this means that there is a Southeast Sulawesi Province. relationship between training and the quality Table 3.Shows that the results of the of human resources at the Bahteramas Chi-square statistical test performed obtained Regional General Hospital, Southeast the value of X2 count> X2 table (18,658> Sulawesi Province.
Table 1 Distribution of Respondents by Age Group at Bahteramas General Hospital, Southeast Sulawesi Province Age group No. n % (Year) 1. 22-29 46 16.6 2. 30-37 118 42.6 3. 38-45 87 31.4 4. 46-53 26 9.4 Total 277 100
Table 2 Analysis of the Relationship between Selection and Quality of Human Resources at Bahteramas General Hospital, Southeast Sulawesi Province Quality of human resources Amount Statistic test Selection Enough Less n % N % n % Enough 74 58.3 53 41.7 127 100.0 X2 hit = 22,378 Less 44 29.3 106 70.7 150 100.0 X2tab = 3,841 Total 118 42.6 159 57.4 277 100.0 φ = 0.292
Table 3 Analysis of the Relationship between Training and Quality of Human Resources at Bahteramas General Hospital, Southeast Sulawesi Province Quality of human resources Amount Statistic test Training Enough Less n % n % n % Ever 71 57.3 53 42.7 124 100.0 X2 hit = 18,658 Not 47 30.7 106 69.3 153 100.0 X2tab = 3,841 Total 118 42.6 159 57.4 277 100.0 φ = 0.267 DISCUSSION abilities and knowledge will be related to the Selection Relationship with the Quality of quality of human resources produced. Human Resources Meanwhile, according to Baverly The results of the chi square test (2017), the many experiences employees show that the statistical value is significant. have will be very helpful in carrying out their This means that selection is related to the duties and can achieve good quality of human resources. The better the performance(12). Employees who have high perceived selection of indicators of skills, work experience can foster cooperation in the learning process where this can affect Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 20
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 employee performance(13). In connection Bahteramas Hospital, Southeast Sulawesi with this, the Bahteramas Hospital in Province. Research shows that on average screening or selecting employees can respondents have not attended or never prioritize prospective employees who already attended training related to their competence have high work experience in order to itself. In this research, training is considered improve the performance of their employees. to have a relationship with the quality of Potale Research; Atikawati and human resources, meaning that the more Udjang (2016) support the results of this employees who have attended training will study. The results of the previous research be in line with the good quality of human stated that the agreement of the research resources at Bahteramas Hospital. results was that there was a positive and This shows that only a proportion of significant effect of selection on the quality respondents have attended training. Training of human resources(14). is one of the factors that influence human The implication of the results of this resource development, by looking at the data study states that the effectiveness of selecting above that only a portion of the respondents a company's employee placement can be have attended training, thus the quality of the achieved when it meets several requirements. apparatus, in this case the health staff in the The requirements in question are the need for Bahteramas General Hospital itself, whether the Bahteramas Hospital to place employees it is in terms of education and The insights in positions according to the talents and are not good enough and adequate and really interests of the employees, according to need to be developed again in the context of academic achievement, employee developing resources so as to produce experience, health and age of employees. superior and qualified and reliable health Every employee certainly has different workers. abilities because they have different Human resource development backgrounds. If the company can observe through education and training is basically employees, then they will be happy in their directed at shaping the character of workers position and will work even harder. who provide services to the community in a The implication of the research result professional, fair and equitable manner(15). states that basically improving the quality of The need for professional and skilled human resources can be carried out by employees in their fields has progressed so companies through several factors. Included rapidly, where this need is an opportunity among these factors are the recruitment and a demand for every agency, including process, placement selection and career the Bahteramas General Hospital. development. Recruitment effectiveness is Based on the results of these carried out by strict selection and screening calculations, it can be seen that the results of of employees. The effectiveness of training can have a positive and significant placement will be achieved when the impact on the quality of human resources. So company can position employees according it can be concluded that if the results of the to their talents and interests. Meanwhile, training are good it will also have a good career development is an effort to improve impact on the quality of human the technical, theoretical, conceptual and resources(16). With the high ability of moral abilities of employees with education employees obtained through training, and training. employees can more easily carry out the Relationship between Training and tasks that are their responsibility, the same as Quality of Human Resources the opinion of Werther and Davis who said The results of the chi square test that training is very helpful in overcoming showed that the training was significant for problems that are directly related to the the quality of human resources at implementation of the work at hand and
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 21
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 career developmentand one's future 3. Nawawi. Human Resource responsibilities(17). Management: For Competitive With training will create employees Businesses. Yogyakarta: Gajahmada who are able to excel for an institution in the University Press; 2011. future movement(18). The importance of 4. Notoatmodjo S. Health Behavior training is not only for the employees Science. Jakarta: Rineka Cipta; 2014. concerned, but also for the benefit of the 5. Afriansyah H. Administration of organization, because by increasing the Infrastructure. 2019. abilities or skills of employees, it can 6. Handayani TN. The influence of increase the work productivity of pengeconsideration of human resources employees(19). Training is also an effort to to employee work performance in the develop employees' intellectual and West Pagaden District Office, Subang personality abilities. Therefore, every Regency: UIN Sunan Gunung Djati organization that wants to develop must Bandung; 2017. develop its human resources, one of which is 7. Prihatminingtyas. Effect of Ability on by holding training so that it can improve the Performance and Its Impact on Job employee's performance. With the awareness Satisfaction. Journal of Social Sciences. of the importance of training for employees, 2005; 17: 216-24. the implementation of training should be 8. Bahteramas R. Health Profile of carried out continuously. And with the Bahteramas Regional General Hospital. provision of training for employees, it is Kendari: Bahteramas Hospital Training hoped that these employees can perform and Education; 2019. optimally for the company(20). 9. Bahteramas Hospital. Data on the . achievement of minimum service standards at Bahteramas Hospital. Kendari: Southeast Sulawesi; 2019. CONCLUSION 10. Mackey A, Gass SM. Second language There is a relationship between the research: Methodology and design: selection process and the quality of human Routledge; 2015. resources and there is a relationship between 11. Sugiyono PD. Qualitative and training and the quality of human resources Quantitative Research Methods R & D. at the Bahteramas Regional General Bandung: Alfabeta; 2011. Hospital, Southeast Sulawesi Province. It is 12. Mangkunegara AP. Company Human hoped that the results of this research can be Resource Management. Bandung: PT an additional reference for the development Remaja Rosdakarya; 2012. of science, especially for improving the 13. Rima N. Analysis of Factors Affecting quality of human resources. Employee Performance in Semarang City Transportation Agency. Essay. . 2019. REFERENCES 14. Etikawati E, Udjang R. Recruitment and selection strategies for employee 1. Trisnantoro L. Understanding the use of performance. Journal of Business economics in hospital management: Behavior and Strategy. 2016; 4 (1). UGM press; 2018. 15. Fathurrochman I. Competency 2. Muliakoswara AH. Quality of Health Development of State Civil Servants Services in the Emergency Room (IGD) (ASN) Curup State Islamic College Regional General Hospital (RSUD) (STAIN) through Education and Bandung City, West Java Province: Training Methods. Education Manager. Postgraduate Library; 2020. 2017; 11 (2).
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 22
Sarewo, P.S.,Tasnim,T., & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/48 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 16. Ardian DA, Mukzam MD. The Influence of On The Job Training And Off The Job Training on Job Ability and PERFORMANCE (Study on Employees of PT. INSASTAMA Kediri, East Java). Journal of Business Administration. 2018; 62 (1): 190-7. 17. Dedi A. Health Service Management. Yogyakarta: Nuha Medika; 2012. 18. Nasfi N. Effect of Leadership Training and Career Development on Employee Performance of the Umkm Cooperative Office of West Sumatra Province. Al- Fikrah: Journal of Educational Management. 2020; 8 (1): 11-28. 19. Wahyuningsih S. Effect of Training in Increasing Employee Productivity. Dharmawangsa News. 2019 (60). 20. Rosmaini R, Tanjung H. The Influence of Competence, Motivation and Job Satisfaction on Employee Performance. Maneggio: Scientific Journal of Master of Management. 2019; 2 (1): 1-15.
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 23
Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718
Research Article Open Access
FACTORS RELATED TO EMPLOYEE SATISFACTION IN THE HOSPITAL PUBLIC SERVICE AGENCY OF KONAWE DISTRICT
Alisia Witanti1, La Ode Saafi2, La Ode Kamalia3
1,2,3Magister of Public Health Study Program, Universitas Mandala Waluya In Kendari, Southeast Sulawesi Province, Indonesia
Corresponding Author : Alisia Witanti Email : [email protected]
Abstract
Background :The increasing of number of patient visits every year and the ratio of bed usege must be comparable to satisfied employees. However, this has not been in line with the satisfaction felt by employees at the Konawe District Hospital. The purpose of this research is to learn factors related to employee satisfaction at the Regional Uum Service Agency Regional General Hospital, Konawe Regency Hospital. Methods: The study was a quantitative study using a cross sectional study design.The population in this study were all employees at the Bombana District Hospital,namely 157 people. The number of samples in this study were 210 people. The sample was determined by simple random sampling technique. The data were processed using thechi square test. Result: The results of the study using the chi square test show that management is significant towards employee satisfaction (X2cal. . = 33,925> X2tab =3,841), education and training are significant to employee satisfaction (X2 cal. = 39,230> X2tab =3,841. Conclusion: Management is related to employee satisfaction and education. training is also related to employee satisfaction at Konawe District Hospital. However, reward is not related to employee satisfaction.
Key words : Satisfaction, Management, Education, Training
Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 24
Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION been a direct employee job satisfaction General hospitals are usually assessment, only patient assessment. facilities that are easily found in a country, Whereas along with patient satisfaction, with a very large hospitalization capacity for employee job satisfaction should also be an intensive or long-term care(1).Hospital is a important concern for the manager of the health service provider institution that is an Konawe District Hospital. Management integral part of the health service system that revealed that employee satisfaction is very provides curative and preventive services important for employees in carrying out their and provides outpatient and inpatient duties, functions and roles in the field of services as well as home care(2). health services. Satisfaction is the general attitude of an individual to the work he does. Someone METHOD with a high level of job satisfaction shows a This study used quantitative research positive attitude towards their job, while methods using a cross sectional study someone who is not satisfied with their job design(6). This research was conducted from shows a negative attitude towards their September 2 to October 2, 2020. The job(3). population in this study were all employees Satisfaction of health service at the BLUD Konawe District Hospital in the providers is indeed very important, but that Inpatient Unit, central surgery room, clinic satisfaction is often overlooked or forgotten. clinic room, nutrition and emergency room Health care providers who are frustrated and totaling 441 people. sample size of 210 disappointed or dissatisfied will be less people. Determination of the sample using productive and less efficient. Employee simple random sampling(7). satisfaction in the long term will have an economic impact. Employee satisfaction RESULT gives direction to expectations, while audits Table 1 shows that out of 210 will lead to work implementation respondents, the largest number of instructions. Thus, the measurement of respondents in the age group were those at employee satisfaction is always seen in the age of 32-39 years, amounting to 72 relation to expectations. Common aspects of people (34.3%) and the least being in the 48- employee satisfaction include organization 55 years group with 38 people (18.1%). and management, educational needs, Table 2 shows that out of 210 rewards, incentives and promotions(4). respondents the highest number of Based on data from the BLUD of respondents was female, amounting to 132 Konawe District Hospital, the number of people (62.9%) while male respondents were employees in 2017 was 612 people, in 2018 78 respondents (37.1%). there were 618 people, in 2019 there were Table 3 shows that the statistical test 604 people and in 2020 the period of results show that the value (X2hit = 33,925> February 2020 was 601 people (BLUD RS X2tab = 3,841), it means that there is a Kab. Konawe, 2019). With the large number relationship between management and of employees in the Konawe Regional employee satisfaction at the Regional Public Hospital, the RSUD should be able to Service Agency of the Konawe District provide satisfaction to all employees in Hospital. Furthermore, the results of the carrying out their work at Konawe relationship closeness test show that the Hospital(5). value ie 0.412 or indicates a moderate The results of further investigation by relationship. asking directly to the management of the Table 4 shows the statistical test Konawe Regional Hospital stated that in the results show that the value (X2hit = 39,230> Konawe Regional Hospital there had never X2tab =3,841), meaning that there is a Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 25
Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 relationship between education and training no relationship between reward and and employee satisfaction at the Regional employee satisfaction at the Regional Public Public Service Agency for the Konawe Service Agency of the Konawe District District Hospital. Furthermore, the results of Hospital. Furthermore, the results of the the relationship closeness test show that the relationship closeness test show that the value that is 0.442 or indicates a moderate value that is 0.025 or indicates a very weak relationship. relationship Table 5 show that the value (X2hit = 0.047 Table 1 Distribution of Respondents by Age Group at the Hospital BLUD Konawe District Age group No. n % (Year) 1. 24-31 43 20.5 2. 32-39 72 34.3 3. 40-47 57 27.1 4. 48-55 38 18.1 Total 210 100 Table 2 Distribution of Respondents by Gender Group in BLUD Konawe District Hospital No. Gender n % 1. Male 78 37.1 2. Women 132 62.9 Total 210 100 Table 3 Distribution of Management According to Employee Satisfaction at the Regional Public Service Agency of the Konawe Regency Hospital Satisfaction Amount Statistic test Management Satisfied Less N % n % n % Good 59 61.5 37 38.5 96 100 X2 hit = 33,230 Less 24 21.1 90 78.9 114 100 X2tab = 3,841 Total 83 39.5 127 60.5 210 100 φ = 0.442 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 26 Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Distribution of Training and Education according to Employee Satisfaction in Service BodiesKonawe District General Hospital Satisfaction Amount Statistic test Training Satisfied Less n % N % n % Enough 55 66.3 28 33.7 83 55 X2 hit = 39,230 Less 28 22.0 99 78.0 127 28 X2tab = 3,841 Total 83 39.5 127 60.5 210 83 φ = 0.412 Table 5 Reward Distribution According to Employee Satisfaction in Service BodiesKonawe District General Hospital Satisfaction Amount Statistic test Rewards Satisfied Less n % N % n % Enough 40 40.8 58 59.2 98 40 X2 hit = 0.047 Less 43 38.4 69 61.6 112 43 X2tab = 3,841 Total 83 39.5 127 60.5 210 83 φ = 0.025 DISCUSSION of human cooperation that exists within the Management Relationship with Employee organization and the scope of the problems Satisfaction faced, in the health sector, management is Management as a typical process applied to regulate the behavior of staff consisting of planning, directing and working within the health organization controlling actions carried out to determine (service institution) to maintain and and achieve predetermined goals through the overcome health disorders in individuals. or use of human resources and other community groups effectively, efficiently sources.(8). and productively(10). The results showed that the hypothesis was accepted, meaning that there is a The Relationship between Training and relationship between management and Quality of Human Resources employee satisfaction at the Regional Public Good governance (Good Govermence), Service Agency for the Konawe District it is absolutely necessary to have qualified, Hospital. Furthermore, the results of the tested and professional good government relationship closeness test show that the apparatus, including police institutions, need value ie 0.412 or indicates a moderate to pay attention to its human resources(11). relationship. PThis study is in line with The results showed that the hypothesis research conducted by (9)which states that was accepted. means thatthere is a the management function has a positive relationship between education and training influence on member satisfaction in the with employee satisfaction at the Regional organization, where performance is Public Service Agency for the Konawe influenced by the level of employee job District Hospital. Furthermore, the results of satisfaction of 72.50% in an industry. the relationship closeness test show that the Its application must be adjusted to the value that is 0.442 or indicates a moderate scope of organizational functions, the form relationship. The results of this study are Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 27 Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 supported by research (12), which states that contributions that exceed their responsibility training has a significant effect on job to the company(16). Rewarding consists of satisfaction. Based on the results of the the desired reward and the expected reward, discussion, every education and training is both extrinsic and intrinsic. Perceived carried out, will be able to increase job rewards are evaluative assessments in the satisfaction. The more often education and form of financial and non-financial benefits training are carried out, the higher the level received by workers as a result of their of job satisfaction(13). performance with the company(17). According to Notoadmodjo, defining The results showed that the hypothesis education and training is an effort to develop was accepted. means thatthere is no human resources, especially to develop relationship between reward and employee intellectual abilities and human personality satisfaction at the Regional Public Service in education and training programs for Agency for the Konawe District Hospital. employees. We often hear training and Furthermore, the results of the relationship development in the world of work in closeness test show that the value that is companies, organizations, institutions, or 0.025 or indicates a very weak relationship. even in health agencies. It can be assumed The results of hypothesis 1 testing that training and development are very indicate that reward does not have a important for the workforce to work more significant effect on employee job masterfully and better at the job that is satisfaction at PT Bank Central Asia Tbk. currently held or will be held in the future. Surakarta Main Branch. The findings of this Not too far from government agencies, study are not in line with the results of training and development are often carried research conducted by (18), that reward has a out as an effort to improve the performance significant effect on employee job of employees who are deemed incapable of satisfaction. The inconsistency of the carrying out their duties due to the findings of this study is due to the different development of community needs in terms of attitudes and behaviors of employees from services(14). each organization or company. Training can be viewed as a form of The implication of these findings is investment. Therefore, every organization or that the rewards given by the company can agency that wants to develop, training for its not directly affect employee job satisfaction, employees must receive great attention(15). because the forms of rewards desired by This is important because of the methods employees are very diverse. The form of used by the organization to maintain, reward that employees want is not only in maintain, maintain public employees in the the form of extrinsic rewards such as salary, organization and at the same time improve allowances, but also intrinsic rewards such as the skills of employees so that they can task completion, achievement, autonomy improve their performance. The provision of (independence), and personal education and training is one of the efforts to development(19). For example, the results of improve the quality of human resources the questionnaire show that employees according to job requirements. In order to disagree on task completion indicators. This improve human resources in each work unit, response illustrates that the supervisor's trust it will also be related to the nature of in fostering a sense of employee involvement education and training. in completing tasks with full responsibility is lacking(20). The Relationship between reward and Employee Satisfaction Reward is something that is received by workers as an addition or substitute for Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 28 Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 CONCLUSION 8. Hasibuan M. Human Resource There is a relationship between Management. Jakarta: Earth Literacy; management and employee satisfaction at the 2009. Regional Public Service Agency at the 9. Ridho M, Susanti F. Effect of Job Stress Konawe Regency Hospital, There is a and Work Motivation on Job relationship between education and training Satisfaction of Employees of Bank and employee satisfaction at the Regional Mandiri Syariah Branch of Padang. Public Service Agency at the Konawe 2019. Regency Hospital, There is no relationship 10. Muninjaya PDAAG. Health between reward and employee satisfaction at Management Ed. 3. Jakarta: EGC the Regional Public Service Agency of the Medical Book Publisher; 2015. Hospital Konawe District Hospital. The 11. Hertati D, Arif L. Development of a RSUD KabupatenKonawe needs to pay Web-Based Quality Public Service attention to the problem of giving rewards, Model in the Sidoarjo Regency incentives, and the division of tasks so that it Government District. Publisher is in line with employee expectations in Cakradewa Ilmu. 2020; 1. order to increase job satisfaction and prevent 12. Syahputra I, Jufrizen J. The Influence of employees who are absent from their work. Training, Promotion, and Job Satisfaction on Employee Performance. . Maneggio: Scientific Journal of Master REFERENCES of Management. 2019; 2 (1): 104-16. 1. Rungta N, Zirpe KG, Dixit SB, Mehta 13. Marjaya I, Pasaribu F. The Influence of Y, Chaudhry D, Govil D, et al. Indian Leadership, Motivation, and Training on society of critical care medicine experts Employee Performance. Maneggio: committee consensus statement on ICU Scientific Journal of Master of planning and designing, 2020. Indian Management. 2019; 2 (1): 129-47. journal of critical care medicine: peer- 14. Notoatmodjo S. Health research reviewed, official publication of Indian methodology. Jakarta: inventions; 2010. Society of Critical Care Medicine. 2020; 15. Irmatasari D. Influence of Education and 24 (Suppl 1): S43. Training (Diklat) and work ability on 2. Aditama. Hospital Administration Employee Performance at Tampan Management. Jakarta: UI-Pfress; 2007. Mental Hospital Pekanbaru: State 3. Nursalam. Nursing Management: Islamic University Sultan Syarif Kasim Applications in Professional Nursing Riau; 2019. Practice Jakarta: Salemba Medika; 2012. 16. Hidayatullah S. The Effect of Job 4. Pohan. Health Service Quality Satisfaction and Compensation on Assurance. Jakarta: EGC; 2017. Employee Performance at the Regional 5. Konawe RK. Health Profile of the Company Offices of the Indonesian Konawe District General Hospital. Electrical Professionalist Association Unaaha: Konawe Hospital Education (PD APEI Aceh) 2020. and Training; 2019. 17. Sheikh N. Organizational rewards and 6. Mackey A, Gass SM. Second language employee commitment: a Chinese study. research: Methodology and design: Journal of Managerial Psychology. Routledge; 2015. 2012; 27 (1): 71-89. 7. Sugiyono PD. Qualitative and 18. Maarif M. Effect of Motivation, Job Quantitative Research Methods R & D. Promotion and Compensation on Bandung: Alfabeta; 2011. Employee Performance with Job Satisfaction as an Intervening Variable Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 29 Witanti, A., L.O. Saafi, & L.O. Kamalia. DOI: 10.36566/ijhsrd/Vol3.Iss1/49 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 (study at BPRS Artha Surya Barokah Semarang): IAIN SALATIGA; 2020. 19. Qhotimah SC. Effect of Workload, Work Motivation, Work Environment and Rewards on Employee Performance of Rural Banks (BPR) in Kediri: STIE Perbanas Surabaya; 2019. 20. Pandoyo DB, Lantara I, Nugroho MAS. Efforts to Improve Member Performance in terms of Motivation and Democratic Leadership Style in the Police Sector Dukun Magelang: STIE Widya Wiwaha; 2019. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 30 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE IMPACT OF DEMOGRAPHY AND PERCEPTION ON MALE CONTRACEPTIVE USE IN INDONESIA Yunita Amraeni1, SudijantoKamso2 1 Department of Public Health, Faculty of Sciences, Universitas MandalaWaluya in Kendari, Southeast Sulawesi Province, Indonesia 2 Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Indonesia, 16424 Depok, West Java, Indonesia Corresponding Author : Yunita Amraeni Email : [email protected]. Abstract Background : Increasing men's empowerment in family planning and reproductive health is needed, One of the ways is understanding of factors encourage husbands to a family planning acceptor . This study aims to determine the relationship between knowledge, education and husband's perceptions of family planning with the participation of husbands as family planning acceptors in Indonesia. Methods : A cross sectional study design was applied in this study using the 2017 IDHS basic data with 3,751 respondents. Qualitative study on 20 husband with indepth interview also was done toexploretheir perception aboutcontraception. The study used univariable and bivariable analysis with Chi-square test. Results : The results showed that husband's knowledge, education and perceptions about family planning had a significant relationship with each p-value = 0,000 smaller than α = 0.05. Most of husband sarguedthat men should not be involved in family planning because it is related to culture and fear of side effects. Conclusion : The low percentage of husband's participation in family planning shows that husband should be encouraged to participate into family planning program. Keywords: Husband, Participation, Family Planning , Acceptor Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 31 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION the Indonesia Demographic and Health Indonesian population based on 2015 Survey (SDKI) in 2012 the number of pill census data, amounting to 237.6 million acceptors was 13.6 percent, IUD 3.9 percent, people and if without significant control or injections 31.9 percent, implants 3.3 percent remain with population growth of 1.49 and women's medical operations (MOW) by percent per year, then that number will 3.2 percent, while in men namely 1.8 percent continue to grow.From the rapid increase in condom contraceptive acceptors, and population, the government realizes the vasectomy only 0.2 percent. importance of a quality population as the Men's participation in family planning main capital in accelerating development programs based on the 2012 IDHS results which will ultimately realize the welfare of only rose 0.2 percent per year. Seen from the the community. The government carries out increasing number of male participation in various Human Resources development 1991, 0.8 percent (IDHS 1991). In 2003 it programs, one of which is the was 1.3 percent (2002-2003 IDHS), while in implementation of the Family Planning 2007 it was 1.5 percent (2007 IDHS). Based program. Macro, Family Planning functions on the 2010-2014 RPJMN, in increasing the to control births, while in the micro participation of male family planning, it is perspective it aims to help families and expected that in 2010 there will be 3.6 individuals in realizing reproductive rights, percent in 2011 by 4 percent, in 2012 by 4.3 service delivery, arrangements, and support percent, in 2016 by 4.6 percent, and in 2017 to form a family with an ideal marriage age, by 5 percent. However, if you look at the regulating the number, distance and age the results of the 2012 IDHS, only 2 percent of ideal of giving birth to children, and the male birth control are composed of condoms regulation of pregnancy and the fostering of (1.8 percent) and vasectomy (0.2 percent), family welfare resilience (4,5). which means that the RPJMN target is not The Family Planning program achieved. continues to rotate dynamically. In its Based on the background above, the journey, the family planning program has objective of this study is to identify the significantly changed since 1994. This relationship between demography and adjustment is in line with recommendations perception of husbandon participation in from the 1994 International Conference on accepting family planning in Indonesia. Population and Development (ICPD) in Cairo and the Convention on the Elimination METHOD of all Forms of Discrimination Against This study used a cross sectional Women (CEDAW), currently Indonesia has research design with a quantitative approach begun to implement development oriented to to secondary baseline data from the justice and gender equality in the Family Indonesia Demographic and Health Survey Planning and Reproductive Health (KR) (IDHS) in 2017. The data selection process program 4.Men's participation in family in this study was carried out in three stages, planning is a manifestation of gender first selecting male data by excluding female equality. Gender inequality in family respondents by 8,225 respondents. The planning and reproductive health is very second phase, removing male respondents influential on the success of family planning with living with partner status of 46 programs. Most people and providers and respondents.Finally, issuing the type of policy makers still consider that the use of contraception used by women amounted to contraception is a woman's business (3). 5,085 respondents, resulting in a research When compared with female acceptors sample of 4,175 respondents. 424 out of the number of male acceptors is still 4,175 were missing data, so the final number relatively small. According to the results of analyzed was 3,751 married male Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 32 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 respondents.The study used univariable and and knowledge with enough and less bivariable analysis with Chi-square tests, categories while the perception variable with with a significance level of α = 0.05. negative and positive categories. The dependent variable uses Qualitative study with interview participation in using contraception with the method was conducted on 20 husbands / use and not use categories. the independent couples in Sulawesi and West Sumatra to variable is demographics using education explore perceptions related to contraception. RESULT Table 1.Distribution of Respondents Based on Participation Becoming a Family Planning Acceptor (N = 3751) Frequency(n) Percentage (%) Acceptor No 3301 88 Yes 450 12 Knowledge Less 136 3,6 Good 3615 96,4 Education Low 1879 50 High 1872 49,9 Perception Negative 1361 36,3 Positive 2390 63,7 Respondents who did not participate were more dominant than participating respondents at 12.0 percent and most respondents had good knowledge about contraceptive methods with a percentage of 96.4 percent, greater than 3.6 percent of respondents with less knowledge. while education, it appears that respondents with lower education are slightly more above respondents with higher education, with a difference of only 0.2 percent and the table also shows respondents who have a positive perception of family planning (KB) the percentage is higher (63.7 percent) compared to respondents who had negative perceptions (36.3 percent). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 33 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2. Cross tabulation of demography and perception on participating in family planning Participating Total P value No Yes n % n % Knowledge Less 133 97,8 3 2,2 136 0,000 Good 3168 87,6 1127 12,4 3615 Education Low 1747 93 132 7 1879 0,000 High 1554 83 318 17 1872 Perception Negative 1268 93,2 93 6,8 1361 0,000 Positive 2033 85,1 357 14,9 2390 The results of the analysis of the relationship between knowledge and participation into family planning acceptors obtained that the lack of knowledge of the husband, the tendency to not participate as family planning acceptors will be higher (97.8 percent compared to 87.6 percent) and vice versa the better the knowledge the higher participation for became a family planning acceptor (12.4 percent compared to 2.2 percent). Statistical test results obtained p = 0,000, so it can be concluded that there is a significant relationship between knowledge and participation in family planning acceptors.The results of the analysis of the relationship between education and participation into family planning acceptors showed that respondents with low education had a tendency to not participate in family planning acceptors compared to respondents with high education (93.0 percent> 83.0 percent) and vice versa. The statistical test results obtained p = 0,000, it can be concluded that there is a significant relationship between education and participation in becoming a family planning acceptor.The results of the analysis of the relationship between husband's perceptions about family planning and participation into family planning acceptors showed that respondents who had negative perceptions about family planning had a tendency to not participate as family planning acceptors compared to respondents who had positive perceptions (93.2 percent> 85.1 percent) and vice versa that respondents who have positive perceptions about family planning have a tendency to participate in family planning acceptors (14.9 percent> 6.8 percent). The statistical test results obtained p value = 0,000, it can be concluded that there is a significant relationship between the perception of the husband about family planning and participation in becoming a family planning acceptor. Perception on contraceptive use “all about the affairs of children, Contraception as a taboo subject childbirth and pregnancy are the Dominant in men in both regions responsibility of my wife. considers that the discussion related to the contraception is taboo for me” (Men number of children is a matter that must be participant, 40) discussed but it is different in the case of contraception that most men consider that it Misconceptions and fears about modern is a matter for women. This is illustrated by contraceptives the following: The indepth interview revealed that some people had resorted to using traditional and cultural practices because of the fear of Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 34 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 perceived side-effects of modern communicate and negotiate the use of contraceptives. Commonly held myths, fears contraceptives to her husband. This shows and misconceptions were associated with that the promotion of family planning in men prolonged bleeding, the birth of abnormal is still not optimal(4,7). children and tumors in the womb. It was According to the results of a study believed that those who used modern conducted by the BKKBN research team, methods became infertile, as the methods many factors cause low male participation in were perceived to destroy ova, delay return family planning seen from various aspects, to fertility, and cause cancer and bodily namely from the side of the male client pains. Men feared that women using modern himself (knowledge, attitudes, and desired contraceptives would undergo unhealthy relationship practices), environmental factors weight gain or loss. Based on wife's ( socio-cultural in the community, and experience, husband is also afraid to use families, especially wives, limited contraception.. information and accessibility to male family “..I do not agree that my wife uses planning services, and limited types of male modern contraception because of side contraception while perceptions in the effects such as weight gain, long community are still less favorable).The bleeding that interferes with sexual husband's high knowledge about family activity..and so do i” (men participant, planning in this study had a greater 35) percentage than the low knowledgeed one, so that it was expected to be able to boost the Forbidden Culture participation rate of family planning The society has the belief that the acceptors there is also a significant position of the wife is under the relationship between husband's knowledge husband,makatidakseharusnyakontrasepsidig about family planning with participation in unakanolehsuamikarenasegalaurusanreprodu family planning acceptors. ksimerupakantanggungjawabistri. These results are also in line with “….in tradition, men do have to be above their wives. This is supported previous research, that there is a significant by the grip of religion and culture. relationship between knowledge level and Then all decisions in the household male participation in family planning. should be the husband who decides..” Percentage of respondent's knowledge level (men participant, 45) on male participation in family planning is that for non-family planning men have the smallest proportion with good category in DISCUSSION the level of knowledge of male participation Based on the results of the study note in family planning that is only 36.4 percent, that there are still many husbands who do not while for men having family planning has participate in family planning, of the total the largest proportion with good category for 3,751 respondents there are only 450 the level of knowledge of male participation respondents or 12.0 percent of respondents in family planning is 63.6 percent(1,7,8,12). who participated became family planning Higher education is also expected to acceptors. boost enrollment rates as family planning The low practice of family planning acceptors. It can be concluded that there is a among men is partly due to family planning significant relationship between education policies in Indonesia which are still focused and participation in becoming a family on achieving the target of female FP planning acceptor(15). participants(5). Women remain the main Several studies use the variable target of family planning program number of school years to represent human socialization in the hope that the wife will capital. The longer a person experiences Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 35 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 education, the ability to process ideas or contraceptives were also cited as reasons for utilize technology is seen to be higher as men’s lack of involvement (10,13). well(13,14). There is also suggested that education is one of the factors that can influence knowledge and attitudes about CONCLUSION contraceptive methods (12,10). Highly The first suggestion is need for educated people will respond more rationally knowledge and awareness about the than those who are poorly educated, more participation of husbands as family planning creative and more open to renewal efforts. acceptors. SecondlyHealth Service Agencies He is also more adaptable to social can improve health services to implement of changes(9,11). family planning program for men, especially One's perception of family planning in health care facilities that are still also influences participation into family inadequate. finally counseling about the planning acceptors, in the bivariate results in importance of being a family planning this study that respondents who positively acceptor should be improved. perceive family planning have a tendency to participate in family planning acceptors . compared to respondents who have negative REFERENCES perceptions.The results of this study are also 1. Agustina, Tri R., et al. "Factors in line with another study, which stated that Associated with Selection of Non-IUD one of the reasons why male contraception Contraceptive in Women of Reproductive did not develop in the community, was Age in Semarang, Central Java." Mid- mainly due to the man / husband himself, International Conference on Public Health where the husband's desire or awareness to 2018, Surakarta, Indonesia, April 2018. use contraception was still low(6,15). UniversitasSebelasMaret, 2018, p. 192, Vasra also found a meaningful doi:10.26911/mid.icph.2018.03.28. relationship between respondents who were 2. Allen Kabagenyi, Larissa Jennings, Alice positive about family planning and Reid, GoretteNalwadda, James Ntozi& participation in family planning programs. Lynn Atuyambe 2014. Barriers to male From the results of his research it was found involvement in contraceptive uptake and that the proportion of respondents with a reproductive health services: a qualitative positive attitude and participation in the study of men and women’s perceptions in Family Planning program was more two rural districts in Uganda. Reprod dominant than negative one(15). Health .2014 Mar 5;11(1):21 doi: This studyfound that many participants 10.1186/1742-4755-11-21. perceived men to be obstaclesfor women’s 3. Arief. 2007. Factors Causing Husband to utilization of family planning, and largely Choose a Condom Contraception and Not uninvolveddespite the fact that men are often to Choose a Condom Contraception responsible fordecisions which affect the accessed on 21 sept 2020 at household. This was attributedto men’s http://www.bascommetro.com/2011/03/fa reluctance to support use of modern ktor-penyebab-suy-choosing- contraceptivemethods for their spouses or kondom.html themselves based on fears ofharmful side 4. BKKBN. 2016. Book For Sources of effects and spousal infidelity, as well as Family Planning Advocacy, Reproductive preferencesfor large-sized families. Health, Gender, and Population Institutional and social normswhich define Development. Jakarta: reproductive health as a “woman’s issue” DirektoratAdvokasidan KIE, BKKBN, andthe limited choice of available male UNFPA, Bank Dunia, ADB, dan STARH. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 36 Amraeni, Y. & S. Kamso. DOI: 10.36566/ijhsrd/Vol3.Iss1/50 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 5. BKKBN. 2016. Qualified Population and in strengthening family planning activities Small Family Development. Jakarta: in Malaysia. Malays J Pub Healt Med. BKKBN 2010, 10 (1): 23-27. 6. Cornelius, E.S. Use of Contraception is 14. Shahjahan M, Mumu S, Afroz A, Lacking Natural KB Stagnation. Posted Chowdhury H, Kabir R, Ahmed K: September 25, 2013, accessed September Determinants of male participation in 8, 2020 at http://www.metrotvnews.com reproductive healthcare services: a cross- 7. Istiqomah, A., S. NoviantidanNurlina. sectional study. Reprod Health. 2013, 10: 2012. Men's Participation in Family 27-10.1186/1742-4755-10-27. Planning in Sukamanah Village, Cipedes 15. Vasra, Elita. 2009. Relationship District, Tasikmalaya City. Journal of between husband's knowledge and Siliwangi University. Tasikmalaya. attitudes With the participation in KB in 8. Maharyani, H.W., dan S. Handayani. RT 27 and RT 45 RW 10 2010. Relationship between Husband's KelurahanKebunBunga, Sukarami, Characteristics and Husband's Palembang, 2009. Department of Participation as a Family Planning Midwifery, Health Polytechnic, Ministry Acceptor in Karangduwur Village, of Health RI. Petanahan District, Kebumen Regency, Central Java, Journal Kes Mas UAD, Vol. 4, No. 1, September. 9. Marie Amouroux, Roger Miusset, Raoul Desbriere, Pierre Opinel, et.al .2018. Are the men ready to use thermal male contraception? Acceptability in two French populations. PLoSONE 13(5):e0195824.https://doi.org/10.1371/jo urnal.pone.0195824 10. Mosha I, Ruben R, Kakoko D: Family planning decision, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study. BMC Public Health. 2013, 13: 523- 10.1186/1471-2458-13-523. 11. Omandhi-Odhiambo. 1997. Men's Participation in Family Planning Decision in Kenya. Population Studies, 51 (1997), 29- 40. Printed in Great Britain.https://doi.org/10.1080/0032472031 000149706 12. Prabowo, A., D.K. Sari, 2011. The Relationship between Knowledge and Attitudes of Men about Family Planning with Male Behavior in Participating Using the Family Planning Contraception Method in Larangan Village, Larangan District, Brebes Regency, GASTER, Vol. 8, No. 1 (633 - 646) Februari. 13. Rosliza A, Majdah M: Male participation and sharing of responsibility Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 37 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access GIVING RED RICE (ORIZA NIVARA) TO CHANGE GLUCOSE LEVELS IN DIABETES MELLITUS PATIENTS IN KENDARI CITY Laode Ardiansyah1*, Nawawi2 12Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Laode Ardiansyah Email : - Abstract Background :Diabetes mellitus (DM) is a phenomenon which the body cannot produce insulin supply which is indicated by increasing blood glucose levels. Red Rice (Oriza nivara) contains flavonoid compounds which have antidiabetic abilities. It can reduce blood glucose by increasin g insulin secretion and preventing insulin resistance. This study aims to determine the effect of giving brown rice (Oriza nivara) to change blood glucose levels in people with diabetes mellitus in Kendari City. Methods: This research method was carried out with a quasi-experimental design with pre-post test design for 1 week with primary and secondary data collection techniques. The respondents were determined by proportional random sampling. Respondents in this study were 33 people with DM. Result: The results of the study on checking blood glucose levels before and after giving brown rice (oriza nivara) within 1 week obtained P value = 0.000 < alpha 0.05. Conclusion: there is a significant effect of giving brown rice (oriza nivara) on changes in bl ood glucose level in diabetes mellitus people in Kendari City. Key words: Brown Rice, Blood Glucose, Levels, Diabetes Mellitus. INTRODUCTION Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 38 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 One of health problems faced by the glucose levels in diabetes mellitus patients in government and society in Indonesia is Kendari City. diabetes mellitus. One type of disease experienced by the community is diabetes METHOD mellitus. DM is a disease caused by the body This type of research is a Quasi not being able to produce insulin (a hormone Experiment Design with a pre-post test that produces blood glucose) or an design. The pre-post test design is a research insufficient supply of insulin. This can lead conducted by giving a pretest before being to an increase in blood glucose(1). given intervention, after which intervention Based on IDF data (2015) the number is given, then a posttest is carried out (5). of DM sufferers was 415million people in This research will be carried out in 2015 and is expected to increase to 642 Kendari City with a population of people million in 2040. In Southeast Sulawesi, with DM disease in Kendari City based on according to BPS data (2016), DM is a data from the Kendari City Health Office in disease that ranks 4th out of 10 highest 2018 totaling 190 people. To determine the diseases, with a total of 7,357 patients. The number of samples in this study was to use area in Southeast Sulawesi with the highest the Slovin formula in order to obtain a total DM cases is Kendari City. Kendari City has sample of 66 people with diabetes mellitus. DM data for the last 3 years, namely in 2016 The results of the calculation using this the cases reached 161 cases, in 2017 there formula are the number of samples given was an increase of 223 cases and in 2018 brown rice (Oriza nivara), there are 33 there were 190 patients(2). samples of patients with intervention given Diabetes mellitus is closely related to for 1 week with blood glucose measurements blood glucose levels, so it is necessary to before being given and after being given check blood glucose at any time. Control of intervention in DM patients, with blood glucose levels in DM sufferers is information on GDS test on venous plasma ≤ related to excess food intake which results in 100 mg / dL means normal or decreased an increase in blood sugar levels (3). GDS,if ≥ 200 mg / dL means that the GDS is Increased blood glucose (hyperglycemia) can not normal or there is no decrease, while the cause damage to insulin-producing β cells of capillary GDS measurement ≤ 90 mg / dL the pancreas. Free radicals such as means that the GDS is normal or decreases, supraoxide, hydrogen peroxide, nitric oxide if ≥ 200 mg / dL means that the GDS is not and hydroxyl that damage the β cells of the normal or does not occur(6). pancreas so that the amount of insulin produced by the body will decrease. This RESULT causes glucose unable to enter the cells and Table 1 shows that the most age group accumulate in the blood, causing is at the age of 60-69 years there are 10 hyperglycemia. In this case, antioxidants are patients (30.30%), then in the group and needed to fight free radicals. age> 70 years there are 9 people (30.30%), Brown rice (Oriza nivara) contains aged 50 - 59 years as many as 8 sufferers carbohydrates, fats, protein, fiber and (24.24%) while the age group 40-49 years minerals and also contains flavonoid were 6 patients (18.18%). compounds which have the ability to be Table 2 shows that the lowest gender antidiabetic which lowers blood glucose by of the respondents is male 27 people increasing insulin secretion and preventing (40.91%) and the highest is female, insulin resistance (4). The purpose of this amounting to 39 people (59.09%). study was to determine the effect of giving Table 3 shows that the measurement red rice (Oriza nivara) to changes in blood results of respondents with diabetes mellitus in Kendari City before and after giving Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 39 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 brown rice (oriza nivara) for one week with a normality test of giving brown rice (oriza frequency of 3 times a day with portions nivara) before and after the data was not adjusted for their calorie needs. There were normally distributed. Therefore, the 19 people with diabetes mellitus who normality test used is the non-parametric experienced changes in normal blood statistical test Wilcoxon Signed Ranks test. glucose levels, and those who did not After the Wilcoxon Signed Ranks test experience normal changes but entered after statistical test was carried out with a being given red rice intervention (Oriza determined significant level of P Value nivara) were 14 people. <0.05 on the examination of blood glucose Table 4 shows that the data normality levels before and after giving brown rice test uses the Shapiro-Wilk statistical test (oriza nivara) within 1 week obtained P with the interpretation that if the P Value> Value = 0.000 from these data P Value <0.05 0.05 then the data is normally distributed, but (Table 5). This shows that there is an effect if the P Value <0.05 then the data is not of giving brown rice (oriza nivara) on normally distributed. But if there is one test changes in blood glucose in people with before giving intervention and after the diabetes mellitus in Kendari City. intervention is not normally distributed, it is assumed that the test results are not normally distributed. Based on the results of the Table 1 Distribution of Respondents by Age Group No. Age Group (years) n % 1. 40-49 6 18.18 2. 50-59 8 24.24 3. 60-69 10 30.30 4. ≥ 70 9 27.27 amount 33 100 Primary data, 2020 Table 2 Distribution of Respondents by Gender No. Gender n % 1. Male 14 42.42 2. Women 19 57.57 amount 33 100 Primary data, 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 40 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 Measurement of Blood Glucose Levels Before and After Giving Brown Rice (Oriza nivara) Changes in Blood Differe Description Normal Glucose nce ≤ 200 mg / dL Value No. Pre Post Test (1 Test Week) (mg / (mg / dl) dL) 1 485 527 -42 Abnormal 2 561 328 233 Abnormal 3 350 268 82 Abnormal 4 220 109 111 Normal 5 201 319 -118 Abnormal 6 215 137 78 Normal 7 228 149 79 Normal 8 298 334 -36 Abnormal 9 500 328 172 Abnormal 10 450 220 230 Abnormal 11 550 245 305 Abnormal 12 448 248 200 Abnormal 13 240 185 55 Normal 14 550 245 305 Abnormal 15 374 184 190 Normal 16 450 129 321 Normal 17 260 138 122 Normal 18 285 195 90 Normal 19 276 152 124 Normal 20 347 198 149 Normal 21 545 238 307 Abnormal 22 336 185 151 Normal 23 274 128 146 Normal 24 380 192 188 Normal 25 420 200 220 Normal 26 229 138 91 Normal 27 580 258 322 Abnormal 28 420 209 211 Abnormal 29 480 198 282 Normal 30 385 182 203 Normal 31 450 216 234 Abnormal 32 480 200 280 Normal 33 300 165 135 Normal amount 12567 7147 5420 Primary data, 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 41 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Data Normality Test Before and After giving Brown Rice (Oriza nivara) to Changes in Blood Glucose Levels in Patients with Diabetes Mellitus Examination of Blood Glucose P-Value ɑ Conclusion Levels Pre 0,000 0.78 Abnormal Post 0,000 0.00 Normal Primary data, 2020 Table 5 The Wilcoxon Signed Ranks test of the Provision of Brown Rice (Oriza nivara) Giving of Red Median Maximum Maximum Statistic p value Nas (Oriza test nivara) Measurement of 380,000 201 580 0.00 0,000 Blood Glucose Levels Pre-Post Test (1 Week) Primary data, 2020 DISCUSSION The results of this study are in line The Effect of Giving Brown Rice (Oriza with(7) research, regarding the effectiveness nivara) to Changes in Blood Glucose of giving rice diets in reducing blood sugar Levels in Diabetes Mellitus Patients in the levels in diabetes mellitus sufferers at Working Area of Kendari City Puskesmas Pandemawu Pamekasan, out of Measurement of blood glucose levels 76 diabetes mellitus patients before and after in people with diabetes mellitus, before and giving brown rice intervention for 1 week, after the intervention of brown rice (oriza brown rice results are effective. against nivara) with a time span of 1 week frequency decreased blood glucose levels in diabetes 3 times a day with portions adjusted for mellitus patients. On research(8), of the total calorie needs. Thus, 19 patients with blood research sample amounted to 36 samples glucose in the normal range ≤ 200 mg / dl consisting of the treatment group being given had diabetes mellitus, while 14 patients who brown rice for 6 days at breakfast and dinner, did not experience changes in blood glucose while the control group did not receive any levels were still above> 200 mg / dl. The intervention. The results showed that the results of the data normality test obtained initial and final cholesterol levels of the that the data were not normally distributed so treatment group were 235.69 mg / dL and that it was continued with the non-parametric 198.56 mg / dL, while the initial and final statistical test Wilcoxon Signed Ranks test cholesterol levels of the control group were with a significant level determined was P 235.72 mg / dL and 256.50 mg / dL. In this Value <0.05 on checking blood glucose study, giving brown rice was effective in levels before and after giving brown rice reducing total cholesterol levels in patients (oriza nivara) in time 1 week obtained P with type 2 diabetes mellitus. Value = 0.000 from the data P value <0.05. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 42 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 The process of changing blood glucose secretion so that pancreatic β cells by giving brown rice (oriza nivara) is due to experience fatigue so that it can trigger the high fiber content in brown rice. The diabetes mellitus (12). Women are also more benefits of fiber in brown rice can increase at risk of experiencing postrandial the viscosity of the lumen in the intestine so hyperglycemia than men (13). that it can decrease the efficiency of carbohydrate absorption and insulin response. By decreasing the insulin response, CONCLUSION the work of the pancreas will be lighter in Examination of blood glucose levels producing insulin. Brown rice (oriza nivara) before and after giving brown rice (oriza can also reduce lipid levels in serum so that nivara) within 1 week obtained P value = it can reduce glucose levels in the blood. In 0.000 from P value <0.05. The conclusion is addition, brown rice contains the mineral that there is an effect of giving brown rice selenium and anthocyanin pigments (red) (oriza nivara) on changes in blood glucose in which function as antioxidants and act as an diabetes mellitus sufferers in Kendari City inhibitor of various degenerative diseases . including diabetes mellitus (9). REFERENCES Brown rice also contains Gama Amino 1. Ministry of Health R. Main results of Butiric Acid (GABA) which can stimulate RISKESDAS 2018. Online) http: // pancreatic β cells to produce more wwwMinistry of Health go id / insulin(10). If insulin production increases, it resources / download / latest-info / will suppress the Sensitive Lipase Hormone material_rakorpop_2018 / Results% (HSL) which plays a role in lipolysis so that 20Riskesdas. 2018; 202018. blood glucose levels will decrease. In 2. BP statistics. Human Development addition, brown rice contains essential fatty Index 2016. Kendari Southeast Sulawesi: acids that can reduce blood glucose levels by clearing plasma from chylomicron Central Bureau of Statistics. 2017. lipoproteins and reducing the production of 3. Amir SM, Wungouw H, Pangemanan D. triglycerides and β apoloproteins in the Current blood glucose levels in type 2 liver(11). As for diabetes mellitus sufferers diabetes mellitus patients at the after being given brown rice (oriza nivara) Shoulder Health Center, Manado city. but there is no change in the normal range eBiomedics. 2015; 3 (1). due to the presence of patients consuming 4. DAHLIA S. The Effect of White Rice, Red foods that can trigger an increase in blood and Black Rice Dekok on the Effects of glucose, drinking coffee, smoking which can Hyperglycemia in Swiss Webster 2019 cause an increase in blood glucose in people Male White Mice. with diabetes mellitus. 5. Mackey A, Gass SM. Second language External factors that cause no change research: Methodology and design: in blood glucose levels after the intervention Routledge; 2015. of brown rice (oriza nivara) is that patients 6. Ratu G, Badji A. Profile of Urinary Tract have various characteristics of age and Stones Analysis in Clinical Pathology gender. A person aged 35 years and over is Laboratory. Indonesian Journal of more likely to have postprandial Clinical Pathology and Medical hyperglycemia than someone less than 35 years of age. Likewise for gender, women Laboratory. 2018; 12 (3): 114-7. are more likely to suffer from diabetes 7. Kuszairi K. The Effectiveness of Giving mellitus due to the influence of the hormone Brown Rice Diet in Lowering Blood estrogen which can directly increase insulin Sugar Levels in Diabetes Mellitus and strengthen glucose stimulation to insulin Patients at Pademawu Puskesmas Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 43 Ardiansyah, L & Nawawi DOI: 10.36566/ijhsrd/Vol3.Iss1/52 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Pamekasan. Journal of Islamic Medicine. 2017; 1 (2): 97-107. 8. Pradini WU, Marchianti ACN, Riyanti R. The effectiveness of brown rice to reduce total cholesterol levels in Type 2 DM patients (The Effectiveness of Red Rice to Decrease Total Cholesterol in Type 2 DM Patients). 2017. 9. Salamah IR. Diversification of Cookies with Addition of Red Rice Flour (Oryza nivara) Against Anthocyanin Levels and Acceptability: STIKES PKU Muhammadiyah Surakarta; 2017. 10. Pradini WU, Marchianti ACN, Riyanti R. The effect of red rice to decrease total cholesterol in type 2 dm patients. AMS Journal. 2017; 3 (1): 7-12. 11. Diass WC, Estiasih T. Effect of Dioscoreaceae Family Tuber Bioactive Compounds on Blood Lipid Profile Conditions: A Literature Review [IN PRESS APRIL 2015]. Journal of Food and Agroindustry. 2014; 3 (2): 424-30. 12. McLennan R, Schumacher LJ, Morrison JA, Teddy JM, Ridenour DA, Box AC, et al. Neural crest migration is driven by a few trailblazer cells with a unique molecular signature narrowly confined to the invasive front. Development. 2015; 142 (11): 2014-25. 13. Rensiansi L, Iwaningsih S. Effect of Consumption of Ir-36 Rice and Brown Rice on Blood Sugar Level Profiles of Type 2 Diabetes Patients in Public Health Centers, Pasar Rebo District, East Jakarta. ARGIPA (Nutrition and Food Archives). 2016; 1 (1): 41-50. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 44 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access PROVISION OF SUPPLEMENTARY FOOD FOR SASIGO AND BISCUIT IN INCREASING THE WEIGHT OF CHILDREN : A COMPARATIVE STUDY IN NAMBO PRIMARY HEALTH CARE IN KENDARI CITY Mariyatni Rasyid1, Timbul Supodo2, La Banudi3 1,2,3Magister of Public Health Study Program, Universitas Mandala Waluya In Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Mariyatni Rasyid Email : - ABSTRACT Background:The prevalence of community nutritional status in the Kendari City area in 2016 was 0.23%. In 2017, the prevalence of nutritional status decreased in 0.13% and then increased in 2018 by 4.67%. in 2019, the prevalence of nutritional status decreased by 2.25% . Thus, children under five have nutritional status did not reached the target This study aimed to understand the effect of giving the sasigo and biscuit on increase the children’s weight in Nambo Primary Health Care in Kendari City. Methods:The type of research in this research is pre-experimental research with a Pre Test - Post Test design. This research was conducted in the working area of Nambo Primary Health Care, Kendari City. Population were 227 and a sample was 67 malnourished toddlers in 2019. Result:Based on the independent sample test output in the Equal Variances Assumed section on Local supplementaty food (BageaSasigo), it is known that the sig (2-tailed) value is 0.001 <0.05, so Ha is accepted so that there is a significant difference between the provision of local supplementary food (BageaSasigo). Whereas in the Government PMT (biscuits) it is known that the sig (2-tailed) value is 0.000 <0.05, so Ha is accepted so that there is a significant difference between the provision of government PMT (biscuits) to toddlers in the Work Area of the Nambo Primary Health Care, Kendari City. Conclusion:Provision of Local supplementary food (Bagea Sasigo) and Government SP (Biscuits) for toddlers. Before giving the intervention it was not effective while after giving the intervention it was effective and significant. Key words: Food, Biscuits, Nutrition, Toddlers Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 45 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION growth and development which causes World Health Organization (WHO) malnutrition in children under five. explained that nutritional problems can be Cassava is used as a material for indicated by the large incidence of making bagea because cassava is one of the malnutrition in that country. In Indonesia in secondary crops which is the third food 2015, monitoring of nutritional status ingredient after rice and corn. Cassava as one showed that 79.9% of good nutrition, 14.9% of the most important commodities in of malnutrition, 3.8% of malnutrition and Indonesia should be encouraged and 1.5% of overnutrition. In the nutritional developed for its products in the context of status of toddlers according to the height agricultural diversification and food index according to age, the results were 71% diversification, which are currently being normal, 29.9% short and very short. implemented(3). Meanwhile, for the nutritional status of Bagea cake is a typical snack in the children under five according to the weight Kendari mainland. This cake has a dry index according to height, the results were texture a bit hard and tastes sweet and 82.7% normal, 8.2% thin, 5.3% fat and 3.7% savory. Judging from the basic ingredients of very thin(1). the bagea cake made from sago, this bagea The prevalence of community cake has a characteristic because besides it nutritional status in the Kendari City area in tastes good, this bagea cake is also unique 2016 was 0.23%, decreased in 2017 by because it is almost similar to biscuits(4). 0.13%, increased in 2018 by 4.67% and This study provides a form of PMT in decreased by 2.25% in 2019 Although the the form of snacks (Bagea) made from local prevalence rate of nutrition tends to decrease, sago with added gonads. This Bagea is a although not significantly, the problem is modification of the traditional Tolaki ethnic nutritional statusthere are still many in the food with the regional name Bagea Cake. Kendari City Area. Thus Kendari City shows Bagea is made from a mixture of sago, sugar, that children under five have not reached the chicken eggs and added with sea urchins, target of nutritional status, where the current which is almost the same shape as sago nutritional status of children under five is biscuits. Based on (5), the development of 0.21% while the Minimum Service Standard supplementary feeding with complementary is 8.1%(2). breastmilk in addition to paying attention to Based on the initial survey and biological values must also pay attention to observations carried out, in the working area prices so that they are affordable and of the Nambo Puskesmas, which is the processed by taking into account the eating Puskesmas with malnourished children under habits of local communities. five, the highest is 227 under 15 health The added PMT biscuits in this study centers in Kendari City. From the results of were to see the differences in body weight of observations, the cause of high malnutrition toddlers who consumed Sasigo bagea and is due to the behavior of mothers, especially PMT biscuits(6). The use of PMT from the in the provision of food intake to children government is usually given to children aged under five and eating care in providing food, 6-59 months who experience nutritional they are more interested in fast food but problems. the content of PMT biscuits is a contain preservatives and lack of nutrients, nutritional supplement in the form of especially protein, vitamins and minerals so additional food in the form of crackers with that many toddlers prefer to eat fast food. special formulations and fortified with fast food and the level of activities of vitamins and minerals and enriched with mothers helping their husbands to earn a vitamins B1, B2, B3, B5, B6 and B12, folic living so that they do not bring their toddlers acid and seven (7) kinds of minerals (Iron, to the posyandu so that they cannot monitor Calcium, Sodium, Zinc, Iodine, Phosphorus Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 46 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 and Selenium) are given to children to meet lowest frequency is in the 8-20 months age their nutritional needs (7). category. 15 respondents (22.4%). Indicators of improvement in Table 3.It is known that before the nutritional status were measured using treatment was given, namely Local PMT anthropometry. Anthropometric indicators (BageaSasigo) and Government PMT consist of weight and height. Weight is the (Biscuits), which was 0, while after most important and most frequently used treatment with the provision of Local PMT anthropometric measure. Body weight (BageaSasigo) and Government PMT describes the amount of protein, fat, water (Biscuits), namely 67 respondents (50%) and minerals in the bones. A person's weight respectively. with the research procedure, is influenced by several factors, including namely for 4 weeks of treatment. age, gender, physical activity and heredity Table 4.It is known that before being (8). For indicators, height is an important given treatment (Pre Test), namely Local parameter for past nutritional conditions and PMT (BageaSasigo) for body weight current conditions if age is not known amounted to 67 respondents (100%) while accurately(9). after treatment (Post Test) by giving Local PMT (BageaSasigo) for body weight category fixed (negative) totaled 42 METHOD respondents (62.7%). Whereas for the The type of research that will be used positive category (increasing) after getting in this research is pre-experimental research treatment, namely the provision of Local with a Pre Test - Post Test design which is PMT (BageaSasigo) amounted to 25 used to see the differences before and after respondents (23.7%). treatment(10). This research was conducted Table 5.It is known that before being in the work area of PuskesmasNambo, given treatment (Pre Test), namely Kendari City for one (1) month, starting Government PMT (Biscuits) for body weight from September to October 2020. The amounted to 67 respondents (100%) while population in this study were children under after treatment (Post Test) by giving five with malnutrition in the work area of Government PMT (Biscuits) for body weight PuskesmasNambo as many as 227 children category fixed (negative) amounted to 22 with a sample of 67 nutritional infants. less respondents (32.8%). Meanwhile, for the in 2019.Sampling in this study using the positive category (increased) after receiving Probability Sampling Technique, namely treatment, namely the provision of cluster sampling and simple random Government PMT (Biscuits) amounted to 45 sampling(11). respondents (67.2%). Table 6 is known that of the 67 RESULT respondents who were given Local PMT Table 1.It shows that of the 67 (BageaSasigo) treatment before being given respondents who consumed local PMT treatment (Pre Test) which is 9.4 times then (BageaSasigo), the highest frequency was in after treatment (Post Test) by giving Local the 8-20 month age category, namely 29 PMT (BageaSasigo) to 9.5 times. The respondents (43.3%) and the lowest difference between the average BageaSasigo frequency was in the> 40 months age Pre-Test and Post-Test is 0.1 times. category, namely 6 respondents (9.0%) . Table 7 is known that of the 67 Table 2.It shows that out of 67 respondents who were given the Government respondents who consume Government PMT PMT (Biscuits) treatment before being given (Biscuits), the highest frequency is in the 31- the treatment (Pre Test) which was 10.5 40 months and> 40 months age category, times then after the treatment (Post Test) was respectively 18 respondents (26.9%) and the given the Government PMT (Biscuits) to 11 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 47 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 times. The difference between the average 0.129> 0.05, it means that the variance of the BageaSasigo Pre-Test and Post-Test is 0.5 Case group data is Homogeneous or the times. same (V. WiratnaSujarweni, 2014). While Table 8 is known that from 67 for the Biscuits the amount of 0.052> 0.05, it respondents, the value of sig. Levene's Test means that the data variance of the Control for Equality of Variances on bageasasigo is group is Homogeneous or the same. Table 1 Distribution of Respondents Based on Age of Toddlers Who Get Local PMT (BageaSasigo) in the Work Area of PuskesmasNambo, Kendari City Toddler Age (Month) n % 8-20 months 29 43.3 21-30 months 17 25.4 31-40 months 15 22.4 > 40 months 6 9.0 amount 67 100 Source: Primary data processed in 2020 Table 2 Distribution of Respondents Based on Age of Toddlers Who Get Government PMT (Biscuits) in the Work Area of PuskesmasNambo, Kendari City Toddler Age (Month) n % 8-20 months 15 22.4 21-30 months 16 23.9 31-40 months 18 26.9 > 40 months 18 26.9 amount 67 100 Source: Primary data processed in 2020 Table 3 Distribution of Respondents Based on Giving Local PMT (BageaSasigo) and using government PMT such as Biscuits in the Work Area of PuskesmasNambo, Kendari City Measurement PMT Pre Test Post Test n % n % Local (BageaSasigo) 0 0 67 50 Biscuits 0 0 67 50 amount 0 0 134 100 Source: Primary data processed in 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 48 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Distribution of Respondents Based on Weight Gain before and after being given Local PMT (BageaSasigo) and Biscuits in the Regions The work of PuskesmasNambo, Kendari City Local PMT (BageaSasigo) Weight Pre - Test Post - Test n % n % Negative 67 100 42 62.7 Positive 0 0 25 37.3 amount 67 100 67 100 Source: Primary data processed in 2020 Table 5 Distribution of Respondents Based on Weight Gain before and after being given PMT (Biscuits) in the Regions The work of PuskesmasNambo, Kendari City Government PMT (Biscuits) Weight Pre - Test Post - Test n % n % Negative 67 100 22 32.8 Positive 0 0 45 67.2 amount 67 100 67 100 Source: Primary data processed in 2020 Table 6 Effectiveness based on increasing body weight before and after being given Local PMT (BageaSasigo) in the region The work of PuskesmasNambo, Kendari City Variable Mean SD P-Value n BageaSasigo Pre-Test 9,370 1,7638 0.001 67 BageaSasigo Post Test 9,494 1,7882 0,000 67 Source: Primary data processed in 2020 Table 7 Effectiveness based on increasing body weight before and after being given PMT (Biscuits) in the region The work of PuskesmasNambo, Kendari City Variable Mean SD P-Value n Pre-Test Biscuits 10,516 2,1709 0.001 67 Post Test Biscuits 10,806 2,1672 0,000 67 Source: Primary data processed in 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 49 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 8 Differences in the effectiveness of weight gain before and after being given Local PMT (BageaSasigo) and Government PMT (Biscuits) in the Work Area of PuskesmasNambo, Kendari City Variable Sig Sig (2-tailed) n BageaSasigo 0.129 0.001 67 Biskuits 0.052 0,000 67 Source: Primary data processed in 2020 DISCUSSION nutritional status of children under five is The Effectiveness of Giving Local caused by various factors including poor PMT (Bagea Sasigo) to Toddlers in the diet, infectious and comorbid diseases, Work Area of Nambo Primary health income levels and unhealthy living care, Kendari City conditions. Efforts that have been made by Before the main research was carried the Kendari City Health Office to overcome out, a food content test was conducted at the the problem of malnutrition are the FMIPA Laboratory of Halu Oleo University management of malnourished toddlers at the to determine the nutritional content Rumah Gizi. contained in Bagea food ingredients. After Based on the results of the study knowing the content, a preliminary research showed that before being given treatment was carried out with the aim of finding out (Pre Test), namely Local PMT (Bagea how to make the right bagea cake product so Sasigo) for body weight amounted to 67 that the product could be consumed and to respondents (100%) while after treatment know the acceptability both in terms of (Post Test) was given Local PMT (Bagea color, aroma, texture and taste. The process Sasigo) for body weight in the fixed of making sago, cassava and gonad flour category. (negative) amounted to 42 which is used as the main ingredient in respondents (62.7%), meaning that they making bagea cakes begins with the mixing experienced significant changes before the process of sago flour and cassava. The dry treatment. Whereas for the positive category tapioca is then mashed using a dry blender at (increased) after getting treatment, namely a speed of 8 rpm / minute then sieved using a the provision of Local PMT (Bagea Sasigo), mesh size of 80. amounting to 25 respondents (23.7%), which Bagea cake is a typical snack in the means that there is a change in body weight Kendari mainland. This cake has a dry but not significantly yet because respondents texture a bit hard and tastes sweet and are not used to consuming Bagea Sasigo so savory. Judging from the basic ingredients of that the level of energy and protein the bagea cake made from sago, this bagea consumption of toddlers still not enough. cake has a characteristic because besides it The average toddler consumes rice as an tastes good, this bagea cake is also unique energy source compared to snacks. because it is almost similar to biscuits(12). The texture and taste of bagea is an In the manufacture of bagea cakes, the important component in increasing the results of trials that produced a pretty good appetite of toddlers because the sensitivity of product in terms of color, aroma, texture and the taste senses is influenced by the texture taste, where this trial took 1 day. This study of the food. Foods that are dense or thick shows that before being given the treatment, will provide slower stimulation to the senses. the under-five's weight was below the Texture also affects the appearance of the average so that at the time of measuring the food served (Shukri, Hamzah, Halim, Isa, & Body Mass Index (BMI) the nutritional Sarbon, 2014). Therefore, the texture of this status category was lacking. The low bagea is perfect for toddlers(13). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 50 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Taste is a sensation that arises and is children under five in the Work Area of caused by a volatile or non-volatile chemical Puskesmas Nambo, Kendari City. component that comes from natural or synthetic origin and occurs when eating or The Effectiveness of Giving drinking. The volatile components are those Government PMT (Biscuits) to Toddlers that give off a taste of smell, give off top in the Work Area of Nambo Primary notes and evaporate quickly. The non- health care, Kendari City volatile components provide the sensation of The Government Supplementary Food taste, namely sweet, bitter, sour and salty, do Program (biscuits) in Puskesmas is a product not give the sensation of smell but become a of the Ministry of Health's central volatile medium and help withstand the supplementary food. Supplementary food evaporation of volatile components or can be provision (PMT) has not reached the simplified, namely the sensation produced by Minimum Service Standard (SPM) target for food and other chemical components when good nutritional status in children under five stimulating receptors in the sense of taste or in the Kendari City area. This result is taste on the tongue. These basic tastes are known from interviews with most mothers received by the receptors in the rash (tase whose children are malnourished because buds)(14). there are some children under five who do Bagea Sasigo is a snack made from not like the Ministry of Health Center's sago, cassava and gonad. Bagea sasigo is a Supplementary food biscuitsthey prefer local typical food of Southeast Sulawesi Province, supplements from their mothers(15), shows but it is still new to children because it has a that several factors that can cause children gonad taste compared to government biscuits under five to not consume PMT according to which have a strawberry flavor and are loved standards are the child's poor appetite so that by children.Prior to the intervention for the child does not want to spend PMT(16). under-five children with low body weight, PMT recovery is an effort to overcome the introduction of local PMT as early as malnutrition. Functional Mixed Food possible through socialization or counseling Ingredients (BMC) are foods that are able to to the community so that it can be accepted provide beneficial effects for health in in the community related to local PMT addition to the nutritional effects that food which comes from basic ingredients of sago, has in principle(17). In this study, PMT was cassava and gonad so that it has a liking given, in the control group or given PMT value and acceptance for toddlers. and can be biscuits to toddlers with low nutritional an alternative to increase the weight of status. Additional food is given every day as children under five who experience loss of a snack for four (4) weeks. PMT evaluation appetite. can be monitored through weight gain to The results of statistical tests show that determine weight gain. at the beginning and of the 67 respondents who were given Local end of the PMT implementation. Toddlers in PMT (Bagea Sasigo) treatment before being the low weight category with under given treatment (Pre Test) which was 9.4 nutritional status, aged 8- 59 months, are the times then after treatment (Post Test) by priority targets for PMT recipients. giving Local PMT (Bagea Sasigo) to 9.5 Measurements on the body weight / times . The difference between the average age anthropometric index before and after Bagea Sasigo Pre-Test and Post-Test is 0.1 the Government PMT (Biscuits) showed that times. Independent T-test obtained a P-Value more children experienced changes in body of 0.001 at the pre-test and 0.000 at the time weight with an increase of about 1-3 ounces. of the post-test <0.05, then Ha is accepted, so This is directly proportional to the level of it is concluded that there is an effect of PMT consumption of children under five, in which Bagea Sasigo on increasing weight of these children consume PMT (biscuits) Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 51 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 according to the determined standards. In Differences in the Increased contrast to toddlers who have not consumed Provision of Local PMT (Bagea Sasigo) PMT according to standards who do not and Government PMT (Biscuits) for experience changes in nutritional status, all Toddlers in the Work Area of the Nambo children under five have gained weight, Primary health care, Kendari City. which is indicated by a positive value on The manufacture of food such as bagea changes in weight of children under five is a ready to use food (RUF) which is before and after Government PMT (biscuits). suitable for preventing and handling The results showed that before being malnutrition has the potential to increase given treatment (Pre Test), namely nutritional yield(18). The results of the Government PMT (Biscuits) for body weight Government PMT form show that children amounted to 67 respondents (100%) while under five with a higher percentage of after treatment (Post Test) was given Government PMT (biscuits) consume more Government PMT (Biscuits) for body weight than the percentage who consume Local category fixed (negative) totaled 22 PMT (Bagea Sasigo). The difference in the respondents (32.8%). Meanwhile, for the results of the statistical test results for weight positive category (increased) after receiving / height and weight / age index can be caused treatment, namely the provision of by the sensitivity of BW / U which is Government PMT (Biscuits), amounting to relatively high to sudden small changes and 45 respondents (67.2%) experienced a affects the results of weight measurement, significant increase. while the indicator of height at weight / The results of the statistical test height has a lower sensitivity level to showed that of the 67 respondents who were nutritional deficiency in the long term. short given the Government PMT (Biscuits) time (16). treatment before being given the treatment Statistical test results show that of the (Pre Test), that was 10.5 times then after the 67 respondents, the sig. Levene's Test for treatment (Post Test) was given the Equality of Variances on bagea sasigo is Government PMT (Biscuits) to 11 times. 0.129> 0.05, it means that the variance of the The difference between the average Bagea Case group data is Homogeneous or the Sasigo Pre-Test and Post-Test is 0.5 times. same(19). While for the Biscuits the amount The results of the Independent T-test of 0.052> 0.05, it means that the data obtained a P-Value of 0.001 at the pre-test variance of the Control group is and 0,000 at the time of the post-test <0.05, Homogeneous or the same. then Ha is accepted, so it is concluded that Based on the independent sample test there is an effect of Government PMT output table in the Equal Variances Assumed (Biscuits) on the increase in weight of section on Local PMT (Bagea Sasigo), it is children under five in the working area of known that the sig (2-tailed) value is 0.001 Puskesmas Nambo Kendari City. <0.05, so Ha is accepted so that there is a The results of this study are in line significant difference between the provision with research conducted by Retnowati at the of local PMT (Bagea Sasigo). Whereas in the Kelambu Community Health Center, Government PMT (biscuits) it is known that Grobogan Regency, which stated that giving the sig (2-tailed) value is 0.000 <0.05, so Ha additional government food (biscuits) for 90 is accepted so that there is a significant days can help increase body weight in under- difference between the provision of nourished toddlers with an average weight government PMT (biscuits) to toddlers in the gain of around 2-4 ounces. Work Area of the Puskesmas Nambo, Kendari City. Research conducted by Salma in 2016 explained that the iron (Fe) content in the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 52 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 gonads of diadema setosum in 100 grams of 6. Doren WK, Regaletha TA, Dodo DO. 1.00 mg is almost equal to that of salmon of Evaluation of the Recovery 1.50 mg. Thus, diadema setosum gonads are Supplementary Food Program (PMT-P) very suitable as additives in the diet of on the Malnutrition Status of Toddlers at pregnant women who require appropriate Fe. the Oepoi Health Center, Kupang City. Iron is needed for the manufacture of Lontar: Journal of Community Health. hemoglobin (Hb), which is an oxygen 2019; 1 (3): 111-8. transporter to tissues(20). 7. Nutrition DB. Health of both mother and child. Guidelines for Organizing CONCLUSION Supplementary Foods for Giving Local PMT (Bagea Sasigo) Undernourished Toddlers Jakarta: and PMT Government (Biscuits) to children Kemenkes RI. 2011. under five before the intervention was not 8. Erpridawati DD. The relationship effective while after the intervention was between knowledge about nutrition and effective and significant. Shouldmaking nutritional status of junior high school bagea is used as an alternative food for students in Kerjo sub-district, toddlers with the composition of sago starch: Karanganyar district: Muhammadiyah 50%, cassava flour: 50% and gonad: 20%. University of Surakarta; 2012. To increase the favorite value of bagea and 9. Rahayu A, Khairiyati L. The risk of appetite for toddlers with the addition of mother's education on the incidence of various flavors of both chocolate, vanilla and stunting in children 6-23 months. strawberry to add to the taste of bageasasigo Nutrition and Food Research. 2014; 37 so that it attracts toddlers' interest in (2): 129-36. consuming the bagea. 10. Mackey A, Gass SM. Second language research: Methodology and design: Routledge; 2015. REFERENCES 11. Sugiyono. Nonparametric Statistics for Research. 2015. 1. World Helath Organization. World health 12. Hidayah Z. Encyclopedia of ethnic statistics 2015: World Health groups in Indonesia: Yayasan Pustaka Organization; 2015. Obor Indonesia; 2015. 2. DinkesProv. Toddler nutritional status. 13. Banudi L, Anasiru MA, Petrus P, Southeast Sulawesi2017. Leksono P. A Bagea Formulation Made 3. Rajasekaran A, Kalaivani M. Designer From Cassava Starch Extract and Gonad foods and their benefits: A review. Diadema Setosum (Sea Urchins) as an Journal of food science and technology. Alternative Food for Pregnant Women. 2013; 50 (1): 1-16. Health Information: Research Journal. 4. Santosa H. Enzymatic Hydrolysis of 2017; 9 (2): 18-26. Tapioca Starch with Combination of 14. Zuliana C, Widyastuti E, Susanto WH. Microwave-Water Bath in Dextrins Making Coconut Ants Sugar (Study of Making. Momentum. 2010; 6 (2). Coconut Sugar Ph and Sodium 5. Denas S. Effect of Local-Based Food Bicarbonate Concentration) [IN PRESS Supplementation and Optimization of JANUARI 2016]. Journal of Food and Father's Support on Changes in Levels Agroindustry. 2015; 4 (1). of Albumin, Hemoglobin, 15. Rakhmawati NZ, Panunggal B. Immunoglobulin A, and Anthropometry Relationship between knowledge and in Undernourished Children in Padang attitudes of mothers with maternal Pariaman Regency: Andalas University; behavior in providing food for children 2016. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 53 Rasyid, M., T. Supodo, & L. Banudi. DOI: 10.36566/ijhsrd/Vol3.Iss1/53 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 aged 12-24 months: Diponegoro University; 2014. 16. Rini I, Pangestuti DR, Rahfiludin MZ. The Effect of Supplementary Recovery Food (PMT-P) on the Change in Nutritional Status of Malnourished Toddlers in 2017 (Study at the Semarang City Nutrition House). Journal of Public Health (e-Journal). 2017; 5 (4): 698-705. 17. Juhartini J. The Effect of Supplementing Biscuits and Mixed Food Ingredients of Moringa on Body Weight and Hemoglobin Studies of Infants with Thin Nutritional Status in the Work Area of the Kalumpang Health Center, Ternate City, 2015. Hospital Majapahit (Health Scientific Journal of the Majapahit Health Polytechnic, Mojokerto). 2016; 8 (2). 18. Owino V. Why lipid-based ready to use foods (RUF) must be key components of strategies to manage acute malnutrition in resource poor settings Victor Owino. 2010. 19. Sujarweni VW. Research methodology: Complete, practical, and easy to understand. Yogyakarta: Pustakabarupress. 2014. 20. Salma I, Németh Z, Kerminen VM, Aalto P, Nieminen T, Weidinger T, et al. Regional effect on urban atmospheric nucleation. Atmospheric Chemistry and Physics. 2016. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 54 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE EFFECTIVENESS OF THE BARK DREDGING OF THE JAVA WOOD TREE (LANNEA COROMANDELICA) ON THE DIABETIC ULCER HEALING PROCESS Dwi Wulandari Ningtias Purnama1, Wa Ode Rahmadania2 1,2Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Wa Ode Rahmadania Email : [email protected] ABSTRACT Background: Diabetic ulcer is a micro vascular complication which can be experienced by all Diabetes Mellitus (DM)’s patients. This condition need an appropriate wound care management to prevent infection, reduce necrotic tissue, and enhance the wound healing process. This study aims to determine the effect of using Javanese tree bark scraping on the healing process of diabetic ulcers, namely changes in the size of diabetic ulcers. Methods: This type of research is a Quasy Experiment with a Pre-test Post-test approach with control group. The populations in this study were all diabetic ulcer patients who came for wound care at Puuwatuhealth care, namely 16 respondents. Result: The results of statistical tests show that that there is no difference in wound size before and after the intervention in the intervention group and the control group. In the Mann Whitney statistical test found that the p-value in the intervention group was 0.189, which is greater than the value of α = 0.05. Conclusion: The dredging of the bark of the Java tree is not effective against changes in wound size in patients with diabetic ulcers. Keywords: Bark, Java tree, Process, Diabetic ulcers, Change. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 55 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION growth of granulation tissue which will later Diabetes mellitus (DM) is a metabolic form the extracellular matrix and reduce the disease with a high incidence in the world, size of the wound as a sign of starting the including in Indonesia, with a prevalence of wound healing process.(1, 3, 4) ulcer patients of around 15% with a risk of DFU patient care, apart from requiring amputation of 30%, and is the biggest cause a long treatment time and appropriate wound of hospitalization, which is 80%.DM has a care management, also needs to pay attention tendency to experience diabetic ulcers to the amount of costs incurred by the patient caused by microvascular complications, and family because it will affect the which is a form of chronic complications of readiness of the patient in undergoing the DM1, in the form of open wounds on the treatment process (7). Thus, in an effort to skin surface due to blockages in blood provide more affordable alternative therapies vessels in the legs and peripheral neuropathy for DFU patients, it is deemed necessary to due to high blood sugar levels so that clients conduct research on the effectiveness of often don'tfeel a wound that could develop Javanese tree dredging for the healing into an infection2.Foot ulcers in DM clients process of diabetic ulcers in the Puuwatu that have progressed to putrefaction are more Public Health Center which is a quase likely to be amputated. (3) experiment research to see the effect of using The World Council of Enterostomal java tree bark dredgingagainst the healing Therapy explains that DFU patients need process of diabetic ulcers, namely changes in long treatment time and appropriate wound the size of the diabetic ulcer wound. care management to prevent infection, reduce necrotic tissue, and improve the METHOD wound healing process4.The existence of This study is a Quase experimental public awareness of the quality and value of study to see the effectiveness of using the health has led to the re-rolling of a trend bark of Java wood against the healing known as the back to nature movement.One process of diabetic ulcers, namely changes in of the traditional medicinal plant that is still the size of diabetic ulcer wounds using a pre- widely used for the treatment of the people test post-test approach with a control group. of Southeast Sulawesi is Javanese wood This research was conducted from 31 July to (Lannea coromandelica) because of its very 31 September 2020 in the working area of effective properties in treating wounds.(5) Puuwatu Public Health Center, Southeast Previous research has shown that 96% Sulawesi. The research was designed with ethanol extract of the bark of Java wood has the initial stages, the stages of treating ulcer antibacterial activity against the wounds, and the final stages. The initial Staphylococcus aureus bacteria that causes stage of the study carried out screening of skin infections, Escherichia coli, DM patients with ulcers who went to the Helicobacter pylori and Pseudomonas Puuwatu Community Health Center using aeruginosa which are often found in severe the Bates-Jensen Wound Assessment Tool burns, thus inhibiting the wound healing (BJWAT). Patients with a BJWAT score> 13 process6. were used as the study population, then by Physiologically, wound healing occurs random sampling, 16 patients who met the within one week after the injury, which inclusion criteria were selected as the study includes the phases of inflammation, sample which were divided into two groups, proliferation, and remodeling.However, in namely 8 people as the intervention group ulcer wounds there is a prolonged time in the and 8 people as the control group. inflammatory phase which causes the wound Furthermore, the stages of ulcer wound care to not heal (chronic). (2) By controlling the are carried out, and the final stage is carried infection in the ulcer, it will accelerate the out. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 56 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULT Size Group Group Table 1.Frequency Distribution and Z p- Z p- Percentage Characteristics of value* valu e* Respondents with Diabetic Ulcers who Pre-Test 16 0.000 perform wound care at Puskesmas Post- 16 - 0,317 1,00 Puuwatu Test 1,000 0 * Wilcoxon Signed Rank Test Variable Category f % Gender Male 5 31,2 In the table above, it can be seen that Female 11 68,8 from the test results obtained the p-value for Age 47 - 51 3 18,8 the intervention group is 0.317 and the p- 52 - 56 7 43,8 value for the control group is 1,000, where this value is smaller than the alpha (α) 0.05 57 - 61 2 12,5 so it means that statistically there is noa 62 – 66 1 6,2 significant difference in wound size in the two groups. 67 – 71 1 6,2 72 – 76 2 12,5 Table 3.Analysis of the Effectiveness of the Education Primary school 0 0 Bark Dredging of the Java Wood Tree on Level Junior high 2 12,5 the Size of Wounds between the school Intervention and Control Groups Senior high 8 50 school Wound Size n Mean Z p- Diploma 0 0 Rank value* Bachelor 6 37,5 Intervention 8 6,94 Work Housewife 6 37,5 Group -1,314 0,189 Entrepreneur 6 37,5 Control 8 10,06 Swasta 2 12,5 Group Government 2 12,5 Total 16 employees * Uji Mann Whitney U Test Current Blood Normal 6 37,5 Sugar Abnormal 10 62,5 Based on the table above, it is known Levels that the p-value = 0.189 is greater than the Based on the table above, it can be value of α = 0.05, which means that the seen that the characteristics of respondents dredging of the bark of the Java tree (Lannea based on gender are mostly women, namely Coromandelica) is not effective against 11 respondents (31.2%).The most changes in wound size in patients with respondents aged 52 - 56 years amounted to diabetic ulcers. 7 respondents (43.8%), while those at least DISCUSSION 62 years old and 67 years old respectively The results showed that the most amounted to 1 respondent. respondents who suffered from diabetic Of the total number of respondents, ulcers based on gender were women as many there were many respondents whose GDS as 11 people (68.8%) with the most levels were not normal, namely 10 vulnerable ages being in the 52-56 years age respondents (62.5%).According to Perkeni group as many as 6 people (37.5%).The body (2015) the results of examining blood sugar physiologically decreases due to the aging levels are said to be normal if the current process; there is a decrease in insulin blood sugar (GDS) is <140 mg / dL. secretion or resistance so that the body's Table 2. Differences in pre-test and post- ability to function to control high blood test wound sizes in diabetic ulcer patients glucose is not optimal.The aging process Wound n Intervention Control causes a decrease in insulin secretion or Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 57 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 resistance resulting in macroangiopathy, examination and there were 6 people which will affect the decrease in blood (37.5%) of respondents whose blood sugar circulation, one of which is large or medium levels were in the normal group at the time blood vessels in the legs where diabetic foot or the blood sugar levels were below 140 mg ulcers are more prone to occur.(2). / dL at the time of the examination, while the This is in line with the results of blood sugar levels after the research conducted by Fitria which states interventionThere were 7 people (43.8%) of that diabetic ulcers are mostly suffered by respondents whose GDS was in normal women (63.5%) with a dominant age of 56- susceptibility and 9 people (56.2%) whose 65 years followed by 46-55 years.Age is a GDS was not normal. risk factor for DM that cannot be modified Checking blood sugar levels when and the age of women in the menopausal age carried out regularly every time the range (40-45 years) will accelerate the respondent performs wound care and the decrease in estrogen production and insulin results of the GDS measurement for all resistance.The earlier the menopausal respondents are fluctuating in table 9 above, woman is the more risk for type 2 diabetes the data presented in the post-test is the mellitus. In postmenopausal women, result of the examination on the last day of metabolic disorders, obesity and steroid the study (day 14).All respondents in this hormone disorders increase the incidence of study took drugs to lower blood sugar levels, metabolic syndrome, type 2 diabetes some were given therapy in the form of mellitus, cardiovascular disease, and Metformin and Glibenclamide and some malignancy. (3). were given Novorapid injection therapy. The cause of the large number of The results showed that in the control wound incidence begins with the incidence group before the intervention, the of diabetes in women because of the respondent's wound size was in the range of decrease in the hormone estrogen due to 36.1 - 80 cm or at a score of 4 a total of 8 menopause.The hormones estrogen and people (100%) were assessed using the progesterone can affect cells to respond to observation sheet Bates Jansen Wound insulin because after menopause changes in Assessment Tools (BJWAT) and after hormone levels will trigger blood sugar Interventions were carried out in the form of levels to rise and fall.The increase in glucose wound care using NaCl solution every time levels is caused by the accumulation of they carried out wound care without the use glucose which results in obstruction of the of other drugs for 14 days there was no flow of nutrients to the surface of cells in change in the wound size score for all blood vessels, this result in the absence of respondents in the control group but from other nutrients that supply cells other than direct observation it appears that there was a glucose. (4). change in wound size in some respondents In this study, the current blood sugar but changes in size The wound was not level (GDS) was said to be normal if the significant with an average change in wound amount was <140 mg / dL5, so that the blood size of 0.21 cm so that it could not get out of sugar level when it was grouped into normal the score range for the BJWAT wound size and abnormal groups.From the results of the assessment and after the Wilcoxon signed study, it can be seen from 16 respondents rank test was carried out the p-value was before the intervention (pre-test) there were greater than the α value of 0.05, namely 10 people (62.5%) of respondents whose 1,000. meaning that there was no change in blood sugar levels were in the abnormal the size of the pre and set cuts Intervention group or it could be interpreted that there using NaCl solution has been carried out in were 10 respondents who had blood sugar control group respondents. levels above 140 mg./ dL at the time of the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 58 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Whereas in the intervention group score = 3), in other respondents there was before the intervention, the most also an average reduction in wound size.-The respondents' wound size was in the range of average change in wound size was 5.41 cm scores of 4 with a wound size of 36.1 - 80 but it was not significant so that it could not cm for 5 people (62.5%) and a score of 3 get out of the range of wound sizes on the with a wound size of 16.1 - 36 cm for 3 BJWAT observation sheet which resulted in people (37.5%) and after the intervention the statistical test results showing a p-value there was a change in wound size in 1 greater than α value 0.05, which means that respondent from a range of 36.1 - 80 cm to H0 is accepted and Harejected. 16.1 - 36 cm or in other words from a score According to Pradika(6), the reduction of 4 to a score of 3.In the Wilcoxon sign rank in wound size is caused by the test onThe intervention group obtained a p- epithelialization process that occurs after the value of 0.317 with alpha (α) 0.05, which granulation process, while the granulation means that the p-value is greater than the α process can take place on the 2nd to the 24th value so that it is statistically concluded that day.Epithelialization occurs after granulation there is no significant change in wound size tissue grows and starts from the wound edge, prior to the intervention in the form of the cells experience contraction (shift), the granting Java tree bark wound edges fuse together until the wound scrapings(LanneaCoromandelica) and after size decreases until it enters the remodeling intervention for 14 days. phase that occurs on day 21 to one or two Based on the description above, it can years.From this, it can be seen that to see a be concluded that based on the results of the more significant change in wound size it Wilcoxon sign rank test, the p-value is takes a longer time, while the time of this greater than the value of α = 0.05, which study is only 14 days so that no significant statistically means that the first hypothesis is change can be seen. rejected or it is described that there is no Based on the description above, it difference in wound size before and after explains that changes in wound size can interventionin the control group and the occur quickly if the formation of granulation intervention group. The results of the Mann tissue occurs well and quickly and the Whitney test for wound size showed a p- perfect epithelialization process that occurs value of 0.189 which is greater than α 0.05, after the granulation tissue formation process which means that the hypothesis is rejected reaches the remodeling stage that occurs on or it is described that the dredging of the day 21 to one or two. Years, so to see bark of the Java tree (lannea coromandelica) changes in wound size it takes a longer study is not effective against the size of the wound time. in patients withdiabetic ulcers. The observations made and the measurement of the wound size before and CONCLUSION after the intervention in the study carried out The dredging of the bark of the Java there was a change in the size of the wound tree is not effective against the healing in the intervention group but which was process of diabetic ulcers, namely changes in significant and able to get out of the wound the size of the diabetic ulcer wound. size range, resulting in a change in the score on the BJWAT observation sheet in only 1 REFERENCES patient with a large wound size(length x width) before the intervention was 48.75 cm 1. American Diabetes Association. (BJWAT score = 4) and after the Standards of medical care in diabetes. intervention was carried out on the 14th day Diabetes Care (2018) Vol. 41 (1) the size of the wound was 24 cm (BJWAT Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 59 Purnama, D.W.N. & W.O. Rahmadania DOI: 10.36566/ijhsrd/Vol3.Iss1/54 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 2. Devi, Anakardian. 2017. Anatomy of nt%20Tool.pdf. Nursing Physiology and Biochemistry, Yogyakarta: New Library Press. 3. Fitria, Eka, et al. 2017. Characteristics of Diabetic Ulcers in Diabetes Mellitus Patients at dr. Zainal Abidin and Meuraxa Hospital Banda Aceh. Health Research Bulletin, Vol. 45, No. 3, September 2017: 153 - 160. 4. Yunus, Bahri. 2014. Factors Affecting the Length of Wound Healing in Diabetic Ulcer Patients at the Makassar ETN Center Nursing Home. http://repositori.uin- alauddin.ac.id/1333/1/Bahri%20Yunus.p df 5. Kshanti, Ida Ayu Made., et al. 2019. Guidelines for Independent Blood Glucose Monitoring. PB Permit. https://pbperkeni.or.id/wp- content/uploads/2019/12/Pedoman-Peng Manajemen-Glucose-Darah-Mandiri- 2019.pdf 6. Pradika, Jaka. 2015. The Effectiveness of Wound Cleansing Using Guava Leaves 20% with 15 Psi Pressure Showering Technique on the Healing of Diabetic Foot Ulcers at Kitamura Clinic, Pontianak. http://repository.umy.ac.id/bitstream/han dle/123456789/8979/12.%20NASKAH %20].pdf?sequence=12&isAllowed=y 7. Kristiyaningrum, et al. The effectiveness of using NaCl solution was compared with D40% on the healing process of DM ulcers. https://ejr.stikesmuhkudus.ac.id/index.p hp/jikk/article/viewFile/208/139. Retrieved August 13, 2019. 8. Prawirohardjo, Erwin. Anti-Oxidant Activity Test and Toxicity Test of 70% Ethanol Extract and Water Extract of Java Wood Bark (LanneaCoromandelica). 9. Bates Jensen Assesment Tools. http://fikes.ummgl.ac.id/downlot.php?fil e=BatesJensen%20Wound%20Assessme Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 60 Amanah, I., M. Jannah, & Ishak. DOI: 10.36566/ijhsrd/Vol3.Iss1/55 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access WASTE UTILIZATION TRAINING ABOUT STYROFOAM BECOME A BATAKO IN THE SCAVENGER WASTE COMMUNITY IN PALOPO CITY Indra Amanah1, Miftahul Jannah2, Ishak3 1,2,3 Faculty of Health , Mega Buana Palopo University Corresponding Author : Indra Amanah Email : : [email protected] Abstract Background : The amount of waste that is not processed and classified as non-biodegradable waste such as Styrofoam, well managed household waste is 36.8%. The amount of waste that is not properly managed is 63.2% of the total weighted waste of 282,654 tonnes. Lack of training for scavengers and the community has resulted in a large amount of stytrofoam waste not being used. Methods: The purpose of this study was to assess the effect of training on using Styrofoam waste into bataco. This research is a pre-experimental study with a one group pre testpost test design, conducted a pretest, then given treatment in the form of training and practice recycling styrofoam into concrete blocks. After that, within a period of approximately 1 month after treatment, a posttest is carried out to measure again. The respondents were trash scavengers, amounting to 83 people. Result s: The test results in this study indicate that there is an effect of training on the use of Styrofoam waste into concrete blocks in the garbage scavenger community in Palopo City with a value of p = 0.000. Conclusion : Styrofoam can be modified to become concrete clocks. This can reduce the garbage waste in the community in Palopo City. Keywords: Training, Styrofoam, Scavengers, Garbage Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 61 Amanah, I., M. Jannah, & Ishak. DOI: 10.36566/ijhsrd/Vol3.Iss1/55 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION the recycle birthday or utilize the back of Total volume of garbage in South garbage into a material that is useful as a Sulawesi, every day reached 1000 tons form of concern about the / day , bins were not treated reached 425 tons environment and health . As well as / day. Figures this will continueto increase ev the research that is carried out showed that ery year, given that the population the factor education in terms of Indonesia more years will continue of this training , a factor that is to grow and will affect large to increase the most holding role important in volumeof garbage ,especially garbage inorga the sustainability of the craft - nic (Ministry of Environment and Forestry, based garbage in the 2018; the Environment Agency, hamlet Sukunan (Atmaji, 2017; Wirahadi, 2018) Managementof garbage house househ 2016). As is in the study is based on the old in South Sulawesi which is managed by results the well of 35.8% and whichis not managed of interviews with respondents who are scav by the well amounted to 64.2% of the engers declare that they at all have amount of garbage that is weighted as much not been given the as 8,677 tons (Ministry of Health of the training associated with the use Republic of Indonesia, of garbage styrofoam , so not yet know how, 2018) . 3R behavior (Reuse, Reduce, moreover to practice cultivation or use Recycle) is still rarely done . The percentage was at once yet had an idea. It is also the of themost frequently treated garbage to the r underlying research to provide treatment in ecycling reset to0.19%, making manure com the form of training of the utilization post 0.53%, is of waste styrofoam on a scavenger of used for food animal 0.26%, still less than 1 garbage in City Palopo . %. While approximately 54.65% house stairs most often dispose of garbage by means burnt (Health, METHOD 2018) . Penglolaan garbage home household Research is a research pre experiment who managed with good by 36.8% and the with the design of one amount of garbage that group pretest posttest design (Creswell, is not managed by either of 63.2% of the 2016) done pretest , then given a treatment in amount of garbage that is weighted as much the form of training and practice as 282.654 tons (Ministry of Environment of recycling the Styrofoam into and Forestry, 2018; Sucipto, C, 2012) a brick . After that in the period of A large amount of trash that is thrown time less over 1 month after treatment carrie away every day shows that in every day soci d out post-test to measure the return of self- ety produce bins with the number efficacy , knowledge and skills of the of the lot. The amount of garbage that utilization of waste Styrofoam into is generated and is not managed by a brick . The number the well can cause pollution . Contamination of respondents in this study were occurs when people who used 83 scavengers . The to burn garbage, and throw trash any place su data obtained in this study were analyzed usi ch as a river or the ng the Wilcoxon test . gardens empty and hoarding rubbish which i s difficult to unravel as Styrofoam (Abida, 2017; Sumantri, 2015). To overcome the problem that, it is necessary to do an effort to improve the knowledge, self efficacay and skills of people in Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 62 Amanah, I., M. Jannah, & Ishak. DOI: 10.36566/ijhsrd/Vol3.Iss1/55 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULTS AND DISCUSSION been done by Kurniaty& Rizal ( 2011) on the utilization of the results of the management Table 1. Distribution of garbage as an alternative material of of respondents based on gender building construction . In addition it is also no research that has the effect that the type gender Frequency (f) Percentage research that is (%) done by Marliani ( 2015) concerning the Male 28 33.73 usof waste home household (garbage anrorga nik) as a form of implementation of Women 55 66.27 the educational environment. Total 83 100 Source : Primary data, 2020 CONCLUSIONS In table 1 show of There is the effect of the training on the use the 83 respondents , the distribution of types of waste Styrofoam into of sex male number 28 (33.73%) a brick on scavenger of garbage in of scavengers and the manifold sex women a City Palopo . This study suggests: s much as 55 (66.27%) of scavengers . 1. The environmental office can adapt t Table 2. Effect of training on his training to be applied to the use of styrofoam waste . other groups of scavengers. 2. The Government through p- Mean SD the office environment life that overs value hadowed the field of hygiene needs to be much socializing related to the Pretest 20.59 5.25 utilization 0,000 of waste Styrofoam and establish coo Posttest 34.98 0.15 peration with the private consumer re Note : Wilcoxon test sults of the work of the scavenger as a step minimize trash that Based on table 2, from is not processed. the results of the Wilcoxon test analysis , the mean pretest = 20.59 and posttest = REFERENCES 34.98 and the pretest and posttest p values ar e 0.000 or less than 0.05. In the study it was 1. Abida, H. N. (2017). Model of also obtained that before given training of sc Environmental Empowerment and avengers at once has not been able Community Economic Empowerment to practice the way of through Recycling of Waste in Sukunan processing garbage Styrofoam, but once give Environmental Tourism Village. Social n the Studies, 6(6), 654–667. training they are skilled to practice to produc e work thatis worth economical form 2. Atmaji, L. T. (2017). Management of of bricks from waste Styrofoam. It is demons Waste Empowerment Based Crafts trated that the difference in value of the Businesses in Sukunan Hamlet, average Banyuraden Village, Sleman Regency. /mean between pretest to posttest . Results Jurnal Tata Kelola Seni, 2(2), 1–6. of the study is also in https://doi.org/10.24821/jtks.v2i2.1818 line with research that has 3. Creswell, J. W. (2016). Research Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 63 Amanah, I., M. Jannah, & Ishak. DOI: 10.36566/ijhsrd/Vol3.Iss1/55 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Design, Qualitative, Quantitative, and Utilization of Waste Management Result Mixed Methods Approaches. 368. as Alternative Construction Building Materials. Jurnal Smartek, 9(1), 47–60. 4. Dewi, P. K. (2017). Empowering Woman through the Plastic Waste 11. Marliani, N. (2015). Utilization of Recycling Program at the Kartini Household Waste (Inorganic Waste) as a Independent Waste Management Group, Form of Implementation of Radungunting Tamansari Kalasan, Enfironmental Education. Formatif: Sleman. Universitas Negeri Yogyakarta. Jurnal Ilmiah Pendidikan MIPA, 4(2), 124–132. 5. Environmental Services. (2018). Annual https://doi.org/10.30998/formatif.v4i2.1 Program Profile. Palopo. 46 6. Faizah. (2008). Community Based 12. Purwaningrum, P. (2016). Effort to Housedhold Waste Management 1–154. Reduce the Generation of Plastic Waste in the Environment. 8(2), 141-147. 7. Ministry of Health of the Republic of Indonesia. (2018). Riskesda. Jakarta. 13. Santoso, A., & Widodo, S. (2011). Utilization of Styrofoam Waste ( 8. Ministry of Environment and Forestry, Expanded Polysterene ) For Wall Republic of Indonesia. (2018). National Making. VII(1), 1–18. Waste Management Information System. https://doi.org/10.1109/ICCV.2013.269 Retrieved from http://sipsn.menlhk.go.id/?q=3a-data- 14. Sucipto, C, D. (2012). Waste Processing umum and Recycling Technology. Yogyakarta: Nuha Medika. 9. Ministry of Health of the Republic of Indonesia(2018). Main Result of Basic 15. Sumantri. (2015). Environmental Health Research. Ministry of Health of Health. Jakarta: Kencana. the Republic of Indonesia, 1–100. https://doi.org/1 Desember 2013 16. Wirahadi, M. (2016). Interior Elements Made of Raw Styrofoam Waste and 10. Kurniaty, D. R., & Rizal, M. (2011). Orange Peel Waste.None, 5(2), 144–153. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 64 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN POTENTIAL OF VACCINE AND IMMUNIZATION SERVICES WITH QUALITY OF MEASLES VACCINE IN KONAWE KEPULAUAN DISTRICT Afiat1, Timbul Supodo2, Sunarsih3 1,2,3Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Afiat Email : [email protected] Abstract Background : Based on a report from the Directorate General of Disease Prevention and Control of the Ministry of Health, measles cases in Indonesia continued to rise in 2016 the prevalence of measles was about 7,204 people. In 2017 there were 11,389 cases, where this year there were many measles outbreaks. In 2018 there were 3,995 cases. The number of cases was still higher in 2012 namely about 6,419 cases. Methods: This research is an observational analytic study with a cross sectional study design. The population was the measles vaccine which was found in 8 health centers withThe sample size was 82 Vaccine for Measles. Result s: Statistical test shows kai squared at α = 5% and df = 1, obtained the value of X2 count> X2 table 32,210> 3,841 and α = 5% and df = 1, obtained the value of X2 count Key words: Vaccines, Services, Immunization, Measles Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 65 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION government is routine immunization Indonesia is one of the SEARO consisting of basic immunization and countries included in the country that will advanced immunization(7). The complete implement measles elimination in 2026(1). basic and advanced immunization required Measles elimination, i.e. the absence of by the government is measles immunization. measles endemic areas for more than 12 Measles immunization is getting more months and zero transmission through attention from the government because strong measles surveillance(2). Indonesia is participating in a measles Measles is a contagious disease elimination program in 2020 with a caused by the measles virus. This disease is minimum measles coverage of 95% in every still one of the health problems in Indonesia. region equally.(8). This disease mainly affects children aged Based on the profile data of the less than 5 (five) years(3). The clinical Konawe Islands District Health Office, the symptom of measles is a sudden fever Immunization Coverage of followed by the appearance of a rash (rash) KonaweKepulauan Regency in 2019 is HB a few days later. The rash usually appears 0 coverage (0 <7 days) 113.4%, BCG from behind the ear to spread throughout the immunization coverage is 116%, this high body. If measles attacks children with less enough figure can occur due to incorrect nutritional status, secondary infections can target data collection. as well as inaccurate occur in the form of pneumonia, diarrhea, recording and reporting. Polio 1 encephalitis and otitis media, this can lead immunization coverage is 101.4%, DPT / to death if not treated immediately.Measles HB-Hib 1 immunization coverage is 127%, is also known as Morbili or Measles(4). Polio 2 immunization coverage is 102.2%, Measles is a highly contagious disease DPT / HB-Hib 2 immunization coverage is caused by a virus and is transmitted through 99%, Polio 3 immunization coverage is 98 , coughing, sneezing and nasal discharge. 3%, DPT / Hb-Hib 3 immunization Symptoms of measles are high fever, reddish coverage is 95.8%, Polio 4 immunization patches on the skin (rash) accompanied by coverage is 102% and measles cough and / or runny nose and / or red eyes immunization coverage is 95%. (conjunctivitis). Humans are thought to be the only host (reservoir), although monkeys METHOD can be infected but do not play a role in This quantitative of research is an transmission(5). observational analytic study with a cross Immunization coverage in Southeast sectional study design(9). The population Sulawesi Province in 2019 is HB 0 was the measles vaccine which was found in immunization coverage (0 <7 days) 79.2%, 8 Puskesmas withThe sample size was 82 BCG immunization coverage 89%, Polio 1 Vaccine for Measles.This research was immunization coverage is 88.6%, DPT / carried out in all Puskesmas in Konawe HB-Hib 1 immunization coverage is 89.2%, Islands Regency in 2020. Polio 2 immunization coverage is 89.6%, DPT / HB-Hib 2 immunization coverage is RESULT 87.5%, Polio 3 immunization coverage is The table 1 shows that of the 82 83.7%, DPT / Hb-Hib 3 immunization samples, 33 samples (40.2%) had low coverage is 81, 6%, Polio 4 immunization vaccine potential, and 49 samples (59.8%) coverage is 84.6% and measles had good potency. immunization coverage is 85.9%(6). The table 2 shows that the Measles is a disease that can be immunization service category is less than prevented by immunization. One form of the 39 people (47.6%) and the good immunization program implemented by the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 66 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 immunization service category is 43 people limit is 7,964> 1, which means that the (52.4%). vaccine potency is a risk factor. Based on the results of statistical tests Based on the results of statistical tests using kai squared analysis at α = 5% and df = using kai squared analysis at α = 5% and df = 1, it was obtained that the value of X2 was 1, the value of X2 was calculated < X2 table calculated > X2 table 32.210> 3,841, 1.247 < 3,841, meaning that immunization meaning that the potential of the vaccine as a services were not a determining factor for the determining factor for the quality of the quality of the measles vaccine in Konawe measles vaccine in Konawe Kepulauan Kepulauan Regency (Table 4). The result of Regency (Table 3). The results of the the relationship closeness test shows the Phi relationship closeness test showed a coefficient (Φ) of 0.148, this shows the coefficient of Phi (Φ) of 0.652, this shows strength of the weak relationship between the strength of a strong relationship between immunization services and the quality of the vaccine potency and the quality of measles measles vaccine in Konawe Kepulauan vaccine in Konawe Kepulauan Regency. Regency. Based on the calculation of the Based on the calculation of the Odds Ratio Odds Ratio (OR) of immunization services (OR) potential of the vaccine against the to the quality of the measles vaccine, the quality of the measles vaccine, the lower lower limit is 0.755 <1, which means that immunization services are a protective factor Table 1 Sample Distribution Based on Potential Measles Vaccine in the District Konawe Islands No. Vaccine potential total % 1. Less 33 40.2 2. Good 49 59.8 Total 82 100 Source: Primary Data 2020 Table 2 Distribution of Respondents Based on Measles Vaccine Immunization Officer in Konawe Islands Regency No. Immunization Officer total % 1. Less 33 40.2 2. Good 49 59.8 Total 82 100 Source: Primary Data 2020 Table 3 Potential Analysis of Vaccines as Determinants of Vaccine Quality in Konawe Islands Regency Measles Vaccine Quality Potential X2 Phi Good Less total OR Vaccines Count (Φ) n % n % n % Less 3 3,7 30 36.6 33 40.2 30,833 Good 37 45.1 12 14.6 49 59.8 LL = 32,210 0.652 7,964 total 40 48.8 42 51.2 82 100 UP = 119,377 Source: Primary Data 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 67 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Analysis of Immunization Services as a Determining Factor of Vaccine Quality in Konawe Islands Regency Immuniza Measles Vaccine Quality X2 Phi tion Good Less total OR Count (Φ) Services n % n % n % Less 16 19.5 23 28.0 39 47.6 1,816 Good 24 29.3 19 23.2 43 52.4 LL = 1,247 0.148 0.755 total 40 48.8 42 51.2 82 100 UP = 4,356 Source: Primary Data 2020 DISCUSSION sometimes in the Puskesmas there were still frequent blackouts so that it would disturb Potential of Vaccines as Determinants of the temperature conditions of the vaccine Vaccine Quality storage. Vaccines are biological products that The results of the tests conducted contain antigens in the form of weakened show that the vaccine potency is a variable dead or alive microorganisms, intact or part that determines the quality of the measles of them, or in the form of microorganism vaccine. In addition to being known to have toxins that have been processed into toxoid a strong relationship with adherence, it is or recombinant protein, which when given to also known that vaccine potency is a risk a person will actively create specific factor for determining vaccine quality immunity against certain diseases.(10). through Odds Ratio (OR) testing. The results of the study show thatIn To maintain quality, all vaccines the lack of vaccine potential, there were 3 must continuously be stored at the correct samples with good measles vaccine quality temperature from the time they are made and 30 samples (36.6%) with poor vaccine until they are used. Once the potency of the quality. This shows that the potential for vaccine is lost or damaged, it cannot be vaccines clearly illustrates the relationship recovered or repaired(11). Without proper between the management of vaccine potency treatment, each vaccine becomes ineffective and the quality of the measles vaccine. in providing protection against targets. In However, it was also found that the lack of some cases, the loss of potency can also vaccine potency but the quality of the make the vaccine easier to cause a reaction. vaccine was still good, this could happen in Damage to the potential of the vaccine can all the sample observations because there be prevented by carrying out transportation, were other variables that would have an storage and handling of the vaccine properly, effect during the researchers conducting the from the time the vaccine is produced in research. factories to being used in service units. Furthermore, for good vaccine potential, there are 37 samples with good Immunization Services as a Determining vaccine quality and 12 samples with poor Factor of Vaccine Quality vaccine quality. This could have happened According to the Regulation of the because in addition to the officers' Minister of Health Number 12 of 2017 negligence in carrying out the storage or concerning the Implementation of recording process, it was also due to the Immunization, before carrying out the condition of the Puskesmas itself, which Immunization Program service, health Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 68 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 workers must provide an explanation of also consider how to bring vaccines or Immunization including the types of transportation to be used because how to vaccines to be given, the benefits, carry vaccines and the means of consequences of not being immunized, the transportation used are also an important part possibility of AEFI and efforts to be made, of vaccine management.(13). The wrong way as well as a schedule. Next immunization. to carry the vaccine when you are going to The officer must also screen for any contra immunization services will reduce the indication on the immunization target(12). quality of the vaccine itself. The results of the study show thatIn immunization services that are lacking, there are 16 samples (19.5%) with good measles CONCLUSION vaccine quality and 23 samples (28.0%) with There is a strong relationship between poor vaccine quality. This can happen if the vaccine potential and the quality of the immunization service is carried out outside measles vaccine and there is no relationship the predetermined schedule, or done earlier between immunization services and the or on a different schedule so that the use or quality of the measles vaccine in Konawe frequency to open and close the vaccine Islands District. It is hoped that the head of storage refrigerator will of course affect the the Puskesmas will improve supervision and refrigerator temperature. That the more often control over vaccine management strictly, the refrigerator is opened, the temperature of given the potential for perishable vaccines the refrigerator will become more unstable so and knowledge in the field of vaccine that the quality of the vaccine will also be management. affected. Furthermore, in good immunization services there are 24 samples with good . quality vaccines and 19 samples with poor REFERENCES quality vaccines. This could happen because 1. Supriatin E. The Relationship between to ensure maximum vaccine quality,vaccine Knowledge and Family Support with the storage and handling requires special Timeliness of Giving Measles attention. Often times adequate electricity Immunization at Pasir Kaliki Bandung. intake and refrigeration are important BSI Nursing Journal. 2015; 3 (1). problems for health service facilities, 2. Alimuddin A. Case Study of especially in areas with less than optimal Extraordinary Measles Incident in the access to electricity, where it should be Pijorkoling Puskesmas storage, handling and temperature stability Padangsidimpuan City Health Center require special attention. Area in 2019: Helvetia Health Institute; The results of the tests conducted 2019. show that immunization management is a variable that is not related to vaccine quality 3. Ananda AW. Differences in knowledge or is not a determining factor for the quality between before and after training of the measles vaccine. In addition, based on regarding complete immunization of the relationship closeness test, it is known toddlers at Posyandu cadres in that immunization services have a weak Gunungtiga Village, Ulubelu District, relationship and through the Odds Ratio Tanggamus Regency, Lampung. (OR) analysis test it is also known that http://digilib.unila.ac.id; 2019. immunization services are a protective factor 4. Nelfrides N. Risk Factors for Measles in for cases. Toddlers in the City of Padang in 2015: Apart from the above, in terms of Andalas University; 2016. providing immunization services, you should Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 69 Afiat, Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/56 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 5. Ministry of Health R. Ministry of Health Islamic Law Perspective. of the Republic of Indonesia. Indonesia: Https://dspace.uii.ac.id; 2018. Directorate General of Nutrition and MCH. 2017. 6. Southeast Sulawesi Provincial Health Office. Immunization Coverage. Southeast Sulawesi2019. 7. Sari DD. Maternal factors associated with basic infant immunization in the working area of the Korpri Public Health Center, Sub-district of Kecamatan Kota, Bandarlampung. Http://digilib.unila.ac.id; 2018. 8. Alamsyah A, Rasyid Z, Ikhtiaruddin I, Wahyudi W. Determinants of Measles in Toddlers in the Work Area of the UPTD Puskesmas Harapan Raya, Pekanbaru City. Endurance Journal: Scientific Study of Health Problems. 2020; 5 (2): 202-15. 9. Mackey A, Gass SM. Second language research: Methodology and design: Routledge; 2015. 10. Indonesian KR. Indonesia Health Profile 2014. Jakarta: Ministry of Health RI. 2015: 1-382. 11. Jamaluddin J. Effectiveness of Binahong Leaf Extract (Anredera cordifolia) and Earring (Acalypha indica) as Antibacterial Staphylococcus aureus (As an Alternative Material for Developing Practicum Instructions for Kingdom Monera SMA Class X, Odd Semester): UIN Raden Intan Lampung; 2017. 12. Raidanti D. Relationship of Accessibility, Support of Health Workers and Perceptions of the Implementation of Immunization for Pre-Marriage Family at Sukamulya Health Center, Sukamulya District, Kab. Tangerang in 2017. Pomegranate Health Scientific Journal. 2019; 3 (1): 52-65. 13. Indriani D. Fatwa Mui No 04 of 2016 concerning the Legalization of Immunization Vaccines for Toddlers in Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 70 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE EFFECT OF LEAFLET AND VIDEO METHODS OF HEALTH COUNSELING ABOUT INNECTICIDED GAMBUS IN MABODO PRIMARY HEALTH CARE Zanuma1, Timbul Supodo2, Sanihu Munir3, Anry Hariadhin Depu4 1234Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Zanuma Email : [email protected] Abstract Background: Mabodo is one of the Primary health cares where had the higher cases of malaria disease in 2018. The incident rate of malaria disease was 11.61 per 1,000 population. The incident increased in 9,387 / 1,000 population in 2019. This study aims to determine the effect of extension methods on changes in the behavior of pregnant women in the use of insecticide- treated mosquito nets in the working area of Mabodo Health Center, Muna Regency. Methods: The research used quantitative research with, quasi-experimental study of a nonequivalent control group design. Result s: The statistical test results obtained p value = 0.000 <0.05 between groups, this indicates that there are differences in respondent knowledge in each group, there are differences in respondent attitudes in all groups with p value = 0.033 <0.05 between groups, there are differences in respondent attitudes all groups p value = 0.011 <0.05 between groups. Conclusion: There is an effect of leaflet and video counseling on the use of textured bed nets in the working area of the Mabodo Health Center. Key words: Malaria, Leaflets, Videos, Uses, Insecticide-treated Bed Nets Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 71 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION Center is still high in malaria cases, in 2018 Malaria is a health problem in the the number of positive malaria cases for world in the last decade. Eradicating malaria pregnant women was forty five (45) people disease is one of the goals of the Global with plasmodium falcifarum as many 25 Sustainable Development Goals (SDGs). people and Plasmodium vivax as many as 20 This global program by 2030 aims to end the people. Data for 2019 on malaria cases for malaria epidemic. (1). The World Health pregnant women were found thirty one (31) Organization (WHO) in 2016 there were 216 people, of one hundred and twenty one (121) million cases of malaria in 91 countries with pregnant women were screened for malaria 445,000 deaths due to malaria(2). at the first visit(6). The prevention of malaria is carried The results of the preliminary study out by means of prevention and treatment show that on average pregnant women have with the aim of reducing malaria cases and not received clear information about the deaths due to malaria and avoiding malaria proper and correct use of bed nets, the outbreaks. In order to get maximum results, distribution of bed nets for pregnant women both prevention and treatment efforts must is carried out at the Integrated Health care be done with good and comprehensive Center for pregnant women and babies with efforts(3). One way is by using insecticide- brief counseling and without the use of treated mosquito nets at bedtime. The proper extension media so that it is less effective in and correct use of mosquito nets can protect delivering the information. to pregnant people from mosquito bites that transmit women is not well absorbed as a result of malaria(4). low knowledge of pregnant women about Southeast Sulawesi is one of the the use of bed nets. For this reason, provinces in Indonesia that is included in the researchers are interested in using leaflet category of endemic areas. Of the 17 districts extension methods and video playback as a / cities in Southeast Sulawesi that have been health promotion against the use of eliminated, there are 9 districts / cities, so the insecticide-treated bed nets. This is what number of malaria cases in Southeast underlies researchers to intervene with Sulawesi tends to decline. This is according leaflet and video outreach. to data from the 2018 Southeast Sulawesi Provincial Health Office, the number of malaria cases in Southeast Sulawesi, as many METHOD as 916 with an API of 0.347 per 1,000 The type of research used is population2. Muna Regency is one of seven quantitative research, namely Quasi- districts / cities in Southeast Sulawesi, which experimental research with a nonequivalent has not yet eliminated malaria in the last five control group design(7). Both the years. In 2019 the number of malaria cases experimental group and the control group was 289 with API of 1.30 per 1000 were chosen randomly, the control class did population(5). not fully function to control the external The Mabodo is the Health care centre variables that influenced the implementation with the most malaria cases found out of 28 of the experiment. The population was all Health care centre in Muna Regency in the pregnant women with a total of 60 people. last 2 years, with the 2018 API of 11.61 per and the research sample is a portion of the 1,000 population and the 2019 API of 9,387 / population which is considered to be 1,000 population. Malaria in pregnant representative of the entire population. women is also abundant in the Mabodo Respondents were pregnant women who met Health Center area, of the 12 Health care the inclusion criteria, amounting to 58 centre that provide antenatal care malaria people. The sampling technique in this study services, the Mabodo Community Health used probability sampling with a systematic Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 72 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 sampling technique. By using the KrussKal use of the pre test compared to the post test I, Walis, Mann Whitney and Friedman II, and III. The results of the Friedman test statistical tests(8). analysis showed p value = 0.000 for all groups. This shows that there are differences RESULT in the use of respondents in each intervention group and the control group. To compare the Table 1 shows that before the significant differences between the intervention (pre test) 18 respondents (69%) intervention and control groups, the Kruskal- of respondents in the video group used Wallis test was used. mosquito nets in the poor category and 12 Table 3 shows the Kruskal-Wallis respondents (71%) in the leaflet group who test which results obtained p value = 0.011 used mosquito nets in the poor category. <0.05 between groups, this indicates a After the intervention (post test) there was a difference in the use of respondents in each change, 15 respondents (58%) in the video group. The highest increase in scores was in group using mosquito nets were in the good the video intervention group, leaflets and the category and 10 respondents (59%) in the lowest was in the control group. leaflet group were in the good category. Table 4 shows the results of the Respondents in the control group at the time Mann-Whitney U test that at the time of the of the pre-test the use of mosquito nets pre test there were differences in the use which were classified as less were 12 (80%) scores in the video and leaflet and video and and at the time of the post test were 6 control groups. In the post test I there was no respondents (40%) with the use of mosquito difference in the use scores in the group, in nets in the good category. the post test II only on the leaflet and control Table 2 shows that at the end of the there were differences in scores and in the measurement time all respondents post test III there was a difference in the experienced an increase in their knowledge scores for the use of respondents in the video score compared to the initial measurement. and control groups. This shows that there are differences in the Table 1 Descriptive of Changes in the Use of Mosquito Nets in Groups Intervention and Control Changes in the Intervention and Control Group Use of Video Group Leaflet group Control Group mosquito nets Pre test Post test Pre test Post test Pre test Post test n % n % n % n % n % n % Good 0 0 15 58 0 0 10 59 0 0 6 40 Enough 8 31 11 42 5 29 7 41 3 20 9 60 Less 18 69 0 0 12 71 0 0 12 80 0 0 10 10 10 10 10 10 Total 26 26 17 17 15 15 0 0 0 0 0 0 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 73 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Change in the Score of Respondents in Each Group Measurement Standard P- Statistic Table Use Mean Time Deviation value test Value Video Pretest 9.23 1.21 Group Post test I 11.35 0.94 0,000 76,036 7,815 Post test II 12.08 0.93 Post test III 13.23 0.82 Leaflet Pretest 8.82 1.47 group Post test I 11.41 0.94 0,000 47,814 7,815 Post test II 11.88 1.32 Post test III 13.18 0.95 Control Pretest 8.27 1.16 Group Post test I 10.87 0.99 0,000 41,891 7,815 Post test II 11.33 1.18 Post test III 12.20 1.15 Table 3 Analysis of Comparative Scores on the use of Intergroup Respondents Measurement P- Statistic Table Use Mean Time value test Value Video Group Pretest Post test I 33.31 Post test II Post test III Leaflet group Pretest Post test I 33.03 0.011 9,021 5,991 Post test II Post test III Control Pretest Group Post test I 18.90 Post test II Post test III Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 74 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Differences in use scores between groups Mean p- Statistic Table Group n Rank value test Value Video 26 26.41 0.0419 2,035 1,960 Leaflet 17 18.53 Video 26 24.65 Pre test 0.0066 2,715 1,960 Control 15 14.67 Leaflet 17 18.21 0.0726 98,500 75,000 Control 15 14.57 Video 26 24.12 0.6583 0.442 1,960 Leaflet 17 22.44 Video 26 22.92 Post test I 0.1383 1,482 1,960 Control 15 17.67 Leaflet 17 18.68 0.1281 90,500 75,000 Control 15 14.03 Video 26 24.78 0.3845 0.870 1,960 Leaflet 17 21.32 Post test Video 26 23.67 0.0508 1,953 1,960 II Control 15 16.37 Leaflet 17 18.35 0.0158 67,000 75,000 Control 15 14.40 Video 26 24.40 0.5257 0.635 1,960 Leaflet 17 21.97 Post test Video 26 24.79 0.0050 2,806 1,960 III Control 15 14.43 Leaflet 17 20.06 0.0158 67,000 75,000 Control 15 12.47 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 75 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 DISCUSSION the extension agents will determine the success of the respondent's behavior The Effect of Video Counseling on the Use change(11). of Insecticide Nets in Pregnant Women in the working area of Mabodo Health Center, Muna Regency The Effect of Leaflet Extension Methods The results showed that before the on the Use of Insecticidal Mosquito Nets in intervention (pre test) all (100%) respondents Pregnant Women in the working area of in the video group had not used insecticide- Mabodo Health Center, Muna Regency treated bed nets. The use of insecticide- The results showed that before the treated bed nets has increased significantly intervention (pre test) all respondents in the since the first time providing health leaflet group (100%) were not in good education via video. This can be seen from category with the use of insecticide-treated the results of the pre test to the post test I bed nets. The results of the evaluation of the which have a positive rank of 26. use of bed nets until the last measurement Measurement of the use of mosquito were obtained by 59% of the leaflet group nets from pre test to post test II and pre test respondents in the good category in the use to post test III has increased overall. This of insecticide-treated bed nets. Compared proves that providing health education with the initial measurement (pre test), at the through video media has an effect on final measurement all respondents increasing the use of bed nets on a regular experienced an increase in the score of using basis. The results showed that at the final mosquito nets. The results of the Friedman measurement all respondents experienced an test obtained p value = 0.000 in the leaflet increase in their use score compared to the group. This indicates that there is a initial measurement (pre test). This shows difference in use at the beginning of the that there are differences in use at the start of measurement compared to the first, second the measurement compared to the first, and third post tests. second and third post tests. The results of the Based on the results of the study, Friedman test obtained p value = 0.000, this there was a difference in the scores on the indicates that there are differences in the use use of the leaflet group of respondents. The of respondents in each measurement. use of insecticide-treated bed nets has Based on observations made, almost generally increased since the first time the all respondents have used insecticide-treated extension was given through leaflet media. bed nets properly and correctly, there is only This is obtained from the results of the pre one respondent or pregnant women who do test to post test I which has a positive rank of not like the smell of the bed nets because of 17. Measurement of the use of mosquito nets cravings. Many factors influence respondents from pre test to post test II and pre test to in using insecticide-treated bed nets, post test III has increased overall. This including good knowledge, good intentions, proves that the provision of health education reliable and easily accessible sources of through leaflet media has an effect on information.(9). Knowledge is a very increasing the use of insecticide-treated bed important domain in shaping a person's nets. actions(10). Based on observations made, almost According to researchers, changes in all respondents have fully used insecticide- the behavior of using insecticide-treated treated bed nets properly. The score for the mosquito nets in respondents occurred due to use of mosquito nets has increased the quality of stimuli or messages from significantly (P <0.05). This increase was instructors who used natural language. The due to the knowledge gained from providing quality of the communication resources of leaflets about insecticide-treated bed nets in Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 76 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 the form of good and correct use of summary. Acta neuropathologica. insecticide-treated bed nets which can 2016;131(6):803-20. change the respondent's attitude to be 3. Diaz GF. Hubungan Pengetahuan Dan positive. Therefore, in the end, respondents Persepsi Kepala Keluarga Tentang will take an action to change their behavior Malaria Terhadap Perilaku Pencegahan for the better in using insecticide-treated bed Penularan Penyakit Malaria Di nets. Wilayah Kerja Puskesmas Kori The use of mosquito nets is an Kabupaten Sumba Barat Daya: activity or human activity that can be directly Universitas Airlangga; 2018. observed by outsiders(12). Measuring the 4. Sugiarto S, Hadi UK, Soviana S, use of mosquito nets can be done by directly Hakim L. efektivitas kelambu observing the use of mosquito nets at the berinsektisida terhadap nyamuk an. respondent's house at night and during the sundaicus (diptera: culicidae) dan day when conducting interviews with penggunaannya di desa sungai respondents(13). Behavior is a form of nyamuk, Kalimantan Utara. Spirakel. response or reaction to stimuli or stimuli 2018;10(1):1-11. from outside the organism (person), but in 5. Dinas Kesehatan Provinsi Sulawesi response it is highly dependent on the Tenggara. Cakupan Imunisasi. characteristics or other factors of the person Sulawesi Tenggara2019. concerned.(14). This research is in line 6. Dinas Kesehatan Kabupaten Muna. with(15) that the provision of health Jumlah Kasus Malaria. Muna Sulawesi education through leaflet media has an effect Tenggara2018. on malaria prevention practices in 7. Mackey A, Gass SM. Second language earthquake victims. research: Methodology and design: Routledge; 2015. 8. Sugiyono. Statistik Nonparametris CONCLUSION Untuk Penelitian. 2015. Extension with video and leaflet 9. Askar M, Yusuf M, Putri DE. methods has an effect on the use of nets with Hubungan pengetahuan dan sikap textiles in the working area of the Mabodo dengan perilaku masyarakat terhadap Health Center so that there is a need for pencegahan malaria di wilayah kerja counseling to the community about malaria, puskesmas Barugaia Kabupaten the function and how to use insecticide- Kepulauan Selayar. Jurnal Ilmiah treated nets on an ongoing basis by health Kesehatan Diagnosis. 2013;3(3):23-9. workers. 10. Notoatmodjo S, Krianto T, Hassan A, Mamdy Z. Promosi kesehatan global. Jakarta: Rineka Cipta. 2013. REFERENCES 11. Nesi H. 21 ESP and Corpus Studies. The handbook of English for specific 1. Anggraeni I, Nurrachmawati A. purposes. 2013:407. Malaria Dalam Kehamilan: Kualitatif 12. Ujang S. Hubungan Pengetahuan Model Kepercayaan Kesehatan Di Dengan Perilaku Masyarakat Tentang Muara Wahau Provinsi Kalimantan Pencegahan Penyakit Kaki Gajah Timur. 2017. (Filariasis) Di Rt 02, Rw 02, Dusun 2. Louis DN, Perry A, Reifenberger G, Krajan, Desa Caluk, Kecamatan Von Deimling A, Figarella-Branger D, Slahung, Kabupaten Ponorogo: Cavenee WK, et al. The 2016 World Universitas Muhammadiyah Ponorogo; Health Organization classification of 2018. tumors of the central nervous system: a Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 77 Zanuma, Supodo, T., Munir, S., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/57 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 13. Ayun LL. Hubungan Antara Faktor Lingkungan Fisik dan Perilaku Dengan Kejadian Demam Berdarah Dengue (DBD) di Wilayah Kerja Puskesmas Sekaran, Kecamatan Gunungpati, Kota Semarang Tahun 2015: Universitas Negeri Semarang; 2015. 14. Notoatmodjo S. Promosi Kesehatan dan Perilaku Kesehatan (Cetakan V). Jakarta: Rineka Cipta. 2015. 15. Yulianti E, Jannah R, Khoiroh LM, Istighfarini VN. Briket Arang Tempurung Kawista (Limonia acidissima) Teraktivasi NaOH dengan Perekat Alami. al-Kimiya: Jurnal Ilmu Kimia dan Terapan. 2019;6(1):1-8. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 78 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN COMPETENCY AND SERVICE OFFICERS ON THE ACHIEVEMENT OF EXCLUSIVE BREASTFEEDING TARGETS IN KENDARI CITY HEALTH DEPARTMENT Asmawati1, Tasnim Tasnim2, Sunarsih3 123UUniversitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Asmawati Email : [email protected] Abstract Background: The coverage of exclusive breastfeeding in Kendari City is in the 4th (fourth) lowest place out of 17 city districts in Southeast Sulawesi Province. Although Kendari City is not in the lowest rank, it will be used as a research area considering that the number of children under five in Kendari City is the highest in Southeast Sulawesi Province, so it is necessary to get attention to carry out programs to increase the coverage of exclusive breastfeeding. Methods: The research used quantitative method with an observational analytic method which applied a cross sectional approach.The population was 150 with the sample size was 59 respondents namely health workers in the Kendari City Health Department. 2 2 Result s:The results of statistical tests using Chi-Square obtained the value of X > X tab 4,262> 3,841 with Sig. 0.039 <α 0.05 and a phi value of 0.290, namely Ha accepted, which means that there is a weak relationship between the competence of officers and the target achievement of exclusive breastfeeding 2 2 and the value of X > X tab 7,884> 3,841 with Sig. 0.005 <α 0.05 with a phi value of 0.371, which is Ha accepted, which means that there is a moderate relationship between health care services and the achievement of the target of exclusive breastfeeding in the work area of the Kendari City Health Office. Conclusion: There is a weak relationship between the competence of health workers and the achievement of targets for exclusive breastfeeding. There is a moderate relationship between health services and the achievement of targets for exclusive breastfeeding in the working area of the Kendari City Health Department. Key words: Competence, Service, Exclusive breastfeeding, Health workers Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 79 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION increase in cases of certain diseases, National data on the percentage of especially in the fields of MCH or Family exclusive breastfeeding in Indonesia in 2018 Planning, Nutrition and Health Promotion. reached 74.8% while in 2019 it was 67.74% (1). For the Achievement of Exclusive Asi, METHOD Southeast Sulawesi Provincial Health Office The type of research used in this in 2018, namely 55.94%, while in 2019 it study isquantitative with an observational was 66.81% (2). method with a cross sectional approach(3). The highest coverage data for The design used in this study is a cross exclusive breastfeeding at the City Level sectional design(4). This research has been District of Southeast Sulawesi Province was conducted for 1 (one) month, from October Konawe Selatan District 100%, followed by to November 2020. The population is 150 Konawe Islands District 94.92%, Central with 59 samples of all health workers (KIA, Buton Regency 72.49%, North Buton Nutrition and Promkes) in the Kendari City Regency 72.44%, East Kolaka Regency 67, Health Office Work Area. 14 %, Konawe Regency 66.78%, Kolaka Regency 62.31%, North Kolaka Regency RESULTS 59.87% Bau-Bau City 57.94%, South Buton Table 1 shows that the competence of Regency 57.37%, West Muna Regency 53, officers is more in the moderate category, 70%, Buton Regency 53.44%, Bombana namely 31 respondents (52.5%) and the Regency 52.74%, Kendari City 52, 49%, lowest in the poor category, namely 28 Wakatobi Regency 39.43%, Muna Regency respondents (47.5%). 28, 54%, and the lowest is North Konawe Table 2 shows that more health care Regency 23.27%. workers in the moderate category, amounting Based on data for exclusive to 30 respondents (50.8%) and the lowest in breastfeeding coverage in Kendari City in the poor category, namely 29 respondents 2019, the number of babies who received (49.2%). exclusive breastfeeding was 62.49% with a Table 3 shows that of the 59 target of 90% exclusive breastfeeding. Based respondents, it shows that the competence of on these data, so that exclusive breastfeeding officers is higher in the sufficient category, is still a health problem because Kendari namely 31 respondents, and the lowest is in City is a local transmission area or the less category, namely 28 respondents. Of malnutrition cases that originate from the the 31 respondents who had sufficient region, the target of exclusive breastfeeding competency, 17 respondents (54.8%) in Kendari City is still not achieved because achieved the target of exclusive Kendari City has a very large population of breastfeeding and 14 respondents (45.2%) babies, namely 5,865 babies with the number who did not achieve the target of exclusive of babies who are exclusively breastfed, breastfeeding. Of the 28 respondents who namely 3,665 babies. There are still 2,200 had low competency categories, 7 babies who have to get exclusive respondents (25.0%) achieved the target of breastfeeding. The Exclusive Breastfeeding exclusive breastfeeding and 21 respondents Program will not be achieved if there is a (75.0%) who did not achieve the target of lack of knowledge and understanding factors exclusive breastfeeding. The results of for mothers about exclusive breastfeeding. statistical tests using Chi-Square obtained the Based on data related to Exclusive value of X2> X2 tab 4,262> 3,841 with Sig. Breastfeeding in Kendari City, it is hoped 0.039 <α 0.05 and a phi value of 0.290. that health workers will play a more Table 4 shows that of the 59 important role in improving public and respondents it shows that the Officer Service individual health efforts to prevent an is higher in the moderate category, namely Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 80 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 30 respondents, and the lowest is in the less had low level officer service, there were 6 category, which is 29 respondents. Of the 30 respondents (20.7%) who achieved the target respondents who had sufficient service of exclusive breastfeeding and 23 category officers, 18 respondents (60%) respondents (79.3%) who did not achieve the achieved the target of exclusive target of exclusive breastfeeding. The results breastfeeding and 12 respondents (40%) who of statistical tests using Chi-Square obtained did not achieve the target of exclusive the value of X2 > X2 tab 7,884> 3,841 with breastfeeding. Of the 29 respondents who Sig. 0.005 <α 0.05 with a phi value of 0.371. Table 1 Distribution of Competency of Officers in Kendari City Health Department No. Officer Competence n Percentage (%) 1 Enough 31 52.5 2 Less 28 47.5 total 59 100 Source: Primary Data, Processed 2020 Table 2 Distribution of Health Officer Services in Kendari City Health Department No. Officer Services n Percentage (%) 1 Enough 30 50.8 2 Less 29 49.2 total 59 100 Source: Primary Data, Processed 2020 Table 3 Relationship between competence and the target of achieving exclusive breastfeeding in the Kendari City Health Department No Officer Target of Exclusive Breastfeeding total Statistical . Compete Reached Not achieved Results nce n % n % n % 1 Enough 17 54.8 14 45.2 31 100 X2 hit = 4,262 2 Less 7 25.0 21 75.0 28 100 X2 Tab = 3,841 total 24 40.7 35 59.3 59 100 Phi = 0.290 Source: Primary data, processed in 2020 Table 4 Relationship between health care workers and the target of achieving exclusive breastfeeding in the Kendari City Health Department No Health Target of Exclusive . Officer Breastfeeding total Statistical Services Reached Not achieved Results n % n % n % 1 Enough 18 60 12 40 30 100 X2 hit = 7,884 2 Less 6 20.7 23 79.3 29 100 X2 Tab = 3,841 total 24 40.7 35 59.3 59 100 Phi = 0.371 Source: Primary data, processed in 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 81 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 DISCUSSION Relationship between Health Services and the Achievement of Exclusive The Relationship between Competence of Breastfeeding Targets in Kendari City Health Workers and Achievement of Heath Department. Exclusive Breastfeeding Targets in First level health services are Kendari City Heath Department. individual health services that are primary in Competence is a basic character of a nature(7). It takes a long time and a lot of person that allows them to produce superior effort to improve the health development performance in improving their work(5). A program(8). There are four first-level health competent person is a person who with his service functions, including every patient skills can do the job easily, quickly, who has health problems(9). The relationship intuitively and very rarely or never makes between first-level health services and mistakes(6). patients runs optimally, first-level health The results showed that of the 59 services provide comprehensive health respondents indicated that the competence of services including promotional services, and officers was higher in the sufficient category, first-level health services carry out services namely 31 respondents because the with other health providers(10). respondents had good soft skills in the health The results showed that of the 59 sector which could support the achievement respondents, it was indicated that the service of exclusive breastfeeding targets, and the of officers was higher in the sufficient lowest was in the less category, amounting to category, amounting to 30 respondents 28 respondents because respondents have because respondents always prioritized relatively low soft skills in the health sector. patient comfort in services, based on the Of the 31 respondents who had health service category namely tangible, sufficient competency, 17 respondents reliability, responsiveness, assurance and (54.8%) achieved the target of exclusive empathy and the lowest was in the category. breastfeeding and 14 respondents (45.2%) less, which is 29 respondents because who did not achieve the target of exclusive respondents do not pay attention to patient breastfeeding. Of the 28 respondents who comfort, especially in terms of assurance and had low competency categories, 7 empathy. respondents (25.0%) achieved the target of Of the 30 respondents who had exclusive breastfeeding and 21 respondents sufficient service category, 18 respondents (75.0%) who did not achieve the target of (60%) achieved the target of exclusive exclusive breastfeeding. breastfeeding because respondents always The results of statistical tests using prioritized the quality of health services and Chi-Square obtained the value of X2 > X2 12 respondents (40%) did not achieve the tab 4,262> 3,841 with Sig. 0.039 <α 0.05 and target of exclusive breastfeeding because a phi value of 0.290. Ha is accepted, which respondents did not pay attention to service means that there is a weak relationship quality categories such as assurance. and between the competence of officers and the emphaty. Of the 29 respondents who had achievement of targets for exclusive poor service category, there were 6 breastfeeding in the Kendari City Health respondents (20.7%) who achieved the target Department. of exclusive breastfeeding because the respondents had done their best to improve the quality of service in achieving the target of exclusive breastfeeding and 23 respondents (79.3%) were not achieved. Exclusive breastfeeding targets because Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 82 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 health workers pay less attention to quality infrastructure such as a place to carry out indicators in health services. lactation counseling services or a lactation The results of statistical tests using room are available at the Primary health Chi-Square obtained the value of X2 > X2 tab cares. The health worker explains how 7,884> 3,841 with Sig. 0.005 <α 0.05 with a important it is to provide exclusive phi value of 0.371. Ha is accepted, which breastfeeding, the nutrients or ingredients means that there is a moderate relationship contained in breast milk and the benefits of between Health Care Services and the breast milk, which include breastfeeding that achievement of the target of exclusive is cheap, does not bother to make it, as an breastfeeding in the Kendari City Health anti-infective factor, and can build a closer Department. affectionate relationship between mothers. The successful implementation of the and son. Mother’s breastfeeding practice, ASI program at the Puskesmas cannot be including child feeding is influenced by separated from the role of program several factors including mother’s management(11). Program management knowledge (14). Insufficient food including includes P1 (planning), P2 (movement and breast milk can affect to baby or child’s implementation), P3 (control, monitoring nutritional status. and assessment). In a unified system consisting of input, output process, outcome. The input consists of 6M including humans CONCLUSION (men), money (money), tools (materials), There is a weak relationship between methods (methods), markets (market), and the competence of health workers and the machines (machine). The role of achievement of targets for exclusive management lies in the processes in the breastfeeding and there is a moderate system. While the output is exclusive relationship between health services and the breastfeeding coverage(12). achievement of targets for exclusive The existence of an SOP is intended breastfeeding in Kendari City Health to provide a clear concept, can be understood Department. So as to increase the by everyone and is stated in a procedural competence of health workers through document in each activity(13). From the training activities to develop soft skills and results of research conducted by researchers, improve service quality according to health almost all health workers are aware of the service standards such as tangible, reliability, SOP used as a reference in the service of the responsiveness, assurance and empathy to exclusive breastfeeding program. SOP are increase patient satisfaction in achieving the actually available at the Kendari City Work target of exclusive breastfeeding. Area Health Center, and each programmer works together in a team to provide counseling regarding exclusive breastfeeding for infants up to 6 months of age. REFERENCES Based on the results of the research, 1. Ministry of Health R. Ministry of Health the implementation of the exclusive of the Republic of Indonesia. Indonesia: breastfeeding program at the Puskesmas in Directorate General of Nutrition and Kendari City has been carried out properly, MCH. 2019. as evidenced by the statements of all 2. Southeast Sulawesi Provincial Health informants stating that the existing facilities Office. Exclusive breastfeeding and infrastructure are complete. The achievements. Southeast Sulawesi2019. available infrastructure does not yet support 3. Mackey A, Gass SM. Second language the implementation of the exclusive research: Methodology and design: breastfeeding program. Facilities and Routledge; 2015. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 83 Asmawati, Tasnim,T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/58 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 4. Sugiyono. Nonparametric Statistics for 13. Budihardjo IM. Practical Guide to Research. 2015. Developing SOP: RAS; 2014. 5. Rande D. The influence of competence 14. Tasnim, T., Mwanri L, Dasvarma, G. on the performance of employees at the Mother’s child feeding knowledge and transportation, communication and practices associated with underweight in informatics office in North Mamuju children under-five years: A study from district. Catalogist. 2017; 4 (2). Rural Konawe, Indonesia. Public Health 6. Manik S, Syafrina N. Effect of of Indonesia. 2018;4(1):9–18. Competence on Lecturer Performance at the Riau Economics College. Journal of Economics and Business Scientific (JIEB). 2018; 15 (1): 16. 7. Umami LS, Wulandari DR. Analysis of Implementation of First Level Outpatient Referrals for BPJS Health Participants at Puskesmas: Faculty of Medicine; 2017. 8. Jayadipraja EA, Prasetya F, Azlimin A, Mando WOSY. Family Clean And Healthy Living Behavior And Its Determinant Factors In The Village Of Labunia, Regency Of Muna, Southeast Sulawesi Province Of Indonesia. Public Health of Indonesia. 2018; 4 (1): 39-45. 9. Mujiati M, Yuniar Y. The availability of health human resources at the first level of health facilities in the era of the National Health Insurance in eight regencies-cities in Indonesia. Health Research and Development Media. 2016; 26 (4): 201-10. 10. Wahyuni NS. Factors Related to the Utilization of Health Services at Sumber Rejo Health Center, Balikpapan City, East Kalimantan Province in 2012. Depok Univ Indones. 2012. 11. Farida S, Rahfiludin MZ, Kartini A. Management System Analysis of Lactation Corner Activities at the Surakarta City Health Center in 2014: Diponegoro University; 2014. 12. Alifah N. Analysis of the management system of the exclusive breastfeeding program in the working area of the Candilama Community Health Center, Semarang City. Diponegoro University Public Health Journal. 2012; 1 (2): 18772. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 84 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access COMPARATIVE STUDY OF KNOWLEDGE AND SOCIAL ENVIRONMENT FOR ADOLESCENTS WHICH INFORMATION PROGRAMS AND TEENAGER COUNSELING ABOUT EARLY MARRIAGE IN STATE HIGH SCHOOLS IN KONAWE KEPULAUAN DISTRICT Jumriah Abdullah1, Tasnim Tasnim2, La Banudi3 123Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Jumriah Abdullah Email : [email protected] Abstract Background:Based on data from the Central Statistics Agency of Konawe Islands Regency in 2019, it is known that the number of Senior High Schools is 7 units, with a total of 1,717 students. The results of reports of teenagers who married before the age of 18 in 2019 were as many as 49 people. Based on this, the rate of early marriage in the last 2 years actually shows an increase. Researchers took the theme of early marriage because from the results of preliminary studies conducted by researchers, most adolescents have insufficient knowledge about early marriage and its effects on the social environment of adolescents. So it is not surprising why the rate of early marriage in Konawe Islands Regency is generally the third highest in Southeast Sulawesi Province. Methods:This research is a quantitative research with a comparative study research type. The population in this study were 332 people and 179 samples with the sampling technique using stratified random sampling. Results:The statistical results with the Mann Whitney Test shows that the significant value for knowledge was 0.000 Counseling Program and Information which are active and inactive towards early marriage. Conclusion:There are differences in the knowledge and social environment of adolescents in the senior high School where the Youth Counseling Program and Information which are active and inactive towards early marriage. Key words: Knowledge, Youth, Information, Counseling, Early marriage Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 85 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION can reduce the number of early marriages in Youth motivation for early marriage Konawe Islands Regency(7). can come from themselves or from others Based on the results of the (1). In addition, lack of knowledge about interview, it is known that the factors reproductive health causes ignorance of the causing the rate of early marriage in Konawe dangers of early marriage(2). Early marriage Islands Regency are mostly due to the lack not only takes away youth's future but also of knowledge of adolescents about the risks has negative impacts such as dropping out of of early marriage and public belief that it is school where 85 percent of girls in Indonesia time for adolescents to get married so that end their education after they get married(3). they do not become a burden to their parents. Early marriages also pose a high This is supported by a UNICEF study which risk of physical, sexual, psychological and explains that socio-cultural interactions can emotional violence as well as social isolation be the cause of early marriage and this factor where babies born as a result of early is very difficult to control. For economic marriages also have a higher likelihood of reasons, the hope of achieving social and being born prematurely with low birth financial security after marriage causes many weight and malnutrition.(4). Early marriage parents to encourage their children to marry has a negative impact on death where at a young age(8). pregnancy is the main cause of death for girls aged 15-19 years.Girls aged 10-14 years METHOD have five times the risk of dying during This research is a quantitative pregnancy or childbirth compared to the 20- research with a comparative type of study(9). 24 year age group while this risk doubles in The population in this study were 249 the 15-19 year age group (5). students of class X and class XI of West In line with the high number of Wawonii 1 State Senior High School and 83 early marriages, the number of adolescents South Wawonii 1 High School students, so who gave birth for the first time at the age of that the total population was 332 people. The 15-19 is quite high in Southeast Sulawesi, sample amounted to 179 people with the namely 41.22 percent. There are five districts sampling technique using stratified random in the highest region including Konawe sampling(10). Regency at 54.86%, Konawe Selatan Regency (54.02%), Konawe Islands Regency RESULTS (45.66%), Muna Regency (26.25%) and the last order is Kendari City. namely as much as Table 1 shows that the category of 16.79%(6). knowledge for respondents in West Wawoni Researchers took the theme of State Senior High School is 113 people adolescent knowledge about early age (84.3%) and the poor category is 21 people marriage because from the results of (15.6%), while the category of knowledge is preliminary studies conducted by sufficient in South Wawonii State Senior researchers, most adolescents have less High School as many as 25 people (55.6%) knowledge about early age marriage. So it is and 20 people (44.4%) in less category. not surprising why the rate of early marriage Table 2 shows that the social in Konawe Islands Regency is generally the environment for respondents from West third highest in Southeast Sulawesi Province. Wawoni Senior High School is in the With this research, researchers hope to positive category of 104 people (77.6%) and eliminate the perception of parents to marry the negative category is 30 people (22.4%), off their children at an early age, and prevent while the positive category of the social early marriage among adolescents so that it environment in the South Wawonii State Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 86 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Senior High School is 20. people (44.4%) programs and information about early and in the negative category were 25 people marriage. (55.6%). Table 4 shows that based on the test Table 3 shows that based on the test results with the Mann Whitney Test The results with the Mann Whitney TestThe significant value shows the value of pvalue = significant number shows the value of pvalue 0.000 <α = 0.05, it can be concluded that = 0.000 <α = 0.05, it can be concluded that there are differences in the social there is a difference in the knowledge of environment of adolescents in public high adolescents in public high schools with schools where the Adolescent Counseling active and inactive youth counseling Program and Information is active and inactive towards early marriage. Table 1 Distribution of Respondents' Knowledge about Early Marriage based on Active Adolescent Counseling Programs and Information in Wawonii Barat Public High School and South Wawonii State High School Determinants of Early Marriage No. Knowledge West Wawonii South Wawonii n % n % 1 Enough 113 84.3 25 55.6 2 Less 21 15.7 20 44.4 total 134 100 45 100 Table 2 Distribution of Respondents' Social Environment on Early Marriage based on Active Youth Counseling Programs and Information in Wawonii Barat Public High School and South Wawonii State High School Determinants of Early Marriage No. Social environment West Wawonii South Wawonii n % n % 1 Positive 104 77.6 20 44.4 2 Negative 30 22.4 25 55.6 total 134 100 45 100 Table 3 Analysis of Respondents' Knowledge Difference Based on the Activeness of the Adolescent Counseling Program and Information in Wawonii Barat State Senior High School and Wawonii Selatan Public High School West Wawonii South Wawonii Mann Enough Less Enough Less n Whitney Test 113 21 25 20 179 0,000 Source: Mann Whitney analysisTest Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 87 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Analysis of Respondents' Social Environment Differences Based on the Activeness of Youth Counseling Programs and Information in Wawonii Barat Public High School and Wawonii Selatan Public High School West Wawonii South Wawonii Mann Positive Negative Positive Negative n Whitney Test 104 30 20 25 179 0,000 Source: Mann Whitney Test analysis DISCUSSION knowledge of adolescents tends to improve and vice versa, in high schools with inactive Knowledge adolescent counseling programs and Knowledge is the result of knowing, information, adolescent knowledge tends to and this happens after people sense a certain be no less. Other than that, object. Sensing occurs through the five The results showed that there was a human senses, namely the senses of sight, significant difference in knowledge between smell, hearing, touch and taste. Most of high school and active adolescent counseling human knowledge is obtained from sight and program and information and high school hearing which are very important domains in with inactive adolescent counseling an action(11). information and program. The results of this Measurement of knowledge can be study are in line with research conducted done by interview or questionnaire that asks by(12) who found differences in knowledge about the content of the material to be between respondents who received measured from the research subject or information about reproductive health and respondent into the knowledge that you want those who did not. to know or measure, and can be adjusted to Respondents with good knowledge the levels of knowledge. Knowledge is a are more likely to avoid early marriage. This very important domain for the formation of is because with good knowledge, they will one's actions (over behavior) from understand better about reproductive health, experience and research has shown that the dangers of free sex and the importance of behavior based on knowledge will be more getting married when the reproductive lasting than behavior that is not based on organs are ready, so that they will be more knowledge. organized and prevent early marriage. This is The results showed that the tradition in accordance with the theory presented of respondents from West Wawoni Senior in(13)that the factors causing health High School in the category of believing was problems are behavioral and non-behavioral as many as 93 people (70.9%) and the factors. Behavioral factors are influenced, category of disbelief was 39 people (29.1%), one of which is predisposing factors, namely while the tradition category of believing in factors that are manifested in knowledge, the South Wawonii Senior High School was belief, belief, values and demographic as many as 32 people ( 71.1%) and in the variations. This factor is more of an distrust category were 13 people (28.9%). individual nature. This means that an active youth counseling program and information is proven to Social environment increase adolescent knowledge. This can be Experience is one of the factors that seen in high schools with active youth influence a person(14). The majority of counseling programs and information, so the adolescents tend to discuss their problems Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 88 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 with peers than adults even though they have will open up opportunities for discussion and more experience in terms of age. Even on exchange of information that are able to form problems that are considered very serious, patterns of thought and behavior so that teenagers tend to discuss it with their peers fellow youth group members influence each (friends). When the problem is told to adults, other in shaping character among them. it is usually because they do not find a The need for strong social support solution when discussed with others. This which is believed to be proven to be able to happens because teenagers often have provide mental strength to prevent interest and commitment as well as strong adolescents from falling into negative ties due to the assumption that only their associations(15). Social support that is meant group is able to understand the problem. is reinforcing support, namely good relations Test results with the Mann Whitney with parents, siblings, adults and peers.So it Test The significant value shows the value of needs guidance, counseling and community pvalue = 0.000 <α = 0.05, it can be empowerment, then it needs cross-sector concluded that there are differences in the participation and involvement as well as social environment of adolescents in public parties who can set an example in high schools with active and inactive youth society(16). counseling programs and information on early marriage. This research is in line with research conducted by Retno (2019) with the CONCLUSION results of statistical tests between peer There are differences in the variables and perceptions, obtained a value knowledge and social environment of of p = 0.035 (p <0.05), so it can be adolescents in State Senior High Schools concluded that there is a difference in the where the Youth Counseling Program and proportion of respondents who have a good Information are active and inactive towards perception of marriage below. age of early marriage at the State Senior High respondents who have peers who are not School of KonaweKepulauan Regency. It is supportive compared to respondents who also hoped that students will choose wisely have peers who support underage marriage. their friends who are used as a place to Dannayanti.Y, et al stated that there exchange information, and it is hoped that was a significant difference in premarital sex there will be an even distribution of behavior among adolescents who had peers information for all students so that no one with active sexual behavior compared to else gives wrong information. those who had peers with passive premarital sex behavior (p = 0.004). Furthermore, information about risky sexual behavior from REFERENCES peers can prevent adolescents from engaging in it. If peers do not provide information, it can increase the risk of adolescents to do so 1. Setiawati ER, Marnelly TR. The effect up to 2.6 times. of early merriage to harmonious Peers are a very influential factor in husband and wife in Bagan Bhakti character building in adolescents. The Village,Balai Jaya Sub-district, Rokan current phenomenon shows a tendency for Hilir District. Jurnal Online adolescents to always be with their peers. Mahasiswa (JOM) Bidang Ilmu Sosial The high intensity of interaction between dan Ilmu Politik. 2017;4(1):1-13 adolescents and their peers will form strong (Indonesia). emotional bonds while at the same time 2. Pranata L. Overview of female emotional ties with parents tend to be teenagers' knowledge about health reduced. The emotional links that are formed reproduction in SMAN 1 class X Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 89 Abdullah, J., Tasnim, T. & Banudi, L.. DOI: 10.36566/ijhsrd/Vol3.Iss1/59 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Lalan Musi Banyuasin. Jurnal Kesehatan. 2015;2(2):77-82 Akademika Baiturrahim Jambi. (Indonesia). 2018;7(2):92-9 (Indonesia). 14. Tasnim T, Depu AH. Experience and 3. Harari YN. Homo Deus: Human future training relate to performance clean : Pustaka Alvabet; 2018 (Indonesia). and healthy living behaviour in Cadre 4. Puspasari HW, Pawitaningtyas I. in the working area of Poasia Primary Mother and child health problem and Health Care, Kendari City: Clean and child with early merriage in some Healthy Living Behavior. Indonesian Ethnics in Indonesia; Impacts and Journal Of Health Sciences Research prevention. Buletin Penelitian Sistem And Development (IJHSRD). Kesehatan. 2020;23(4):275-83 2020;2(3):74-9. (Indonesia). 15. Dumilah R, Fariji A, Petralina B. 5. Fadlyana E, Larasaty S. Early merriage Effect of friends, family environment and problems. Sari Pediatri. and culture to teenagers' perception 2016;11(2):136-41(Indonesia). about ealry merriage. Jurnal Ilmiah 6. BKKBN. The prevalence of ASFR, Bidan. 2019;4(1) (Indonesia). TFR and average of UKP based on 16. Jayadipraja EA, Prasetya F, Azlimin A, districts/ city. In: Nasional BKDKB, Mando WOSY. Family clean and editor. Kendari: BKKBN; 2015 healthy living behavior and its (Indonesia). determinant factors in the village of 7. Health Department of Konawe Labunia, Regency of Muna, Southeast Kepulauan District. The number of Sulawesi Province of Indonesia. Public early merriage. Konawe Kepulauan Health of Indonesia. 2018;4(1):39-45. District. 2019. 8. Dwinanda AR, Wijayanti AC, Werdani KE. The relationship between mother's education and thier knowledge about early merriage. Jurnal Kesehatan Masyarakat Andalas. 2017;10(1):76- 81 (Indonesia). 9. Mackey A, Gass SM. Second language research: Methodology and design: Routledge; 2015. 10. Sugiyono. Noanparametric Statistics for research. 2015. 11. Notoatmodjo S. Health Research Methodology. 2014 (Indonesia). 12. Budiono MA, Sulistyowati M. The role of School health program in giving health information about health reproduction for female students in government SMP X in Surabaya. Jurnal Promkes. 2013;1(2):184-91 (Indonesia). 13. Sari GNSN, Fitriana S, Anggraini DH. Factors of education, knowledge, parity, family supprot and family income which relate to antenatal service use. Jurnal Ilmu dan Teknologi Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 90 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN STIGMA AND JOB AND MARRIED ACCESSIBILITY IN HIV- AIDS PATIENTS IN KENDARI CITY Sri Zul Atmi1, Tasnim Tasnim2, Azis Harun3 123Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Sri Zul Atmi Email : [email protected] Abstract Background: Cumulatively, the number of HIV / AIDS cases in Southeast Sulawesi Province were 401 people consisting of 80 cases in Kendari City, 20 cases in Konawe, 1 case in North Ko nawe, 11 cases in East Kolaka, 34 cases in Kolaka, 10 cases in North Kolaka, 39 cases in South Konawe, Bombana 10 cases, Muna 27 cases, West Muna 15 cases, North Buton 26 cases, Bau- Bau 56 cases, South Buton 22 cases, Central Buton 16 cases, Buton 9 cases, Wakatobi 23 cases, and Konawe Islands District 2 cases. Meanwhile, a report from the Kendari City Health Office explained that there were an increase in HIV / AIDS positive cases in Kendari City, namely from 57 cases in 2019 an increase of 23 cases in 2020 so that the total number of HIV / AIDS cases in Kendari City was 80 cases. Methods: This quantitative study used an analytical survey method using a cross-sectional study approach. The population is all HIV / AIDS who sufferers in Kendari City in 2020, namely 80 people. The number of samples was 67 with the sampling technique using simple random sampling. Results: Job accessibility to stigma in people with HIV / AIDS based on the chi square test analysis with a significance level of 95%, obtained the value of X2 cal = 8,242> X2 tab = 3,841; p- value = 0.004 value of X2 cal = 21.102> X2 tab = 3,841; p-value = 0.000 the accessibility of being married to the stigma of HIV / AIDS sufferers in Kendari City. Conclusion: There is a weak relationship between job accessibility and marriage with the stigma of HIV / AIDS patients in Kendari City. Key words: Work, Marriage, Stigma, Accessibility Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 91 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION HIV virus is not the result of their behavior Human Immunodeviciency Virus that deviates from religious or moral norms. (HIV) / Acquired Immune Deficiency It is also said that the difficulty in accessing Syndrome (AIDS) it cannot be to get a decent job and being able to meet the underestimated again when seen from the needs of their family is limited due to the large number of sufferers(1). Because of this, stigma in the community, there are even the Indonesian government issued a sufferers who say that their own family Regulation of the Minister of Health of the distance themselves as a result of suffering Republic of Indonesia Number 21 of 2013 from HIV disease.(8). concerning HIV and AIDS prevention. In The still strong stigma of addition, the community also takes part in discrimination against people living with tackling HIV and AIDS in Indonesia, one of HIV / AIDS is a common problem faced by which is the AIDS Concerned Citizens districts / cities in Southeast Sulawesi in their Forum (WPA) which is expected to be a efforts to deal with HIV / AIDS, which media to provide information about HIV / makes it increasingly difficult for HIV / AIDS so that stigma and discrimination will AIDS sufferers to open up. (9). endpeople living with HIV / AIDS(2). In Cumulatively, HIV / AIDS cases in addition, with the WPA forum, it is also Southeast Sulawesi Province totaled 401 hoped that people who are at high risk will cases consisting of 80 cases in Kendari City, want to go to health services. This is 20 cases in Konawe, 1 case in North expected to improve the quality of service Konawe, 11 cases in East Kolaka, 34 cases better, which is not only limited to health in Kolaka, 10 cases in North Kolaka, 39 services but as a whole(3). And another hope cases in South Konawe. , Bombana 10 cases, from the WPA forum is that people infected Muna 27 cases, West Muna 15 cases, North with HIV / AIDS will open up so that Buton 26 cases, Bau-Bau 56 cases, South transmission can be controlled and receive Buton 22 cases, Central Buton 16 cases, therapy(4). Buton 9 cases, Wakatobi 23 cases, and Fear, stigma and discrimination Konawe Islands District 2 cases.Meanwhile, against people living with HIV / AIDS are a report from the Kendari City Health Office still major obstacles(5). Families and explained that there were an increase in HIV children living with HIV / AIDS are / AIDS positive cases in Kendari City, vulnerable to stigma and discrimination, namely from 57 cases in 2019 an increase of which can be seen in reduced access to 23 cases in 2020 so that the total number of services, loss of dignity and increased HIV / AIDS cases in Kendari City was 80 poverty and deprivation. Fear leads to cases. (9). resistance to HIV testing, embarrassment to start treatment, and in some cases reluctance METHOD to receive education about HIV. All of this This research is an analytical survey complicates epidemic control(6). research method using a cross-sectional The stigma of society towards people approach (10). The population in this study with HIV / AIDS will have an impact on were all HIV / AIDS sufferers in Kendari access to sufferers in almost all aspects, from City in 2020, amounting to 80 people. The access to education, information, getting number of samples in the study were 67 married, work and access to health services people. The sampling technique in this study to the economy of families with HIV positive used simple random sampling, which is a people.(7). Based on the results of interviews simple random sampling technique or in a preliminary study with 5 HIV sufferers, lots(11). they tend to feel ashamed and shut themselves off from society, even though the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 92 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULTS the relationship closeness test by looking at Table 1 shows that the distribution the value of phi show that the closeness of of respondents based on the accessibility of the accessibility relationship based on work work is in the good category, namely 40 with a stigma is 0, respondents (59.7%) and the less category is Table 4 shows that out of 36 27 respondents (40.3%). respondents based on the accessibility of Table 2 shows that the distribution being married, there are 23 people (63.9%) of respondents based on the accessibility of who do not get stigma and 13 people married in good category is 36 respondents (36.1%) experience stigma. Of the 31 (53.7%) and the less category is 31 respondents based on the poor accessibility respondents (46.3%). category, 2 people (6.5%) did not get stigma Table 3 shows that out of 40 and 29 people (93.5%) got the stigma. respondents based on the accessibility of The results of data processing good jobs, there are 21 people (52.5%) who performed using the chi square test analysis do not get stigma and 19 people (47.5%) with a significance level of 95%, were experience stigma. Of the 27 respondents obtained X2 hit value = 21,102> X2 tab = based on job accessibility, there were 4 3,841; pvalue = 0.000 <α = 0.05, so Ho is people (14.8%) who did not get stigma and rejected. This means that there is a 23 people (85.2%) got stigma. The results of relationship between the accessibility of data processing performed using chi square marriage and the stigma of HIV / AIDS test analysis with a significance level of sufferers in Kendari City. In addition, the 95%, obtained the value of X2 hit = 8,242> results of the relationship closeness test by X2 tab = 3,841; pvalue = 0.004 No. Profession n % 1. Good 40 59.7 2. Less 27 40.3 Total 67 100 Source: Primary Data 2020 Table 2 Distribution of Respondents Based on Accessibility to Married No. Married n % 1. Good 36 53.7 2. Less 31 46.3 Total 67 100 Source: Primary Data 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 93 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 The Relationship of Job-based Accessibility with Stigma for HIV / AIDS sufferers in Kendari City Stigma total Statistic test No. Profession Not Yes n % n % n % X2 cal = 8,242 1. Good 21 52.5 19 47.5 40 100 X2 tab = 3,841 2. Less 4 14.8 23 85.2 27 100 pvalue = 0.004 Total 25 37.3 42 62.7 67 100 φ = 0.382 Source: Primary Data 2020 Table 4 Accessibility Relationship Analysis based on Married with Stigma for HIV / AIDS sufferers in Kendari City Stigma total Statistic test No. Married Not Yes n % n % n % X2 cal = 21,102 1. Good 23 63.9 13 36.1 36 100 X2 tab = 3,841 2. Less 2 6.5 29 93.5 31 100 pvalue = 0.000 Total 25 37.3 42 62.7 67 100 φ = 0.592 Source: Primary Data 2020 DISCUSSION results of the relationship closeness test by looking at the value of phi show that the Job Accessibility Relationship with Stigma closeness of the accessibility relationship Employment can be related to based on work with a stigma is 0.382 or research results, that someone who already indicates a weak relationship. Research(12)in has a job and an income tends to be free to Mumbai that stigma and discrimination engage in risky behavior that results in HIV against people with HIV / AIDS occurs in and AIDS. The results showed that of the 40 the family, neighbors, communities, respondents based on the accessibility of workplaces, schools and health services. This good jobs, there were 21 people (52.5%) research is in line with the research who did not get stigma and 19 people conducted by(13)with the chi square results, (47.5%) experienced stigma. Of the 27 it was found that there was a relationship respondents based on job accessibility, there between the work variable and the stigma of were 4 people (14.8%) who did not get HIV sufferers, namely the calculated X2 stigma and 23 people (85.2%) got stigma. value> X2 table and the p value <0.005, The results of data processing namely 0.024. This is also consistent with performed using the chi square test analysis Lim's research in Vietnam which states that with a significance level of 95%, were work is a factor of stigma and discrimination obtained p-value = 0.004 <α = 0.05, so Ho is against people living with HIV / AIDS. rejected. This means that there is a Especially in individuals who work with relationship between knowledge of job HIV key populations such as sex workers. accessibility and stigma in people with HIV / HIV sufferers will be considered to be at risk AIDS in Kendari City. In addition, the according to their work(14). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 94 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 HIV who are single are more silent and do Accessibility Relationship between not have the courage to start a household, for Married and Stigma fear of spreading it to their partners. Research(15) which states that people who are married are more likely to get a CONCLUSION negative stigma because they engage in risky There is a weak relationship sexual behavior indicates that they are between job accessibility and marriage and engaging in unsafe sex (multiple partners). the stigma of HIV / AIDS sufferers in The results showed that Of the 36 Kendari City. So thatThere is a need for respondents based on the accessibility of cross-sector advocacy of health institutions, being married, there were 23 people (63.9%) religious leaders and institutionsgovernance who did not get a stigma and 13 people to create socialization activities about HIV (36.1%) experienced a stigma. Of the 31 andAIDS every month in order to reduce the respondents based on the poor accessibility stigma of societypeople living with HIV / category, 2 people (6.5%) did not get stigma AIDSthose who have worked can continue to and 29 people (93.5%) got the stigma. This work well and get a decent job according to is consistent with research which states that their abilities. As well as socialization people who are married can have a greater activities related to things that can be done risk of being infected with HIV and AIDS if by husband and wife suffererspeople living they have unsafe sex or have multiple with HIV / AIDS so as not to infect their partners.(16). partner, also to people living with HIV / The results of data processing AIDS unmarried. performed using the chi square test analysis with a significance level of 95%, were REFERENCES obtained p-value = 0.000 <α = 0.05, so Ho is rejected. This means that there is a 1. Rahayu DL, Sholihah AN. The effect of relationship between the accessibility of health promotion about HIV/AIDS to marriage and the stigma of HIV / AIDS attitude about HIV/AIDS prevention in sufferers in Kendari City. In addition, the SMK Ma’arif Yogyakarta: results of the relationship closeness test by STIKES'Aisyiyah Yogyakarta; 2015 looking at the value of phi show that the (Indonesia). closeness of the accessibility relationship 2. Nafiâ R, Huda S. Prevention of HIV based on marriage with a stigma is 0.592 or AIDS-Has Save Kids in Now for indicates a moderate relationship. students in SMK AL-Islam Kudus. The household life of couples living Jurnal Pengabdian Kesehatan. 2018 with HIV / AIDS is certainly different from (Indonesia). those of healthy couples in general, they will 3. Jayadipraja EA. The Relationship of definitely experience some more complex Accreditation with Quality of Service problems. Saturation of ARV drugs, people and Satisfaction of Health Care Center who are already HIV positive are required to Patients in East Kolaka District. Asian take ARV drugs every day for their entire Journal of Research in Nursing and life, the authors assume there must be Health. 2020:18-27. saturation with these drugs, but the facts in 4. Ditjen P, RI PK. Statistics of HIV/AIDS the field are different, people who are HIV cases in Indonesia. Jakarta: Kemenkes positive consider ARV drugs as food that RI. 2014 (Indonesia). must be consumed every time. day. 5. Ardani I, Handayani S. Stigma to Fear of the HIV virus which can HIV/AIDS people as a barrier to threaten the health of their partners and health service seeking: A case study families, the majority of people living with for injection Narcotics users in Jakarta. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 95 Atmi, S. Z., Tasnim,T., & Harun, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/60 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Indonesian Bulletin of Health Sanglah Denpasar. E-Jurnal Medika Research. 2017;45(2):81-8 (Indonesia). Udayana. 2017;6(3). 6. Yarmaji Adi Wicaksono, Alifiti 16. Thohari S. Perception from Pandangan Fitrikasari, Muchlis Achsan Udji dissability and accessibility to public Sofro, & Feni H.The relationship facility for dissability people in between stigma and ARV therapy with Malang Citu. IJDS: Indonesian complicated psychiatry disorders for Journal Of Disability Studies. HIV/AIDS patients. Jurnal Penyakit 2017;1(1). dalam Indonesia. 2018;Vol 5 (Indonesia). 7. Lubis NL. Psikologi Kespro. Women and reproduction growing: Based on Physical and Psychological aspects: Kencana; 2016 (Indonesia). 8. Shaluhiyah Z, Musthofa SB, Widjanarko B. Community Stigma to HIV/AIDS patients. Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal). 2015;9(4):333-9 (Indonesia). 9. Dinas Kesehatan Kota Kendari. The cases of HIV/AIDS. Sulawesi Tenggara. 2019 (Indonesia). 10. Mackey A, Gass SM. Second language research: Methodology and design: Routledge; 2015. 11. Sugiyono. Statistik Nonparametris Untuk Penelitian. 2015. 12. Hati K, Shaluhiyah Z, Suryoputro A. Community Stigma to ODHA in Kupang City, NTT Province. Jurnal Promosi Kesehatan Indonesia. 2017;12(1):62-77 (Indonesia). 13. Puspitaningrum W, Agusyahbana F, Mawarni A, Nugroho D. The effect of booklet media to female teenagers knowledge and attitude about personal hygiene during menstruation in Pondok Pesantren Al-Ishlah Demak Triwulan II Tahun 2017. Jurnal Kesehatan Masyarakat (Undip). 2017;5(4):274-81 (Indonesia). 14. Cote G, Silverstein DA, Lim SH, Lin S, Guo H. Systems and method for reducing fixed pattern noise in image data. Google Patents; 2013. 15. Saktina PU, Satriyasa BK. Characteristics of AIDS patients and opportunity to general hospital in Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 96 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access RISK OF ENVIRONMENTAL HEALTH RISK PARAMETERS NO2 AND COMPLAINTS OF RESPIRATION ON PUBLIC TRANSPORTATION DRIVERS (NEW CAMPUS-CITY) IN KENDARI CITY Asri Manafia1*, Erwin Azizi Jayadipraja2, Ridwan Adi Surya3 1,2Master of Public Health Study Program, Universitas Mandala Waluya, 3Department of Environmental Science, Halu Oleo University, In Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Asri Manafia Email : [email protected] Abstract Background:For Kendari City, the NO concentration in the air measured on Jl.Abdullah Silondae 2 street still below the quality standard. However, the NO2 concentration has increased and decreased based on the results of air monitoring from the Environment and Forestry Service regarding the Air Quality Index which is measured 2 times a year with NO2 parameters in 2017, the first measurement is the value obtained of 1.58 µg / m3 and the second measurement. amounting to 1.57 µg / m3. In 2018 the NO2 value in the first measurement was 4.2 µg / m3 and the second measurement was 5.23 µg / m3. Whereas in 2019 the NO2 value in the first measurement was 5.8 µg / m3 and in the second measurement was 3.8 µg / m3. Methods:This type of research is descriptive quantitative (Field Research and Laboratory Research). The population is the total number of public transportation and the number of drivers for the Baru- Kota Rayon 02 route, amounting to 154 public transportation units and 154 public transport drivers with the male gender. The samples are some of the public transport drivers for the New Kampus-Kota rayon 02 route. Results:Nitrogen dioxide (NO2) measurements were obtained96.85 µg / Nm3, 108.79 µg / Nm3 and 100.83 µg / Nm3 for 3 different locations. The highest respiratory complaints were cough symptoms for 47 people and the lowest was shortness of breath as many as 8 people. Conclusion:Risk management is carried out by reducing exposure time, planting trees that can absorb air pollution, maintaining endurance, limiting the age of motor vehicles and using environmentally friendly fuels. Key words: Nitrogen dioxide, Air pollution, Environmental health Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 97 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION motorized vehicle fumes, one of the Air is an important requirement in obstacles to air exchange is caused by the human, animal and plant life(1). The air that number of motorized vehicles that are not was originally fresh is now changing along balanced with the number of trees, besides with the development of industrialization and that the high consumptive nature of society modernization(2). This development can affect the high level of air pollution(7). certainly makes it easier for people to meet The large number of vehicles can their needs and maintain the country's increase the number of pollutants in the air, economic stability, but on the other hand this especially those in Kendari City. This is development actually endangers humans, the important to study, especially for people who environment and other living things(3). The are often exposed. The groups that are at risk development of industrialization and are those who are active around the road modernization can cause air pollution which such as drivers, traders, police and others(8). results in global warming, climate change One group of people who are at risk of being and the emergence of new diseases(4). exposed to air pollution are public transport Air quality is very much influenced drivers. In addition to the work environment by air pollution from vehicles (60%) and on the highway, this public transport driver industry (20-30%), especially in big cities(5). works more than 8 hours per day so that he is As the main source of air pollution in urban easily exposed to air pollution. areas, motorized vehicles have continued to Carbon monoxide (CO) and also experience an increase in demand in recent nitrogen dioxide (NO2) have specific effects years. In 2016 to 2017 it reached 7.17% from on health. Air quality monitoring only looks the previous year and in 2018 it increased by at the level of pollutants in the area as one of 5.57%. The largest percentage of motorized the air quality monitoring information but vehicles is occupied by the capital city of cannot take into account the level of risk to Jakarta, where in 2016 there were 19,848 health and estimate the effects of pollutant 324 units, in 2017 there were 20,730,267 gases specifically(9). To be able to find out units and in 2018 there were 21,897,192 how much the health risk arising from units. For Southeast Sulawesi, the number of polluting gases and risk management, this motorized vehicles also continues to increase study uses an approach called Environmental every year, recorded in 2016 the number of Health Risk Analysis(10). Environmental motorized vehicles was 1,478,725 units, in health risk analysis is an analytical method 2017 there were 1,532,732 units, in 2018 that tries to see how much risk arises from there were 1,612,811 units. Kendari City, the exposure to these pollutants and the amount capital city of Southeast Sulawesi Province, of intake that enters the human body causing has the largest population. It's the same with specific effects on health and steps that must other cities, Kendari City is experiencing an be taken in risk management so as to reduce increasing number of transportation needs. the effects of these pollutants(11). The number of vehicles, both cars and By looking at the current motorbikes in Southeast Sulawesi in 2015- environmental conditions, especially air 2016 was 17,311 units and 2017 was 17,165 pollution, this has not caused a very specific units(6). effect so that the ARKL method can estimate In Indonesia, air pollution occurs in the risk. A vehicle city with a fairly good big cities such as Jakarta, Surabaya, level of air pollution will not always be good Bandung and other big cities. However, if the growth in the number of vehicles is nowadays, air pollution is not only increased and the presence of industrial happening in big cities but has also happened centers so that this will increase the level of to other cities. The most important source of air pollution. air pollution in Indonesia comes from Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 98 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 METHOD location 3 with coordinates S03058'22.28 This type of research is a descriptive "E122036'00.21" of 100.83 µg / Nm3. quantitative research type (Field Research Table 2. The duration of 8 hours of and Laboratory Research)(12). The exposure was 3 people (2.70%), 8 people of population is the entire number of public 9 hours of exposure (7.21%), 25 people of 10 transports and the number of drivers for the hours of exposure (22.52%), 7 people of 11 New campus-city Rayon 02 route totaling hours of exposure ( 6.31%), 12 people of 12 154 public transportation units and 154 hours of exposure (22.52%), 26 people of 13 public transport drivers with the male hours of exposure (10.81%), 12 people of 14 gender. The air population is all the routes hours of exposure (10.81%) and 5 hours of traversed by the new-city campus public exposure people (4,50%). transportation in Kendari City. The sample in Table 3. The level of risk is this study were some of the public transport calculated based on the duration of current drivers for the Kampus Baru-Kota rayon 02 exposure and projected over the next 30 route with sampling techniques using years. Assuming that the data related to Accidental Sampling and Probability intake, namely nitrogen dioxide Sampling(13) concentration, inhalation rate, frequency of exposure, body weight do not change for the next 30 years. RESULT Table 4. There were 47 respiratory Table 1. Obtained the measurement complaints with cough symptoms, 15 results of nitrogen dioxide (NO2) at location sneezing, 16 nasal congestion, 12 colds, 9 1 with coordinatesS03058'22.28 sore throats, 32 headaches, 29 unwell, 33 "E122036'00.21" of 96.85 µg / Nm3.At muscle pain, 12 fever and shortness of location 2 with coordinates S03058'22.28 breath. breath as many as 8 people. "E122036'00.21" of 108.79 µg / Nm3.At Table 1 Nitrogen Dioxide Concentration in Air, 2021 Yield No. Coordinate Location (µg / TLV (µg / Method Nm3) Nm3) S 030 58 '22.28 " 1 location 1 96.85 400 SNI 19-7119.1-2005 E 1220 36'00.21 " S 030 57 '52.12 " 2 location 2 108.79 400 SNI 19-7119.1-2005 E 1220 31'7.29 " S 030 59 '34.87 " 3 location 3 100.83 400 SNI 19-7119.1-2005 E 1220 30'45.91 " Source: Primary Data 2021 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 99 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Distribution of Length of Exposure Each Day, Year 2021 No. Exposure (Hour / Day) total Percentage (%) 1 8 3 2.70 2 9 8 7.21 3 10 25 22.52 4 11 7 6.31 5 12 25 22.52 6 13 26 23.42 7 14 12 10.81 8 15 5 4.50 Total 111 100 Source: Primary Data 2021 Table 3 Risk Quetion for Nitrogen Dioxide (NO2) Concentration in 2021 Risk Quotien (RQ) (I / RfC) = 0.02 NO NAME Point 1 Point 2 Point 3 1 Respondent 001 0.6522322 0.73264161 0.67903533 2 Respondent 002 0.4588213 0.51538642 0.47767637 3 Respondent 003 0.9810435 1.10198986 1.02135893 4 Respondent 004 0.8029374 0.90192623 0.83593365 5 Respondent 005 0.8947016 1.00500351 0.93146892 6 Respondent 006 0.5918408 0.66480492 0.61616215 7 Respondent 007 0.9109689 1.0232763 0.94840472 8 Respondent 008 0.4290278 0.48191977 0.44665842 9 Respondent 009 1.0136571 1.13862422 1.05531281 10 Respondent 010 0.7455847 0.83750293 0.7762241 11 Respondent 011 0.3670571 0.41230913 0.3821411 12 Respondent 012 0.9635248 1.08231147 1.00312038 13 Respondents 013 0.758707 0.85224298 0.78988565 14 Respondents 014 0.5836208 0.65557152 0.60760434 15 Respondents 015 0.5101014 0.57298843 0.53106373 16 Respondents 016 0.5208242 0.58503323 0.54222723 17 Respondents 017 0.6897336 0.77476634 0.71807786 18 Respondents 018 0.6503203 0.73049398 0.67704484 19 Respondents 019 0.5074963 0.57006219 0.5283516 20 Respondent 020 0.9324434 1.0473982 0.97076166 21 Respondent 021 0.8309177 0.93335606 0.86506381 22 Respondent 022 0.8404139 0.94402299 0.87495025 23 Respondent 023 0.5279588 0.59304738 0.549655 24 Respondents 024 0.711526 0.7992454 0.74076582 25 Respondents 025 0.7540629 0.84702637 0.78505073 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 100 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Risk Quotien (RQ) (I / RfC) = 0.02 NO NAME Point 1 Point 2 Point 3 26 Respondents 026 0.758707 0.85224298 0.78988565 27 Respondent 027 0.7137221 0.8017122 0.74305213 28 Respondent 028 0.4668966 0.52445722 0.48608347 29 Respondents 029 0.4771742 0.53600187 0.49678343 30 Respondents 030 0.6366772 0.71516893 0.6628411 31 Respondent 031 0.8947016 1.00500351 0.93146892 32 Respondents 032 0.8754311 0.98335728 0.91140651 33 Respondent 033 0.6271745 0.70449477 0.65294795 34 Respondent 034 0.5005324 0.56223973 0.52110149 35 Respondents 035 0.6741865 0.75730249 0.70189181 36 Respondents 036 0.6506921 0.73091164 0.67743194 37 Respondent 037 0.6464722 0.72617153 0.67303866 38 Respondent 038 0.5667793 0.63665381 0.59007081 39 Respondent 039 1.032348 1.15961944 1.07477183 40 Respondents 040 0.9804829 1.10136016 1,0207753 41 Respondent 041 0.466598 0.52412178 0.48577258 42 Respondent 042 0.8129003 0.91311748 0.84630605 43 Respondent 043 1.0791478 1,21218885 1.12349482 44 Respondents 044 0.9104484 1.02269157 0.94786277 45 Respondents 045 0.7372052 0.82809034 0.76750022 46 Respondent 046 0.466598 0.52412178 0.48577258 47 Respondent 047 0.3871305 0.43485729 0.40303944 48 Respondents 048 0.3539479 0.39758381 0.3684932 49 Respondent 049 0.8129003 0.91311748 0.84630605 50 Respondents 050 0.5585651 0.62742694 0.58151906 51 Respondent 051 1.0376421 1.1655662 1.08028348 52 Respondent 052 0.6777531 0.76130886 0.70560504 53 Respondent 053 0.6506921 0.73091164 0.67743194 54 Respondents 054 0.4244515 0.47677929 0.44189407 55 Respondent 055 1.3444532 1,51020206 1.39970285 56 Respondents 056 0.3771134 0.42360527 0.39261072 57 Respondent 057 0.7542176 0.84720012 0.78521177 58 Respondent 058 0.7007453 0.78713562 0.72954209 59 Respondent 059 0.7181552 0.80669178 0.74766736 60 Respondents 060 0.758707 0.85224298 0.78988565 61 Respondent 061 0.7157613 0.80400281 0.74517514 62 Respondent 062 0.5407537 0.6074197 0.56297572 63 Respondent 063 0.6166559 0.69267934 0.64199704 64 Respondent 064 0.8430078 0.94693664 0.87765072 65 Respondent 065 0.5226455 0.58707897 0.54412329 66 Respondent 066 0.5505856 0.6184637 0.57321164 67 Respondent 067 0.7226436 0.8117336 0.75234028 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 101 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Risk Quotien (RQ) (I / RfC) = 0.02 NO NAME Point 1 Point 2 Point 3 68 Respondent 068 0.6506921 0.73091164 0.67743194 69 Respondent 069 0.9466209 1.06332355 0.98552177 70 Respondents 070 0.5002464 0.56191845 0.52080372 71 Respondent 071 0.6777531 0.76130886 0.70560504 72 Respondent 072 0.4037628 0.45354005 0.42035521 73 Respondent 073 0.4199382 0.4717096 0.43719532 74 Respondents 074 0.5341502 0.6000021 0.55610085 75 Respondents 075 0.7003449 0.78668583 0.72912521 76 Respondents 076 0.7137221 0.8017122 0.74305213 77 Respondent 077 0.711526 0.7992454 0.74076582 78 Respondents 078 0.7104948 0.79808707 0.73969224 79 Respondents 079 0.6006389 0.67468767 0.62532179 80 Respondents 080 0.6897336 0.77476634 0.71807786 81 Respondents 081 0.5138799 0.57723279 0.53499753 82 Respondents 082 0.6411608 0.72020533 0.667509 83 Respondents 083 0.6565733 0.73751796 0.68355489 84 Respondents 084 0.3932754 0.44175979 0.40943689 85 Respondents 085 0.6366772 0.71516893 0.6628411 86 Respondents 086 0.3348156 0.37609279 0.34857465 87 Respondents 087 0.758707 0.85224298 0.78988565 88 Respondents 088 0.688232 0.77307962 0.71651456 89 Respondents 089 0.5729067 0.64353655 0.59644995 90 Respondents 090 0.3643581 0.40927745 0.37933124 91 Respondent 091 0.8129003 0.91311748 0.84630605 92 Respondent 092 0.6644999 0.74642171 0.69180716 93 Respondent 093 0.8702805 0.97757165 0.90604421 94 Respondents 094 0.5756259 0.64659109 0.599281 95 Respondents 095 0.5505856 0.6184637 0.57321164 96 Respondents 096 0.4668966 0.52445722 0.48608347 97 Respondent 097 0.914532 1.02727869 0.95211426 98 Respondents 098 0.4235274 0.47574131 0.44093203 99 Respondents 099 0.4863506 0.5463096 0.50633695 100 Respondents 100 0.7078958 0.79516761 0.7369864 101 Respondents 101 0.6477478 0.72760435 0.67436664 102 Respondents 102 0.5989792 0.6728234 0.62359393 103 Respondents 103 0.4129392 0.46384777 0.42990873 104 Respondents 104 0.5505856 0.6184637 0.57321164 105 Respondents 105 0.608542 0.68356514 0.63354971 106 Respondents 106 0.5935126 0.6666829 0.61790272 107 Respondents 107 0.7640126 0.85820272 0.79540932 108 Respondents 108 0.6513971 0.73170353 0.67816589 109 Respondents 109 0.8195525 0.9205898 0.85323163 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 102 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Risk Quotien (RQ) (I / RfC) = 0.02 NO NAME Point 1 Point 2 Point 3 110 Respondents 110 0.6285147 0.7060001 0.65434314 111 Respondents 111 0.7017268 0.78823805 0.73056386 Source: Primary Data 2020 Table 4 Respondents' Respiratory Complaints in 2021 No. Respiratory complaints total 1 Cough 47 2 Sneezing 15 3 Nasal congestion 16 4 Cold 12 5 Sore throat 9 6 Headache 32 7 Unwell 29 8 Muscle ache 33 9 Fever 12 10 Hard to breathe 8 Source: Primary Data 2020 DISCUSSION Standard based on PP No. 41 of 1999 concerning air pollution control with a value Nitrogen Dioxide (NO2) of 400 µg / Nm3. The low concentration of Measurement of air quality in this nitrogen dioxide was caused by the presence study was taken during busy traffic hours of several trees that function as an absorber with a location on the side of the highway. of air pollutants which affect the nitrogen Measurements were carried out 3 times at dioxide concentration at the study site, different locations to better represent the especially at location 1 and location 2. conditions at the research location. Nitrogen dioxide concentration is also Measurement of each concentration at influenced by the density of traffic around location 1 starts at 13.00 WITA, the study site. The higher the vehicle measurement at location 2 starts at 15.00 volume, the higher the NO2 Wita and at location 3 starts at 16.30 WITA. concentration(14). Location 1 is a vehicle The measurement results for nitrogen lane with a fairly dense level at the time of dioxide at location 1 were 96.85µg / Nm3, at the study because at that time it is the time location 2 it was 108.79 µg / Nm3, and at the ship's passengers disembark so that location 3 it was 100.83 µg / Nm3. The traffic jams occur at that location. The average temperature at location 1 is 330C, existence of trucks and other public transport location 2 is 320C and location 3 is 310C. cars that are quite congested and With an average air temperature of 28.10C experiencing congestion has the potential to and an average humidity of 85%. With a increase nitrogen dioxide. Vehicle speed rainfall of 8.8 mm and an average wind affects the emission of nitrogen dioxide gas speed of 1 m / s. The results of measuring the produced. As the vehicle speed increases, the concentration of Nitrogen dioxide at 1 hour nitrogen dioxide concentration will also measurement show low results when increase, the change in nitrogen dioxide compared with the Ambient Air Quality concentration is clearly visible when the car Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 103 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 is moving from medium speed to high speed. dioxide. The maximum permissible The age of the vehicle, engine maintenance, concentration for occupational (work- smooth traffic, how to drive, and differences related) exposure to nitrogen dioxide has in fuel use can all affect the concentration of been set at 8 ppm over an 8 hour period. nitrogen dioxide produced.concentration However, even at much lower nitrogen dioxide the result is also estimated concentrations, nitrogen dioxide causes an to be influenced by the existence of increase in the incidence of acute bronchitis transportation activities (15). in children and an increase in airway At point 2 the situation around the resistance in adults.(17). Similarly, research research location is not crowded and there is conducted by Irawan in 2016 showed a a lack of human activity at that hour. The positive relationship from the correlation traffic density at location 2 occurs in the analysis of NO2 to the incidence of ARI(18). morning and evening so that the high NO2 gas with various exposures from 30 concentration of nitrogen dioxide minutes to 24 hours will cause various accumulates, which comes from the traffic adverse effects such as inflammation of the density that occurs in the morning. respiratory tract in healthy people and an At location 3, the motorized vehicles increase in symptoms of respiratory disease are quite congested because that hour is the in people with asthma(19). time to come home from work. The research Nitrogen dioxide gas (NO2) is a gas location at point 3 is around a red light which that is toxic to humans and generally irritates automatically stops the vehicle with the the respiratory system. Even though the engine still running, causing the nitrogen amounts are still far below the quality dioxide concentration to increase due to standard, if humans are continuously combustion in an incomplete engine. exposed to nitrogen dioxide (NO2) gas in Apart from traffic density factors, other small amounts it can irritate the respiratory factors that affect the concentration of carbon system. The organs of the body most monoxide in ambient air are meteorological sensitive to NO2 gas pollution are the lungs. factors such as temperature, humidity, wind Lungs that are contaminated with NO2 gas direction and speed, air pressure and rainfall. will swell so that the patient has difficulty The research was conducted to coincide with breathing, then NO exposure at a level of 5 the rainy season and the weather conditions ppm for 10 minutes to humans can cause were cloudy so that this affected the difficulty in breathing(20). difference in concentration at each research point. Risk characteristics The temperature in the air affects the In accordance with the results of the concentration of nitrogen dioxide gas. the calculation of the level of risk (RQ), it is higher the air temperature, the higher the obtained that new campus public transport NO2 concentration. Decreased NO drivers of working cities have an RQ <1 for concentration₂occurs when the wind speed is the next 30 years on carbon monoxide high, and vice versa. the higher the wind exposure provided that carbon monoxide speed, the NO concentration₂generated will concentration, exposure time and body be smaller because pollutants carried by the weight do not change for 30 years. the next wind away from the measurement location. year. This means that new-city campus The effect of humidity on pollutant public transport drivers in Kendari city are concentrations is that if the humidity still in the safe category. For nitrogen increases, it can increase the concentration of dioxide exposure, the RQ calculation results pollutants in the ambient air(16). for new-city campus public transport drivers The respiratory tract is a very in Kendari City, there are 15 drivers (13.5%) influential organ when exposed to nitrogen who are at risk due to nitrogen dioxide Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 104 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 exposure. For example, one respondent who formed, the normal cleansing process may weighs 38 kg, nitrogen dioxide concentration not function properly. When this happens, 0.10879 mg / m3, who works for 11 hours / the mucous membrane is stimulated and the day, 318 days / year and works for 3 years mucus is coughed out as sputum which is with an RfC value of NO2 0, commonly called a cough with phlegm(22). Sputum or phlegm is the secretions that are excreted from the lungs and throat through the mouth. I = Shortness of breath is one of the factors that underlie the symptoms of = 0.022722 mg / kg / day respiratory distress(23). Air pollution causes RQ = several effects on the respiratory tract, namely the movement of cilia slows down = and even becomes stopped, damage to bacteria-killing cells in the respiratory tract, = 1.138624 mg / kg / day excess mucus production which causes constriction of the respiratory tract, swelling This means that the new-city campus of the respiratory tract, and increases cell public transport route with a NO2 growth so that the respiratory tract becomes concentration of 0.10879 mg / m3 is not safe narrow(24). This is what causes shortness of (non-carcinogenic) for public transport breath. Respiratory tract disorders are drivers with an inhalation rate of 0.83 / hour influenced by various factors caused by for 318 days / year who work 11 hours / day several factors from the individual, namely with heavy 38kg body in the next 30 years. age, length of work, years of service, use of The large RQ value results in a high Personal Protective Equipment (PPE) in the risk of poisoning to a person due to motor form of masks and smoking habits. vehicle emissions. This risk can occur due to Age is one of the characteristics of the accumulation of gas that enters the body respondents who have a high risk of which is increasing over time which will respiratory tract disorders. At that age, there have an impact on their health(21). is a decrease in the strength of the respiratory Public transport drivers experience muscles and the chest wall, as a result the respiratory complaints. This is a disease that ability of the respiratory tract muscles to arises due to work done on the road so that close and open during breathing increases in public transport drivers are the workers most number. The longer a person is exposed to an at risk of air pollution (NO2). air pollutant, the higher the risk of health Respiratory complaints are problems, especially respiratory disorders. disturbances in the respiratory tract due to Substances that are inhaled in high constant exposure to pollutants in the air. concentrations and for a long enough time The longer the individual is exposed to air will endanger their health(25). pollutants, the greater the likelihood of Someone who works outdoors and is in respiratory complaints(8). Based on the the vicinity of the pollutant source will be results of the study, public transport drivers directly exposed to these air pollutants and experience respiratory complaints that come experience health problems, so that someone from disturbances in the work environment, who is exposed to continuous exposure will namely public transportation routes in the experience inflammation of the respiratory form of gas, smoke, and dust in ambient tract, respiratory tract irritation, coughing, air(22). difficulty breathing, causing or worsening The production of mucus increases due respiratory diseases such as asthma to irritation from gases and particles that enter the respiratory tract. If excess mucus is Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 105 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Another thing that affects the level of 5. Jayadipraja EA, Daud A, Assegaf AH. risk and respiratory complaints due to Air Pollution and Lung Capacity of exposure to carbon monoxide and nitrogen People Living around the Cement dioxide is the use of personal protective Industry. Public Health of Indonesia. equipment which is still lacking, in terms of 2016;2(2):76-83. the work that the respondents are doing 6. Statistik BP. Badan pusat statistik. requires them not to use personal protective Badan Pusat Statistik. 2019. equipment and car windows must be open so 7. PEPO MMP. Risk analysis of health that the air is polluted. it will be easier to environement caused by air pollution enter. In addition, the smoking habit of the exposure of no2, so2, pb and tsp to respondents, who are mostly smokers, can traders in Ledeng, cicaheum and Leuwi increase the health risks that arise. Shelters in Panjang Bandung City: Fakultas Teknik Unpas; 2020 CONCLUSION (Indonesia). Risk management is carried out by 8. Sandra C. The effect of decreasing of reducing exposure time, planting trees that air quality to lung and respiration can absorb air pollution, maintaining problems for travic policy Polwiltabes endurance, limiting the age of motor vehicles Surabaya. IKESMA. 2013;9(1) and using environmentally friendly fuels. (Indonesia). And it is hoped that public transportation 9. Amaliana A, Darundiati YH, Dewanti drivers, especially new-city campus public NAY. Risk analysis of health transport drivers in Kendari City, reduce environment of Nitrogen Dioksida working time in order to reduce the risks that (No2) exposure to traders in will occur and not smoke while doing their Pulogadung shelter in Jakarta Timur. work and wear masks. Jurnal Kesehatan Masyarakat (e- Journal). 2016;4(4):801-9 (Indonesia). REFERENCES 10. Rohmadini A, Saifi M, Darmawan A. 1. Ismiyati I, Marlita D, Saidah D. Air Effect of Profitabily, Likuidity and pollution caused by gasses from motor Leverage to Financial Distress (Study cycle waste. Jurnal Manajemen in Food & Beverage industry where Transportasi & Logistik. registered in Bursa Efek Indonesia 2014;1(3):241-8 (Indoensia). Periode 2013-2016). Jurnal 2. Susanti ED. Environmental Kuznet Administrasi Bisnis. 2018;61(2):11-9 Curve: The relationship between (Indonesia). economic grow and Degradation of ait 11. Besmanto N. Guideline of risk analysis quality in achieving in Millenium of health environement. Direktorat Development Goals in Indonesia. Jenderal PP dan Pl Kementerian Universitas Negeri Yogyakarta. 2018 Kesehatan; 2012 (Indonesia). (Indonesia). 12. Mackey A, Gass SM. Second language 3. Sahban MA, SE M. Colaboration of research: Methodology and design: economic grow in developing Routledge; 2015. countries. Sah Media; 2018 13. Sugiono S. Research Methods of (Indonesia). qualitative and quantitative 4. Ruhiat D, Suwanda C. Forcase of time researchand R & D. Bandung: frame of season in using spectral Alfabeta. 2019 (Indonesia). regresstion: A case study of Debit in 14. Dwirahmawati F, Nasrullah N, Citarum-Nanjung river. Teorema: Sulistyantara B. Analysis of Teori dan Riset Matematika. consentration change of Nitrogen 2019;4(1):1-12. Dioksida (NO2) pada Area Bervegetasi Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 106 Manafia, A., Jayadipraja, E. A., & Surya, R. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/61 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 and no vegetation in Simpang Susun Journal of Occupational Safety and street. Jurnal Lanskap Indonesia. Health. 2014;3(1):46-57. 2018;10(1):13-8. 22. Hikmiyah AF. Analisis Kadar Debu 15. Agustina T, Jatmika D, Asnawi A, Dan NO2 Di Udara Ambien Serta Wahab A, Rusvitawati D, editors. Keluhan Pernapasan Pada Pekerja Pandemi Covid-19: Mempercepat Penyapu Di Terminal Purabaya UMKM Dalam Sistem Informasi. Kabupaten Sidoarjo. Jurnal Kesehatan Seminar Nasional Sistem Informasi Lingkungan Vol. 2018;10(2):138-48. (SENASIF); 2020. 23. Fitriana D, Siwiendrayanti A. Kualitas 16. Romansyah M. Analisis korelasi Udara Dan Keluhan Sesak Napas karbon monoksida (CO) dan Pemulung Di Tempat Pembuangan particullate metter (PM10) dengan Akhir. HIGEIA (Journal of Public kendaraan bermotor dan faktor yang Health Research and Development). berhubungan (studi kasus pasar induk 2019;3(3):357-68. tradisional Bojonegoro: UIN Sunan 24. Mukono H. Aspek Kesehatan Ampel; 2019. Pencemaran Udara: Airlangga 17. Sodhi MS. Conceptualizing social University Press; 2011. responsibility in operations via 25. Syafrianto A. Hubungan Karakteristik stakeholder resource‐based view. Pekerja Dan Pemakaian Masker Production and Operations Dengan Keluhan Gangguan Pernafasan Management. 2015;24(9):1375-89. Pada Penyemprot Herbisida (Studi di 18. Drescher J, Rembold K, Allen K, PT Gunung Sejahtera Dua Indah, Beckschäfer P, Buchori D, Clough Y, Kalimantan Tengah): Universitas et al. Ecological and socio-economic Airlangga; 2011. functions across tropical land use systems after rainforest conversion. Philosophical Transactions of the Royal Society B: Biological Sciences. 2016;371(1694):20150275. 19. Riani PD. Gambaran Kualitas Udara Ambien (SO2, NO2, TSP) terhadap Keluhan Subyektif Gangguan Pernapasan pada Pedagang Tetap di Kawasan Terminal Bus Kampung Rambutan Jakarta Timur Tahun 2017: UIN Syarif Hidayatullah Jakarta: Fakultas Kedokteran dan Ilmu Kesehatan, 2017; 2017. 20. Sari M. Analisa Kadar Co dan No2 di Udara dan Keluhan Gangguan Saluran Pernapasan pada Pedagang Kaki Lima di Pasar Sangkumpal Bonang Kota Padangsidimpuan Tahun 2013. Lingkungan dan Keselamatan Kerja. 2014;3(1):14469. 21. Rose KDC, Tualeka AR. Penilaian risiko paparan asap kendaraan bermotor pada polantas polrestabes Surabaya tahun 2014. The Indonesian Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 107 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN BENEFITS AND CONSTRAINTS PERCIEVED WITH THE HABIT OF SMOKING IN HEALTH PROFESSIONALS IN LATAMBAGA SUB-DISTRICT KOLAKA DISTRICT Martina Pingak1, Tasnim Tasnim2, Herianto Wahab3 123Master of Public Health Study Program, Universitas Mandala Waluya, In Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Martina Pingak Email : [email protected] Abstract Background:From the results of a preliminary study conducted at the Kolakaasi Health Centre and Latambaga Health Centre, through direct interviews and direct observation that out of 10 (ten) health workers who were observed, 7 (seven) were active smokers and 3 (three) were non- smokers. Therefore, through this research, the researcher wants to conduct in-depth research related to the smoking habits of health workers in which a health worker should be able to provide a good example for the community. Methods:This research is an analytical survey using a cross-sectional approach. The population in this study were 106 all health workers in Latambaga District, with a sample size of 84 respondents using the sampling techniqueSimple random sampling. Result s:Based onanalysis of the chi square test for the benefit variable has a significance level of 95% was obtained p-value = 0.000 <α = 0.05, so Ho is rejected. The constraint variable based on the chi square test analysis has a significance level of 95%, the obtained p-value = 0,000 <α = 0.05, so Ho is rejected. Conclusion: There is a significant between perceived benefits and constraints with habits smoking health personnel in the Latambaga Sub-District, Kolaka Regency. Key words: Benefits, Constraints, Smoking habits, Health workers Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 108 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION smoked and chewed tobacco tended to The World Health Organization increase in Riskesdas 2007 (34.2%), (WHO) explains that smoking kills six Riskesdas 2010 (34.7%) and Riskesdas 2013 million people per year worldwide, including (36.3%). Compared to the Global Adults more than 600,000 passive smokers. Most Tobacco Survey (GATS) research on the developing countries have low rates of population age group = 15 years, the quitting smoking, despite various anti- proportion of male smokers is 67.0 percent smoking campaigns around the world. Based and in the 2013 Riskesdas was 64.9 percent, on this latest data, the number of smokers Basic Health Research Data worldwide increased by almost 250 million (Riskesdas) in 2018 shows that the national between 1980 and 2012. The number of smoking prevalence is 24.3%. The smokers worldwide increased to nearly one prevalence of smoking according to sex, billion people and in a number of countries where the prevalence in men is 47.3% and including Indonesia and Russia more than women are 1.2%. According to the age half of the total male population smoked group, the highest prevalence was at the age every day(1). of 30-34 at 32.2%, while at the young age / The factors that cause a person to tend novice smoker (19 years) was 13.4%. to smoke are uncertain. All of this indirectly According to the place of residence, the indicates the weak awareness in each prevalence of smoking in rural and urban individual and the mindset they have, so that areas is not too different, however in rural without thinking they fall into the habit of areas it is slightly higher (25.8%) than in smoking.(2). So it needs community urban areas (23.0%). counseling and empowerment, then it needs The report on the proportion of cross-sector participation and involvement as smoking in the population in Southeast well as parties who can set an example in Sulawesi Province according to the 2018 society(3). Riskesdas based on the category of daily Most of the reasons for smokers are smokers was 22.3%, occasional smokers because it has been a habit for a long time 3.7%, former smokers 4.0%, and non- and has been a routine for a long time. The smokers 70.0%. Whereas in Kolaka location selection in Latambaga District was Regency, based on the report on the Health based on the consideration that no research Promotion Sector Health Office of Kolaka had been conducted on the smoking habit of Regency in 2017, it was known that the health workers. In addition, in Latambaga proportion of smokers was 9,360 people Subdistrict itself there are 2 (two) Puskesmas (48.1%), in 2018 there were 8,472 (34%) and namely Latambaga Puskesmas and in 2019 there were 9,121 people (31%).(4). Puskesmas Kolakaasi which will be included in the scope of smoking habit research METHOD among health workers. This research is an analytical survey The highest proportion of daily active research method using a cross-sectional smokers at the age of 30-34 years was 33.4 approach, in which the independent variable percent, more men than women smokers and the dependent variable are measured (47.5% vs 1.1%). Based on the type of work, simultaneously. The study was conducted in farmers / fishermen / laborers are active December 2020 with a population of 106 smokers every day with the largest people and a sample of 84 respondents with proportion (44.5%) compared to other all health workers in Latambaga DistrictThe occupational groups. The proportion of daily sampling technique uses simple random smokers appears to tend to decline in the sampling technique. higher quintiles of the ownership index. The proportion of population aged = 15 who Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 109 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULTS addition, the results of the correlation test by Table 1 shows that the distribution looking at the value of phi showed that the of respondents based on the benefit category closeness of the relationship between is sufficient, namely as many as 52 people benefits and smoking was 0.481 or showed a (61.9%) and less categories as many as 32 moderate relationship. people (38.1%). Table 4 shows that of the 55 Table 2 shows that the distribution respondents based on the light category of respondents based on the constraints of constraints, there are 45 people (81.8%) who the light category is as many as 55 people do not smoke and 10 people (18.2%) smoke. (65.5%) and the heavy category is 29 people Of the 29 respondents based on the weight (34.5%). category constraints, there were 4 people Table 3 shows that from 52 (13.8%) who did not smoke and 25 people respondents based on the benefit category is (86.2%) smoked. The results of data sufficient, there are 40 people (76.9%) who processing performed using the chi square do not smoke and 12 people (23.1%) smoke. test analysis with a significance level of Of the 32 respondents based on the benefit 95%, the obtained p-value = 0.000 <α = 0.05, category less, there were 9 people (28.1%) so Ho is rejected. This means that there is a who did not smoke and 23 people (71.9%) relationship between the constraints and smoked. The results of data processing smoking habits of health workers in the performed using the chi square test analysis Latambaga District, Kolaka Regency. In with a significance level of 95%, the addition, the results of the correlation test by obtained p-value = 0.000 <α = 0.05, so Ho is looking at the value of phi show that the rejected. This means that there is a closeness of the relationship between relationship between the perceived benefits constraints and smoking habits is 0.656 or and smoking habits of health workers in the indicates a strong relationship. Latambaga District, Kolaka Regency. In Table 1 Distribution of Respondents Based on Benefits in the Latambaga Sub-District, Kolaka Regency No. Benefits n % 1. Enough 52 61.9 2. Less 32 38.1 Total 84 100 Source: Primary Data 2020 Table 2 Distribution of Respondents Based on Constraints in the Sub-District of Latambaga, Kolaka Regency No. Obstacles n % 1. Light 55 65.5 2. Weight 29 34.5 Total 84 100 Source: Primary Data 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 110 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 Analysis of the Relationship between Health Workers' Benefits and Smoking Habits in the Latambaga Sub-District, Kolaka Regency Smoking habit total Statistic test No. Benefits Not Smoke n % n % n % X2 test = 17.452 1. Enough 40 76.9 12 23.1 52 100 X2 table = 3,841 2. Less 9 28.1 23 71.9 32 100 pvalue = 0.000 Total 49 58.3 35 41.7 84 100 φ = 0.481 Source: Primary Data 2020 Table 4 Analysis of the Relationship of Constraints and Smoking Habits of Health Workers in the Latambaga Sub-District, Kolaka Regency Smoking habit total Statistic test No. Obstacles Not Smoke n % n % n % X2 test = 33,406 1. Light 45 81.8 10 18.2 55 100 X2 table = 3,841 2. Weight 4 13.8 25 86.2 29 100 pvalue = 0.000 Total 49 58.3 35 41.7 84 100 φ = 0.656 Source: Primary Data 2020 DISCUSSION relationship between the perceived benefits and smoking habits of health workers in the Perceptions of Benefits with Smoking Latambaga Sub-District, Kolaka Regency. In Habits addition, the results of the correlation test by If the individual feels himself looking at the value of phi showed that the vulnerable to diseases that are considered closeness of the relationship between serious (serious), he will take certain actions. benefits and smoking was 0.481 or showed a This action will depend on the benefits felt moderate relationship. when taking the action. In general, the The results of this study are in line benefits of the action determine more than with research conducted by (6) The results of the obstacles that may be found in doing the the Spearman test for the variable perception action(5). of the benefits of smoking cessation The results showed that of 52 motivation have a significance value of respondents based on the benefit category 0.003 (p <0.05), which means that there is a sufficient, there were 40 people (76.9%) who relationship between perceptions of the did not smoke and 12 people (23.1%) benefits of quitting smoking and motivation smoked. Of the 32 respondents based on the to quit smoking. benefit category less, there were 9 people The research results are in accordance (28.1%) who did not smoke and 23 people with the theory (7), which explains that the (71.9%) smoked. low perception of the benefits of quitting The results of data processing smoking can significantly affect a person's performed using the chi square test analysis willingness or motivation to quit smoking. with a significance level of 95%, were This is because the perception of benefits is a obtained p-value = 0.000 <α = 0.05, so Ho is strong predictor of the health belief model, rejected. This means that there is a which is the background for various choices Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 111 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 of actions including behavior change to they would be more economical if they did reduce the threat of a disease. The tendency not smoke, they would be prone to disease if for someone to want to quit smoking can be they inhaled cigarette smoke, their bodies motivated by an illness that has been would be healthier if they did not smoke, and suffered before. In addition, the perceived they were afraid of lung cancer if they benefits of quitting smoking can also be a smoked. contributing factor. The perceived benefit factor here is a Perception of Constraints with Smoking person's belief in the success of the action to Habits quit smoking. 52 respondents have a good Potential aspects of a health measure perception of the benefits. Most respondents can become an obstacle to taking the are aware of the advantages and recommended action. Unconsciously, cost disadvantages of smoking and non-smoking and benefit analysis of the effectiveness of behavior, such as a person will be more health measures, harmful (have negative and economical if they do not smoke because no iatrogenic side effects) unpleasant (painful, funds are spent on buying cigarettes. Besides difficult, irritating) uncomfortable, time having a negative impact on yourself, consuming, etc.(11). smoking can also have an impact on the The results showed that of 55 people around people who smoke, because respondents based on the light category these people will become passive smokers. constraints, there were 45 people (81.8%) In this study, respondents who tended who did not smoke and 10 people (18.2%) to have a high self-perception of ability smoked. Of the 29 respondents based on the realized the dangers and benefits of smoking, weight category constraints, there were 4 so they avoided smoking. They realized that people (13.8%) who did not smoke and 25 they could not easily cure a smoking-related people (86.2%) smoked. disease such as lung disease or heart disease. The results of data processing Even though they are still relatively young, performed using the chi square test analysis they do not eliminate the possibility that they with a significance level of 95%, were will also get the disease and regular exercise obtained p-value = 0.000 <α = 0.05, so Ho is is not a solution to avoiding the disease if rejected. This means that there is a they smoke. relationship between the constraints and Smokers who have a low perceived smoking habits of health workers in the benefit will make them quit smoking will be Latambaga Sub-District, Kolaka Regency. In low and that is a barrier for them to quit addition, the results of the correlation test by smoking(8). According to(9), smoking is looking at the value of phi show that the associated with poverty, alcohol use and closeness of the relationship between unemployment, which can be reasons for constraints and smoking habits is 0.656 or them to smoke. The study found that indicates a strong relationship. although some people understand that The results of this study are in line smoking causes damage to their health, some with research conducted by (12). The results people still believe about the benefits of of hypothesis testing using the Rank smoking. The low perception of the benefits Spearman test showed a p value of 0.045 = of smoking as a health risk can make a 0.05, which means that there is a significant person smoke(10). relationship between the perceived barrier In this study, people who have a good perceived by respondents in trying to quit perceived benefit will leave smoking much smoking and the type of smoking behavior. more than people who have a poor Research(13), which states that there is a perception of benefits. Respondents with relationship between the perception of good perceived benefits mostly realized that Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 112 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 smoking cessation barriers with the CONCLUSION incidence of smoking relapse. There is a relationship between The results of this study are in perceived benefits and constraints with accordance with the inner Health Belief habits smoking health personnel in the Model theory (13), which states that the high Latambaga Sub-District, Kolaka Regency. perception of smoking cessation inhibitors So that advicefor leaders in their respective can significantly affect the willingness or technical units to impose a smoking ban in motivation of a person to quit smoking. This areas where health services are located, is because several studies, both retrospective because it will be a bad example for the and prospective, show that the high community in terms of maintaining health. perceived barrier has a very large impact on the dimensions of the Health Belief Model in REFERENCES explaining or predicting a lack of health- maintaining behavior. 1. Ardini PP. Effect of story and A total of 55 respondents had a good communication to child moral grow in perception of obstacles. Perceptions of 7-8 years old. Jurnal Pendidikan Anak. barriers are beliefs about real or 2012;1(1) Indonesia). psychological obstacles to the actions that a 2. Sholihah M. Analysis of smoking person will take. Environmental factors are behavioural change in hipertension factors that influence a person's perception of patients in Ciputat health centre barriers. A person's character is largely Tanggerang Selatan. 2014. shaped by the surrounding environment, both 3. Jayadipraja EA, Prasetya F, Azlimin A, family, neighbors and friends. People who Mando WOSY. Family clean and have a high intensity to interact with a healthy living behavior and its smoker will have a high probability to determinant factors in the village of become a smoker because they will be Labunia, Regency of Muna, Southeast affected because they will have a poor Sulawesi Province of Indonesia. Public perception of inhibition. Health of Indonesia. 2018;4(1):39-45. According to Stretcher et al, the 4. Dinas Kesehatan Kabupaten Kolaka. perception of barriers to quitting smoking Promkes Dinas Kesehatan Kabupaten can include a person being afraid of stress Kolaka Kolaka: Sulawesi Tenggara; when quitting smoking, because they think 2019. that smoking is a stress reliever, besides that 5. Notoatmodjo S. Health promotion and they are also afraid that their weight will health behaviour. Jakarta: rineka cipta. increase and pressure from other smokers 2012:45-62. (friends or family) also inhibits them. 6. Kumboyono K. Analysis of factors of someone not to smoke. Another factor stated barrier of motivaation in stopping of by(14), the level of nicotine addiction also smoking based on Health Belief Model affects the perception of inhibition of a man in students in Faculty of Technique, and a woman. According to(15)mentioned Brawijaya University Malang. that in HBM individuals will take action to Soedirman Journal of Nursing. prevent or control ill health conditions if they 2011;6:1-8. consider themselves vulnerable to a 7. Kurniawati C, Sulistyowati M. condition. If they believe that the available Aplication of Health Belief Model in actions will bring far more benefits, they will prevention of pathology of pale diases. leave the barriers behind and take actions Jurnal Promkes. 2014;2(2):117-27. that are proportionate to the benefits. In this 8. Grimwood J, Gordon LA, Olsen A, study, a person who has poor perceptions Terry A, Schmutz J, Lamerdin J, et al. tends not to smoke. The DNA sequence and biology of Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 113 Pingak, M., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/62 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 human chromosome 19. Nature. 2004;428(6982):529-35. 9. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297-322. 10. Tantri A, Fajar NA, Utama F. The relationship between perseption and warning of smoking effect in cigarrete pack with smoking behaviour in male teenagers in Palembang City. Jurnal Ilmu Kesehatan Masyarakat. 2018;9(1):74-82. 11. Afrianto D. Effect of health promotion to paprika farmer's knowledge, attitude and practice in Kumbo-Pasuruan village with usage of self protection equipments from pesticide effect. 2014. 12. Anisa R. Management of correlation of customer in create clien belief in Bank Mandiri Bandung. Jurnal Kajian Komunikasi. 2016;4(1):43-50. 13. Darojah S. Faktor Determinants of barrier of stop smoking in head of household in Jatiyoso Subdistrict, Karanganyar District: Universitas Muhammadiyah Surakarta; 2014. 14. Alawiyah SS. Overview of perception about electric cigarret in electric cigarret users in Vaporizer community in Tangerang City: UIN Syarif Hidayatullah Jakarta: Fakultas Kedokteran dan Ilmu Kesehatan, 2017; 2017. 15. Larasati H. Deskriptive study of Health Belief in students smokers in Faculty of medicine inUniversitas Islam Bandung: Fakultas Psikologi Universitas Islam Bandung (UNISBA); 2016. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 114 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access RELATIONSHIP BETWEEN INCOME LEVEL, PERCEPTION OF HEALTH SERVICES AND CADRES’S ACTIVITY WITH COMPLIANCE WITH PAYMENT OF INDEPENDENT NATIONAL HEALTH ASSURANCE IN KOLAKA DISTRICT Jumiati Bandu1, La Ode Kamalia2, Erwin Azizi Jayadipraja3 1Kolaka District Health Department 2,3Magister of Public Health Study Program, Universitas Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Jumiati Bandu Email : [email protected] Abstract Background :Every year, the social insurance administration always experiences a very large defi cit. The high number of deficits experienced by the social insurance is due to the low level of compliance of contribution payments by independent participants. The purpose of this study was to determine the relationship between income levels, patient perceptions of health services and activeness of cadres with compliance with payment the Independent National Health Insurance in Kolaka District. Methods: This research is a quantitative study with a cross sectional study approach. The population in this study were 1075 independent National Health Insurance participants. The sample size was 89 respondents who were taken by proportional random sampling. The data were obtained using a questionnaire and then analyzed descriptively and inferentially using the Chi Square test. Result s:The results showed that there was a relationship between income levels, patient perceptions of health services and the activeness of cadres with compliance with the payment of the independent national health insurance in Kolaka District, where the p-value <α= 0.05. Conclusion: Perception of health services is the most related factor in comparison to the level of income and activity of the cadres. It is hoped that the social insurance administration organiz ation will carry out strategies in an effort to increase the regularity or compliance of the independent national health insurance participants and increase the number of cadres. Key words: Income, Perception, Health services,Cadre Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 1 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION earners, 149,584 non-wage workers and Since the launch of the national health 35,147 non-workers. In addition, in 2018 it insurance program in 2014, the program's increased quite significantly, from 2,226,751 membership coverage has continued to people who participated in the national health increase. In 2014, the number of national insurance, 597. health insurance participants was 133,400,000 The most significant increase occurred people, of which 95.1 million (72.3%) were in the segment of non-contribution assistance participants who received contribution recipients, which also occurred in Kolaka assistance and 38.3 million (28.7%) were non- district, where in 2016 there were 51,292 non- contribution assistance recipients. In 2015, the contribution assistance recipients in Kolaka number of participants was 156.7 million, district. In 2017 in Kolaka district, 37782 consisting of 98,900,000 (63.1%) who were workers received wages of 13,300 non-wage participants who received contribution earners and 5,376 non-workers. In 2018, there assistance and 57.8 million (36.9%) were was a significant increase in Kolaka district, participants who were non-contributory where there were 23,605 workers who recipients. In 2016 the number of participants received wages as many as 12,250 workers increased to 171,900,000 people, of which who did not receive wages and 35855 were not 106, 6,000,000 were participants who received workers(2). contribution assistance and 6.5 million (38.0%) The increase in the coverage of the were non-contributory participants. In 2017, non-contribution assistance beneficiary group, the number of participants was 187,000,000, especially in the non-wage earning and non- consisting of 112,600,000 (58.63%) from the worker segmentation of workers has a big contribution assistance segment and 86.1 health risk but with a continuous low million (41. 37%) non-contribution assistance membership contribution payment. This can be recipients. In 2018 the number of participants seen from the data from the social insurance increased dramatically where there were administration organization , in 2014 the 208,100,000 of which 122,000,000 people deficit was IDR 8.5 trillion, then in 2015 it (58.63%) were participants who received increased by IDR 10.67 trillion, in 2016 it was contribution assistance and the remaining 86.1 IDR 11.55 trillion, in 2017 it increased million (41.37%) were non-beneficiary significantly by IDR. 16.62 trillion, in 2018 it participants dues. If you look at the data above, decreased by IDR. 10.98 trillion, and in 2019 the most significant growth of participants the deficit increased again to IDR. 13 trillion. from year to year occurs in the segment of The high number of deficits experienced by non-contribution assistance recipients (1). social insurance administration organization is For the province of Southeast Sulawesi due to the low level of compliance with dues itself, an increase in non-contribution payment by independent participants. assistance beneficiaries also occurred, this can According to a report by the social be seen from the health profile of Southeast insurance administration organization at the Sulawesi province showing, in 2016 of the end of 2019, the level of compliance of 1,582,275 people who participated in the independent participants in paying national health insurance, 466,022 of them contributions is only around 53.7%, which were non-contributory participants who means that around 46.3% of independent received contribution assistance. Consisting of participants are not disciplined in paying dues 324,341 wage earners, 106,510 non-wage or in arrears. Even though the total earners and 35,171 non-workers. In 2017, out contributions from independent participants of 1,820,990 people who participated in the throughout 2019 reached IDR 8.9 trillion, the national health insurance, there were 531,192 total claims reached IDR 27.9 trillion. This people including non-contribution assistance results in a large imbalance between the costs participants consisting of 346,461 wage received by the social insurance administration Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 115 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 organization and the costs that must be virtual account system, which, according to incurred. The low compliance of participants several informants, is not aware of the in paying contributions has resulted in the existence of collective family payments social insurance administration organization through virtual accounts, causing delinquent experiencing a large deficit (Social insurance payment of dues and also some are still in administration organization (3). arrears for payments while still using the This also happened in Kolaka previous system. In addition, most informants Regency, which is one of the districts in stated that they had not received direct Southeast Sulawesi Province, where according socialization from the social insurance to data from the social insurance administration organization and had difficulties administration organization, it shows that the in accessing this information (3). level of active independent participants in Other factors affecting participant 2019, on average only reached 57.79% compliance in making contribution payments registered independent participants. Obedient are the level of participant's income, the to pay dues and 42.21% of participants are in number of family members insured, experience arrears, of which nearly 50% of independent of illness. Participants who do not receive national health insurance participants who are contribution assistance have a greater potential in arrears are scattered in the Kolakadistrict(3). for non-compliance with paying contributions Several studies stated that the cause of because it is different from formal sector jobs the level of compliance of participants in that are directly paid from salaries. Regularity paying the National Health Insurance dues was in paying national health insurance due to several things including according to contributions for independent participants is research conducted on inpatients at dr. the most important component to facilitate the Soebandi, Jember Regency, which states that use of health services (4). the factors of knowledge, education, Based on a preliminary survey, employment, availability of service places, researchers conducted interviews with four distance to service places, ability and respondents who work in the social security willingness to pay contributions, perceptions of agency for health in Kolaka Regency, it is health service places and motivation are factors known that the problem faced in collecting related to low levels of compliance in paying contributions from independent participants is contributions (1). payment arrears (not regularly paying). From Research conducted on non-wage the interview it was also known that the cause worker participants in Pacitan District shows of the large number of participants in arrears different results, where the factors that was due to the participants' low knowledge of influence contribution payment compliance are the importance of paying dues, this was also age, class of participation, participation status, due to the low level of education of the utilization of First Level Health Facility participants, which resulted in the information services and utilization of Advanced Level conveyed by the social security administering Health Facility services. Contribution from agency through the information media not participants is one source of income for the being properly understood. . Then, most of the management of the health insurance scheme. arrears are class II and III maintenance Therefore, the compliance of insurance participants; this is because participants usually participants to pay contributions is very think that they are unable to pay fees and that important for the sustainability of the health the government should be responsible for their insurance scheme (2). contributions. The cause of the lack of The results of research conducted in compliance with the participants of the Denpasar City obtained information that the independent national health insurance is due to reason why there are still many participants in the lack of active cadres in providing arrears is due to the payment system that uses a information about the national health insurance Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 116 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 in the community or the participants of the money will just disappear and even though national health insurance. In addition, the they are sick, it is enough to buy medicine at number of participants was in arrears, about the shop. In addition, the availability of a place 2/3 arrears due to registering when they were for payment of contributions also affects sick and most of them had a history of respondents who do not comply, in, which the catastrophic disease, then after being treated at availability of a place for payment is one form the time of illness the participants did not make of public service carried out by the government any more payments thereafter. The cause of to meet community needs. The public's need the lack of compliance with the participants of for health services is a mandatory thing that the independent national health insurance is must be facilitated by the government, with the due to the lack of active cadres in providing existence of national health insurance and information about the national health insurance people who are obedient in paying in the community or the participants of the contributions, it is hoped that the community national health insurance. In addition, the as a whole can get health services at health number of participants was in arrears, about facilities. 2/3 arrears due to registering when they were Based on the background and problem sick and most of them had a history of studies above, the researcher is interested in catastrophic disease, then after being treated at conducting research on "Determinants of the time of illness the participants did not make Contribution Payment Compliance for any more payments thereafter. The cause of Independent National Health Insurance the lack of compliance with the participants of Participants in Kolaka District". the independent national health insurance is due to the lack of active cadres in providing METHOD information about the national health insurance This type of research is a quantitative in the community or the participants of the study, with a cross sectional study approach, national health insurance. In addition, the which aims to determine the relationship number of participants was in arrears, around between the independent variables (income, 2/3 arrears due to registering when they were active cadres and perceptions of the quality sick and most of them had a history of of health services) and the dependent catastrophic disease, then after being treated at variable (compliance with paying dues) the time of illness the participants did not make which is observed at the same time. (5). This any more payments thereafter. research was conducted in Kolaka District, The results of the researcher interview Kolaka Regency, Southeast Sulawesi with 10 respondents who participated in the Province. Research implementation until the independent national health insurance, seven preparation of the final report starting in (7) respondents stated that the reasons for December 2019 and finishing in August independent participants did not regularly pay 2020. The population in this study were all because their income was uncertain, then the 18293 independent national health insurance fees were too high, where payments were often participants in Kolaka District. In this problematic such as automated teller machines, research, as many as 377 respondents were often offline. , it takes a long time to pay taken by means of proportional random because there are many queues. In addition, the sampling. remaining three (3) stated that the reason they were not compliant in making payments was RESULTS that they thought that the services provided to Table 1.Shows that of the 210 patients using the social security administering respondents whose income levels are in the agency were not optimal. Another reason low category, 143 respondents (68.1%) are people do not regularly pay dues is that less obedient in paying the dues, 44 participants feel that if they are not sick, their respondents (21%) are not obedient in Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 117 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 paying the national health insurance health insurance contributions.Based on the contributions on time and 23 respondents results of statistical tests using the chi square (11%) comply on time in making payments test, at ɑ = 0.05 and DF = two, the value of for national health insurance contributions. X2 is calculated> X2 table (16.663> 5.991), Meanwhile, of the 167 respondents whose which means that there is a significant income level was in the high category, there relationship between the activeness of cadres were 60 respondents (35.9%) who were not and compliance with the national health obedient in paying the dues, 35 respondents insurance participant contributions. (21%) were not obedient in paying the Independently in Kolaka Regency. national health insurance contributions on Table 3. Shows that, of the 177 time and 72 respondents (43.1 %) obey on respondents whose perceptions of health time in paying the national health insurance services were lacking, 126 respondents contributions.Based on the results of (71.2%) were less obedient in paying statistical tests using the chi square test, at ɑ contributions, 34 respondents (19.2%) did = 0.05 and DF = 1, the value of X2 is not obey on time in paying health insurance calculated> X2 table (56.060> 5.991), contributions. nationwide and 17 respondents meaning that there is a significant (9.6%) comply on time in making payments relationship between income levels and for the national health insurance. Meanwhile, compliance with national health insurance of the 200 respondents whose perceptions of participant contributions. independently in the quality of health services were good, Kolaka Regency. there were 77 respondents (38.5%) who were Table 2. Shows that, of the 213 less obedient in paying dues, 45 respondents respondents who stated that their cadres were (22.5%) did not obey on time in making less active, 132 respondents (62%) were less payments for national health insurance obedient in paying the dues, 43 respondents contributions and 78 respondents (39%) (20.2%) were not compliant in paying the comply on time in making payments for national health insurance contributions on national health insurance time and 38 respondents (17.8%) comply on contributions.Based on the results of time in making payments for the national statistical tests using the chi square test, at ɑ health insurance contributions. Meanwhile, = 0.05 and DF = one, the value of X2 is of the 164 respondents with good cadre calculated> X2 table (51.315> 5.991), activity, there were 71 respondents (43.3%) meaning that there is a significant who were less obedient in paying the dues, relationship between perceptions of health 36 respondents (22%) were not obedient in services and compliance with payment of paying the national health insurance contributions from insurance participants. contributions on time and 57 respondents Independent national health service in (34.8 %) obey on time in paying the national Kolaka Regency Table 1 Relationship between Income Level and Contribution Payment Compliance to Participants of the Independent National Health Insurance in Kolaka District Contribution Payment Compliance Obedient Less Obedient total Income Not Statistic test obedient on Time Timely n, % n, % n, % n, % Less 143 68.1 44 21 23 11 210 100 X²count = 56.060 Well 60 35.9 35 21 72 43.1 167 100 X² table = 5.991 total 203 53.8 79 21 95 25.2 377 100 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 118 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 The Relationship between Cadre Activeness and Compliance with Contribution Payment to the Participants of the Independent National Health Insurance in Kolaka District Contribution Payment total Statistic test Compliance Cadre Obedient Less Obedient Activity Not obedient on Time Timely n, % n, % n, % n, % Less 132 62 43 20.2 38 17.8 213 100 X²count = 16.663 Well 71 43.3 36 22 57 34.8 164 100 X² table = 5.991 total 203 53.8 79 21 95 25.2 377 100 Table 3 The Relationship between Perceptions of Health Services and Compliance with Contribution Payment to Participants of the Independent National Health Insurance in Kolaka District Contribution Payment Compliance Perceptions Obedient of Health Less Obedient total Not Statistic test Care obedient on Time Timely Facilities n, % n, % n, % n, % Less 126 71.2 34 19.2 17 9.6 177 100 X²count = 51.315 Well 77 38.5 45 22.5 78 39 200 100 X² table = 5.991 total 203 53.8 79 21 95 25.2 377 100 DISCUSSION contributions to not comply with their monthly payments. As stated by Nurmantu, Relationship between Income Level and who states that if a person works and can Contribution Payment Compliance for then earn money, then instinctively the Independent National Health Insurance money is first aimed at fulfilling one's own Participants in Kolaka District needs or basic needs and that of his family Income is income arising from but at the same time if he has met certain community activities every month according conditions it arises. obligation to pay to the minimum wage standard per capita contributions which in turn result in conflicts income of the region (6). Income or income between family interests or meet health is also an additional economic capacity insurance payments (7). received or obtained from both Indonesia and The results of this study indicate that, outside Indonesia which can be used for of the 210 respondents whose income levels consumption or to increase wealth. The are in the low category, 143 respondents income factor can be used as one of the (68.1%) are less compliant in paying reasons for the participants of the contributions; this is because participants independent national health insurance still prioritize primary needs from health Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 119 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 insurance needs. As a result, the fulfillment take medication at a health service center and of secondary needs and health insurance incur substantial costs. This respondent needs has not been prioritized so that the argued that by regularly paying the National contribution payments for the independent Health Insurance fee from the Social national health insurance are still in arrears. insurance administration organization, the Most people pay independent national health respondent could still get health services that insurance when they are sick, so that when were more convenient than taking public they want to reuse the national health patient facilities, which cost quite a lot. insurance facility, participants have to pay a Meanwhile, of the 167 respondents number of bills that are increasing and whose income level was in the high sometimes exceeding medical costs. category, 60 respondents (35.9%) were not The results of this study, if examined obedient in making contribution payments. more deeply, the causes of respondents are in This is more due to other factors including arrears in making contribution payments are the forgetting factor, the busy work factor also due to the large number of expenses because the national health insurance party such as food expenditures which are quite does not have monthly notification to make high starting from expenditure on rice, side contribution payments so that in this dishes to crackers, non-food expenditures for situation the community forgets to pay the purposes such as durable goods (kitchen independent national health insurance utensils, cell phones ) purchased only when contributions. needed, while the largest non-food In addition, people who have expenditures are payments for electricity, gas sufficient income but are not compliant are and water because of their regular monthly also due to the large number of community needs. Non-essential expenditure, the largest needs that must be fulfilled, for example the amount of expenditure is cigarettes and needs of schoolchildren, household needs snacks. Many respondents are also married etc. The independent national health and have children so that the expenditure for insurance premium payment is quite children's snacks is quite high(8). This is in burdensome because the national health line with research conducted in DarulImarah insurance premium payment must be paid District which shows that the results of the every month and in groups or together with total expenditure on cigarette consumption other family members. Just imagine that and the amount of food consumption every person who participates in the first expenditure for the poor are inversely class health facility (1) must pay a fee of proportional, meaning that if the amount of IDR 150,000 per month. This is in line with cigarette consumption expenditure increases the theory that the size of wealth can affect it will reduce the total expenditure on food health consumption. For example, people consumption.(9). with low incomes will meet the needs of In addition, of the 210 respondents goods first, after the need for goods is whose income level was in the low category, fulfilled will consume health. Factors that there were also 44 respondents (21%) who have a direct effect on income, for example, did not comply on time in making payments costs related to health services, increase the for national health insurance contributions cost of health services. This situation reduces and 23 respondents (11%) were compliant on health consumption, because the increase in time in making payments for national health health costs will reduce the relative income, insurance contributions. Based on the results namely fixed income while health costs of the researchers' interviews with these increase. This difference may occur due to respondents, it was found that these differences in culture and beliefs about the respondents had a history of catastrophic importance of health. diseases which required them to continue to Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 120 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Another reason the respondent did levels and compliance with dues payments to not want to pay was that the card could be independent national health insurance used, later if there is money or later if participants, where the statistical test results someone is sick, such as if the wife wants to obtained p value = 0.023 <ɑ = 0.05. (11). give birth. Apart from that, the reasons why This research is also in accordance the respondents did not want to pay dues with the results of research conducted in were, among others, lazy to pay. The cause Malang Regency, which shows that there is a of this laziness when analyzed further is due relationship between income levels and the to the disappointment experienced by compliance of independent participants in respondents in using the national health paying dues. (12). insurance card which is late in being served Independent participants with low and is not even served by health services. income prioritize their income to meet In addition, of the 167 respondents routine daily living needs, such as food costs, whose income level is in the high category, education costs, electricity and water there are also 35 respondents (21%) who are payments and other costs, while for health not compliant on time in making payments costs, independent participants tend not to for national health insurance contributions prioritize because they are still in a healthy and 72 respondents (43.1%) are compliant on condition. On the other hand, independent time in making payments for national health participants with high income, apart from insurance contributions. This illustrates that being able to allocate their income for daily a high level of income and has a middle to needs, are also able to pay health costs so upper level of welfare have a high level of that they can make regular monthly compliance in making National Health payments.(10). Insurance contributions. This is reinforced Likewise with the influence of by the results of data analysis using the chi income with the regularity of the community square test, at ɑ = 0.05 and df = 1, the value in paying National Health Insurance of X2 is calculated> X2 table (56.060> contributions. A person's income plays an 5.991), meaning that there is a significant important role in increasing one's awareness relationship between income levels and of regularity in paying National Health compliance with participant contributions. Insurance contributions. Low income can Independent national health insurance in reduce the regularity of the community in Kolaka Regency. paying National Health Insurance This research is in line with research contributions because there are still many conducted in Kota Solok which shows that needs that must be met by the family so that the percentage level of independent no income allocation is used by participants participants in paying uranium for the to pay these contributions. It is different with national health insurance program is higher those who have high income and have in the group of participants with high income middle and upper welfare levels who have a levels (39.6%) compared to the group of high level of regularity in paying the participants with low income levels (19, 5). National Health Insurance contributions.(13). 2%), with the results of data analysis showing that there is a relationship between The Relationship between Perceptions of income levels and compliance with the Health Services and Compliance with the national health insurance program premium Participants' Payment Compliance with payments (p = 0.038) (10). the National Independent Health This research is also in line with Insurance in Kolaka District research conducted in the Batailaiworu Perception is the process of Health Center's working area which states organizing; interpreting the stimuli received that there is a relationship between income by the individual so that it is something Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 121 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 meaningful and is an activity that is payments. This can be seen from the integrated in the individual. (14). Patients' respondents' answers, only 48% of perceptions will be influenced by respondents are optimistic that they will not personality, culture, education, previous be disappointed by the services received by events, both positive and negative, which using the national health insurance facility. may often be encountered when receiving That is why some of them are in arrears just services at the hospital. Patients' perceptions because of problems like this. In addition, of service quality are influenced by not all health facilities or health services that expectations of the desired service. are covered by the national health insurance Expectations are shaped by what consumers coverage also influence these participants not hear from other consumers by word of to make contribution payments. This can be mouth, patient needs, past experiences and seen from the respondents' answers, only the influence of external communication. 48% of respondents are optimistic that they Services received from existing expectations will not be disappointed by the services affect consumers on service quality(15). received by using the national health Perception is usually to express about the insurance facility. That is why some of them experience of an object or event where it is are in arrears just because of problems like obtained through information and this. Apart from that, not all health facilities relationships so as to provide meaning or or health services that are covered by the meaning in the form of actions or responses national health insurance coverage also from individuals.(16). influence these participants not to make The results showed that, of the 177 contribution payments. This can be seen respondents who had poor perceptions of from the respondents' answers, only 48% of health services, 126 respondents (71.2%) respondents are optimistic that they will not were less obedient in paying contributions. be disappointed by the services received This illustrates that the low perception of using the national health insurance facility. participants on the quality of health services This can also cause low public received will have an impact on the awareness to buy or want to become a health willingness of participants to make insurance participant. From research, it is payments. This is when examined further also known that there are some people who because these participants feel less satisfied do not care about the risks they face and they with the services provided to patients with take or accept a risk as it is to their health. the national independent health insurance People who behave in this way are called because in terms of services it is rather long. risk takers. If everyone acted as a risk taker, Services require a long and convoluted then the insurance business would never process in terms of health services. Because exist. Conversely, if a person acts as a risk some of the first level health facilities, in this averter, he will try to avoid, reduce, or case the health center in providing patient transfer risks that may occur to him. If many referrals to the advanced level health people are risk averse, the demand for health facilities, in this case the hospital or insurance business will grow. specialist doctor are rather complicated and This is also in line with the theory, seem to be delayed. This makes these which states that perceptions of the quality of participants feel that health services are not health services greatly influence participant good enough, so some of them are in arrears satisfaction, which have an impact on just because of problems like this. Apart participant compliance in making payments. from that, not all health facilities or health The ability to perform services according to services that are covered by the national what was promised immediately, accurately, health insurance coverage also influence and satisfactorily has an impact on these participants not to make contribution Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 122 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 participant satisfaction and participant they would be disadvantaged if they made compliance in making payments(17). regular payments but did not use health In addition, of the 177 respondents service facilities through the national health whose perceptions were less of health insurance. As a result, there were arrears that services, there were 34 respondents (19.2%) were greater than the costs that had to be who did not comply on time in paying the paid when receiving medical treatment national health insurance contributions and through public patients so that these 17 respondents (9.6%) complied on time in respondents no longer wanted to make making payments for national health payments. insurance contributions. The results of the Confidence about the losses that are interview with the respondent were known obtained if you become a participant of the because this respondent was forced to make National Health Insurance, namely getting payments because the respondent was slow / long health services, receiving suffering from a disease, which required the incomplete health services, being served less respondent to continue to seek treatment at kindly, still paying or there are additional the hospital, even though the services costs when sick and getting uncomfortable received were not satisfactory and not all service facilities. This requires a follow-up in were covered by the national health the form of an increase in service speed insurance. In addition, respondents also get followed by friendliness of officers and the support and motivation from family comfort of treatment facilities, which are members who understand the rules for expected to be felt by the community if they obtaining health insurance. become participants in the National Health Meanwhile, of the 200 respondents Insurance. If this can be applied in the field, whose perceptions of the quality of health then the belief about losses from the service services were good, 77 respondents (38.5%) side can be reduced and in the end, it is did not comply with the payment of hoped that it can increase the intention to contributions. According to the researcher become a participant in the National Health interview, it was known that the cause of this Insurance. other than that,(18). respondent was still in arrears even though In addition, of the 200 respondents, he had a good perception of the quality of whose perceptions of the quality of health health services received was another factor, services were good, there were also 45 namely the amount of contributions that respondents (22.5%) who did not comply on were considered quite burdensome. This is time in paying the national health insurance when examined more deeply because the contributions and 78 respondents (39%) wages or income received are still below the complied on time in making payments for Provincial Minimum Wage each month. national health insurance contributions. This Moreover, the payment of national health illustrates that good public perception will insurance contributions must be paid every increase public awareness of the importance month. In addition, when payments are made of making independent national health in one (1) household that must be paid, not insurance premium payments. If examined all family members can be paid individually further, this is because they feel that they in the family. only pay a fee of only IDR. 80.000, - each In addition, there is still a wrong month you can experience optimal health perception of the problem of national health facilities such as doing free cataract eye insurance, namely that national health surgery and others. These results are also insurance is only used when sick and when reinforced by the results of data analysis not sick, and there is no need to pay national using the chi square test, at ɑ = 0.05 and DF health insurance contributions = 1, independently. Respondents also felt that Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 123 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 This research is in line with research (social marketing) functions, recruitment of conducted on the independent participants of participants, reminders and collection of the national health insurance program in contributions (23). Kota Solok, where the results obtained were Participants from the informal worker that there was a significant relationship sector have unique and diverse background between the level of perceptions of health characteristics with a large population, which services and perceptions of risk and is spread across various remote areas in compliance with the payment of dues for Indonesia. In its current condition, participants in the national health insurance community participation is very much program in Solok City. (19). needed in supporting the success of the This research is also in line with national health insurance program, so the research conducted in the Abeli Puskesmas social insurance administration organization Kendari City, which shows that there is a presents a new mechanism in this case strong enough between perceptions and community empowerment with the aim of arrears in the payment of dues from social expanding participation and finding the right insurance administration organization, where contribution collection method for various a value is obtained (p-value = 0,000). (20). community characters(23). The level of needs at the lower level The results of this study indicate that, has been met, so this need will give rise to of the 213 respondents who stated that the the need to meet higher needs. So that when cadres were less active, 132 respondents the National Health Insurance is made as a (62%) were less obedient in paying priority need by the community, the contributions. Based on the results of the community will regularly pay the National researchers' interviews, it is known that so Health Insurance contribution(21). The far cadres have rarely provided information willingness of a person to pay contributions related to national health insurance or social is greatly influenced by the motivation of insurance administration organization, so far each person. A person's motivation can arise cadres have only been active in collecting due to various things, both positive, namely national health insurance contributions only. motivation that can be beneficial and The lack of active cadres resulted in the lack negative, namely motivation that can provide of quality information obtained by losses(22). participants regarding the national health insurance program. Whereas the function of Relationship between Cadres and cadres is not only to collect contributions, Participant Payment Compliance with but also as social marketing, participation Independent National Health Insurance in function, information provider function and Kolaka District complaint receiver. With the cadres, it is Cadre is a person or community hoped will optimize socialization, education, member who collaborates as a partner of a as well as a reminder and collection of health social security provider based on a contributions. partnership relationship that carries out some This in addition, as can be seen from of the functions of the social insurance the respondents' answers, only 43% stated administration organization in a certain area that they had been given information by that has the capacity according to certain cadres regarding participants being able to criteria and is recruited by the social adjust their fees according to their ability to insurance administration organization. Cadres pay. Even though this information is are people who have the capacity according important information that must be conveyed to the criteria of the social insurance to participants so that participants can pay administration organization to carry out dues smoothly and avoid an inactive card certain functions, namely socialization due to delinquency in dues that do not match Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 124 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 their income. Given the information (43.3%) were less obedient in paying provided will affect a person's knowledge to contributions. From the interview, it was behave(24). found that the cadres did not have much From the research results, it is also experience and were less well-known to the known that only 52% of respondents stated participants, so they lacked communication that they received information regarding the during home visits. increase in national health insurance Another reason is because the contributions from cadres. Yet according to participants in the national health insurance Regulations president number i64yyear 2020a independently registered because they were about changei Secondi Oni Regulationsi already sick. so they immediately register as Presidenti Numberi82 year 2018 about participants in the independent national Guarantee Health. Based on beleid that,duesi health insurance. after they do not receive members hipii ndependently classi Iiwillir services at the hospital or puskesmas, ideifrom IDR 80 thousandi Becomes participants do not continue to pay the iIDR150ithousandiperiparticipants. While independent national health insurance dues independently class from IDR 51 contributions. Besides that, the independent thousand Becomes IDR100ithousand national health insurance participants feel periparticipantsiperimonth.iWhileiduesiInde burdened by their finances because the pendenticlassiIIIirideifrom iIDR25,500 benefits they pay are not being felt now periparticipantsiperimonthiBecomes iIDR35 because they are not sick yet. This was thousandiperiparticipantsiperimonth revealed by some respondents themselves IDR16,500 peripersoni perimonthiget that they felt that they had suffered a loss paidibyigovernmenticenteriasi helpiduesitoi because after paying contributions from the participantsi Non-Wage social security administering body, the WorkersiandiparticipantsiNot Workers. benefits would not be felt now. However,iparticipantsiindependentlyiclassiII And of the 164 respondents with Iistillicanienjoyiratesilong IDR25,500 good cadre activity, there were also 36 periparticipantsiperimonthibecauseithere respondents (22%) who did not comply on sihelpisubsidyifromigovernment.iParticipant time in making payments for national health siclassithisinewipayifulliduesiamounting to insurance contributions and 57 respondents iIDR35ithousandistart i1iJanuary i2021(23). (34.8%) were compliant on time in making And of the 213 respondents who payments for national health insurance stated that the cadres were less active, there contributions. In this study, the guidance were also 43 respondents (20.2%) who did provided by the cadres was active and evenly not comply on time in making payments for supported by the factor of cadre education, national health insurance contributions and namely Senior High Schools. According to 38 respondents (17.8%) were compliant on theory, a higher level of education will have time in making payments for national health better insight and better skills so that it will insurance contributions. . According to be better able to provide guidance to the interviews, researchers with several community. respondents stated that they were forced to Apart from that, the positive things make payments because the respondent that the community feels from the social suffered from a disease which required the insurance administration organization are respondent to continue to seek treatment at expressed by some respondents that when the hospital, although the services received they are sick at a very high cost, it is free were not satisfactory and not all were from the facilities provided by the social covered by the national health insurance. insurance administration organization and Meanwhile, out of 164 respondents this makes some participants feel with good cadre activity, 71 respondents comfortable for the national health insurance Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 125 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 independently. so the motivation to register of having National Health Insurance. In as a participant in the independent national addition, Kader also functions as a reminder health insurance is because the facilities and collector of contributions, both active offered by some of the social insurance and in arrears for Non-Wage Recipient administration organization attract Workers. Cadres also work as Online Bank participants. Payment Point agents, so that if participants This increases the motivation of the want to make monthly dues payments, they residents because of the existence of some of can go directly to these Cadres.(26). the facilities provided by the social insurance The cadre program is also inseparable administration organization to participants. from the cooperation and support of all When registering for independent national parties, especially 4 state-owned banks as health insurance, participants feel that it is partners for social insurance administration facilitated by registration because services at organization, stakeholders, local the office of the Kolaka Social insurance governments, local village officials and other administration organization are carried out partners who tirelessly continue to support with good services so that these participants the social insurance administration are enthusiastic about registering themselves organization in realizing quality and and making payments. There are also some sustainable National Health Insurance for all people who think that registering themselves Indonesian residents (27). is a form of guarding themselves from things related to illnesses that occur at certain times. Information from friends to friends, TV CONCLUSION media, and print media also greatly influences and motivates some people to There is a relationship between income register themselves as participants in the levels, activeness of cadres and perceptions independent national health insurance. of health services with compliance with This is in accordance with the theory payment of dues to independent national which states that motivation is an interaction health insurance participants in the between behavior and the environment so Kolakadistrict. Therefore, it is advisable for that it can increase, decrease or maintain social insurance administration organization behavior. Motivation also means the impulse to carry out strategies in an effort to improve from within humans to act or behave(25). the regularity or compliance of independent This is reinforced by the results of data national health insurance participants in analysis using the chi square test, at ɑ = 0.05 paying dues, such as events that the social and df = 1, the value of X2 is calculated> X2 security administering body goes to campus, table (16.663> 5.991), which means that participate actively in social organization there is a significant relationship between the activities. , increasing the number of cadres, activeness of cadres and compliance with actively socializing the national health participant contributions. independent insurance program through social media. national health insurance in Kolaka Regency. Cadres have a social marketing REFERENCES function that aims to change people's 1. Ministry of Health of Republic of behavior to register as non-Wage Workers Indonesia. Indonesia Health Profile and pay dues regularly. Periodically, 2019. Jakarta: Ministry of Health of participants and prospective participants in the Republic of Indonesia. 2020. the national health insurance will be given 2. Kolaka District Health Office. Health education through visits so that they are orderly in carrying out their obligation to pay Profile of Kolaka Regency in 2018. contributions and understand the importance Dinkese district Kolaka: Kolaka. 2020. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 126 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 3. BPJS Health. Profile of the BPJS Contribution in Tamalate District, Health Social Security Administering Makassar City. Journal of Health Body: Jakarta. 2020. Management at Dr. Soetomo Hospital Foundation. 2019; 5 (2): 102-13. 4. Pratiwi AN. Factors Affecting Regularity of Contribution Paying to 12. Satria D. Correlation of Total Cigarette National Health Insurance (JKN) Consumption Expenditures with Total Participants in the Independent Food Consumption Expenditures for Participant Category (Case Study of the Poor (Case Study of Darul Imarah Inpatients at dr. Soebandi Hospital, District, Aceh Besar District). Jember Regency). 2016. Development Economics Student 5. Ditta T. Predisposing, Supporting, and Scientific Journal. 2017; 2 (1): 84-93. Driving Factors Affecting Behavior 13. Wulandari A, Syah NA, Ernawati T. Towards Payment Compliance of Non- Factors Influencing Compliance of Wage Recipient Workers (Pbpu) Independent Participants in Payment of Participants in Pacitan Regency in National Health Insurance Program 2018: Stikes Bhakti Husada Mulia; Contribution in Solok City. Andalas 2018. Health Journal. 2020; 9 (1): 7-17. 6. NWAP Citizen. Perceptions of 14. Rismawati L, Jufri N. Factors Related Mandiri National Health Insurance With Compliance Paying of BPJS Participants Regarding the Policy for Mandiri Insurance / Contribution in the Family Virtual Account Fee Payment Working Area of Batalaiworu Public in Denpasar City in 2017. Public Health Center In 2017 '. Public Health Health Study Program, Faculty of Student Scientific Journal. 2017; 2 (8): Medicine, Udayana University, 1-10. Denpasar. 2017. 15. Izza N. Independent Participant 7. Nurul A. Factors Related to Collective Payment System with Willingness to Pay National Health Membership Status and BPJS Health Insurance Contribution to Non-Wage Contribution Payment Compliance in Workers in the Work Area of the Malan Regencyg. Health Systems Payakumbuh Public Health Center in Research Bulletin. 2019; 22 (1): 44-53. 2015: Andalas University; 2015. 16. BPJS Health. Info on BPJS Health 8. Notoatmodjo S. Health Research edition XXII. Jakarta: BPJS Health. Methods. Jakarta Rineka Cipta. 2014. 2016. 9. Siregar PN. Analysis of Irregularity 17. Syaputra AD. Relationship between Factors in Paying Contribution for BPJS Health Service Quality and Bpjs Mandiri Participants in Rantau Patient Satisfaction in Class I Inpatient Utara District, Labuhanbatu Regency. Installation at Sekayu Regional Helvetia Institute of Health. 2018. General Hospital in 2015.Journal of 10. Nurmantu S. Introduction to taxation. Nursing Palembang: Musi Banyuasin Jakarta: Granit CPEd, editor: Yayasan Regency Government Nursing Obor Indonesia; 2013. Academy. 2015. 11. Marzuki DS, Abadi MY, 18. Simanjuntak SO. The Effect of Service Darmawansyah D, Arifin MA, Quality on Consumer Loyalty at PT. Rahmadani S, Al Fajrin M. Analysis of Eka Mega Adika Medan. 2019. Ability to Pay and Willingness to Pay 19. Rifa'i A. Analysis of the Influence of PBPU Participants Who Arreated JKN Perception and Behavior of Jamiah Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 127 Bandu, J., Kamalia, L. O., & Jayadipraja, E. A.. DOI: 10.36566/ijhsrd/Vol3.Iss1/63 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Pondok Pesulukan Tarekat Agung Health Office. Mala'bi: Journal of Tulungagung on Saving Interest in Economic Management STIE Yapman Islamic Banking with Attitude as a Majene. 2020; 2 (2): 65-84. Moderating Variable. 2019. 28. Aidha CN, Chrisnahutama A. Deficit 20. Puspitasari W, Hasbie NF. The Effect of National Health Insurance (JKN) - of Service Quality on the Satisfaction Suggestions for Alternative Sustainable Level of Outpatient Bpjs Patients at Funding. 2020. Pertamina Bintang Amin Hospital in 29. Djamhari EA, Aidha CN, Bandar Lampung in 2016.Journal of Ramdlaningrum H, Kurniawan DW, Medical and Health Sciences. 2017; 4 Fanggidae SJ, Herawati H, et al. (2). Deficit of National Health Insurance 21. Pakki TR. The Effect of Service (JKN):Why and How to Solve It? Quality on Income, which is moderated PRAKARSA Association, 2020. by LOS (Length Of Stay) at RS. Dr. Lung HA Rotinsulu Bandung: UNPAS; 2016. 22. Ayu W. Compliance Analysis of Independent Participants in the Payment of National Health Insurance Program Contribution in Solok City. Andalas University Public Health Journal. 2019. 23. Hasyim A, Idrus M, Rizky S. Miracle Journal Of Public Health. 2019; 2 (1): 1-9. 24. Sondari A. Satisfaction Analysis of Outpatient Participants in National Health Insurance (Jkn) at the Regional General Hospital (Rsud) in Brebes Regency in 2015. Semarang State University. 2015. 25. Tiaraningrum R. Descriptive Study of Motivation and Personal Reference of Jkn Independent Participants in the Highest Areas in Mojosongo Village, Surakarta City. Muhammadiyah Surakarta university. 2014. 26. Mangidi MAGT, Sunarsih S, Jayadipraja EA. The Effect of Triggering on Larva Free Rate (Abj) in Rahandouna Village, Kendari City.Al- sihah: The Public Health Science Journal. 2019; 11 (2). 27. Rahmi N. The Influence of Work Environment on Employee Work Motivation at the Boalemo District Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 128 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access ANALYSIS OF THE INFLUENCE OF HEALTH EDUCATION TO IMPROVE MOTHER'S KNOWLEDGE IN PREVENTING STUNTING IN MASOLAKA RAYA SUB-DISTRICT, BOMBANA DISTRICT Yulfiah Suleman1, Tasnim Tasnim2, Herianto Wahab3 1,2,3Master of Public Health Study Program, Universitas Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Yulfiah Suleman Email : [email protected] Abstract Background: Data showed that the Bombana Health Office stated that the details of stunting cases in 19 Districts were highest in Central Kabaena District with 160 cases, Central Kabaena 120 cases, Masolaka Raya 57 cases, North Poleang 54 cases, and the lowest was Mataoleo District. The purpose of this research isto analyze the effect of health education in efforts to prevent stunting through changes in knowledge, attitudes and actions of mothers of children under five in Masolaka Raya District, Bombana Regency. Methods: The research used a quasi-experimental study with a non-equivalent control group design. The population in this study were 159 people. The sample size was 114 people. The data were processed using the Wilcoxon signed rank test and the Kruskal Wallis H. test. Result s:Based on the test with the Wilcoxon signed rank test, the significance value shows the value of p-value = 0.000 <α = 0.05 for all health education methods to increase the knowledge of mothers under five in preventing stunting in Masolaka Raya District, Bombana Regency. Conclusion: There is an effect of health education with the lecture method, lecture method and leaflet, lecture method and video on increasing the knowledge of mothers under five in preventing stunting in Masolaka Raya Sub-District, Bombana Regency. Key words: Lecture,Method, Leaflet, Video, Knowledge, Stunting Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 129 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION 0-59 months exceeded the number 2,920 The problem of stunting is one of the cases, with details of the highest cases being problems faced in the world, especially in in North Kolaka Regency with 577 cases, the poor and developing countries (1). Stunting second place was Bombana Regency with is a problem because it is associated with an 262 cases, Kolaka Regency 255. cases, 207 increased risk of illness and death, cases and the lowest was in Wakatobi suboptimal brain development so that motor District (6). development is stunted and mental growth Health education is the activity of retarded(2). acquiring new knowledge, changing Bappenas (2018) shows that attitudes, adopting new behaviors or “stunting” in toddlers is increasing. With this implementing new skills (7). Health condition, attention to the problem of education is an effort or activity carried out multiple nutrition needs to be increased to assist individuals, families and because it is an important factor in communities in improving their behavior to preventing nutritional problems and achieve optimal health(8). The goal of health maintaining a good nutritional status(3). education is to help individuals, families or Riskesdas 2018, shows an improvement in communities to reach an optimal level(9). the proportion of stunting from 37.2% in Education is a part of health education 2013 to 30.8%, which means an activities. Health education is defined as a improvement in the nutritional status of learning process carried out to individuals, children in Indonesia. However, the stunting families, groups and communities with the rate is still considered high when compared aim of changing unhealthy behavior to to WHO standards, which is less than healthier patterns. The health education 20%(4). process involves several components, Efforts to prevent stunting are including using teaching and learning fulfilling the nutritional needs of mothers, strategies, maintaining decisions to make both macro and micro and giving exclusive action / behavior changes, and health breastfeeding to babies until the age of 6 education also focusing on changing (six) months (Sutarto, Mayasari, & Indriyani, behavior to improve their health 2018). The obstacles faced today are that status(10).So it needs community counseling there are still many pregnant women who do and empowerment, then it needs cross-sector not realize the importance of paying attention participation and involvement as well as to the nutrients consumed during pregnancy parties who can set an example in and how to prepare themselves to breastfeed society(11). their babies immediately after birth so that Mothers with good nutritional they do not suffer from malnutrition. knowledge are likely to provide adequate The results of Riskesdas (2018) show nutrition to their babies. If a mother has good that the incidence of stunting in Indonesia in knowledge, the mother will try to fulfill her 2007 for the short and very short category nutritional needs as well as her baby's was 36.8% in 2013 the short and very short knowledge of pregnant women about category was 37.2% and in 2018 for the short nutrition will influence decision making and and very short category it was 30.8 %. will also affect the mother's behavior(12). Although the data shows a decrease in the Based on the background description above, incidence of stunting, this value is not yet in it shows that the incidence of stunting is still accordance with the National target for the a serious problem that needs further incidence of stunting, which is 20%(5). treatment and prevention so that it can Data from the Southeast Sulawesi achieve the national target. Provincial Health Office shows that in 2019 the stunting rate for children under five aged Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 130 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 METHOD health education through the lecture and This type of research uses a quasi- leaflet method there was an increase in experimental (all research) research design knowledge with an average value of 76.32 with a non-equivalent control group design. with a standard deviation of 14,031. This research was conducted in the Masolaka Table 3 shows that the average value Raya Subdistrict, Bombana Regency. The of the respondent's knowledge before being population in this study were all mothers of given health education through the lecture & toddlers who have children under five in the video method is 55.26 with a standard Masolaka Raya sub-district, totaling 159 deviation of 7.965, while after being given people consisting of 37 Masolaka Village, 38 health education through the lecture and Masolaka Timur Village, 50 Batu Lamburi video methods there is an increase in Village, and 34 children under West knowledge with an average value of 81.58 Masolaka Village. The sample in this study with standard deviation 8,861. was divided into 3 parts according to Table 4 shows that based on the test research interests with 38 samples per group results with the Wilcoxon signed rank test, each. Namely the group that received the the significant value shows the value of p- lecture method intervention, the group that value = 0.000 <α = 0.05, it can be concluded received the lecture and leaflet intervention, that there is an effect of the lecture method and the group that received the lecture and on increasing the knowledge of mothers video intervention.The statistical tests used under five in preventing stunting in in this research are: Test Wilcoxon signed Masolaka Raya District, Bombana Regency. rank test and Kruskal Wallis H. test. Table 5 shows that based on the test results with the Wilcoxon signed rank test, RESULTS the significant value shows the value of p- Table 1 shows that the average value value = 0.000 <α = 0.05, it can be concluded of the respondent's knowledge before being that there is an effect of lecture and leaflet given health education through the lecture methods on increasing knowledge of mothers method was 54.47 with a standard deviation under five in preventing stunting in of 8.605, while after being given health Masolaka Raya District, Bombana Regency. education through the lecture method there Table 6 shows that based on the test was an increase in knowledge with an results with the Wilcoxon signed rank test, average value of 74.47 with a standard the significant value shows the value of p- deviation of 14.084. value = 0.000 <α = 0.05, it can be concluded Table 2 shows that the average value that there is an effect of lecture and video of the respondent's knowledge before being methods on increasing the knowledge of given health education through the lecture & mothers under five in preventing stunting in leaflet method was 55.53 with a standard Masolaka Raya District, Bombana Regency. deviation of 7.952 while after being given Table 1 Distribution of Respondents' Knowledge Before and After Giving Health Education through Lecture Method to Mother Toddlers in Masaloka Raya Sub-District Knowledge n Mean Standard Deviation Before 38 54.47 8,605 After 38 74.47 14,084 Source: Primary Data 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 131 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Distribution of Respondents' Knowledge Before and After Giving Health Education through Lecture Methods & Leaflets for Mother Toddlers in Masaloka Raya Sub- District Knowledge n Mean Standard Deviation Before 38 55.53 7,952 After 38 76.32 14,031 Source: Primary Data 2020 Table 3 Distribution of Respondents' Knowledge Before and After Giving Health Education through Lecture & Video Methods for Mother Toddlers in Masaloka Raya Sub-District Knowledge n Mean Standard Deviation Before 38 55.26 7,965 After 38 81.58 8,861 Source: Primary Data 2020 Table 4 Analysis of the Effect of the Lecture Method on Knowledge of Prevention of Stunting in Toddlers in Masaloka Raya Sub-District, Bombana Regency Prior Knowledge Knowledge After Less Enough Less Enough n Statistic test 19 19 4 34 38 P Value = 0.000 Source: Primary Data 2020 Table 5 Analysis of the Effect of Lecture and Leaflet Methods on Knowledge of Prevention of Stunting in Toddlers in Masaloka Raya Sub-District Bombana Regency Prior Knowledge Knowledge After n Statistic test Less Enough Less Enough 14 24 0 38 38 P Value = 0.000 Source: Primary Data 2020 DISCUSSION lecture method, the average results obtained were that the respondents had insufficient The Effect of the Lecture Method on the knowledge of 19 and the respondents had Knowledge of Toddler Mother in Stunting sufficient knowledge of 19. For respondents Prevention in Masaloka Raya Sub- with sufficient knowledge the values District, Bombana Regency obtained were not too far from the standard Before being given the treatment of value range. After being given health the health education method in the form of a education in the form of a lecture method, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 132 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 the results of the respondent's knowledge mother was not able to explain the efforts to with a score of less than 4 respondents and a prevent stunting in toddlers, and some were sufficient value increased to 34 people. This able to explain but still some of the answers shows that the health education method are wrong. However, after being given health using the lecture method is able to have an education methods in the form of lecture effect so that respondents' knowledge about methods and leaflets, it was found that none stunting prevention can increase even though of the respondents got less value and all there are still respondents who have not respondents increased to sufficient increased their knowledge. knowledge. The result of the test with the The result of the test with the Wilcoxon signed rank test, the significant Wilcoxon signed rank test, the significant value shows the value of p-value = 0.000 <α value shows the value of p-value = 0.000 <α = 0.05, it can be concluded that there is an = 0.05, it can be concluded that there is an effect of the lecture method on increasing the effect of lecture and leaflet methods on knowledge of mothers under five in increasing the knowledge of mothers under preventing stunting in Masolaka Raya five in preventing stunting in Masolaka Raya District, Bombana Regency. The results of District, Bombana Regency. this study are in line with research conducted According to(7)Delivering by Masyudi (2020). The results obtained in information through flipchart media or this study are that the use of media in flipchart media will get maximum results counseling can increase the knowledge of and as expected, because this media has two mothers under five as evidenced by a p-value benefits besides being able to be heard and of 0,000. being able to observe what is in front of the The weakness of the lecture media is mother, although not directly. In the teaching that most of the pregnant women did not methodology, there are two most prominent focus when the research began because there aspects, namely the teaching method and were no visible images or examples in the teaching media as teaching aids. If form of photos, so mothers under five were counseling is carried out using the media, unable to absorb what was conveyed by mothers are more active in following researchers, because flipchart media was counseling, because the media can create more effective in delivering material other interest and attract the attention of mothers than explained by the researcher, the which can foster motivation and interest of respondents were able to see directly the respondents, so that mothers understand and photos or examples on the flipchart. understand the purpose of doing counseling. The Influence of Lecture & Leaflet The Effect of Lecture & Video Methods Methods on Maternal Toddler Knowledge on Maternal Toddler Knowledge in in Stunting Prevention in Masaloka Raya Stunting Prevention in Masaloka Raya Sub-District, Bombana Regency Sub-district, Bombana Regency The media is one of the tools that Health promotion media is one of the greatly influences an extension because it means or efforts that can be used to display can help and facilitate the delivery of messages or health information to be material and aids to demonstrate something conveyed to mothers under toddlers so that the instructor wants to convey. (6). they can increase their knowledge which in The results showed that before the turn is expected to change their behavior health education methods were given in the towards positive or supportive health. form of lectures and leaflets of the The results showed that in 38 respondent's knowledge of 14 people and 24 respondents, it was found that 12 people who were sufficient, the average respondents had insufficient knowledge and Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 133 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 26 people had sufficient knowledge. fast behavior, but these changes will not last Respondents 'knowledge of efforts to prevent long because behavior changes that occur are stunting was measured prior to the not or have not been based on one's own implementation of health education methods awareness.(9). to measure the extent of respondents' knowledge about stunting prevention efforts. Although the results of the measurement The Most Effective Educational Method before being given the health education for Maternal Toddler Knowledge in method, there were 26 respondents with Stunting Prevention in Masaloka Raya sufficient knowledge, but the average results Sub-district, Bombana Regency of the respondents were not far from the The health education method used in predetermined standard values so that there this research is the lecture method, the are still many efforts to prevent stunting that lecture method with leaflets and the lecture must be known by mothers of toddlers in method with videos. All of these health terms of preventing stunting. education methods were tested on mothers of After being given treatment in the children under five to increase respondents' form of health education methods by means knowledge of stunting prevention efforts. of lectures and videos, it is known that there The results of the research conducted show are no more respondents who have less thatHealth education methods using lectures knowledge and all respondents' knowledge is and videos are more effective in increasing sufficient. The results of this study are able the knowledge of mothers under five in to have an influence on the respondent's preventing stunting compared to lecture knowledge because in addition to giving methods or lecture methods using leaflets. lectures but also given to respondents about This is evidenced by the mean rank value of the display of videos which are expected to the lecture and video methods with the attract the attention of respondents so that the highest value, namely 72.88. meaning of carrying out health education On the results of research that will be easily conveyed to respondents. researchers have tested using the SPSs test The results of the test with the Kruskal Wallis H The results show that Wilcoxon signed rank test with the among the three media, the three of them can significant value showed the value of pvalue increase the knowledge of mothers under = 0.000 <α = 0.05, it can be concluded that five, but the one that is more dominant in there is an effect of lecture and video increasing knowledge in this study is the methods on increasing the knowledge of lecture method with video. Mother’s mothers under five in preventing stunting in knowledge can help mothers to give child Masolaka Raya District, Bombana Regency. feeding. Therefore, their knowledge affects This is in accordance with the research significantly to child nutritional status (10). conducted by (8), which suggests that there is an effect of health education with the video method, because the message CONCLUSION conveyed can be received well. This means There is an effect of health education that the success of counseling can be with the lecture method, lecture method and influenced by the media because the media leaflet, lecture method and video on can influence knowledge, attitudes and increasing the knowledge of mothers under emotions. The use of appropriate extension five in preventing stunting in Masolaka Raya methods and extension media can increase District, Bombana Regency. It is also known efficiency and effectiveness in the that the health education method using implementation of health education in the lectures and videos is more effective in community, urgent motivation will result in increasing the knowledge of mothers under Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 134 Suleman, Y., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol3.Iss1/65 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 five in preventing stunting compared to the 8. Afrianto D. The effect of heapth lecture method or the lecture method with promotion to paprica farmers' leaflets. So it is necessary to consider the use knowledge, attitude and practice in of lecture and video methods so that in Kumbo-Pasuruan Village relating to carrying out health education, respondents personal protection equipment of can quickly understand and the messages pesticade effect in 2014. 2014. conveyed will be easily understood by the 9. Siahaan VR, Pangestu JF, Fitriyani M. mothers of toddlers. Effectivity of audio visual methods users to increase the teenagers' knowledge about sexs before marriage. REFERENCES Jurnal Kebidanan Malahayati. 2020;6(1):32-6 (Indonesia). 1. World Health Organization & 10. Tasnim, T., Mwanri L, Dasvarma, G. UNICEF. Progress on sanitation and Mother’s child feeding knowledge and drinking-water: World Health practices associated with underweight Organization; 2013. in children under-five years: A study 2. Mitra M. Stunting problems and from Rural Konawe, Indonesia. Public interventions to prevent stunting (a Health of Indonesia. 2018;4(1):9–18. Literature Review). Jurnal Kesehatan Komunitas. 2015;2(6):254-61. 3. Park LP, Chu VH, Peterson G, Skoutelis A, Lejko‐Zupa T, Bouza E, et al. Validated risk score for predicting 6‐month mortality in infective endocarditis. Journal of the American Heart Association. 2016;5(4):e003016. 4. Lestari W, Kristiana L, Paramita A. Stunting: Study about social construction in village and urban communities relating to nutrition and pattern of nursury for under-five years old children in Jember District. Aspirasi: Jurnal Masalah-masalah Sosial. 2018;9(1):17-33 (Indonesia). 5. Satriawan E. Increasing in national strategi in Stunting prevention in 2018-2024. Jakata: Tim Nasional Percepatan Penanggulangan Kemiskinan (TNP2K). 2018 (Indonesia). 6. Notoadmodjo S. Introduction of Health and Behaviour Sciences. Andi Offset Yogyakarta. 2003. 7. Utami ASF, Baiti N. The effect of social media to behaviour in cyberbullying in teenagers. Cakrawala-Jurnal Humaniora. 2018;18(2):257-62 (Indonesia). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 135 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP A BETWEEN LEADERSHIP STYLE AND WORKING CONDITIONS WITH NURSES' WORKING SATISFACTION IN INPATIENT ROOMS, BAHTERAMAS HOSPITAL Nur Ardiana1*, La Ode Saafi2, Tasnim Tasnim3 123Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Nur Ardiana Email : [email protected] Abstract Background: From the preliminary study by the researcher with the inpatient nursing department through in-depth interviews, there were problems such as complaints from patients who were in pain, there were nurses who did not come immediately and provide nursing care. Through interviews with nurses, it was found that career development procedures had not been prepared in nursing management. In addition, there are nurses who are several times late more than the stipulated time. Then there are still complaints that the incentives received are still insufficient. Methods: This type of research uses quantitative research with a cross sectional design. The population was 257 all nurses in the inpatient room at Bahteramas Hospital, with a sample of 141 samples using simple random sampling. Result s:Using the cramer coefficient, it is obtained a value of 0.732, this shows the strength of the relationship between leadership style in work and job satisfaction of nurses. And the cramer coefficient is obtained a value of 0.620, this shows the strength of the relationship between leadership style in work and job satisfaction of nurses in the inpatient room at Bahteramas Hospital in the strong relationship category. Conclusion: There is a relationship between leadership style and working conditions on the job satisfaction of nurses in the inpatient room of the Bahteramas Hospital. Key words: Leadership, Style, Working, Conditions, Job, Satisfaction Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 136 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 expectations that will be achieved. 3. the INTRODUCTION leader conveys the criteria for evaluating the The concept of Total Quality performance effectively. 4. leaders provide Management (TQM) is all management and invite feedback when employees have efforts that lead to a main goal, namely the achieved goals, and 5. leaders allocate realization of customer satisfaction, both rewards or salaries based on the results they external and internal customers. Everything have achieved. that management does is useless if it does Considering that employee job not succeed in increasing customer satisfaction is very important for the satisfaction. Customers have an important continuity of an organization's work, in this role in building the quality of a product or case the hospital, it is necessary to examine service. Management is defined as the the relationship between leadership style and process of completing work through other working conditions of nurses in the inpatient people to achieve organizational goals in a room of Bahteramas Hospital, Southeast changing environment (1). Sulawesi Province. Quality health services are the most important part of improving public health(2). METHOD So it takes a long time and a lot of effort to This type of research uses change people's behavior in line with the quantitative research, analytic observational health development program(3). The hospital research. The research design used was a is a health service facility that aims to cross sectional study. The population was facilitate quality and affordable public health 257 all nurses in the inpatient room at services currentlyhealth service support Bahteramas Hospital, with a sample of 141 facilities have a very strategic role to samples using simple random sampling. The accelerate the improvement of the health of research is located at Bahteramas Hospital. the Indonesian people.(4) This research was conducted on 10 Nursing is a profession that plays an November - 10 December 2021 important role in the success of providing services to improve the quality of health. RESULTS One result of the greatest activity comes Table 1 shows that the number of from nursing services that are carried out in respondents who answered based on the hospitals, in theory(5). leadership style questionnaire for the correct Basically, someone's job satisfaction criteria was 945 and the wrong answers were is what makes individuals feel happy when 585. doing. Some things are. Significantly affects Table 2 explains that the number of employee job satisfaction, namely conditions respondents who answered based on the related to the job itself, working conditions, work conditions questionnaire for the right leadership, co-workers, surveyors, criteria was 953 and the wrong answers were promotions and salaries.(6). 577. The quality of workers can never be Table 3 shows that of the 49 separated from the role of the leader. respondents who answered lack of leadership According to(7), the role of superior style with less job satisfaction, 49 leadership in contributing to employees to respondents (65.3%). From 57 respondents achieve good and optimal performance is with sufficient leadership style, 36 people carried out in five ways, namely: 1. The (46.2%) had sufficient job satisfaction. leader clarifies what is expected of each Meanwhile, of the 47 respondents who have individual worker, specifically the goals and a good leadership style with sufficient job objectives of their performance. 2. The satisfaction, 42 respondents (53.8%). This leader directs and explains how to meet means that respondents with less leadership Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 137 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 style are more likely to have less job satisfaction, and of the 32 respondents who satisfaction. Based on table 18, it is found had good job security with sufficient job that the significance value (p) value is 0.000, satisfaction were 5 respondents (6.7%). This which means that p <0.05 so that Ha is means that respondents with less job security accepted and Ho is rejected, which means are more likely to have less job satisfaction. that there is a significant association or Based on table 21, it is found that the relationship between the leadership style of significance value (p) value is 0.000, which the head of the room with job satisfaction of means that p <0.05 so that Ha is accepted nurses in the inpatient room of the and Ho is rejected, which means that there is Bahteramas Hospital. . a significant association or relationship Table 4 shows that of the 42 between job security and job satisfaction of respondents who answered less job security nurses in the inpatient room of Bahteramas with less job satisfaction were 41 Hospital. The results of the relationship respondents (54.7%). Of the 79 respondents closeness test using the Cramer coefficient with sufficient job security, there were 50 obtained a value of 0, people (64.1%) who had sufficient job Table 1 Variable Description of Leadership Style based on questionnaire questions YES NOT NO ITEM STATEMENT n % n % 1 Describe assignments 96 62.74 57 37.25 Invite group members to formulate 121 32 2 goals 79.08 20.91 Show things that can attract work 90 63 3 interest 58.82 41.17 Gives the opportunity to discuss 97 56 4 problems 63.39 36.60 5 Work together to organize tasks 86 56.20 67 43.79 6 Develop a friendly atmosphere 103 67.32 50 32.67 7 Reward and punishment 113 73.85 40 26.14 8 Opportunity to convey feelings 107 69.93 46 30.06 9 Pay attention to the conflicts that occur 75 49.01 78 50.98 Leaders give gifts to employees so that 57 37.25 96 62.74 10 they are enthusiastic about working TOTAL 945 617.64 585 382.35 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 138 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Variable description of working conditions based on questionnaire questions YES NOT NO ITEM STATEMENT n % n % The working environment is good and 67 43.79 86 56.20 1 comfortable A harmonious relationship between nurses and 125 81.69 28 18.30 2 superiors A harmonious relationship between fellow nurses 65 42.48 88 57.51 3 by providing mutual support 4 Clean room work environment 122 79.73 31 20.26 Clear work procedures in the implementation of 84 54.90 69 45.09 5 work / actions in the room 6 Has a toilet that is worth using 77 50.32 76 49.67 7 Has a wash tofel that is suitable for use 116 75.81 37 24.18 8 Has a good ventilation of air 95 62.09 58 37.90 9 Has a special room for nurses 84 54.90 69 45.09 10 There is a bed for nurses during the late night 118 77.12 35 22.87 TOTAL 953 622.87 577 377.12 Table 3 Distribution of Leadership Style on Job Satisfaction in Bahteramas Inpatient Rooms NO. Leadership Job satisfaction Style Less enough amount P value C n % n % 1. Less 49 65.3 0 0 49 2. Enough 21 28 36 46.2 57 0.000 0.732 3. Good 5 6.7 42 53.8 47 TOTAL 75 100 78 100 153 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 139 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 4 Distribution of Working Conditions on Job Satisfaction in Bahteramas Inpatient Rooms NO. Working Job satisfaction Conditions Less enough amount P value C n % n % 1. Less 41 54.7 1 1.3 42 2. Enough 29 38.7 50 64.1 79 0.000 0.620 3. Good 5 6.7 27 34.6 32 TOTAL 75 100 78 100 153 DISCUSSION satisfaction, concluding that there is a significant positive relationship between Relationship between Leadership Style leadership style and job satisfaction.(10). In and Nurse Job Satisfaction line with this research, research with the title This research shows that there is a of the influence of leadership style on job relationship between leadership style and job satisfaction proves that there is a positive and satisfaction of nurses because according to significant influence between leadership the results of hypothesis testing using chi style on job satisfaction.(11). square analysis Based on table 18, it is found that the significance value (p) value is 0.000 Relationship between working conditions which means that p <0.05 so that Ha is and job satisfaction of nurses accepted and Ho is rejected, which means This research shows that there is a that there is a significant association or moderate relationship between leadership relationship between the leadership style of style and job satisfaction of nurses because the head of the room with job satisfaction of according to the results of hypothesis testing nurses in the inpatient room of the using chi square analysis. Based on table 20, Bahteramas Hospital. . The results of the it shows that of the 42 respondents who relationship closeness test using the cramer answered lack of job security with less job coefficient obtained a value of 0.732, this satisfaction were 41 respondents (54.7%). Of shows the strength of the relationship the 79 respondents with sufficient job between leadership style at work and job security, there were 50 people (64.1%) who satisfaction of nurses in the inpatient room at had sufficient job satisfaction, and of the 32 Bahteramas Hospital in the strong respondents who had good job security with relationship category. sufficient job satisfaction were 5 respondents Kjob satisfaction is closely related to (6.7%). This means that respondents with the cooperation between subordinates and less job security are more likely to have less the leader, the better the cooperation carried job satisfaction. out by the leadership, the better the job Based on table 21, it is found that the satisfaction of his subordinates. This is also significance value (p) value is 0.000, which supported by Hasibuan in(8) which states means that p <0.05 so that Ha is accepted that one of the factors that affect job and Ho is rejected, which means that there is satisfaction is the attitude of the leader in his a significant association or relationship leadership, meaning that the attitude of a between job security and job satisfaction of leader who is friendly, understands his nurses in the inpatient room of Bahteramas employees, is fair and can increase employee Hospital. job satisfaction. (9). Another study that The results of the relationship supports this research is a study entitled the closeness test using the cramer coefficient relationship between leadership style and job obtained a value of 0.620, this shows the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 140 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 strength of the relationship between the satisfaction for inpatients so that the services leadership style at work and job satisfaction provided to patients can also be improved, of nurses in the inpatient room at Bahteramas namely by increasing effective Hospital in the strong relationship category. communication and establishing good This researchaccording to research relationships with inpatient officers. results(12)about the influence of the work environment on employee job satisfaction at the BPS Probolinggo office shows that there is a positive influence between the work REFERENCES environment on job satisfaction, so it can be said that the higher the work environment, 1. Hibana H, Kuntoro SA, Sutrisno S. the higher the level of job satisfaction. Development of education in humanic Working conditions are a condition of the religious in Madrasah. Jurnal work environment that can affect work Pembangunan Pendidikan: Fondasi comfort, security and safety. dan Aplikasi. 2015;3(1):19-30 Similar results were obtained from (Indonesia). the research conducted (13)in Sultan Agung 2. Damopoli RV. Implementation of the Hospital, it states that there is a relationship local goventment policy about public between the variable working conditions and health services (Study in Kotamobagu job satisfaction. Supporting working Sub-district, Selatan Kota conditions will satisfy employees at Kotamobagu). Politico: Jurnal Ilmu work(14). The conditions of the work Politik. 2016;3(1):1168 (Indonesia). environment have an important meaning for 3. Jayadipraja EA, Prasetya F, Azlimin A, workers in completing their duties because if Mando WOSY. Family clean and the employee likes the situation in his work healthy living behavior and its environment, the employee will feel at home determinant factors in the village of in his workplace to carry out activities so Labunia, Regency of Muna, Southeast that work time is used effectively and Sulawesi Province of Indonesia. Public optimally so that job satisfaction can also Health of Indonesia. 2018;4(1):39-45. increase.(15). Based on the results of the 4. Akbar MI. Analysis Of The Needs Of research and theory above, the authors General Practitioners In Public Health conclude that the conditions in the work Centers Using Health Workload environment greatly affect the job Method. Public Health of Indonesia. satisfaction of employees, so it is 2020;6(2):63-9. recommended that the hospital pay more 5. Trihastuti E. The effect of leadership, attention to the planning and arrangement of Motivation and workload to nurse the work environment because both physical performance in filing about nursing and non-physical work environments cannot treatment in patient rooms of serious be ignored because they affect the nets of disease in X Hospital Surabaya: activity. profession. Universitas Airlangga; 2016 (Indonesia). CONCLUSION 6. Parathon H, Kuntaman K, Widiastoety There is a relationship between TH, Muliawan BT, Karuniawati A, leadership style and working conditions on Qibtiyah M, et al. Progress towards the job satisfaction of nurses in the inpatient antimicrobial resistance containment room of the Bahteramas Hospital. So it is and control in Indonesia. BMJ. hoped that the hospital, in this case the 2017;358 (Indonesia). hospital leadership as the leader of the organization, can further increase job Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 141 Ardiana, N., Saafi, L. O., & Tasnim, T. DOI: 10.36566/ijhsrd/Vol3.Iss1/66 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 7. Dewi IK. Nilai-nilai Profetic in modern work satisfaction as Intervening leadership in Management variable. Maneggio: Jurnal Ilmiah performance: Gre Publishing; 2019. Magister Manajemen. 2018;1(1):59- 8. Jan AT, Azam M, Siddiqui K, Ali A, 70. Choi I, Haq QM. Heavy metals and human health: mechanistic insight into toxicity and counter defense system of antioxidants. International journal of molecular sciences. 2015;16(12):29592-630. 9. Rumondor M, Gannika L, Bataha YY. Leadership style of head of room and nurse satisfaction. Jurnal Keperawatan. 2019;7(2) (Indonesia). 10. Baihaqi MF, SUHARNOMO S. The effect of Leadership style to work satisfaction and performance with organization commitment as Intervening variable (study in PT. Yudhistira Ghalia Indonesia Yogyakarta): Universitas Diponegoro; 2010 (Indonesia). 11. Hidayati LN. Measurment of risks of banking and VaR (Value at Risk). Jurnal Ilmu Manajemen. 2006. 12. Rudianto D. The effect of facility, environment and work stress to work satisfaction. Skripsi, Universitas Muhammadiyah Magelang; 2019 (Indonesia). 13. Putra KDY, Wahyuni I, Kurniawan B. The relationship between Supervision, colleagues, salary, work safety, work condition, job Promotion and type of occupation with work satisfaction (Case Study in staff in Koperasi Simpan Pinjam X in Pemalang District, Jawa Tengah). Jurnal Kesehatan Masyarakat (e-Journal). 2018;6(4):321-9 (Indonesia). 14. Elizar E, Tanjung H. The effect of training, competency, work environment to staff performance. Maneggio: Jurnal Ilmiah Magister Manajemen. 2018;1(1):46-58 (Indonesia). 15. Siagian TS, Khair H. The effect od leadership styles and work environment to staff performance with Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 142 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access EXPERIENCE AND TRAINING RELATE TO PERFORMANCE CLEAN AND HEALTHY LIVING BEHAVIOR IN CADRE IN THE WORKING AREA OF POASIA PRIMARY HEALTH CARE, KENDARI CITY Hasmariana1, La Ode Saafi2, Tasnim Tasnim3, Anry Hariadhin Depu4 1,2,3,4 Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Hasmariana Email : [email protected] ABSTRACT Background:Southeast Sulawesi Provincial data shows that Community life behavior is measured by the number of households with a clean and healthy lifestyle which is based on predetermined indicators. In 2015, the percentage of Clean and Healthy Living Behaviors was 45%, in 2016 there was an increase of 52% and decreased in 2017 by 49% and in 2018 by 46%, while in 2019 there was an increase in the percentage of 53% again. Based on these data, the coverage was still low because the target was set according to the minimum service standard was 80%. The orientation of community empowerment for health cadres is still insufficient, it is noted that only 36 people have received community empowerment training. The insufficient number of cadres can also make a negative contribution, resulting in the lack of achievement of the primary health care s program Methods:This type of research is a quantitative study, with a cross sectional study approach. The population of this study were 100 people and the samples of this study were 80 cadres in 20 comprehensive health Post in the working area of Poasia primary health care centre in Kendari City. The sampling technique which was used in this study was a simple random sampling. Results: Based on the results of statistical tests show that the value (X2test) = 0.286 Conclusion:Cadres are expected to play an active role in increasing their knowledge and experience through training activities on cadre performance held by Puskesmas Poasia. Key words: Experience, Training, Cadre, Performance, Healthy, Lifestyle Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 143 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION Health Center, another reason was that The percentage of households with a during the Covid-19 pandemic, it was clean and healthy lifestyle based on data at deemed necessary to restrict movement the National level in Indonesia is still low, in within Kendari City, therefore the research 2015 amounting to 55.46%, in 2016 scope of the Regency or the whole Kendari amounting to 56.58% while the target for City was not chosen. But of course by not achieving clean and healthy living behavior reducing the quality of the results of the for the minimum household structure is 80%. research to be carried out. There are 10 indicators in the household The role of cadres in health services structure consisting of (1) delivery by health can be caused by various factors such as workers in health facilities, (2) exclusive internal factors, namely from cadres such as breastfeeding for babies, (3) weighing cadre characteristics, knowledge, attitudes, children under five, (4) using clean water, (5) motivation, busyness, while external factors washing hands with clean water and soap, such as providing incentives, rewards, (6) use of healthy latrines, (7) eradication of training and so on(3). The knowledge and larvae at home once a week, (8) eating attitudes of cadres need to be improved with vegetables and fruit every day, (9) physical a health promotion strategy for clean and activity every day and (10) the habit of not healthy living behavior guidance to cadres smoking in the house (1). and are comprehensive, empowerment in Data from the Health Office of household arrangements is carried out for Southeast Sulawesi Province also explains individuals, families and community the distribution of the percentage of groups(4). households with clean and healthy living behavior starting from the highest district, METHOD namely North Konawe Regency at 94%, This type of research is a quantitative Muna Regency at 81%, Kendari City at 74%, study, with a cross sectional study and the lowest percentage is in West Munar approach(5). The location of this research Regency, 14%. Broadly speaking, Southeast has been carried out in the working area of Sulawesi Province has not reached the target the Puskesmas Poasia, Kendari City, which of the SPM set for clean and healthy living was carried out from October to November behavior coverage, which is 80%, as well as 2020. The population in this study was 100 Kendari City, which has quite complete people and a sample of 80 people all cadres facilities, is the capital of Southeast Sulawesi in 20 Posyandu in the working area of Province but has not yet been able to achieve Puskesmas Poasia, Kendari City. The the predetermined targets (2). sampling technique used in this study was This study took the research location simple random sampling(6). at Puskesmas Poasia, the reason for choosing Puskesmas Poasia as the research location RESULTS compared to other Puskesmas in Kendari Table-1 shows that of the 80 City because after comparing it with respondents who have sufficient experience Puskesmas Lepo-Lepo, and Puskesmas category as many as 37 people (46.2%) and Mokoau it is known that the performance of less experience category are 43 people cadres at Puskesmas Poasia has not shown (53.8%). the target of clean and healthy living Table-2 shows that of the 80 behavior coverage in the community that is, respondents based on the assessment of at least 80% while the Lepo-Lepo Puskesmas sufficient category training as many as 36 and Mokoau Puskesmas. Apart from the low people (45.0%) and less category training performance of clean and healthy living were 44 people (55.0%). behavior cadres at the Poasia Community Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 144 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table-3 shows that among 37 Table-4 shows that among 36 respondents with sufficient experience, there respondents with sufficient category training, are 16 people (43.2%) who have sufficient there are 23 people (63.9%) who have performance. Meanwhile, of the 43 sufficient performance. Meanwhile, of the 44 respondents with less experience, there were respondents with poor category training, 15 people (34.9%) who had sufficient there were 8 people (18.2%) who had performance. This shows that PHBS cadres sufficient performance. This shows that with sufficient performance are more than PHBS cadres with sufficient performance are respondents with sufficient experience. The more than respondents with sufficient results of statistical tests show that the value training. The results of statistical tests show (X2hit) = 0.286 Table 1 Distribution According to Respondents' Experience in the Work Area Poasia Health Centre, Kendari City No. Experience n % 1. Enough 37 46.2 2. Less 43 53.8 Total 80 100 Table 2 Distribution by Respondent Training in Work Areas Poasia Health Centre, Kendari City No. Training n % 1. Enough 36 45.0 2. Less 44 55.0 Total 80 100 Table 3 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 145 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Distribution of Experience According to the Performance of Tatanan clean and healthy living behavior Cadres Households in PoasiaHealth Centre, Kendari City Clean and Healthy Living Behavior Cadre total No. Experience Performance Enough Less n % n % n % 1. Enough 16 43.2 21 56.8 37 100 3 Less 15 34.9 28 65.1 43 100 Total 31 38.8 49 61.2 80 100 Table 4 Distribution of Training According to the Performance of Tatanan clean and healthy living behavior Cadres Households in Poasia Health Centre, Kendari City Clean and Healthy Living Behavior Cadre total No. Training Performance Enough Less n % n % n % 1. Enough 23 63.9 13 36.1 36 100 3 Less 8 18.2 36 81.8 44 100 Total 31 38.8 49 61.2 80 100 DISCUSSION out tasks in order to achieve organizational Relationship of Experience with goals(8). Work experience is an ability that Clean and Healthy Living Behavior Cadre employees have in carrying out the tasks Performance assigned to them. In this study, experience This study shows there is no did not provide a significant value to the relationship between experience and performance of Clean and Healthy Living performance of Clean and Healthy Living Behavior cadres(9). This could have Behavior cadres in household arrangements. happened because the data from the Poasian This is in line with (7) entitled The Effect of Health Center stated that the Clean and Education, Training and Work Experience on Healthy Living Behavior coverage at the Employee Performance in the Marketing Poasia Health Center had not shown any Department of PT. Central Santosa Finance significant changes since three years ago. So (BCA GROUP) Mojokerto Branch. These even though cadres are known to have work results indicate that work experience has no experience that is in accordance with the effect on cadre performance. The results of indicators, because the work experience that the analysis show that the work experience is usually applied is still or cannot be of Clean and Healthy Living Behavior cadres developed so that it impacts on the results of in the household structure is less than or Clean and Healthy Living Behavior equal to three years, so that the cadres are achievements that are not in accordance with less able to carry out the tasks given by their the standards. superiors to the fullest. Experience is one of the factors that influence a person's performance in carrying Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 146 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Relationship between Training and CONCLUSION Clean and Healthy Living Behavior Cadre Cadres are expected to play an active Performance role in increasing their knowledge and This study shows that there is a experience through training activities on relationship between training and the cadre performance and the Puskesmas Poasia performance of PHBS cadres in household is expected to be selective by determining arrangements. So it can be concluded that the criteria needed in selecting cadres so that cadre training is related to the performance the purpose of appointing cadres, namely to of cadres in posyandu activities. increase Clean and Healthy Living Behavior Respondents with sufficient training showed coverage, can be achieved. more good performance, while respondents with less training showed less performance. . The results of this study are in line with REFERENCES research conducted by (10)who found that there was a relationship between cadre 1. Ministry oh Health of Republic of training and the performance of posyandu Indonesia. Indonesian Health Profile cadres in the work area of Lisi Puskesmas, in 2015. Jakarta: Kementerian Tanete Riaja sub-district, Barru district. Kesehatan Republik Indonesia. 2015 States that training is intended so that (Indonesia). cadres who have participated are expected to 2. Health Department of Southeast gain knowledge and skills so that they are Sulawesi Province. Distibution of able to carry out health-minded interventions Healthy life and clean behaviour data for the community and someone who has In Kendari. Sulawesi Tenggara. 2020 taken non-formal education such as training (Indonesia). will have better performance than someone 3. Putri IM, Surjadi LM. The relationship who is less even not getting any training at between internal dan external factors all(11). In training, in principle, there are and regular antanal treatment. Jurnal learning process activities, both theoretical Biomedika dan Kesehatan. and practical, aiming at improving and 2019;2(1):27-33 (Indonesia). developing academic, social and personal 4. Ministry oh Health of Republic of competencies or abilities in the fields of Indonesia. Health ministry decision knowledge, skills and attitudes, as well as number 1995/Menkes. SK/XII/2011 being useful for training participants in about Antropometry standar of body improving performance on tasks or jobs for mass index measuremen. 2011 which they are responsible(12). (Indonesia). Effective training must be oriented 5. Mackey A, Gass SM. Second language towards results (goals) and processes (the research: Methodology and design: ability of the organization to adapt and Routledge; 2015. survive)(13). The results of an effective 6. Sugiyono. Nonparametrict statistics training process will be able to make an for research. 2015. organization well able to carry out its 7. Alfin MR, Nurdin S. The effect of planned programs systematically in an effort Atmosphere store to clien satisfaction to achieve the results or objectives that have which affects to clien Loyality. Jurnal been set(14). In other words, a training is Ecodemica: Jurnal Ekonomi, called effective if the training can produce Manajemen, dan Bisnis. human resources whose abilities, skills, and 2017;1(2):249-58 (Indonesia). attitude change are more independent. In this 8. Rakhmatullah AE, Hadiati S, Setia way will also affect the quality of KA. The effect of competency, work performance. experiment and work Etos to staff Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 147 Hasmariana, L.O. Saafi, Tasnim, T., & Depu, A.H. DOI: 10.36566/ijhsrd/Vol3.Iss1/67 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 performance in Dimediasi Profesionalisme in Education department in Probolinggo District. Jurnal Ekonomi dan Manajemen. 2018;19(1). 9. Aldi Y, Susanti F. The effect of work Stress Kerja and work motivation to staff's work prestige in PT. Frisian Flag Indonesia in Padang. 2019. 10. Napirah MR, Rahman A, Tony A. Factors of health service usage in Tambarana Health Care in Poso Pesisir Utara Sub-district, Poso District. Jurnal Pengembangan Kota. 2016;4(1):29-39. 11. Daulay H. The effect of education and training to civil servance performance in Badan Pendapatan Pengelolaan Keuangan dan Asset Daerah in Padang Lawas District. 2017 (Indonesia). 12. Elizar E, Tanjung H. The effect of training, competency, and environment to staff performance. Maneggio: Jurnal Ilmiah Magister Manajemen. 2018;1(1):46-58. 13. Setiawan H. Training Management. Aktualita: Jurnal Penelitian Sosial Keagamaan. 2018;8(2):32-47. 14. Fadhilah AT. The effect of budgeting based on performance to effectivity in Purabaya-Jati-Saguling street development project in Bandung Barat District (Survey in Department of general work and room setting in Bandung Barat District): Universitas Widyatama; 2017. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 148 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access RISK FACTORS PULMONARYTUBERCULOSIS IN POASIA HEALTH CENTRES IN THE COASTAL REGION OF KENDARI CITY Ifon1*, Timbul Supodo2, Sunarsih3, H. Sanihu Munir4, Abd Aziz Harun5 1,2,3,4Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Ifon Email : [email protected] Abstract Background :Tuberculosis or pulmonary tuberculosis is an infectious disease caused by the presence of the bacteria Mycobacterium Tubercolusis. Tuberculosis is a health problem. Kendari City prevalence is 3.53 per 1,000 population, especially in the work area of the Poasia Health centre, coastal area of Kendari City, every year there is a decrease, namely in 2017 as much 51 cases of lung TB smear positive, in 2018 as many50 cases of smear positive pulmonary TB and in 2019 as many49 cases of smear positive. However, this has not yet been able to achieve the National target, which is a minimum cure rate of 85%.The research objective was to determine the risk factors for the incidence of smear positive pulmonary TB in PuskesmasPoasia in the coastal area of Kendari City. Method s: This type of research is a case control Study conducted from December 2020 to January 2021, the sample used are 30 cases taken by random sampling and 30 controls. Result s: Using Odds Ratio (OR). OR valuehabit of cleaning mosquito nets OR = 9,036> 1, cleaning or drying bedding or mattress OR = 6,571> 1, Drop Out Treatment nno OR value, humidity OR = 6.909> 1, sunlight lighting OR = 5,675> 1and home ventilationOR = 4.030> 1. Conclusion : Habit of cleaning mosquito nets, cleaning or drying bedding or mattress, moisture , sunlight lighting and home ventilation is a risk factor meanwhile drop out treatmentis not a risk factor for the incidence of smear positive pulmonary TB in PuskesmasPoasia in the coastal area of Kendari City. Keywords: Pulmonary TB, Mosquito, Bedding, Humidity, Lighting, Ventilation. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 149 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 tuberculosis the following year, there was INTRODUCTION no increase in cases again, more so in Tuberculosis is an infectious disease Kendari City. Other than that,Kendari City caused by Mycrobacterium Tuberculosis(1). is an area where part of its territory consists Air pollution is not good one of the causes of of bay waters and mangrove vegetation, lung disorders(2). Tuberculosis is a disease which have potential tourist attractions and that has been known for a long time and is can encourage community social and still a major problem of death worldwide(3). economic activities in Kendari City. Based Based on data from WHO (World on the aspect of the Regional Spatial Plan, Health Organization), it shows that the coastal bay of Kendari City is divided tuberculosis causes the death of nearly 2,000 into trade and tourism zones (6).Apart from people every day. In addition, about 40% of the unique geographical conditions, the Tuberculosis cases worldwide are in the Kendari City Bay Area is the gateway to Southeast Asia region. Indonesia ranks third Kendari City from the sea. Therefore, in the world after India and China in terms of management planning and regional all cases of pulmonary tuberculosis, development of Kendari City must prioritize amounting to 583 thousand people and the characteristics of the sea, coastal areas around 140 thousand people are estimated to and upstream areas(7). Aside from die each year due to pulmonary thatKendari City is on the Trans-Sulawesi tuberculosis(4). route which is very dense and has high Source from the profile of the population mobility, so the entry and exit of Southeast Sulawesi Provincial Health Office the disease is not detected properly. The in 2019, the prevalence rate of positive BTA total population of Kendari City in 2019 is TB cases was 3.96per 1,000 population. around 392,830 people(5). While the most new case findings reported in Data from the Kendari City Health 2019 came from six districts, namely Office in 2017 found that the number of BTA Kendari City with 711 cases with a positive sufferers was 538 cases or 1.45 per prevalence of 3.53 per 1,000 population, 1,000 population, in 2018 the number of South Konawe with 475 cases with a positive AFB cases was 676 or 1.77 per prevalence of 2.12 per 1,000 population, 1,000 population, and in 2019 in Find the Bombana with 451 cases with prevalence number of BTA positive sufferers as many as 3.59 per 1,000 population, Konawe as many 711 or 1.80 per 1,000 population(8). as 409 cases with a prevalence of 3.34 per The public health center is as one of 1,000 population, Kolaka as many as 402 the first-level health service facilities has an cases with a prevalence of 2.75 per 1,000 important role in the national health population and Muna as many as 377 cases system.(9) Based on data obtained from the with prevalence of 3.95 per 1,000 Kendari City Office, the Puskesmas located population. The number of new cases in in the coastal area include the Nambo these six districts reached>50% of the total Community Health Center, Poasia new BTA positive cases in Southeast Community Health Center, Abeli Sulawesi(5). Community Health Center and the Eye Judging by the prevalence data, Health Center. PuskesmasPoasia ranks third Kendari City occupies the third level after in Kendari City after PuskesmasPuuwatu, Muna and Bombana, but in the last two and PuskesmasKemaraya in terms of the years case detection in Kendari city number of pulmonary TB patients. However, continues to increase, namely in 2018 as PuskesmasPoasia ranks first for coastal areas. many as 676 cases and in 2019 continued to So the researchers were interested in increase to 711 so that the government tries researching "Risk Factors Associated to prevent the incidence of pulmonary toprevalence of Pulmonary TB in the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 150 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 PuskesmasPoasia, the Coastal Region of respondents have a good habit of locking or Kendari City". drying the mosquito nets, including 7 respondents (25.9%) who were cases and 20 respondents (74.1%) were controls. METHOD The results of statistical tests show that The research method used is a the calculated chi square value (X2hit) = quantitative method with a case control study 11,380> X2tab = 3,841 or p value = 0,000 design. To determine the risk factors <0.05, with a test value of closeness (φ = between the independent variables and the 0.436) ,. Also obtained the OR = 6,571> 1. dependent variable retrospectively at the Logistic regression test results that is 0.203 Poasia Health Center which is located in the Table 3 shows that 31 respondents had coastal area of the city of Kendari. The incomplete treatment, including 1 respondent population of all patients suffering from (3.2%) who was a case and 30 respondents pulmonary tuberculosis and seeking (96.8%) who was a control. Then 29 treatment at the Poasia Health Center in the respondents had complete treatment, coastal area of Kendari City was 49 patients. including 29 respondents (100.0%) who With a total sample of 30 cases and 30 were cases and 0 respondents (0.0%) who controls (10). The variable in this study is the were controls. The statistical test results habit of cleaning the mosquito net, cleaning show that the calculated chi square value or drying bedding or mattress , Drop Out (X2hit) = 56,129> X2tab = 3,841 or p value Treatment , humidity, sunlight lighting and = 0.001 <0.05, with a test value of closeness home ventilation.Data analysis was carried (φ = - 0.967). out in several stages, namely descriptive, Table 4 shows that 34 respondents had inferential analysis (11) and epidemiological lighting that did not meet the requirements, analysis (Odd Ratio), and logistic including 23 respondents (67.6%) who were regression(12). This analysis was carried out cases and 11 respondents (32.4%) who were using the help of statistical applications. controls. Then 26 respondents had lighting that met the requirements, including 7 RESULTS respondents (26.9%) who were cases and 19 Table 1 shows that 31 respondents respondents (73.1%) who were controls. The have a habit of locking or drying the statistical test results show that the calculated mosquito nets that are lacking, including 23 chi square value (X2hit) = 9.774> (X2 tab) = respondents (74.2%) who were cases and 8 3.841 or p value = 0.002 <0.05, with a test respondents (25.8%) were controls. Then 29 value of closeness (φ = 0.404). Also obtained respondents have a good habit of locking or the OR value = 5.675> 1. Logistic regression drying the mosquito nets, including 7 test results that is 1,000. respondents (24.1%) who were cases and 22 Table 5 shows that 35 respondents respondents (75.9%) were controls.The have lighting that does not meet the statistical test results show that the calculated requirements, including 24 respondents chi square value (X2hit) = 15.017> X2tab = (68.6%) who are cases and 11 respondents 3.841 or p value = 0.000 <0.05, with a test (31.4%) who are controls. Then 25 value of closeness (φ = 0.500. Also obtained respondents had lighting that met the the OR = 9.036> 1. Logistic regression test requirements, including 6 respondents resultsis 0.036. (24.0%) who were cases and 19 respondents Table 2 shows that 33 respondents (76.0%) who were controls. The results of have the habit of cleaning or drying statistical tests show that the calculated chi mattresses or bedding, including 23 square value (X2hit) = 11.589> X2tab = respondents (69.7%) who were cases and 10 3.841841 or p value = 0.001 <0.05, with a respondents (30.3%) were controls. Then 27 test value of closeness (φ = 0.439). Also Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 151 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 obtained the OR value = 6.909> 1. Logistic cases and 21 respondents (65.6%) who were regression test results that is 1,000. controls. The results of statistical tests show Table 6 shows that of the 28 that the calculated chi square value (X2hit) = respondents having ventilation does not meet 6.696> X2tab = 3.841841 or p value = the requirements, including 19 respondents 0.010> 0.05, with a test value of closeness (φ (67.9%) who were cases and 9 respondents = 0.334). Also obtained the OR value = (32.1%) were controls. Then 32 respondents 4.030> 1.Logistic regression test results that had ventilation that met the requirements, is 0.014. including 11 respondents (34.4%) who were Table 1 Association between washing or drying the mosquito nets with the prevalence of pulmonary tuberculosis at the Poasia Health Centre, the Coastal Region of Kendari City The habit of Pulmonary TB Statistic test washing or Total drying the prevalence 2 φ OR mosquito Case Control nets n % n % n % X2test = 15,017 0.500 OR = 2 Less 23 74.2 8 25.8 31 100 X table = 3,841 9,036 Good 7 24.1 22 75.9 29 100 P value = 0.000 LL = α = 0.05 2.802 Total 30 50.0 30 50.0 60 100 UL = 29,134 Source: Primary data 2020 Table 2 Association between Cleaning and Drying Habits of Bedding or Mattresses withthe prevalence of pulmonary tuberculosis at the Poasia Health Centre, the Coastal Region of Kendari City The habit of Pulmonary TB prevalence Statistic test cleaning or drying Total the mattress or 2 φ OR mattress Case Control 2 n % n % n % X test = 11,380 0.436 OR = 2 6,571 Less 23 69.7 10 30.3 33 100 X table = LL = Good 7 25.9 20 74.1 27 100 3,841 2.109 P value = 0.001 UL = Total 30 50.0 30 50.0 60 100 α = 0.05 20,479 Source: Primary data 2020. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 152 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 Associationof Drop Out of Treatment with the prevalence of pulmonary tuberculosis at the PuskesmasPoasia, the Coastal Region of Kendari City Pulmonary TB prevalence Statistic test Drop Out Total Treatment 2 φ OR Case Control 2 n % n % n % X test = 56,129 -0,967 OR = - 2 Incomplete 1 3,2 30 96.8 31 100 X table = LL = - Complete 29 100.0 0 0.0 29 100 3,841 UL = - Total 30 50.0 30 50.0 60 100 P value = 0.000 α = 0.05 Source: Primary data 2020. Table 4 Associationbetween Sunlight Lighting with the prevalence of pulmonary tuberculosis at the Poasia Health Centre, the Coastal Region of Kendari City Pulmonary TB Statistic test Total Sunlight Lighting incidence 2 φ OR Case Control n % n % n % X2test = 9,774 0.404 OR = 2 Not eligible 23 67.6 11 32.4 34 100 X table = 3,841 5,675 P value = 0.002 LL = qualify 7 26.9 19 73.1 26 100 1,841 Total 30 50.0 30 50.0 60 100 α = 0.05 UL = 17,494 Source: Primary data 2020. Table 5 Association between Humidity with the prevalence of pulmonary tuberculosis at the Poasia Health Centre, the Coastal Region of Kendari City Pulmonary TB Statistic test Total Humidity incidence 2 φ OR Case Control n % n % n % X2test = 0.439 OR = Not eligible 24 68.6 11 31.4 35 100 11,589 6.909 2 qualify 6 24.0 19 76.0 25 100 X table = LL = 2,160 UL = Total 30 50.0 30 50.0 60 100 3,841 P value= 0.001 22,098 α = 0.05 Source: Primary data 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 153 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 6 Association between Home Ventilation with the prevalence of pulmonary tuberculosis at the Poasia Health Centre, the Coastal Region of Kendari City Pulmonary TB incidence Statistic test Home Ventilation Total 2 φ OR Case Control n % n % n % X2test = 6,696 0.334 OR = 2 4.030 Not eligible 19 67.9 9 32.1 28 100 X table = LL = qualify 11 34.4 21 65.6 32 100 3,841 1.372 Total 30 50.0 30 50.0 60 100 P value= 0.010 UL = α = 0.05 1,839 Source: Primary data 2020 DISCUSSION at the Poasia Health Center Kendari City Regional Coastal Area. Association between washing or drying According to Sidiq (2013) tuberculosis the mosquito nets with the prevalence of germs can last for 1 to 2 hours in the air, pulmonary tuberculosis at the while in a humid and dark place the PuskesmasPoasia, the Coastal Region of tuberculosis germs can last for months(13). Kendari City The results showed that there were 8 Association between Cleaning and Drying respondents (25.8%) who lacked the habit of Habits of Bedding or Mattresses withthe locking or drying the mosquito nets but did prevalence of pulmonary tuberculosis at not suffer from pulmonary TB. This is due to the Poasia Health Centre, the Coastal several things including respondents who Region of Kendari City often apply PHBS in their homes, do not The results showed that there were still have a history of contact with other TB 10 respondents (25.8%) who had less habits sufferers, and do a lot of activities under the of cleaning or drying mattresses or hot sun. Furthermore, there were also 7 mattresses but did not suffer from pulmonary respondents (24.1%) who had the habit of TB. This is due to several things, including locking or drying the mosquito nets in the respondents who often apply PHBS at home good category but suffering from pulmonary and do not have a history of contact with TB. This is because the respondent has a other TB sufferers. Furthermore, there were history of contact with a friend who is also 7 respondents (24.1%) who had the suffering from pulmonary TB. habit of cleaning or drying the mattresses or The results of the inferential analysis mattresses in the good category but suffering show that there is a fairly close relationship from pulmonary TB. This is because the between the habit of washing or drying the respondent has a history of contact with a mosquito nets with the incidence of friend who is suffering from pulmonary TB, pulmonary tuberculosis at the Poasia Health besides that the respondent has never done CenterKendari City Regional Coastal Area. any activities under the hot sun. Based on the results of the logistic regression The results of inferential analysis test, it was found that the habit of washing or show that there is a fairly close relationship drying the mosquito nets had a relationship between the habit of cleaning or drying with the incidence of pulmonary tuberculosis bedding or mattresses with the incidence of pulmonary tuberculosis at the Poasia Health Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 154 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 CenterKendari City Regional Coastal Area. Association between Sunlight Lighting The results of this study are in line with the with the prevalence of pulmonary research of Azhar&Perwitasari (2013) which tuberculosis at the Poasia Health Centre, states that the behavior of not drying the the Coastal Region of Kendari City mattress has the risk of being infected with The results showed that there were 11 pulmonary tuberculosis by 1,423 times(14). respondents (25.8%) who had less sunlight Based on the results of the logistic but did not suffer from pulmonary TB. This regression test, it was found that the habit of is due to several things including the cleaning or drying the mats of the bed or respondent who has no history of contact mattress was related to the incidence of with other TB sufferers, the respondent's pulmonary tuberculosis at the Poasia Health habit of opening the window and letting the Center. Kendari City Regional Coastal Area. sun directly enter the room. Furthermore, Tuberculosis germs cannot tolerate sunlight there were also 7 respondents (24.1%) who and air currents. Tuberculosis germs will die had good sunlight but suffered from within 2 hours by sunlight(15). pulmonary TB. This is because the Association of Drop Out of Treatment respondent has a history of contact with a with the prevalence of pulmonary friend who is suffering from pulmonary TB. tuberculosis at the Poasia Health Centre, The results of inferential analysis show the Coastal Region of Kendari City that there is a fairly close relationship In this study, it appears that drop out of between sunlight lighting and the incidence treatment is not a risk factor for pulmonary of pulmonary tuberculosis at the Poasia TB incidence. This is because in the case Health Center Kendari City Regional Coastal sample, almost all respondents have a Area. This research is in line witha research complete history of TB treatment drop out. by Atmosukarto and Soeswati which proves Meanwhile, the control respondents did not that a house with poor lighting has a experience pulmonary TB pain, so they felt significant risk of suffering from tuberculosis that they did not need to take TB drugs 3-7 times compared to a house with good regularly or had to always obey the lighting. Nurbaity (2016) also shows that instructions for ingesting drugs. residents whose lighting does not meet the The results of inferential analysis show requirements significantly will have a 2.5 that there is a very small (negligible) times risk of contracting pulmonary relationship between Drop Out of Treatment tuberculosis compared to residents whose and the incidence of pulmonary tuberculosis house lighting meets the requirements in at PuskesmasPoasia. Kendari City Regional East Jakarta(17). Coastal Area. This is not in line with Based on the results of the logistic research conducted by Devica (2017) at the regression test, it was found that sunlight Poasia Health Center where the results of lighting had no relationship to the incidence their research show that attitudes toward of pulmonary tuberculosis at the Poasia treatment history, namely the habit of taking Health Center Kendari City Regional Coastal medication by MDR-TB patients are Area. This is not in line with research partially regular and irregular. Based on the conducted by Rina Puspita Sari et al (2018) results of the logistic regression test, who stated that there was a relationship treatment Drop Out had no relationship with between lighting and the incidence of the incidence of pulmonary tuberculosis at pulmonary tuberculosis where the p value = the Poasia Health CenterKendari City 0.026 was obtained, at α = 0.05 (p ≤ α)(18). Regional Coastal Area(16). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 155 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Association between Humidity with the Association between Home Ventilation prevalence of pulmonary tuberculosis at with the prevalence of pulmonary the Poasia Health Centre, the Coastal tuberculosis at the Poasia Health Centre, Region of Kendari City the Coastal Region of Kendari City The results showed that there were 11 The results showed that there were still respondents (25.8%) who had inadequate 9 respondents (25.8%) who had unqualified humidity but did not suffer from pulmonary house ventilation but did not suffer from TB. This is due to several things including pulmonary TB. This is due to several things the respondent who does not have a history including the respondent who does not have of contact with other TB sufferers, the habit a history of contact with other TB sufferers, of the respondent always opening the the habit of the respondent always opening window so that the sun enters the room the window so that the sun enters the room directly. Furthermore, there were also 6 directly, besides that respondents often respondents (24.1%) who had the qualifying practice clean and healthy living habits. category of humidity but suffered from Furthermore, there were also 11 respondents pulmonary TB. This is because the (24.1%) who had the qualifying category of respondent has a history of contact with a house ventilation but suffered from friend who is suffering from pulmonary pulmonary TB. This is because the tuberculosis, besides that there is no vent in respondent has a history of contact with a the room or a tightly closed ventilation. friend who is suffering from pulmonary The results of inferential analysis tuberculosis, besides that he does not open showed that there was a fairly close the window to let the sun enter directly in the relationship between humidity and the room incidence of pulmonary tuberculosis at the The results of inferential analysis show Poasia Health Center Kendari City Regional that there is a small relationship between Coastal Area. So that humidity is a risk home ventilation and the incidence of factor for the incidence of pulmonary pulmonary tuberculosis at the Poasia Health tuberculosis at the Poasia Health Center Kendari City Regional Coastal Area. CenterKendari City Regional Coastal research conducted by Qanata (2018) which Area.According to Notoatmodjo (2010), lack states that there is a relationship between of ventilation causes indoor air humidity to home ventilation and the incidence of rise due to the process of evaporation of pulmonary tuberculosis, this study has a risk fluids from the skin and absorption. This of getting pulmonary tuberculosis 1,314 moisture can be a good medium for times in occupants who have ventilation that pathogenic bacteria(19). do not meet the requirements compared to This research is in line with the respondents who are ventilated meet health research conducted by Atmosukarto in Bogor requirements(21). Based on the test results City, which shows that residents who have a logistic regressionIt was found that home humidity in their living room that do not ventilation had the greatest influence on the meet the requirements have a significant risk incidence of pulmonary tuberculosis in the of contracting pulmonary tuberculosis 10.7 Puskesmas Poasia in the Coastal Region of times that of residents who live in housing Kendari City. This is because the p value is that has adequate humidity(20). <0.05 which is 0.014. Based on the results of the logistic regression test, it was found that humidity CONCLUSION had no effect because the p value> 0.05 was In this study there is no association 1,000. betweenDrop Out of treatment with pulmonary TB incidence at the Poasia Health Center in the coastal area of Kendari City. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 156 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Howeverhumidity variable is the variable 10. Hermawan I. Metodologi Penelitian that has the strongest or most dominant Pendidikan (Kualitatif, Kuantitatif dan relationship with the incidence of pulmonary Mixed Method): Hidayatul Quran; tuberculosis in the Poasia Community Health 2019. Center in the coastal area of Kendari City. 11. Arikunto S. Prosedur Penelitian Suatu Pendekatan Praktik. 2019. REFERENCES 12. Zakariah MA, Afriani V, Zakariah KM. Metodologi Penelitian Kualitatif, Kuantitatif, Action Research, Research 1. Health department of Republic of And Development (R n D): Yayasan Indonesia. National Guideline about Pondok Pesantren Al Mawaddah Tuberculosis treatment. 2007. Warrahmah Kolaka; 2020. 2. Klemens M. Analisis Faktor-Faktor 13. Sidiq N, Wahiduddin W, Sidik D. Yang Berhubungan Dengan Kejadian Faktor Risiko Lingkungan Terhadap Drop Out Pengobatan Kategori I Pada Kejadian Tuberkulosis Paru Di Penderita Tb Paru Di Wilayah Kerja Wilayah Kerja Puskesmas Somba Opu. Dinas Kesehatan Kota Kupang. Jurnal Gizi Masyarakat Indonesia (The 3. Carolia N, Mardhiyyah A. Multi Drug Journal of Indonesian Community Resistant Tuberculosis pada Pasien Nutrition). 2013;9(1):29-35. Drop Out dan Tatalaksana OAT Lini 14. Perwitasari D, Azhar K. Kondisi Fisik Kedua. Jurnal Majority. 2016;5(2):11- Rumah dan Perilaku dengan Prevalensi 6. Tb Paru di Propinsi DKI Jakarta, 4. DepKes RI. Pedoman Nasional Banten dan Sulawesi Utara. Media Penanggulangan Tuberkulosis. 2019. Penelitian dan Pengembangan 5. Dinkes Provinsi Sultra. Profil Kesehatan. 2013;23(4):20687. Kesehatan. In: Tenggara DKPS, editor. 15. Sejati A, Sofiana L. Faktor-faktor Kendari: Dinas Kesehatan Provinsi terjadinya tuberkulosis. KEMAS: Sulawesi Tenggara; 2019. Jurnal Kesehatan Masyarakat. 6. Nurbaity DP. Penataan Ruang Luar 2015;10(2):122-8. Kampung Nelayan Berbasis Pada 16. Hapsari DSP, Prasetya F. Studi Social-Activity (Studi Kasus: Kualitatif Perilaku Pasien Tuberkulosis Kampung Nelayan Lapulu–Kota Multi Drugs Resistant Di Wilayah Kendari): Institut Teknologi Sepuluh Kerja Puskesmas Poasia Kota Kendari Nopember Surabaya; 2016. Tahun 2017. (Jurnal Ilmiah Mahasiswa 7. Putra A, Husrin S, Mutmainah H. Pola Kesehatan Masyarakat). 2017;3(1). Sebaran Kualitas Air Berdasarkan 17. Adnani H, Mahastuti A. Hubungan Kesesuaian Baku Mutu Untuk Biota Kondisi Rumah Dengan Penyakit TBC Laut di Teluk Kendari Provinsi Paru Di Wilayah Kerja Puskesmas Sulawesi Tenggara. Maspari journal. Karangmojo II Kabupaten 2017;9(1):51-60. Gunungkidul Tahun 2003-2006. Jurnal 8. Kendari DK. Profil Dinas Kesehatan Kesehatan Surya Medika Yogyakarta. Kota Kendari. In: Kendari DKk, editor. 2006:76-9. Kendari: Dinas Kesehatan kota 18. Sari RP. Factors related to Kendari; 2019. Tuberculosis disease in Walantaka 9. Akbar MI. Analysis Of The Needs Of Health Care. Jurnal Ilmu Kesehatan General Practitioners In Public Health Masyarakat. 2018;7(01):25-32. Centers Using Health Workload 19. Notoatmodjo S. Health Behaviour Method. Public Health of Indonesia. Sciences. 2010. 2020;6(2):63-9. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 157 Ifon, Supodo, T., Sunarsih, Munir, S., & Harun, A. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/68 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 20. Atmosukarto SS. The effect of household environemnt in distrubution of Tuberculosis. Jakarta, Media Litbang Kesehatan. 2000;9(4). 21. Qanata AM. The relationship between the quality of Tuberculosis services and regular visiting in Pakusari Health Care in Jember District. 2018. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 158 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access ANALYSIS OF SMOKING HABITS AND MONOXIDE CARBON CONTENTS IN HOME WITH CARBOXIHEMOGLOBINE (COHb) IN ACTIVE SMOKING IN III ENVIRONMENT, KEMARAYA, KENDARI CITY Sari Arie Lestari B1, Titi Saparina L.2, Leniarti Ali3 1,2,3 Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Sari Arie Lestari B Email : [email protected] Abstract Background: around 10,000,000 people is estimated to be death per year by 2020 because of smoking. Smokers emit smoke around 20,000 ppm of CO, when it is inhaled. It will become diluted with a concentration of around 400 until 5,000 ppm. This situation is dangerous because it will increase the COHb concentration in the human blood by up to 6.9%. It can prone to heart attacks. The purpose of this research is to analyze smoking habits and CO levels in the house with carboxyhemoglobin (COHb) levels in active smokers in 3 Districts of Kemaraya in Kendari City. Methods: The research was conducted using the Analytical Descriptive method. Data were collected by interview using a structured questionnaire and laboratory analysis. While the approach used is a cross- sectional study. The population in this study was 81 and the number of samples was 45. Result s: The The results obtained were that there was no relationship between CO and COHb levels ( p value = 0.623> 0.05); there was a weak relationship between smoking and COHb levels (p value= 0.029 <0.05); and there is a low relationship between the number of cigarettes and COHb levels ( p value= 0.0298 < 0.05). Conclusion: It can be concluded that there is an insignificant relationship between smoking duration, types of cigarettes smoked, number of cigarettes smoked and levels of carbon monoxide in the house and levels of carboxyhemoglobin (COHb) in active smokers in environment III District of Kemaraya Kendari City. . Keywords: Smoking, Carbon monoxide, Carboxy hemoglobin, Active Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 159 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION capital city of Southeast Sulawesi Province. Smoking is a health problem in Based on Riskesdas data, the prevalence of society and is a big threat to health in the smoking in the house was 89.6% and based world. Smoking has implications for various on the initial survey in Environment III of major risk factors for disease, such as Kemaraya Village Kendari City, information chronic obstructive pulmonary disease, was obtained that the smoking habit in the emphysema and various heart diseases. The house had become a tradition by the head of number of deaths due to smoking if smoking the family. In daily activities, the habit of the continues, is estimated to be around head of the household who smokes in the 10,000,000 people per year by 2020, and house, where the cigarette smoked will 70% of them will occur in developing release carbon monoxide which will worsen countries in various parts of the world[1]. indoor air quality and will result in Carbon Monoxide is also produced carboxyhemoglobin in the human body, from cigarette smoke which can cause indoor therefore some parts of the body do not get air pollution. Indoor air pollution is very enough oxygen [4]. dangerous because the source is in direct The purpose of this study is that the proximity to humans. Until now, more than researcher wants to analyze smoking habits 4,000 chemicals have been known to be (number of cigarettes smoked, length of contained in cigarette smoke, including smoking, type of cigarette) with CO[2]. The concentration of CO in the room carboxyhemoglobin in active smokers in the increases when there is a clog. Smokers emit Kemaraya Family Environment III District smoke containing a concentration of 20,000 of Kemaraya Kendari City. As well as ppm of CO, when smoked it will become analyzing CO levels in the house with dilute with a concentration of around 400 - carboxyhemoglobin in active smokers in 5,000 ppm. This situation is dangerous Environment III District of Kemaraya because it will increase the COHb Kendari City. concentration in the blood by up to 6.9%, making it prone to heart attacks [3]. METHOD Carbon Monoxide (CO) has a strong This type of research is a descriptive tendency to bind to hemoglobin in red blood study with a cross sectional study approach cells, this bond is 210-300 times stronger [5]. Data on smoking habits were collected than that of hemoglobin with oxygen by interview using a structured questionnaire (oxyhemoglobin). Supposedly, this and in-depth analysis of carboxyhemoglobin hemoglobin binds to oxygen which is (COHb) levels by laboratory tests and indoor essential for respiration of the body's cells, carbon monoxide levels. but because CO gas is stronger than oxygen, The population in this study were all this CO gas takes its place. So, hemoglobin household heads who resided in coupled with CO gas. The level of CO gas in Environment III District of Kemaraya the blood of nonsmokers is less than 1 Kendari City who became active smokers, percent, while in the blood of smokers it totaling 81 people. The number of samples reaches 4 - 15 percent. If the situation used the Yamane formula quoted by continues, polycythemia will occur which Surakhmad (1994) using a precision of 10% affects central nerve function. in order to obtain a sample of 45 Based on the 2013 RISKESDAS data respondents. Sampling was done by according to smoking habits in Indonesia, purposive sampling. Southeast Sulawesi Province has the number The selected sample was then of smokers in Indonesia with a total interviewed using a questionnaire to obtain percentage of 19.8%. Kendari City is the data on smoking duration, number of Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 160 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 cigarettes and type of cigarette smoked. Then members play a role in the collection, blood samples were taken to check the correspondence and preparation of reports. COHb levels in the blood using a This data collection was carried out spectrophotometer. The sample is taken to during the Covid 19 pandemic, so that in its the Diagnostic laboratory for analysis. implementation researchers still pay attention Meanwhile, the CO level in the house was to the Covid 19 protocol. Because there were measured using an NDIR Analyzer. 45 respondents, so blood sampling was Meanwhile, secondary data were obtained carried out gradually. through observation of the research location, Meanwhile, the research ethics as well as articles related to this study. carried out by researchers were informed Then the data was processed using a consent, anonymity, and confidentiality. computer with SPSS version 16.0 software. Univariate analysis was performed to RESULT describe all variables, both independent and Characteristics of respondents dependent variables. After determining the Age characteristics of each variable, the analysis Table 1 Characteristics of Respondents of the relationship between the two variables by Age can be continued. Before the independent Age n % and dependent variables are analyzed, the 30 – 20 44.44 Kolmogorov Smirnov test is first performed 40 to test the data normality, if the data is 41 – 17 37.78 normally distributed then the Pearson 50 Product Moment correlation test is used. If 51 – 8 17.78 the data is not normally distributed, the Rank 60 Spearman correlation test is used. Total 45 100 Hypothesis testing / drawing conclusions on From table 1 it can be concluded that there each statistical analysis results using a 95% were 20 respondents aged 30-40 years confidence level (α = 0.05) [5]. (44.44%), then respondents aged 41-50 years In the research implementation were 17 respondents (37.78%), while process, the head of the study identified the respondents aged 51-60% were 8 health problems to be raised. Then the respondents (17.78%). chairperson and members carry out an in- depth study of health problems. The results Gender of identification and assessment of health Table 2 Characteristics of Respondents problems are then discussed together, by Gender followed by looking for literature references Gender n % and compiling research proposals. During Men 45 100 the implementation of the research, the Women 0 0 chairperson and members jointly collected Total 45 100 data and carried out a calibration test for measuring CO and COHb levels and carried From table 2 it can be concluded that the out the validity and reliability of the respondents in this study were all male. specified instrument to be assisted by the technician. Processing of data collection results, carried out jointly between the chairman and members. The implementation of analysis and presentation is the responsibility of the chairman, while Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 161 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 12 respondents (26.7%) who smoke non- filtered cigarettes. Univariate Analysis CO levels in the room Number of Cigarettes Table 6 Distribution of Respondents Based Table 3 Distribution of Respondents Based on Indoor CO Levels on Number of Cigarettes Variable n % Variable n % Indoor CO Number of levels cigarrets > 30.000 12 26.7 > 10 Bars / Day 27 60 µg/Nm3 < 10 Bars / Day 18 40 < 30.000 33 73.3 Total 45 100 µg/Nm3 Total 45 100 From table 3 it can be concluded that respondents who smoked> 10 bars / day From table 6 it can be concluded that were 27 respondents (60%), and respondents respondents with indoor CO levels <30,000 who smoked < 10 bars / day were 18 µg / Nm3 were more than 33 respondents respondents (40%). (73.3%), and respondents with indoor CO levels> 30,000 µg / Nm3 were 12 Durating Smoking respondents (26.7%). Table 4 Distribution of Respondents by Duration of Smoking COHb levels Variable n % Table 7 Distribution of Respondents Based Durating on COHb Levels Smoking Variable n % > 2 Years 33 73.3 COHb Levels < 2 Years 12 26.7 COHb 9 20 Total 45 100 levels>10% Kadar levels < 36 80 From table 4 it can be concluded that 10 % respondents with duration of smoking> years Total 45 100 were more than 33 respondents (73.3%), and respondents with smoking duration <2 years From table 7 it can be concluded that were 12 respondents (26.7%) respondents with COHb levels <10% were more than 36 respondents (80%), and Types of Cigarettes respondents with COHb levels> 10% were 9 Table 5 Distribution of Respondents by Type respondents (20%). of Cigarettes Variabel n % Types of Bivariate Analysis Cigarettes After doing the normality test using the Filtered 33 71.1 Kolmogorof Smirnof test, it was found that Not filtered 12 26.7 the data were normally distributed. So that Total 45 100 the statistical test used is the Pearson Product Moment correlation test. So that the analysis From table 5 it can be concluded that of smoking habits and levels of carbon respondents who smoke with filtered monoxide in the house with cigarettes are 33 respondents (73.3%), and carboxyhemoglobin (COHb) in active smokers in Environment III District of Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 162 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Kemaraya Kendari City can be seen in table blood level reaches 5%. In non-smokers, the 8 below; level is 1%. Smokers with carbon monoxide Table 8 Bivariate Analysis of Monoxide levels of 5% and above had three times more Levels, attacks than nonsmokers. The combination Duration of smoking, types of cigarettes, and of carbon monoxide with nicotine will make number of cigarettes with COHb levels in it easier for smokers to suffer from active smokers narrowing and closing of blood vessels with Variable C0 HB levels its consequences [6]. sig α According to health data published by Monoxide levels 0.623 0,05 the British Heart Foundation, smoking can Durating of Smoking 0.029 0,05 make the chemicals contained in it stick to Number of cigarettes 0.298 0,05 artery walls. This condition clogs the arteries smoked that carry blood to the heart and can cause a Type of cigarette 0.000 0,05 heart attack. This fact shows that smoking smoked can increase a person's risk of heart disease Primary Data Sources for 2020 by four times. From table 8 it can be seen that the value of α is 0.05, so it can be concluded that there is Number of cigarettes smoked an insignificant relationship between Regarding the number of cigarettes monoxide levels, length of smoking, the smoked, our results show that 27 people number of cigarettes smoked and the type of (60%) in the sample smoked with more than cigarette smoked with carboxyhemoglobin 10 cigarettes smoked. Meanwhile, 18 people (COHb) levels in active smokers in (40%) smoked less than 10 cigarettes per Environment III District of Kemaraya day. Based on the number of cigarettes Kendari City. smoked, this can basically be a reference for us to divide the types of smokers based on the number of cigarettes smoked. From this DISSCUSION study, it can be seen that the samples in this Durating of Smoking study were categorized as light smokers, Of the total 45 samples we studied, 33 some were moderate. samples had smoked for more than 2 years or Light smokers are those who smoke as much as 73.3%, while 12 samples or less than 10 cigarettes per day. In contrast, 26.7% of the other samples stated that they moderate and heavy smokers are those who had smoked for less than 2 years. As it is smoke more than 10 to 20 cigarettes per day. known that people who smoke for 10 years Based on the data above, moderate to heavy get a decrease in HDL cholesterol, which smokers were seen as dominant, namely 27 means that it increases the factor of people. The number of cigarettes even atherosclerosis or calcification of blood though it is less than 10 cigarettes per day vessels. Although the data above shows that actually still affects one's health. If a there are still samples who started smoking cigarette is consumed in ten cigarette smoke less than two years, in fact the smokers suction, within a year for a smoker a total of group has become a group at risk of 10 cigarettes (one pack) per day will developing degenerative diseases. Because experience 35,000 cigarette smoke just one cigarette contains approximately suction[7]. Chemical substances contained in 4000 types of chemicals with 40% toxic cigarettes will experience a buildup, until content. one day the dose of the poison will reach a Cigarettes also contain carbon toxic point and will cause various symptoms monoxide (CO). One cigarette that is burned of disease [8]. contains 3-6% carbon monoxide and the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 163 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Every time someone smokes, nicotine impact on the body because the fibers in the will be absorbed by the blood and then flow filter made of cellulose acetate can be to the brain. Generally, smokers absorb 1– inhaled along with cigarette smoke[10]. 1.5 mg of nicotine from one cigarette. Once However, both filtered and non- in the brain, nicotine will increase the release filtered, smokers are still susceptible to of dopamine, a chemical that helps improve diseases caused by the nicotine content in mood and lead to feelings of satisfaction. cigarettes. Kretek (non-filtered) cigarettes Nicotine can have a temporary pleasure contain 60-70% tobacco, the remaining 30- effect on the brain, which makes a person 40% cloves and other ingredients, cloves dependent on this substance. People who are contain eugenol which is considered to have addicted will usually show several physical the potential to cause cancer in humans. and mental symptoms such as feeling Besides that, in kretek cigarettes contain anxious, irritable, diarrhea, difficulty various additives that are different as spices concentrating, constipation to insomnia when that can create a unique taste for each type of they don't get nicotine intake. cigarette. Some of them are ammonia which So that for the treatment or can increase the absorption of nicotine management of active smokers who have alkaloids[11]. been addicted to cigarettes, starting from counseling, giving drugs to behavioral therapy. Carbon Monoxide (CO) Levels in the Home Types of Cigarettes Smoked For carbon monoxide levels based on As for the types of cigarettes smoked, the results of the study showed that there based on the table above, it shows that 33 were 12 or as many as 26.7% of the samples samples or 73.3% of the samples smoked contained CO levels of more than 30,000 µg filtered types of cigarettes, while 12 samples / NM3 and as many as 33 or as many as or 26.7% of the samples used unfiltered 73.3% of room samples with CO levels of cigarettes. This shows that the respondents less than 30,000 µg / NM3. The living who use filtered cigarettes are more than the environment can also be one of the causes respondents who use unfiltered cigarettes. for the increase in COHb levels in the blood, Filter cigarettes, also known as white so that someone who lives in an environment cigarettes, are cigarettes without clove / room with high ambient CO gas can mixtures such as those found in kretek or increase a person's COHb levels in their unfiltered cigarettes. The difference between blood, even though the cause of an increase the two cigarettes is based on the blend of in COHb levels in the blood is not the only their content and also the presence of a filter one. caused by CO gas that is inhaled at the end of the cigarette [1]. In filter through the air, but a condition in a person's cigarettes the tar and nicotine content is disease such as chronic lung disease can also lower when compared to kretek or unfiltered increase COHb levels in a person's blood. cigarettes. Filters are generally made from Carbon monoxide (CO) is known to affect cellulose acetate, which is usually obtained the work of the heart (cardiovascular from processed wood. This material is used system), central nervous system, fetuses, and because of its ability to filter tar and nicotine all organs of the body that are sensitive to from cigarettes, so it is believed that the tar lack of oxygen. The effect of carbon and nicotine inhaled is lower when compared monoxide (CO) on the cardiovascular system to unfiltered cigarettes, so people tend to is quite significant, although at low levels. increase the number of cigarette One cigarette that is burned contains 3-6% consumption per day [9]. However, filter carbon monoxide and the blood level reaches cigarettes can actually have a negative 5%. In non-smokers, the level is 1%. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 164 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Smokers with carbon monoxide levels of 5% in active smokers in the Kemaraya Family and above have three times more attacks than Environment of Kendari City. nonsmokers. The combination of carbon monoxide with nicotine will make it easier for smokers to suffer from narrowing and CONCLUSION closing of the blood vessels and its From these studies, it can be seen that the consequences[12]. duration of smoking, the number of cigarettes smoked, the types of cigarettes, Carboxyhemoglobin COHb levels and the indoor CO levels are not The most important biological significantly related to carboxyhemoglobin characteristic of CO is its ability to bind to in active smokers in the Kemaraya Family hemoglobin, the red blood pigmentel that Environment III of Kendari City carries oxygen throughout the body. This property will result in the formation of REFERENCES carboxyhaemoglobin (HbCO) which is 200 times more stable than Oxyhaemoglobin 1. Aji Amri, L.M.A.S.A "Isolation of (HbO2). The relatively slow breakdown of Nicotine from Cigarette Butts as an HbCO causes inhibition of the work of the Insecticide," Jurnal of Chemical pigment cell molecules in their function of Technology Unimal, vol. 4, no. 1, pp. carrying oxygen throughout the body. This 100-120, 2015. condition can be serious to fatal, because it 2. Sari, G. Environmental Pollution and can cause poisoning[13]. Destruction and Countermeasures, Of the total 45 samples we studied, it Yogyakarta: TP. Pustaka Insan was seen that 9 samples (20%) had Madani, 2009. carboxyhemoglobin levels of more than 10% 3. Rogaya, Cigarette Smoke As Pollutants and 36 samples (80%) had less than 10% In The Room, Jakarta: Departemen carboxyhemoglobin levels. This shows that 9 Pulmonologi dan Ilmu Kedokteran samples in this study are at risk of Respirasi, 2017. experiencing CO poisoning. Carbon 4. Health Ministry of Republic of monoxide (CO) gas that enters the Indonesia, Basic Health Research, circulatory system will replace the position Jakarta, 2013. of oxygen in binding to hemoglobin (Hb) in 5. Sopiyudin, D. Statistics For Medicine the blood. CO gas eventually easily enters And Health, Jakarta: Salemba Medika, the heart, brain and other vital organs that 2009. support human life. This gas is very toxic to 6. S. Triswanto, Stop Smoking, Jakarta: the human body, so the consequences can be Progresif Books, 2007. fatal. The CO and Hb bonds in the blood will 7. Nadia, L. The Negative Effects of form carboxy hemoglobin[14]. Smoking on Health and Awareness of Another factor that can increase COHb Urban Communities," in The Negative levels is age. Decreased cardiovascular Effects of Smoking on Health and capacity due to aging and reduced elasticity Awareness of Urban Communities, of lung tissue function, making a person 2016, pp. 77-104. more susceptible to exposure to CO gas [14]. 8. PMI, The Health Impact of Smoking From these studies, it can be seen that Smoking Cause Serious Illness And the duration of smoking, the number of Addiction Are All Cigarettes Or Cigars cigarettes smoked, the types of cigarettes, Harmful And Addictive? Tar, Nicotine, and the indoor CO levels are not And Carbon Monoxide Levels Of significantly related to carboxyhemoglobin Passive Cigarette Smoke, 2018. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 165 Lestari, S.A., T. Saparina L, & L. Ali. DOI: 10.36566/ijhsrd/Vol3.Iss1/69 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 9. Dinas Kesehatan Republik Indonesia, Indonesian Community Smoking Behavior, 2014, pp. 1-11. 10. Susanna, Dewi B.H.A.H.F. Determination Of Nicotine Levels In Cigarette Smoke, 2003. 11. Bustan, Epidemiology of Non- Communicable Diseases, Jakarta: Rineka Cipta, 2000. 12. Dewanti, R. "Identification of CO Exposure, Habits, COHb Blood and Worker’s Health Complaints on Basement Waterplace Apartment, Surabaya, Journal of Environmental Health, vol. 10, no. 1, pp. 59-69, 2018. 13. Rogaya, Cigarette Smoke As Pollutants In The Room, Jakarta: Departement of Pulmonology and Respiratory Medicine, 2017. 14. Sadikin, Blood Biochemistry, Jakarta: Widya Medika, 2012. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No. 1, March 2021 166 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN DEMOGRAPHIC FACTORS AND INDIVIDUAL PERCEPTION ABOUT COVID-19 VACCINES Tasnim Tasnim Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Tasnim Email : [email protected] Abstract Background: The cases of Covid-19 disease continue to rise in Kendari city, Southeast Sulawesi Province, Indonesia. In 2020, the task force of Covid-19 cases reported there were about 3,736 people who got Covid-19 diseases in Southeast Sulawesi Province.To reduce the cases, the Indonesian government have prepared some of covid-19 vaccines. However, the majority of community in this Province are still hesitant to accept covid-19 vaccines. Therefore, this study aimed to understand the relationship between demographic factors and individual perception about covid-19 vaccines surrounding people in Southeast Sulawesi Province. Methods: This study was conducted since January 2020 until October 2020 in Southeast Sulawesi Province of Indonesia. This study recruited 210 respondents with 95% of interval confidence. Dependent variables were demographic factors which comprised age, sex, educational status, mariage status and occupation. Independent variable was individual perception about covid-19 vaccines. Data collection used Google form which was sent through WhattsApp of social media. Statistical analysis used chi-square test and Cramer’s test to understand significant association. Results: This study showed Sex had significant association with individual perception about covid- 19 vaccines (P value=0.041<0.05; Cramer’s value=0.174). However, age, educational status, mariage status, and occupation were not associated significantly with the individual perception about covid-19 vaccines. Female had better perception than male about covid-19 vaccines. Conclusions: This study shows that female have more information than male about covid-19 vaccines. This is caused by several media to get information including female organizations in the village such as women organization, islamic women organization and social media groups. Women is more communicative than male. Key words: Demographic, Perception, Covid-19, Disease, Virus Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 167 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 of Covid-19 vaccines which are allowed in INTRODUCTION vaccination program such as vaccines which Covid-19 is a disease which is caused are produced by PT Bio Farma (Persero), by severe acute respiratory syndrome corona AstraZeneca, China National Pharmaceutical virus 2 (SARS-Cov-2) (1). The covid-19 Group Corporation (Sinopharm), Moderna, cases continue to rise around the world. On Pfezer Inc. and BioNTech, and Sinovac September 19, 2020, the cases became about Biotech Ltd (7). 30,369,778 cases and about 3.1% was death However, the majority of community (948,795 patients) (2). Patients who died in Indonesia feel anxiety about affectivity of were caused by several factors such as covid-19 vaccines which are testing pneumonia and other degenerative diseases, clinically. Several questions emerge in including coronary artery for five years, public media about the ways of SARS-Cov-2 diabetes mellitus type 2 for 14 years, and mutation. The SARS-Cov-2 mutated fastly, chronic pulmonary obstructive for 8 years while the vaccines are still tested clinically. (3). Other cause are covid-19 patients who Therefore, communities in Indonesia, had palsy cerebral for 10 years, pregnant including communities in Kendari city of mothers who had complication disease and Southeast Sulawesi Province are confused those who got HIV disease for 5 years. with the effective Covid-19 vaccines although those have not been exist yet. This Also in Indonesia, the covid-19 cases condition happens in the communities became about 344,749 people and 12,156 because there were many huge misleading patients died on October 14, 2020 (4). The information in social media. The misleading cases increased compared to 266,8445 information which are received by people and 10,218 of them died on communities will affect to their perception September 25, 2020. Southeast Sulawesi and success of the vaccination program in province of Indonesia gave 1.1% Indonesia, including in Southeast Sulawesi contribution of increase the covid-19 cases in Province. Therefore, the study to understand Indonesia. The covid-19 cases in Southeast public perception about covid-19 vaccine is Sulawesi province were reported around necessary because the result will help 3,736 people and 2,393 of them died on Indonesian government to develop October 14, 2020 (4). One of seventeen appropriate health promotion strategies districts or cities in Southeast Sulawesi which can increase public perception. Province, Kendari city had the highest cases of covid-19. On October 14, 2020, People Specific questions in this study were who got Covid-19 diseases were reported followed as: 1) How is community’s about 1,924 people in Kendari City. Kendari perception about Covid-19 vaccine in city is a smallest city compared to sixteen Southeast Sulawesi Province?; and 2) What cities or districts in Southeast Sulawesi does community’s perception associate with Province, namely about 300.89 with big individual demography such as sex, age, population, about 334,335 people. (5). education, job and marital status? Based on worst condition of covid-19 cases around the world, World Health The objectives of this study: Organization (WHO) motivated all countries in the world to develop covid-19 vaccine. This study have two objectives. The Currently, WHO has identified 42 candidate first objective of this study is to understand covid-19 vaccine and those were took the level of community’s perception about clinical tests (6). The ten vaccines of those covid-19 vaccine in Southeast Sulawesi were on the level of three of clinical tests. Province. The second objective of this study While in Indonesia, there are only six types is to analyse the relationship between Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 168 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 community’s perception with their value < 0.05. The symmetric measures used demography characteristic, such as sex, age, Cramer’s value between 0 and 1. The education, job and marital status Cramer’s value of more than 0.5 was decided as a strong association between individual The Impacts of this study: perception and demographical variable. However, if the Cramer’s value was less than This study will give benefit for 0.5, the association between individual government to take health promotion and perception and demographical variable was develop appropriate tools to increase decided to be a weak association. The criteria community perception about covid-19 of the individual perception level included vaccine. Increasing the community perception will affect to acceptance for three categories, namely: covid-19 vaccination which protect human’s Less : If the total scores of the immunity. Finally, this will affect to increase perception about covid-19 vaccine is less public health status in Southeast Sulawesi than 6; Province of Indonesia. Medium : if the total scores of the perception about covid-19 vaccine is MATERIALS AND METHODS between 7 and This study used a quantitative method 13; with using a cross sectional study design. Good : If the total scores of the This study was conducted since September perception about covid-19 vaccine is more 2020 until December 2020 in Southeast than 14. Sulawesi Province. This study recruited 210 people through social media, WhatsApp with using Snowball sampling technique. The Research Ethics questioners were developed through google This study was approached by Research and form with link as below: Development Agency of Southeast Sulawesi https://docs.google.com/forms/d/e/1FAIpQL Province number 070/7089/Balitbang/2020. ScjeubOJes3lcMBqJuW5t3_nJSmc2VJuZY In questionnaire form is attached about X4DDIVWWZ1eKV8w/viewform?usp=sf_li informed consent to participate in this study. nk. Identification of the participants was protected and the documents became Data analysis used descriptive and inferential anonymity. analysis. Descriptive analysis was used to understand distribution of the level of RESULTS community perception and demography. While, the inferential analysis was used to 1. Participant’s demographic understand the relationship between the Characters and The level of perception about the covid-19 individual perceptions about covid-19 vaccines vaccine with their demography characteristic such as sex, age, education, job and marital The participants who involved in this study status. The inferential analysis with were 64 males (30.5%) and 146 females statistical tests included Chi-Square and (69.5%) (See on table-1). The majority of Cramer’s tests. The significant association participants were married (49.5%) and single (48.6%). There were only 4 participants who between individual perception and their each were widow/ widower (1.9%). Most of demographical variable were based on p- Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 169 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 participants passed from bachelor degree (25.2%). Other few participants aged (39.5%) and undergradute (28.1%). While, between 10-19 years old (18.6%), between other participants passed from Senior High 40-49 years old (12.9%) and only 7.6% of School (4.8%), Diploma (15.7%), Master them who aged between 50-59 years old. degree (11.0%) and 1 % of Doctoral degree. This study found that there were only Most of them had no job (37.6%), civil 14.3% people who had good perception servant (31%), and private (21.4%). There about covid-19 vaccine (see on table-2). The were a few people who were a honorary in majority of participants had medium level of the local government institution (3.8%) and a perception about covid-19 vaccine (59%). lecturer/ teacher (6.2%). The majority of However, there were still people who had participante aged between 20-29 years old less perception about the vaccine. (35.7%) and between 30-39 years old Table-1. Distribution of participants’ demographic Character In Southeast Sulawesi Province in 2020 Demographic Variables Number (n) Percentage (%) Sex: Male 64 30.5 Female 146 69.5 Marriage status: Widow/widower 4 1.9 Marry 104 49.5 Single 102 48.6 Educational level: Senior High School 10 4.8 Undergraduate 59 28.1 Diploma 33 15.7 Bachelor 83 39.5 Master 23 11.0 Doctor 2 1.0 Occupation: No Job 79 37.6 Honorary 8 3.8 Lecturer/ Teacher 13 6.2 Civil Servant 65 31.0 Private 45 21.4 Age: (Year) 10 – 19 39 18.6 20 – 29 75 35.7 30 – 39 53 25.2 40 – 49 27 12.9 50 - 59 16 7.6 Total of participants 210 100.0 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 170 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table-2. Distribution of community’s perception about Covid-19 Vaccine in Southeast Sulawesi Province in 2020 Level of perception Number (n) Percentage (%) Less 56 26.7 Medium 124 59.0 Good 30 14.3 Total 210 100.0 2. The relationship between participants who had good perception about Demographic factors and individual covic-19 vaccine were around 23.3% and perception about Covid-19 Vaccines there were only 19.6% of participants who had less perception. In contrast, female Based on the chi-square test, one of the participants did not have significant demographic variables which had significant differences of the level of perception about association was sex (see on table-3). covid-19 vaccine. Females who had less However, the level of significant association perception about covid-19 vaccine were between sex and perception about covid-19 about 80.4%. Similarly, they who had vaccine was weak (p-value= 0.041 < 0.05; medium and good perception about covid-19 Cramer’s value = 0.174). Male tended to vaccine were 62.9% and 76.7%, respectively. have medium perception (37.1%). Male Table-3. The relationship between Sex and individual perception about Covid-19 Vaccines in Southeast Sulawesi in 2020 Sex Perception Level Total Percentage P- Cramer’s Less Medium Good (%) value value n % n % n % Male 11 19.6 46 37.1 7 23.3 64 30.5 Female 45 80.4 78 62.9 23 76.7 146 69.5 0.041 0.174 Total 56 100.0 124 100.0 30 100.0 210 % 26.7 59.0 14.3 100.0 Other demographic factors did not have significant association with perception about covid- 19 vaccine. The other demographic factors included marriage status (p.value= 0.467 > 0.05) (table-4), educational status (p.value=0.302 > 0.05) (table-5), occupation (p.value=0.124 >0.05) (table-6), and age (p.value=0.218) (table-7). Table-4. The relationship between Marriage Status and Individual perception about Covid-19 Vaccines in Southeast Sulawesi in 2020 Marriage Perception Total Percentage P- Cramer’s Status Less Medium Good (%) value value Single 28 56 18 102 100.0 Marry 26 66 12 104 100.0 0.467 0.092 Widow/ 2 2 0 4 100.0 Widower Total 56 124 30 210 100.0 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 171 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 % 26.7 59.0 14.3 Table-5. The relationship between Educational Status and Individual perception about Covid-19 Vaccines in Southeast Sulawesi in 2020 Educational Perception Total Percentage P- Cramer’s Status Less Medium Good (%) value value Senior High 4 5 1 10 100.0 School Undergraduate 14 35 10 59 100.0 0.302 0.167 Diploma 14 16 2 33 100.0 Bachelor 20 52 11 83 100.0 Master 3 16 4 23 100.0 Doctor 1 0 1 2 100.0 Total 56 124 30 210 % 26.7 59.0 14.3 100.0 Table-6. The relationship between Occupation and Individual perception about Covid- 19 Vaccines in Southeast Sulawesi in 2020 Occupation Perception Total Percentage P- Cramer’s Less Medium Good (%) value value Lecturer/ Teacher 3 6 4 13 100.0 Honorary 3 4 1 8 100.0 0.124 0.174 Civil Servant 23 37 5 65 100.0 Private 6 33 6 45 100.0 No Job 21 44 14 79 100.0 Total 56 124 30 210 100,0 % 26.7 59.0 14.3 Table-7. The relationship between Age and Individual perception about Covid-19 Vaccines in Southeast Sulawesi in 2020 Age (Year) Perception Total Percentage P- Cramer’s Less Medium Good (%) value value 10-19 13 23 3 39 100.0 20-29 16 44 15 75 100.0 30-39 13 32 8 53 100.0 0.218 0.160 40-49 6 19 2 27 100.0 50-59 8 6 2 16 100.0 Total 56 124 30 210 100,0 % 26.7 59.0 14.3 100.0 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 172 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 DISCUSSION welfare, harmonious and autonomous. The study also shows that those women This study shows that the majority of organizations are effective as a group which people in Southeast Sulawesi have had can increase women knowledge and skill, medium level of their perception about including accessibility to information. covid-19 vaccine, namely about 59%. There Accessibility to huge information is very were only around 14.3% of them who had important for people cognition and good perception. This community perception consciousness (9). Both cognition and generated them to be vaccinated if covid-19 consciousness system are essential for vaccine is ready. There were about 66.2% individuals to have good sensitivity in people who were willing to be vaccinated surrounding life. People will have high with covid-19 vaccine. However, there were intellectuality and high capacity to manage still about 26.7% of Southeast Sulawesi their social relationships. people who had less perception about covid- As we know that some of members of 19 vaccine. This means that Southeast women organizations are marriage rather Sulawesi province government, especially than single women. A mother who involves for the task force team of covid-19 disease actively, especially in the women treatment in this province remain to have organization will increase their knowledge urgent task to increase the community’s and skill, including about covid-19 vaccines. perception about covid-19 vaccination. Therefore, they can share their knowledge Increasing the community’s perception is and skill to their family members, including very important to result the successful their children. Married people who involved program of covid-19 vaccination especially in this study were around 49.5%. This means in Southeast Sulawesi province and in that they can become a information source Indonesia, generally. The successful program for other people including their family of this vaccination will lead to reduce or members and neighbours. This study also eliminate the covid-19 disease transmission. identified other information sources which One of demographic factors which influenced to community’s perception about associated significantly with individual covid-19 vaccines. The information sources perception about covid-19 vaccine is sex. included television, new papers, social media Based on this research, woman had better such as facebook, instagram, whatsApp, perception about covid-19 vaccine than man. telegram, website, youtube, radio and This means that woman had enough access posters. Another information source to to information about covid-19 compared to increase individual knowledge and man. In Indonesia generally including in perception about covid-19 vaccine was a Southeast Sulawesi Province, there are many friend. People when used the soocial media women organization in each area or in each will have big change to get information village such as Family Welfare through some their sense organs including Empowerment organization, Islamic Women eyes and ear. Many sense organs which can Organization, and Ten Households Group involve in the information transmission organization. Those women organizations mechanism, people can remember and recall are the organizations which had the role to the information in their memories (10). increase woman’s general knowledge and Eventually, those can affect to the individual skill, including about health. Family Welfare belief and perception (11). empowerment organization was established However, the way of emerging by Indonesia President in the president individual perception also is based on the regulation number 99 in 2017 (8). This individual ability to analyse and synthesize organization has the important roles to help all of information which they got. This the village governments in increasing family individual ability is significant association Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 173 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 with individual formal educational level become the role model for communities in (12). People with higher educational level Southeast Sulawesi province. They can will have high capacity to analyze and motivate the village community to synthesize information and become lighter participate in all of health promotion for them and other people surrounding them. program which are done by the local Because there were still about 26.7% governments. The local government is participants who had less perception about necessary to engage with the religious covid-19 vaccine, so this study gives some leaders in covid-19 vaccine promotion recommendation for Southeast Sulawesi because the majority of community in government, especially about how to Indonesia including in Southeast Sulawesi increase the community perception about province is Muslim (15). This is because the covid-19 vaccine in Southeast Sulawesi public issue of covid-19 vaccine is about province. First of all, the Southeast Sulawesi halal issue of covid-19 vaccine composition government has to take health promotion in Indonesia. Those strategies can be through several mass media, such as implemented in Indonesia including in television and social media including Southeast Sulawesi province to increase the facebook, whatsApp and instagram. Several public perception about covid-19 vaccine. interesting programs in the television must Thus, covid-19 vaccine will be accepted by be created to increase the viewers. Television all of community in Indonesia and programs have strong power to stimulate eventually, all communities increase their public’s perception because the viewers can immunity and covid-19 disease transmission record the message form some sense organs, can be prevented or eliminated in Indonesia. including eyes and ear. The two sense organs can increase recall power the message until ACKNOWLEDGEMENTS 60% (13). Television prepare writing I would like to thank for Yayasan messages, videos, images and audios. Thus, Mandala Waluya Kendari for finantial the social media also prepare several support to take this study. I also thank very interesting message forms including writing much for communities who participated in messages, image, audios, graphic and video. this study. My thanks also goes to my Those of interesting forms include one of institution namely Universitas Mandala common motion which translates Waluya which gave opportunities to take information through horizontal and vertical this research. motion with colour and texture. Eventually, those become two object parts which can Conflict Of Interest Statement influence human cognitive and perception The author has no potential conflict of (14). interest associated with the material . presented in this article. CONCLUSION Other strategy to increase public ORCID perception about covid-19 vaccine is improving the role of community Tasnim Tasnim : https://orcid.org/0000- organizations such as women organization, 0002-6016-9989 teenage organization, and several religion organizations in health promotion program. REFERENCES To implement the strategy, the local 1. Yuan, Z., Xiao, Y., Dai, Z., Huang, J., governments need to collaborate with village Zhang, Z., & Chen Y. Modelling the leaders, village traditional leaders and effects of Wuhan’s lockdown during religious leaders. Those village leaders Covid-19, China. Bull World Heal Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 174 Tasnim,T. DOI: 10.36566/ijhsrd/Vol3.Iss1/70 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Organ. 2020;98(7):484–94. 9. Tononi G. Information integration: its relevance to brain functionn and 2. World Health Organization. WHO consciousness. Arch Ital Biol. Coronavirus Disease (COVID-19). 2010;148:299–322. Geneva: World Health Organization; 2020. 10. Sari, R. A. Students’ perceptions on the video project in their speaking 3. World Health Organization. Medical class: A study of 11th grade of SMAN certification, ICD mortality coding, 1 Kasian Students [Internet]. Sanata and reporting mortality associated Dharma University; 2016. Available with Covid-19. Geneva: World Health from: Organization; 2020. https://repository.usd.ac.id/7303/2/121 214043_full.pdf 4. Task force for Covid-19 treatment. Distribution of Covid-19 cases in 11. Ramadhani, Y. R., Masrul, Indonesia [Internet]. Task force for Ramadhani R, Rahim R, Tamrin AF, Covid-19 treatment, Indonesia. 2020 Daulay JS, et al. Methode and [cited 2020 Oct 14]. Available from: Technique in Inovative learning. https://covid19.go.id/peta-sebaran Medan, Indonesia: Yayasan Kita Menulis; 2020. 5. Southeast Sulawesi Province Agency of Statistic Center. Southeast Sulawesi 12. Brandley KS, Brandley, J. A. Province in 2020. Kendari: Southeast Teaching students to organize and Sulawesi Province Agency of Statistic synthesize information. J Int Assoc Center; 2020. Spec Eduation. 2006;7(1):75–9. 6. World Health Organization. Draft 13. Davis B, Summers, M. Applying landscape of Covid-19 candidate Dale’s Cone of Ecperience to increase vaccines. Geneva: World Health learning and retention: A study of Organization; 2020. student learning in a foundational leadership course. West Lafayette, 7. Health Ministry of Republic of USA: Purdue University; 2015. Indonesia. Regulation of Health Ministry of Republic of Indonesia 14. Kuhn D, Siegler, R. S. Handbook of Number child psychology: Cognition, HK.01.07/MENKES/9860/2020 about perception, and language. New Jersey: Types of vaccines to Corona Virus John Wiley & Sons; 2006. 138 p. Disease 2019 (COVID-19) vaccination Program. Jakarta: Health 15. Padmawati, R. S, Heywood A, Ministry of Republic of Indonesia; Sitaresmi MN, Atthobari J, Macintyre 2020. CR, Soenarto Y, et al. Religious and community leaders’ acceptance of 8. President of Republic of Indonesia. rotavirus vaccine introduction in President Regulation of Republic of Yogyakarta, Indonesia: A qualitative Indonesia [Internet]. Jakarta: Ministry study. BMC Public Health. of Law & Human Right of Republic 2019;19(368):1–6. of Indonesia; 2017. Available from: http://gurudesa.com/wp- content/uploads/2018/10/PERPRES_ NO_99_2017.pdf Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 175 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE IMPLEMENTATION AND HUMAN RIGHT LAW OF POLICY ABOUT STUNTING PREVENTIONIN COVID -19 ERA IN KENDARI Yunita Amraeni1, Toto Surianto2, M. Nirwan3 1,2,3Department of Public Health, Faculty of Sciences, Universitas Mandala Waluya, in Kendari, Southeast Sulawesi Province, Indonesia. Corresponding Author : Yunita Amraeni Email : [email protected]. Abstract Background .Stunting during the covid period requires policies of handling and prevention in accordance with law and human rights. Therefore, this study aims to determine the prevention strategies and human rights law related stunting to develop the health policy. Method .A qualitative method through in-depth interviews was conducted on 6 informants from the city health office and health centre for strategy and literature study related to human rights and stunting policy law. Result s. The results show that there are several strategies that can be prioritized to overcome stunting in the Covid era, such as promotion and support of breastfeeding, Campaign for balanced nutrition and Clean and Healthy Living Behavior (PHBS), Education and counseling using the media, including Short Letter (SMS), or WhatsApp group, Priority services for children under five, through health services and home visits, provision of additional food for malnourished toddlers and pregnant women with chronic energy deficiency, and provision of nutritional supplementation. Conclusion . It is necessary to modify the policy to improve the strategies at the regional level so that stunting can be solved in the pandemic and providing child protection people with stunting an obligation and the joint responsibility of the state, community, family and parents covering juridical protection, economic, social and cultural. Therefore, in fulfilling basic rights child, then the responsibility is carried out holistically by collaborating with the stakeholder. Keywords : Stunting, Human Right, Policy, Kendari Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 176 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION Term Development Plan (RPJMN) 2020- Another problem that needs to be faced 2024 has also set a target rate of national by Indonesia besides the COVID-19 stunting dropped to 14%(6,10,15). pandemic is malnutrition which can lead to Overburdened health facilities, disrupted stunting. Stunting important issue to be food supply chains, and lost income due to resolved, as it relates to health, even the COVID-19 can cause a sharp increase in the death of the child (3). Inadequate intake can number of malnourished children in affect weight loss, weight loss (weight gain Indonesia. Even before COVID-19, does not match the curve), the difficulty of Indonesia was already facing high nutritional appetite, and malnutrition. Growth and problems (17). Currently, more than two development are not in accordance with age million children suffer from malnutrition and can also be a sign that the immune system of more than seven million children under the children has decreased which makes it more age of 5 are stunted (18).Recent UNICEF vulnerable to infection, including pathogens estimates suggest that if there is no timely such as viruses(19,21). action, the number of children who are Toddlers Nutritional Status Survey severely deprived or malnourished under 5 Indonesia (SSGBI) showed a decline in the years of age could increase globally by about numbers of stunting from 30.8 percent in 15 percent this year due to COVID-19 (13). 2018 to 27.67 percent in 20197. Although This means that there is an increased risk of this figure decreased stunting, the figure is wasting, a condition characterized by low still relatively high, given the WHO target body weight when compared to height, the stunting figures should not be more than besides that in Indonesia, many families have 20 percent. This condition was exacerbated lost household income and are less able to by the Covid-19 pandemic attack which led buy healthy and nutritious food for their to an increase in poverty in the community. children. At the same time, there is ample Problems stunting or conditions of growth evidence to suggest that children who are failure in children under five that have losing are more likely to be stunted, or have bodies that are too short compared to the age, a lower height for their age, and may result remains a major challenge facing this in more children being stunted in that nation6. Based on the Global Nutrition country (21). Children who experience Report 2018, Indonesia Stunting prevalence stunting and miscarriage are prone to long- of 132 countries ranked 108, while in term developmental disorders11. Posyandu is Southeast Asia, the prevalence of stunting actively trying to prevent stunting, conduct Indonesia ranks second to that of Cambodia socialization and education, and implement (13). programs. However, during the COVID-19 Based on data from the Health Research pandemic, this activity was hampered (Riskesdas) Ministry of Health, the number (15,21). of national stunting decreased from 37.2% in The number is certainly very worrying, 2013 to 30.8% in 2018. Based on Nutritional given that the most valuable resource for a Status Survey Toddler Indonesia (SSGBI) in country is a human resources (HR) quality. 2019 decreased to 27.7%(3). The decline in The future of our nation is in the hands of stunting has been declared a national priority 79.55 million children in Indonesia (4). So, it programs. Currently, the Government is important in fulfilling children's rights to continues to move to organize the quality of resources in the future. Some implementation tools to accelerate stunting of the factors that cause stunting among prevention and formulate the National others due to poor parenting, health services Strategy (Stranas) for the Acceleration of are limited, families lacking access to Stunting Prevention for 2018-202421. The nutritious food, lack of access to clean water Government through the National Medium and sanitation nutrition must be optimized by Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 177 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 all parties to ensure the fulfillment of nutritious food due to the Covid-19 balanced nutrition for children. pandemic” (HA). Therefore,This study aims to explore ―Due to covid, community visits stunting prevention policies based on have been minimized to health existing policy strategies and laws. service facilities (fasyankes) and prioritize them for urgent and Method emergency ones.We balance it with This study uses a qualitative study with service modification plans such as Indepth Interview to explore the policy home visits for at-risk targets, strategy of prevention of stunting during virtual counseling, community pandemics and literature studies for legal education, and communication alignment stunting policies that have been through groups on social media. implemented.One Heads of city agencies and Monitoring of the nutritional status Fivehealth centers in the city kendari as of children under five at Posyandu policy makers. Then the qualitative data is now on hold‖ (HC 1). transcript is made according to the theme and coded to get the keywords. ―However, the community is expected to continue to provide Result breast milk for babies, food according to the guidelines for Strategy of Stunting Prevention in Covid balanced nutrition for children, era wash hands and PHBS, to carry out Following are some statements from physical activities‖ (HC 5). informants regarding policies and strategies for preventing stunting during a pandemic “The public is urged to immediately ―In the event of this pandemic, it is contact cadres or health care feared that the national program to facilities if the child has decreased reduce stunting and tackle appetite, weight loss, or other health malnutrition cannot be carried out problems.This effort cannot be run properly‖ (HA). by families alone, but also requires collaboration between parties such ―The issue of fund refocusing as schools, to provide supervisory programs that can reduce funds for education among adolescents‖ (HC the implementation of the national 2). stunting program in the regions” (HC 3). ―One of the efforts is socialization, education and online monitoring ―The importance of the role of through social media. Assistance is macronutrients and essential amino provided so that pregnant women acids from the first 2 years of life and their partners can get and calling on the use of digital information related to good media for stunting prevention, for nutritional intake during pregnancy, example the use of digital such as a healthy balanced menu, technology to monitor the intake of iron, folic acid and iodine‖ nutritional status of children at (HC 4) home. There is an increased risk of acute and chronic nutritional Stunting prevention legal policies problems caused by reduced access Malnutrition (stunting) is not new and purchasing power of people to because since the first government has taken Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 178 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 policy through the program tackling the take legislative, administrative, law, and problem of stunting in Indonesia (5). In other acts for fully realize children's human addition, the government has protected rights rights. children like the right to life, the right to health, the right to grow and develop like Discussion humans generally as stipulated in of the Stunting (short) is a condition in constitution Article (28) B paragraph (2) of which children under five are less long or tall the Law Republic of Indonesia (UUD NRI) than their age (19).Stunting is one of the In 1945 it was emphasized that: "Every child targets of the Sustainable Development entitled to survival, growth and developing Goals (SDGs) which is included in the and entitled to protection from violence and second sustainable development goal, discrimination ", in addition, in various laws namely eliminating hunger and all forms of and regulations which regulates the right to malnutrition by 2030 and achieving food life of children such as Law Number 4 of security20.The target set is to reduce the 1979 concerningChild Welfare, Law No. 23 stunting rate by 40% by 2025 (13). 2002 concerning Child Protection, Law Based on this research, the following Number 36 of 2009 concerning Health, it is are ways to prevent stunting during the even regulated in Law Number 39 of 1999 pandemic COVID-19 prioritized at toddler concerning Human Rights (2). Fact it groups, pregnant women, and breastfeeding happens that the sufferer is relatively stunted such as 1) Promotion and support of high or still below the standard 20% by breastfeeding, 2) Campaign for balanced WHO (12,14). Stunting it should be becomes nutrition and Clean and Healthy Living the government's concern, given the impact Behavior (PHBS), 3) Education and which is quite serious for the child and has counseling using the media, including Short implications on the nation's future. From this Letter (SMS), or WhatsApp group 4) Priority phenomenon, then the focus of the study in services for children under five, through this study, namely protection and health services and home visits, 5) Provision enforcement of human rights law humans for of additional food for malnourished toddlers children with stunting (8,9). and pregnant women with chronic energy There are three forms of liability and deficiency, 6) Provision of nutritional responsibility state responsibility for supplementation. protecting children which is based on human In response to COVID-19, UNICEF rights, firstly, Respect (obligation to respect) is working with the government to continue that is the state's obligation not to interfere in nutrition services for vulnerable children and regulating citizens his country when families, including growth monitoring, exercising his rights. In this case, the state distribution of micronutrients, support for has an obligation to do those actions will mothers to adequately feed babies and hinder fulfillment of all the human rights of children, and screening and care for children children with stunting. Secondly, Protect under five due to poor nutrition (21).The (obligation to protect) that is the state's government cannot work alone, it needs obligation to act active to guarantee synergy, commitment and good innovation protection. This means that the state is with community institutions, especially local obliged to take actions for prevent violations governments.The importance of convergence of all children's rights by party. Thirdly, between programs, so that they can target the Fulfill (obligation to fulfill) is an obligation smallest community groups.The stunting and responsibility state to act actively in reduction strategy is carried out through 5 order All citizens of that country have their (five) pillars, namely (1) leadership rights fulfilled, including the rights of commitment and vision;(2) campaigns and children with stunting. The state is obliged to behavior change;(3) convergence of central, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 179 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 regional and village programs;(4) food and are urged to immediately contact cadres or nutrition security;and (5) monitoring and health facilities if the child has decreased evaluation (17). appetite, weight loss, or other health The importance of implementing a problems. With regard to specific strategies strategy to reduce stunting rates through for preventing stunting during the pandemic, education and meeting the needs of nutrition the key is to provide good nutrition, routine and sanitation, behavior change, especially growth and development monitoring for for pregnant women and ensuring that the early detection, and a tiered referral system. baby's growth remains good from the womb Government program policies to after birth.Pitasari and Kirana also said relating to the handling of stunting as that the target to reduce stunting to 14% is manifestation of protection of children's very difficult to achieve under normal rights is a constitutional order for protection conditions, especially in the midst of a towards children is part of human rights pandemic (17).For this reason, high-level human (12). Hence, child recovery from commitment is required through various stunting is the responsibility of the state in policies / regulations, developing innovation, order children can live healthy and get life human resources, and institutions in order to worthy. Every child has the right to service expand the scope of the program."The good health, the right to food (intake importance of strengthening the quality of nutrition), the right to welfare. This right is existing programs with creativity and recognized in statutory regulations, namely culture-based innovation according to the UUD NRI 1945, Law Number 4 of 1979 potential of each region.This will accelerate concerning Child Welfare, Law Number 23 the stunting reduction target in Indonesia. of 2002 concerning Child Protection, Law The COVID-19 pandemic makes it No. 36 2009 concerning Health, Law possible for the number of stunted children Number 3 of 1997 concerning Juvenile (chronic malnutrition) in Indonesia to Justice, The Food Law is even regulated in increase. So it is predicted that the target to Law Number 39 of 1999 concerning Human reduce stunting of up to 14 percent is rights. Meanwhile, special rights for children difficult to achieve, considering that stunting sufferers have not been specifically Posyandu is no longer operating and health regulated in national law. workers at Puskesmas are also not immune Health is a human right that must be from the impact of COVID-19. Early fulfilled by the government because it is its detection such as routine growth monitoring constitutional duty, as mandated in Article in health facilities is important in preventing (28) paragraph (1) of the NRI Constitution malnutrition in children (13). If it is not which reads "everyone has the right to live in quickly detected by measuring body weight, physical and mental well-being, to live in, body length and head circumference, and to have a good and healthy living children can suffer from chronic malnutrition environment. and entitled to health services. and become stunted. In order for the stunting The right to health is also explicitly regulated rate to fall, it is necessary to modify the in Article (4) of Law of the Republic of policy strategy that can be implemented at Indonesia Number 36 of 2009 concerning the local level. It is hoped that the closure of Health which states that "everyone has the the posyandu can be overcome by the right to health". Because the right to health is application of a clean and healthy life for a fundamental right that the government each family. Mothers are expected to must strive to fulfill for citizens, especially continue giving breastmilk to babies, eating children who are the nation's next generation, according to balanced nutrition guidelines efforts to prevent stunting in children must for children, washing hands and PHBS, to be of particular concern. doing physical activity. In addition, people Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 180 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 According to the theory of human is a difference in ability (caused because the rights, natural rights (natural rights): Human developing social structure tends to rights are rights that belong to all human marginalize it) to access protection and beings at all times and in all places by virtue fulfillment of the rights given by state. of being born as human beings) (1,2,8). Providing child protection people with HAM is a right that belongs to all humans at stunting an obligation and the joint all times and places based destiny as a responsibility of the state, community, human (8). In the context of Indonesian family and parents covering juridical people's life that death who took the lives of protection, economic, social and cultural. the nation's children with because of the Therefore, in fulfilling basic rights child, unavailability of protection and health then the responsibility is carried out services can be categorized as human rights holistically by collaborating with the violations. Violation of rights health is a stakeholder. violation of the constitution (14). Thus, the government's failure in maximizing Reference prevention program policies and restoring the health of stunting children is a form of 1. Al-Atok, A. Rashid. ―Indonesian rule human rights violation carried out by the of law‖ (2016): 1–18. state, because it does not fulfill their rights http://lab.pancasila.um.ac. id / wp- constitutional child. If the child is stunted not content / uploads / 2016/05 / The State restored, it will ruin the future children and Law of Indonesia By A-Rosyid-Al- nation even cause death. The rights violated Atok. Pdf by the state are rights healthy, the right to 2. Asshidiqie, Jimly. Caring for and grow and develop, the right to welfare Fulfilling the Guarantee of Citizens' children, right to education, right to standard Constitutional Rights. Jakarta, 2010. of living proper, and includes the right to 3. Azizah, KhadijahNur (2018). "Ministry life. Right to life is a non derogable right of Health Launches Riskesdas 2018, which cannot be restricted under any Stunting Rate Declines!" Detik Health, circumstances as a boon from God. November 2018. https: // health. Conclussion detik.com/berita-detikhealth/d- A number of health protocols urged by 4284274/ kemenkes-launch-riskesdas- the government to handle the Covid-19 2018-stunting-numbers-down. pandemic have the potential to have an 4. Izwardi, Doddy (2019). "Policies and impact on handling stress or stunting in Strategies for Poverty Reduction in Indonesia. For this reason, it is necessary to Indonesia." DYNAMICS Rural and modify the policy strategy at the regional Area 2, no. 2: 41–52. level so that the handling of stunting can 5. Ministry of Health of the Republic of continue amid the pandemic. In order to Indonesia (2018). "Stunting Reduction achieve the target of reducing the national is the Government's Focus." Ministry stunting rate, which is a national priority of Health RI. Jakarta. http: // www. program, it is necessary to modify the policy depkes.go.id/article/view/18050800004 strategy that can be implemented at the / reduction-stunting-so-focus- regional level. So, we can still prevent government. html. malnutrition and save the future of 6. ——— (2018). "Pusdatin: Situation of Indonesian children in the midst of a Short Toddler (Stunting) in Indonesia." pandemic.Protection and fulfillment of rights Indonesian Ministry of Health 1: 2. constitutional citizen must do in accordance 7. Kurnia, TitonSlamet (2007) ,. Right to with the conditions of citizens of the country Optimal Health Degrees as Human with the fact that in Indonesian society there Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 181 Amraeni, Y., Surianto, T., & Nirwan, M. DOI: 10.36566/ijhsrd/Vol3.Iss1/72 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Rights in Indonesia. Bandung: 2018. https: // m. PT.Alumni. republika.co.id/amp/p30s85396 S, 8. Mahmud Marzuki, Peter (2016). Legal 17. Almatseir, 2011. Basic Principles of Research. Revision. Jakarta: Nutrition. Jakarta: PT. KencanaPranada Media Group. GramediaPustakaUtama. 9. Mayasari, Diana, Reni Indriyani 18. Satriawan, ELan (2018). National (2018). "Stunting, Risk Factors and Strategy for the Acceleration of Prevention of Stunting, Risk Factors Stunting Prevention 2018-2024. and Prevention" 5: 540–545. Ikkom Jakarta: National Team for the Division, Faculty of Medicine, Acceleration of Poverty Reduction University of Lampung, (TNP2K). PoltekkesKemenkesTanjungkarang, 19. Sugiyanto, S., Sumarlan, S., & Hadi, and Bandar Lampung. A. J. (2020). Analysis of Balanced 10. Mugianti, Sri; Mulyadi, Arif; Khoirul, Nutrition Program Implementation Agus; Lukluin, Zian, 2018. "Factors Against Stunting in Toddlers. Unnes Causing Stunting Children Age 25-60 Journal of Public Health, 9(2), 148- Months in Sukorejo District, Blitar 159. City 1." Ners, Journal of Midwifery, https://doi.org/10.15294/ujph.v0i0.341 Volume 5: 268–278. El Muhtsj, Majda. 41 Dimensions of Human Rights 20. Law of the Republic of Indonesia (Describing Economic, Social and Number 39 of 1999 concerning Human Cultural Rights). Jakarta: PT. Rights (State Gazette of the Republic RajawaliPers, 2008. of Indonesia of 1999 Number 165, 11. Mustafa (2015). Stunting Problems and Supplement to the State Gazette of the Interventions to Prevent Stunting (A Republic of Indonesia Number 3886). Literature Review) ‖2, no. 5. 21. Law of the Republic of Indonesia 12. Neta, Yulia, 2013. Community Number 36 of 2009 concerning Health Participation in Upholding of Human (State Gazette of the Republic of Rights in Democratic Countries. Indonesia of 2009 Number 144, Monograph. Supplement to the State Gazette of the 13. Presidential Regulation Number 42 of Republic of Indonesia Number 5063). 2013 which regulates the 22. Law of the Republic of Indonesia Implementation of the National Number 23 of 2002 concerning Child Movement for the Acceleration of Protection (State Gazette of the Nutrition Improvement. Republic of Indonesia of 2002 Number 14. Regulation of the Minister of Health 109, Supplement to the State Gazette Number 39 of 2016 concerning of the Republic of Indonesia Number Guidelines for Implementing a Healthy 4235). Indonesia Program with a Family 23. Law of the Republic of Indonesia Approach Number 18 of 2012 concerning Food 15. Pritasari, Kirana, 2019. "Efforts to (State Gazette of the Republic of Accelerate Stunting Reduction: 2018 Indonesia of 2012 Number 227, Implementation Evaluation & 2019 Supplement to State Gazette of the Action Plan." Bogor: Indonesian Republic of Indonesia Number 5360). Ministry of Health. 16. Republika. WHO: 7.8 Million Toddlers in Indonesia are Stunting. Jakarta, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 182 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RELATIONSHIP BETWEEN HUSBAND SUPPORT AND MIDWIFE ROLE WITH POST PARTUM CONTRACEPTION IN KONAWE KEPULAUAN DISTRICT Dian Wulandari1, Sunarsih2, Akbar Torontju3 1,2,3Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Dian Wulandari Email : [email protected] Abstract Background: Postpartum contraceptive coverage in Konawe Kepulauan Regency in 2018, through data obtained at the Konawe Kepualaun District Health Office, Southeast Sulawesi Province as much as 8.4% and data in 2019 decreased to 1.26%. Methods: This quantitative research is observational with a cross sectional study design. The population in this study was 96 people with the determination of the sample using stratified cluster sampling, totaling 77 all post-partum mothers in the working area of the health centre in Konawe Kepulauan Regency. Result s:The significance value (p) value of husband support and the role of midwife is 0.000 which means that p <0.05 so that Ha is accepted and Ho is rejected, which means that there is a significant correlation or relationship between husband's support and the role of midwives on the use of postpartum contraception. Both have a value of phi C which is 0.100 which means very weak relationship. Conclusion: There is a relationship between husband's support and the role of the midwife against the use of postpartum contraceptives in the Konawe Islands district. Key words: Support, Husband, Midwife, Contraception, Postpartum Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 182 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 people or 8.4% of the 869 births with 59 INTRODUCTION people using injection contraceptives Maternal mortality or maternal death (80.8%), 10 people with Pill contraceptives according to the limits of The Tenth (13.7%), Family planning program of Revision of International Classification of Implants for 4 (four) people (5.5%) and IUD Diseases (ICD-10) is a woman's death that users were not there at all. Meanwhile, the occurs during pregnancy or within 42 days contraceptive coverage data in 2019 after pregnancy, regardless of the length and amounted to 11 people or 1.26%, consisting location of the pregnancy, caused by of 7 people using pill contraception (0.8%) anything related to pregnancy. pregnancy, or and 4 (four) people using injection was aggravated by the pregnancy, or its contraception (0.4%) and using IUD treatment, but not death caused by accident contraception and The Male Operation or chance(1). Method (MOP) / the Female Operation The causes of direct maternal death in Method (MOW) did not exist at all from the Indonesia are dominated by postpartum total number of mothers who gave birth to hemorrhage, hypertension, eclampsia, and 869 people. From these data, the coverage infection.The need for community shows that public interest in the use of empowerment, then it requires cross-sector postpartum contraception is very low(5). participation and involvement as well as Based on this study, it shows that there parties who can provide role models in are several problems regarding the society(2). The indirect cause of maternal achievement of postpartum contraception, death is the number of cases 3 (three) too late especially in Kabubaten Konawe Islands, by and 4 (four) too. Case 3 (three) being late, looking at the national targets that have been includes: 1. Being late in recognizing the set. So the researchers are interested in doing danger signs of childbirth and making a research on "The Relationship between decision, 2. Being late in being referred to a Husband's Support and the Role of Midwives health facility, and 3. Being late in being on the Use of Postpartum Contraception in handled by a health worker at a health Konawe Islands District". service facility Case 4 (four) too, covers: 1 Too old pregnant (over 35 years old), 2. Too METHOD young pregnant (under 20 years old), 3. Too This quantitative research is many (more than 4 children), and 4. Too observational with a cross sectional study close the distance between births (less than 2 design(6). The population in this study was years)(3). 96 people with the determination of the In Indonesia, the coverage of sample using stratified cluster sampling, postpartum contraception services is still far amounting to 77 all post-partum mothers in from the target set by the government, which the working area of the Konawe Islands is 80%. Postpartum family planning service District Health Center. The study was coverage in Indonesia in 2013 was 59.6%. conducted from December 14 to January 29, Postpartum family planning service 2021. achievement in urban areas was 60.9%, while in rural areas it was 58.3%(4). RESULTS Postpartum family planning coverage Table 1 shows that of the 77 for the Provision of Southeast Sulawesi in respondents based on the support of their 2018 as many as 25628 people or as much as husbands, 0 people are good (0%), enough as 4.69%(5). many as 8 people (10.38%), and less than 69 The coverage of postpartum people (89.61%). contraceptive use in Konawe Kepulauan Table 2 shows that of the 77 Regency in 2018 shows as many as 73 respondents based on the role of a midwife, 0 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 183 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 people are good (0%), enough as many as 8 contraceptive use. And the value of phi C is people (10.38%), and less than 69 people 0.100 which meansvery weak relationship. (89.61%). Table 4 shows that of the 77 Table 3 shows that of the 77 respondents who answered that the role of respondents who answered that their midwives was less by using postpartum husband's support was lacking by using contraception, not one respondent (0%), postpartum contraception, not one while there were 69 respondents (100%) who respondent (0%), while not using postpartum did not use postpartum contraception. Of the contraception there were 69 respondents 77 respondents who answered that the role of (100%). Of the 77 respondents who midwives was enough to use postpartum answered that their husband's support was contraception, there were 8 respondents sufficient by using postpartum contraception, (100%), while none of those who did not use there were 8 respondents (100%) while none postpartum contraception (0%), and of the 77 of those who did not use postpartum respondents who answered that the role of contraception (0%), and of the 77 midwives was good by using postpartum respondents who answered that their contraception there were none none of the husband's support was good by using respondents (0%) so that at the time of postpartum contraception there was none testing the variables were illegible. This none of the respondents (0%) so that at the means that respondents with the role of a time of testing the variables were illegible. midwife do not use postpartum contraception This means that respondents with the support more or less. The significance value (p) of their husbands do not use postpartum value is 0.000 which means that p <0, 05 so contraception more or less. The significance that Ha is accepted and Ho is rejected, which value (p) value is 0.000 which means that p means that there is a significant correlation <0, 05 so that Ha is accepted and Ho is or relationship between maternal knowledge rejected, which means that there is a and postpartum contraceptive use. And the significant correlation or relationship value of phi C is 0.100 which meansvery between maternal knowledge and postpartum weak relationship. Table 1 Husband's support according to respondents in Konawe Kepulauan district No. Husband's support n % 1 Good 0 0 2 Enough 8 10.38961039 3 Less 69 89.61038961 total 77 100 Table 2 The role of the midwife according to respondents in Konawe Kepulauan district No. The role of the midwife n % 1 Good 0 0 2 Enough 8 10.38961039 3 Less 69 89.61038961 total 77 100 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 184 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 Distribution of Husband's Support for Postpartum Contraception in Konawe Kepulauan Regency Postpartum Contraception Husband's p No. Use do not use amount C Support value n % n % 1. Enough 8 100 0 0 8 2. Less 0 0 69 100 69 0.000 0.100 Total 8 100 69 100 77 Table 4 Distribution of the role of midwives on postpartum contraception in the district Konawe Islands Postpartum Contraception The role of p No. Use do not use amount C the midwife value n % n % 1. Enough 8 100 0 0 8 2. Less 0 0 69 100 69 0.000 0.100 Total 8 100 69 100 77 is quite influential in determining the use of DISCUSSION the family method by the wife. In previous research in Indonesia, the husband's consent Relationship between Husband's Support was the most important factor in determining and Postpartum Contraception whether a wife would use contraception or This study shows that there is a not because the husband was seen as the relationship between husband's support and protector, the breadwinner of the household, postpartum contraception in accordance with and the decision maker.(7). the results of hypothesis testing using chi Research that supports "Analysis of square analysis. Based on the table, it is Achievement of Kb Post-Copy Intra Uterine found that the significance value (p) value is Device (IUD)" shows that the support of 0.000, which means that p <0.05 so that Ha husband and family is very influential on the is accepted and Ho is rejected, which means use of postpartum contraceptives.(8). other a significant relationship betweenhusband's than that"Factors Associated with support with postpartum contraceptionin Postpartum Birth Control in Postpartum Konawe Islands Regency. Women in the Work Area of the Pakuan According to the opinion of experts, Baru Community Health Center in Jambi Notoatmodjo S, in 2007 stated that family City in 2013" showed that there was a support is a set of interpersonal behavior, the significant relationship between family nature, this activity is related to individuals support and postpartum family planning.(9). in the family based on the behavior patterns of the family, group and society. In addition, Relationship between the Role of family support is one of the reinforcing Midwives and Postpartum Contraception factors in the formation of behavior.The This study shows that there is a husband's opinion regarding family planning relationship between the role of midwives Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 185 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 and postpartum contraception in accordance midwives in the working area of the with the results of hypothesis testing using Puskesmas in monthly meetings. chi square analysis. Based on the table, it is found that the significance value (p) value is 0.000, which means that p <0.05 so that Ha REFERENCES is accepted and Ho is rejected, which means 1. World Health Organization. World a significant relationship betweenrole of health statistics 2015: World Health midwives with postpartum contraception in Organization; 2015. Konawe Islands Regency. Opinion of experts, according to(10), 2. Jayadipraja EA, Prasetya F, Azlimin A, factors that influence interest in family Mando WOSY. Family clean and planning such as reinforcing or reinforcing or healthy living behavior and its encouraging (health workers).The determinant factors in the village of implementation of the role of the midwife in Labunia, Regency of Muna, Southeast the family planning program includes Sulawesi Province of Indonesia. Public independent duties and government tasks, Health of Indonesia. 2018; 4 (1): 39-45. namely implementing health services which 3. Aryawati W. Development of a Planned are a government program. In accordance and Anticipatory Model of Prevention of with the authority of the midwife in High Risk Pregnancy and Childbirth implementing the family planning program, (REGITA). Indonesian Journal of it is stated in Articles 9, 12, 13 and 15(11). Health Policy: JKKI. 2016; 5 (2): 86-93. Supporting research"Factors Associated with Post-Copying Birth Control 4. Anggraeni P. Determinants of Long- in Postpartum Women in the Work Area of Term Contraceptive Method Use the Pakuan Baru Community Health Center (MKJP) for Family Planning Acceptors in Jambi City in 2013," it was found that in the Pamulang Community Health there was a significant relationship between Center 2014: UIN Syarif Hidaayatullah the role of health workers and postpartum Jakarta: Faculty of Medicine and Health family planning.(9). In addition, the Sciences, 2015; 2015. supporting research entitled "Factors 5. Konawe Islands District Health Office. Associated with Willingness to Become Coverage of postpartum contraceptive Postpartum Family Planning Acceptor at use in Southeast Sulawesi; 2019. Deli Serdang Lubuk Pakam Hospital in 2019", concludes that there is a significant 6. Mackey A, Gass SM. Second language relationship between the level of role of research: Methodology and design: health workers related to willingness to be Routledge; 2015. postpartum family planning acceptors.(12). 7. Fatimah D. Factors Related to the Use of Contraceptives in the Womb (IUD) in CONCLUSION the Work Area of the Pasar Rebo There is a relationship between District Health Center. 2013. husband's support and the role of the 8. Wahyuni R, Irawan Y. Web-Based midwife against the use of postpartum Heart Disease Diagnosis System With contraceptives in the Konawe Islands Forward Chaining Method (Case Study district. So that the need for support from Of Ibnu Sina Islamic Hospital). Journal husbands and midwife coordinators in Of Applied Engineering And conducting mini workshop meetings Technological Science (Jaets). 2019; 1 conveyed a joint commitment to the use of (1): 43-50. postpartum family planning as well as conducting training for independent Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 186 Wulandari, D., Sunarsih, & Torontju, A. DOI: 10.36566/ijhsrd/Vol3.Iss1/74 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 9. Ruwayda R. Factors Associated with Post-Copy Kb in Post-partum Mother in the Work Area of Puskesmas Pakuan Baru, Jambi City, 2013. Scientific Journal of Batanghari University, Jambi. 2017; 14 (1): 49-57. 10. Notoatmodjo S, Anwar H, Ella N, Tri K. Health promotion at school. Jakarta: inventions. 2012: 21-3. 11. RI D. Guidelines for the management of malaria cases in Indonesia. Jakarta: Ministry of Health of the Republic of Indonesia. 2008. 12. Sembiring JB, Suwardi S, Saragih HJ. Factors Associated with Willingness to Become Postpartum Family Planning Acceptor at Deli Serdang Lubuk Pakam Regional Hospital in 2019. Scientific Journal of Batanghari University, Jambi. 2020; 20 (2): 571-9. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 187 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE RISK FACTORS OF RESIDENTIAL DENSITY AND HABITS OF WASHING THE CURTAINS TO POSITIVE LUNG TUBERCOLOSIS PREVALENCE IN BOMBANA DISTRICT Eka Januati1, Timbul Supodo2, Sunarsih3 1,2,3Master of Public Health Study Program, Universitas Mandala Waluya In Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Eka Januati Email : [email protected] Abstract Background: Based on a preliminary survey conducted in Bombana District on new TB smear positive patients, this was carried out by interviews with 15 respondents, the following results were obtained. It was also found that 73.3% of patients who live in the same house exceed the area of the house and 26.6% of patients who have a very decent house as well as ventilation and almost all sufferers who wash their curtains for more than 3 (three) months, around 93.3% and the rest (6.7%) are quite good at washing their curtains. Methods: This research is quantitative method with a case control study approach. Guided interviews were conducted using an occupancy density questionnaire, and the habit of washing curtains for risk factors for the incidence of smear positive pulmonary TB which were traced retrospectively. The population isall tuberculosis patients, both positive and suspected, were recorded in Bombana Regency in 2019. With 77 case samples, each for cases and controls. Results: Occupancy densityChi square test obtained the calculated x² value = 9.416 and x² table = 3.841 at α = 5% and df = 1, or the calculated x² value is greater than the x² table, namely (9.416> 3.841). This shows that there is a relationship between occupancy density and the incidence of positive smear pulmonary tuberculosis in Bombana Regency. The habit of washing curtains in the chi square test obtained the calculated x² value = 6.690 and x² table = 3.841 at α = 5% and df = 1, or the calculated x² value is greater than the x² table, namely (6.690> 3.841). This shows that there is a relationship between the habit of washing curtains and the incidence of positive smear pulmonary tuberculosis in Bombana Regency. Conclusion: There is a relationship between the risk factors for occupancy density and the habit of washing curtains to the incidence of positive smear pulmonary tuberculosis in Bombana District. Key words: Occupancy, Density, Washing, Curtains, Tuberculosis Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 188 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION transmitted and, more importantly, how to The spread of infectious diseases is prevent it. A person's health behavior is a still a global health problem that can threaten risk factor for the transmission of pulmonary health and cause death. According to the tuberculosis. Behaviors that are at risk of World Health Organization (WHO) in 2018, infection include not opening windows, the the disease is included in the top 10 deadly habit of not washing or drying curtains and diseases in the world, one of which is mosquito nets once a week, using eating and tuberculosis which contributes (2.4%) to all drinking utensils together with sufferers, to deaths in the world. The five countries with the habit of spitting in any place. This causes the highest cases are India, China , it to be related to the capacity or condition of Indonesia, the Philippines and Pakistan(1). the lungs of the surrounding community(4) . This situation also occurred in Even the habit of a person not covering his Southeast Sulawesi Province, where the mouth when coughing and people who close prevalence rate was recorded in 2017 of 2.5 their windows during the day are also per 1000 population. In 2018, there was a associated with the transmission of significant increase, where the prevalence tuberculosis. (5). rate was recorded at 2.9 per 1000 population, The increasing coverage of the while in 2019 the prevalence rate increased discovery of new TB sufferers is evenly by 3.1 per 1000 population. The increase in distributed in all health centres in Bombana the prevalence rate of pulmonary Regency, adding to the anxiety and fear of tuberculosis in 2019 is directly proportional many TB cases that are found due to the to the mortality rate due Tuberculosis, where density of the occupancy and the habit of in 2019 the death rate due to TB disease washing curtains against the incidence of reached 1.73% (127 cases)(2). positive Acid-Resistant Lung Tuberculosis Bombana Regency is an area with a (BTA) which is a risk factor for the fairly high mortality rate due to pulmonary occurrence TB in Bombana Regency. tuberculosis in the Southeast Sulawesi Province, with the number of cases METHOD experiencing a significant increase, which This type of research is quantitative was recorded in 2017, the prevalence rate of with a case control study approach. Guided TB was 1.29 per 1000 population. In 2018 interviews were conducted using an the prevalence rate decreased by 1.17 per occupancy density questionnaire, and the 1000 population. In 2019, there was a habit of washing curtains for risk factors for significant increase, where the prevalence the incidence of smear positive pulmonary rate was recorded at 2.36 per 1000 TB which were traced retrospectively. The population. Tuberculosis mortality rate in population was all tuberculosis patients, both 2019, no less, reaching 4.69%(3). positive and suspected, recorded in Bombana The case finding of pulmonary Regency in 2019, consisting of a case tuberculosis every year continues to increase. population of 369 people and a control This is due to various factors including the population of 184,201. The number of case behavior of the community who do not care samples was 77 people each for cases and about the prevention of transmission of controls, the sample was taken using simple pulmonary tuberculosis and do not know random sampling. how to behave towards someone who has the disease, so that there is no transmission. RESULTS Especially families diagnosed with Table 1 shows that most of the pulmonary tuberculosis must know exactly respondents have an occupancy density level what pulmonary tuberculosis is, how it is in the high risk category, namely as many as Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 189 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 82 respondents (53.2%) and 72 respondents categories (95% CI: 1,510-5,610). Because (46.8%) the rest are in the low risk category. the OR value> 1, it can be concluded that the Table 2 shows that most respondents occupancy density is a risk factor for the have the habit of washing curtains in the low incidence of positive AFB pulmonary risk category, namely 83 respondents tuberculosis in Bombana Regency. (53.9%), while the remaining 71 respondents Table 4 shows that out of 71 (46.1%) are in the high category. respondents with the habit of washing Table 3 shows that of the 82 curtains in the high risk category, 44 respondents with high occupancy density respondents (62%) had smear positive categorized as high risk, 51 respondents pulmonary tuberculosis and 27 respondents (62.2%) had smear positive pulmonary (38%) did not suffer from smear positive tuberculosis and 31 respondents (37.8%) did pulmonary tuberculosis. Meanwhile, of the not suffer from smear positive pulmonary 83 respondents with the habit of washing tuberculosis. Meanwhile, of the 72 curtains in the low risk category, 33 respondents with a low-risk category of respondents (39.8%) had smear positive occupancy, 26 respondents (36.1%) had pulmonary tuberculosis and 50 respondents smear positive pulmonary tuberculosis and (60.2%) did not suffer from smear positive 46 respondents (63.9%) did not suffer from pulmonary tuberculosis. The results of data smear positive pulmonary tuberculosis. The analysis using the chi square test obtained results of data analysis using the chi square the calculated x² value = 6.690 and x² table = test obtained the calculated x² value = 9.416 3.841 at α = 5% and df = 1, or the calculated and x² table = 3.841 at α = 5% and df = 1, or x² value is greater than the x² table, namely the calculated x² value is greater than the x² (6.690> 3.841). This shows that there is a table, namely (9.416> 3.841). This shows relationship between the habit of washing that there is a relationship between curtains and the incidence of positive smear occupancy density with the incidence of pulmonary tuberculosis in Bombana positive smear pulmonary tuberculosis in Regency. 289-4,731). Because the OR Bombana Regency. The results of the value> 1, it can be concluded that the habit calculation of the Odds Ratio (occupancy of washing curtains is a risk factor for the density to the incidence of positive smear incidence of positive AFB pulmonary pulmonary tuberculosis at a 95% CI), tuberculosis in Bombana Regency. 289- obtained OR equal to 2,911. This means that 4,731). Because the OR value> 1, it can be people with high-risk occupancy categories concluded that the habit of washing curtains have a 2,911 times greater risk of suffering is a risk factor for the incidence of positive from smear-positive pulmonary tuberculosis AFB pulmonary tuberculosis in Bombana than people with low occupancy density Regency. Table 1 Distribution of Respondents Based on Occupancy Density in Bombana Regency amount Occupancy Density n % High Risk 82 53.2 Low Risk 72 46.8 amount 154 100 Source: Primary Data, 2020 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 190 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 2 Distribution of Respondents Based on the Habit of Washing Curtains in Bombana Regency amount Habits of Washing Curtains n % High Risk 71 46.1 Low Risk 83 53.9 amount 154 100 Source: Primary Data, 2020 Table 3 Analysis of Residential Density Risk Factors For Incidence of Positive BTA Lung Tuberculosis in Bombana Regency TB incidence Occupancy amount Statistic test Case Control Density n % n % n % X²Calculate = 9,416 High Risk 51 62.2 31 37.8 82 100 X² table = 3,841 Low Risk 26 36.1 46 63.9 72 100 OR = 2,911 amount 77 50.0 77 50.0 154 100 LL-UL = 1,510-5,610 Source, Primary Data, 2020 Table 4 Analysis of Risk Factors for the Habit of Washing Curtains on the Incidence of Positive BTA Lung Tuberculosis in Bombana Regency Habits of TB incidence amount Statistic test Washing Case Control Curtains n % n % n % X²Calculate = 6,690 High Risk 44 62.0 27 38.0 71 100 X² table = 3,841 Low Risk 33 39.8 50 60.2 83 100 OR = 2.469 amount 77 50.0 77 50.0 154 100 LL-UL = 1.289-4,731 Source, Primary Data, 2020 the floor area to the number of family DISCUSSION members in one house. The floor area of a healthy house building must be sufficient for Occupancy Density the occupants in it, meaning that the floor The density of residents in one house area of the building must be adjusted to the will have an impact on the residents. This is number of occupants. Building area that is unhealthy because in addition to causing a not proportional to the number of occupants lack of oxygen, if one of the family members will cause overcrowded. In general, the is infected with a disease, especially assessment of occupant density using the pulmonary TB disease, it will be easily minimum standard provisions, namely the transmitted to other family members.(6). The density of occupants who meet health occupancy density in this study is the ratio of requirements is obtained from the quotient Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 191 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 between the floor area and the number of The results of this study also showed occupants of 8 m2 / person.(7). that of the 82 respondents with high-risk The results of this study indicate that category, 31 respondents (37.8%) did not occupancy density is a risk factor for the suffer from smear positive pulmonary incidence of positive AFB pulmonary tuberculosis. According to researchers, this is tuberculosis in Bombana Regency, where the more due to other factors including the OR was 2,911. This also means that people respondent never having direct contact with with high occupancy rates in the high risk the patient and the respondent's good category have a 2,911 times greater risk of nutritional status so as to increase body suffering from smear-positive pulmonary immunity. This is in line with the theory tuberculosis than people with low occupancy which states that good nutrition will increase density. This research is in line with research a person's resistance to infection and disease. conducted at the Hutarakyat Sidikalang A good immune system and antibodies will Health Center, which states that there is a make a person less susceptible to infection, significant effect between dense and non- one of which is smear positive pulmonary crowded occupancy on the occurrence of tuberculosis. And vice versa if when the pulmonary tuberculosis p = 0.000 (p <0.05) body's defense system is disrupted, and Odds Ratio = 5,400(8). This study is also This is in line with the theory which in line with research conducted in the slum states that the spread of smear positive areas of Palembang City, which stated that pulmonary tuberculosis will occur more occupancy density is the most dominant easily in people who live in groups or are variable in the incidence of pulmonary densely populated in an environment such as tuberculosis, with an OR value of 6.42.(9). dormitories, groups of school children, If this result is analyzed more deeply, it among family members in a densely is because a person with a relatively dense populated house, even among residents in a occupancy will facilitate the transmission of village. . Occupancy density is one of the smear positive pulmonary tuberculosis from requirements for housing health, where the one person to another in one house. This high density of occupancy, especially in the happens because the frequency of contact bedroom, will facilitate the transmission of and closeness between one person and smear positive pulmonary tuberculosis by another in a densely packed house is getting direct contact from one person to another. In higher, thus affecting the temperature and addition, the density of the occupancy can humidity in the room. High humidity also affect the humidity in the room, where conditions in the room, causing bacteria to residents who exceed the capacity of the multiply rapidly so that it can increase the room will increase the room temperature to risk of disease. become hot. This temperature change is due In addition, the density of the to the process of expelling heat from the occupancy also causes mycobacterium that human body and coupled with the release of causes smear positive pulmonary moisture from respiration and evaporation of tuberculosis to reproduce more rapidly in the body fluids through smear positive air, because the density of the occupancy can pulmonary tuberculosis. This will increase affect the air quality in the house, where the the humidity in the room. Humidity in the greater the number of residents, the faster the room is not only influenced by one factor, air in the house is polluted, because of CO2 but by several factors, namely local climate, in the house will quickly increase and will ventilation conditions, intensity of incoming reduce the level of O2 in the room, sunlight and so on.(10). occupancy density is closely related to the Meanwhile, of the 72 respondents with number of bacteria that cause infectious a low-risk category, 26 respondents (36.1%) diseases had smear positive pulmonary tuberculosis. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 192 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 This is due to several factors, one of the tuberculosis in Bombana Regency, where the strongest factors according to the researchers OR of 2.469 was obtained. This also means is the contact history factor. Based on the that people with the habit of washing researcher interview with this respondent, it curtains in the high risk category have a is known that the respondent has ever lived 2.469 times greater risk of suffering from or is living in the same house with smear smear positive pulmonary tuberculosis positive pulmonary tuberculosis. This compared to people who wash curtains in the respondent lives with the patient when he low risk category. returns to his hometown. Living in a house This result, if examined more deeply, with a smear positive pulmonary tuberculosis is due to the habit or behavior of the patient can cause infection. The main source community using drapery as a mouth cloth. of infection with AFB positive lung Dirty, unwashed curtains and sputum from tuberculosis is untreated or untreated TB sufferers can be an intermediary for the sufferers, so there needs to be public transmission of TB disease by awareness in adhering to treatment.(11). mycobacterium tuberculosis. Mycobacterium This research is in line with the tuberculosis can last a long time in fabrics at regulation of the Director General of the temperatures below 4 ° C, this can be an Indonesian Ministry of Health No. 829 / intermediary vehicle for the transmission of Menkes / SK / VII / 1999 regarding Housing TB disease. However, according to Health requirements stipulates that the researchers, the main factor of the above minimum bedroom area is (8) m², and it is cases is actually a history of household not recommended that more than (2) people contact with patients with pulmonary sleep in one bedroom, except for children tuberculosis. under (5) years old. The transmission of The results of this study also showed smear positive pulmonary tuberculosis that out of 71 respondents with the habit of occurs due to contact between the patient and washing curtains, there were 27 respondents other occupants of the house, the possibility (38%) who did not suffer from smear of this contact is greater in a house with a positive pulmonary tuberculosis. According densely populated population. Density of to the results of interviews with researchers, occupants is associated with respiratory these respondents had never had direct infections because high occupancy density contact with patients with pulmonary affects intensive inhalation, which makes it tuberculosis, so there was no transmission by easier for other family members to be mycobacterium tuberculosis. In addition, transmitted. The high level of occupancy there are several other factors that support density can cause high levels of this respondent not suffering from environmental pollution. So that the number pulmonary tuberculosis such as good of morbidity increases.(12). nutrition and the respondent does not smoke so that the respondent's immune system Habits of Washing Curtains against infection increases. The habit of washing curtains is the Meanwhile, of the 83 respondents with behavior of the community in an effort to the habit of washing curtains in the low risk keep the house clean, by cleaning curtains or category, 33 respondents (39.8%) had smear blinds using laundry soap.(13). Curtains may positive pulmonary tuberculosis and 34 offer a space of privacy, but curtains can also respondents (60.7%) did not suffer from contain harmful bacteria that can transmit smear positive pulmonary tuberculosis. various diseases(14). Based on the researcher interview with this The results of this study indicate that respondent, it is known that the respondent the habit of washing curtains is a risk factor had or is currently living in the same house for the incidence of positive AFB pulmonary as a smear positive pulmonary tuberculosis Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 193 Januati, E., Supodo, T., & Sunarsih. DOI: 10.36566/ijhsrd/Vol3.Iss1/75 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 patient. Living in a house with a smear City in 2016. Ibnu Sina Scientific positive pulmonary tuberculosis patient can Journal. 2016; 1 (2): 235-47. cause infection. The main source of infection 7. Ibadurrahmi H, Veronica S, with AFB positive lung tuberculosis is Nugrohowati N. Factors that influence untreated or untreated sufferers, so there the incidence of scabies in santri at needs to be public awareness in adhering to Qotrun Nada Cipayung Islamic treatment (11). Boarding School, Depok February 2016. Journal of Medical Profession: Journal CONCLUSION of Medicine and Health. 2017; 10 (1). There is a relationship between the risk 8. Banu S, Sitepu R, Sulistiasari R. Risk factors for occupancy density and the habit Factors for Pulmonary TB at Hutarakyat of washing curtains to the incidence of Sidikalang Public Health Center 2017. positive smear pulmonary tuberculosis in Journal of Medicine and Health. 2018; 5 Bombana District. So thatIt is hoped that the (4). government will be able to facilitate people 9. Budi IS, Ardillah Y, Sari IP, Septiawati who will make their houses according to the D. Risk Factor Analysis of Tuberculosis standards of a healthy house and always in Slum Areas of Palembang City. maintain the cleanliness of their home Indonesian Journal of Environmental environment. One of the ways is to always Health. 2018; 17 (2): 87-94. clean the house curtains, at least once a 10. Lathifa M. Factors Associated with week. Suspect Scabies in Santriwati Modern Islamic Boarding School Diniyyah Pasia, Kec. Ampek Angkek, Kab. REFERENCES Agam, West Sumatra 2014. 2014. 11. Susanti KN, Azam M. Relationship 1. WHO. WHO consolidated guidelines on between BCG Vaccination Status, tuberculosis: module 4: treatment: drug- Contact History and Personal Hygiene resistant tuberculosis treatment: online with Leprosy in Pekalongan City. Unnes annexes. 2020. Journal of Public Health. 2016; 5 (2): 2. Southeast Sulawesi Health Office. 130-9. Southeast Sulawesi Province Health 12. Lubis IPL, Ferusgel A. The Relationship Profile. Kendari; 2020. between the Physical Conditions of 3. Bombana District Health Office. Profile Houses and the Existence of Smokers in of the Bombana District Health Office in the House with the Incidence of ISPA in 2019. 2020. Toddlers in Silo Bonto Village, Silau 4. Jayadipraja EA, Daud A, Assegaf AH. Laut District, Asahan Regency. PUBLIC Air Pollution and Lung Capacity of HEALTH SCIENTIFIC JOURNAL: People Living around the Cement Community Health Communication Industry. Public Health of Indonesia. Media. 2019; 11 (2): 166-73. 2016; 2 (2): 76-83. 13. Haryanti CS. Evaluation of Prerequisite 5. Amalagusman A, Junaid J, Fachlevy Program Implementation and Haccp AF. Analysis of Risk Factors for Plan Design for Grilled Ribs Soup Pulmonary TB Disease in the Work Production at a Catering Company in Area of Puskesmas Puuwatu, Kendari Semarang: Unika Soegijapranata City in 2017. (Public Health Student Semarang; 2017. Scientific Journal). 2017; 2 (7). 14. Armand A. Other architectures: 6. Qiyaam N, Furqani N, Febriyanti A. Gramedia Pustaka Utama; 2013. Mother's Knowledge Level on ARI (Acute Respiratory Infection) in Toddlers at Paruga Health Center, Bima Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 194 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access HEALTH RISKS OF SULFUR DIOXIDE (S02) TAXATION IN COMMUNITIES IN RESIDENTIAL SURROUNDING INDUSTRY PT. DIAN SWASTATIKA SENTOSA POWER IN KONAWE SELATAN DISTRICT Ikhsan Dwianto1*, Sunarsih2, Erwin Azizi Jayadipraja3 1,2,3Master of Public Health Study Program, Universitas Mandala Waluya, In Kendari, Southeast Sulawesi Province, Indonesia Corresponding Author : Ikhsan Dwianto Email : [email protected] Abstract Background: Sulfur dioxide (S02)and fine particles are one of the emissions produced by coal- fired power plants which are harmful to breathing because they can damage the airways, causing irritation of the walls of the tubes and blocking the smooth passages in the lungs. Methods:This research is an observational study with the study method of Environmental Health Risk Analysis. The location of this research is in the area of the PT. DSSP in Konawe Selatan District. The population is 2,723 people and the human sample is 337 respondents using Clustersampling. While environmental samples (air) were divided into 4 locations where air concentration measurements were carried out in the morning, afternoon and evening. Result s:The average sulfur dioxide intake of respondents at point 1 has a mean of 0.0101, at point 2 has a mean of 0.0084, at point 3 has a mean of 0.0105, and at point 4 has an average of 0.0101. Meanwhile, the respondent's risk level for sulfur dioxide RQ> 1 was 5 people. Conclusion: Risk is influenced by body weight, rate of inhalation, time of exposure, frequency of exposure, duration of exposure. Risk management is carried out by reducing exposure time, planting trees that can absorb air pollution, maintaining endurance, implementing safe residential locations from the center of the factory which should be above 2.5 km. Key words: Environmental, Health, Sulfur dioxide, Exposure, Analysis Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 195 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION The results of air quality monitoring Steam power plants are an industry that around the industrial area of South Konawe can change air quality by relying primarily Regency in 2017 in April showed an average on coal, diesel and sand. Coal is a solid S02 value of 6.10 µg / Nm3 and in December hydrocarbon fuel derived from decomposing it showed an average value of 6.12 µg / plants, both biochemically, chemically and Nm3. In 2018, April showed an average S02 physically, which are free from oxygen and value of 9.29 µg / Nm3 and in December it last for a long time at certain pressures and showed an average value of 8.39 µg / Nm3. temperatures(1). In 2019, April showed an average S02 value Several industrial centers in Europe, of 9.94 µg / Nm3 and in December it showed North America and East Asia produce high an average value of 8.45 µg / Nm3. The data levels of S02. In Western Europe, 90% of S02 shows that the S02 concentration has produced is anthropogenic. Meanwhile, in increased in the last 3 years. the UK 2/3 S02 is produced by coal power PT Dian Swastatika Sentosa Power plants, while in Germany 50% of S02 is (DSSP) is a coal-fired power plant company. produced by industry and 63% in Canada(2). Where in technical terms, the emission or Sulfur dioxide comes from sulfur oxide exhaust gas released by PT. DSSP is in the gas (SOx). This gas is colorless, has an odor, form of carbon dioxide, sulfur dioxide, and and is more easily dissolved in water. particulate matter. This gas can affect human Likewise O3, secondary pollutants such as respiration if inhaled for a very long time. sulfate particles originating from S02 gas, One of them is the people who live in the can be deposited far from the source(3). area around the DSSP PLTU who can Sulfur dioxide is formed when fossil breathe CO2, S02, and PM2.5 every day fuels containing sulfur burn such as coal, because the location of the PLTU and crude oil, and ores containing copper, zinc, community settlements is only ± 3 km from aluminum, lead and iron. Power plant the industrial center. The distance of ± 3 km activities whose fuel uses coal or diesel oil, determined refers to the results of the exhaust gas from vehicles using diesel and study(5). industries whose fuel is coal or crude oil are According to the Ministry of one of the main sources of sulfur in urban Environment in 2013, S02 gas is a gas that is areas(4). harmful to human health and also has an Based on the Risk of Sulfur Dioxide impact on the environment both locally and (S02) Exposure in Communities Living globally. The existence of research on the Around PT. PLN (Persero) Sektor Tello in disease burden caused by the increase in S02 2014 with the highest level of S02 was found emissions in Southeast Asian countries has at location IV with a concentration of 55,778 strengthened this point where burning with µg / Nm3. The results of the calculation of coal fuel can release S02 emissions so that it the amount of risk for the average can form PM2.5 which can cause respiratory community living around PT. PLN (Persero) disease and heart disease(6). The Tello Power Sector has an RQ> 1 so it An environmental impact analysis or has a high risk of being exposed to S02 and AMDAL is a study that starts from planning, requires control. The impact of S02 on health implementation to the final assessment when is that it can harm the respiratory system and the activity or business is operating. The lung function and can also cause eye benefits of conducting this study are to irritation. Inflammation of the respiratory assess the extent of the physical, chemical, tract can cause coughing, mucus secretions, biological, economic, social and cultural chronic bronchitis and asthma can make impacts caused by the activity or business. people more susceptible to respiratory This has been regulated in Law of the infections(4). Republic of Indonesia number 32 of 2009 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 196 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 article 47 paragraph 2 concerning people (19.88%) of 15 hours of exposure ( environmental protection and management, 11.87%), 52 people of 16 hours of exposure Decree of the Minister of Health number 876 (15.43%), 19 people of 18 hours of exposure of 2001 concerning technical guidelines for (5.64%), 11 people of 20 hours of exposure environmental health impact analysis, and (3.26%), and 11 hours of exposure 5 people Government Regulation number 27 of 1999 (1.48%). concerning analysis of environmental health Table 3 explains the frequency of impacts. environmental impact(7). exposure per year with the category of 240 Therefore, an environmental health days is 166 people (49.26%), the annual risk analysis method is needed to determine exposure is for the category of 288 days as how much risk will be accepted by the many as 155 people (45.99%), and the community around the DSSP PLTU in annual exposure is for the category of 365 Konawe Selatan Regency. days as many as 16 people (4 , 75%). Table 4 explains the body weight of METHOD respondents 40-44 as many as 38 people This research is an observational study (11.28%), body weight 45-49 as many as 48 with the study method of Environmental people (14.24%), body weight 50-54 as Health Risk Analysis. . Risk identification is many as 73 people (21.66%), body weight 55 carried out by Hazard Identification, -59 as many as 56 people (16.62%), body Exposure Analysis, and Dose Response weight 65-69 as many as 100 people Analysis to identify the risk from S02 (29.67%) and body weight 75-79 as many as exposure. The location of this research is in 22 people (6.53%). the area around the PT. DSSP in Konawe Table 5 shows the results of the Selatan District. The population is 2,723 calculation of intake of exposure to sulfur people and the human sample is 337 air dioxide (S02) in the community of Wawatu respondents to residents who live around PT. Village and Tanjung Tiram Village, North DSSP in Konawe Selatan District. Moramo District for the duration of exposure UseClustersamplingwhile environmental of 30 years at point 1 minimum value of samples (air) were divided into 4 locations 0.0022, maximum 0.0131, at point 2 the where air concentration measurements were minimum value is 0.0018, the maximum carried out in the morning, afternoon and 0.0110, at point 3 the minimum value is evening. 0.0023, the maximum 0.0137, and at point 4 the minimum value is 0.0022, the maximum 0.0131. Whereas for the duration of exposure RESULTS to 70 years at point 1 the minimum value is Table 1 shows the measurement results 0.0051, the maximum0.0306, at point 2 the of Sulfur Dioxide (S02) at location 1 with minimum value is 0.0043, the maximum coordinatesS 040 02'15.066 ", E 1220 0.0025, at point 3 the minimum value is 40'02.200" of 26.4 µg / Nm3. At location 2 0.0053, the maximum 0.0319, and at point 4 with coordinates S 040 02'20.239 ", E the minimum value is 0.0051, the maximum 122039'13.500" of 22.1 µg / Nm3.At location 3 0.0306. with coordinates S 040 03'30.373 ", E 1220 Table 6 explains the level of risk is 38'52,297" amounting to 27.5 µg / Nm3. At calculated based on the duration of current location 4 with coordinates S 04004'08.426 ", exposure and projected over the next 30 and E 1220 38'42.469" of 26.4 µg / Nm3. 70 years. With the assumption that data Table 2 shows the duration of 12 hours related to intake, namely sulfur dioxide of exposure was 90 people (26.71%), 53 concentration and particulate matter, people (15.73%) 13 hours of exposure, 67 inhalation rate, frequency of exposure, body people (19.88%) of 14 hours of exposure, 40 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 197 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 weight do not change until the next 30 and and body weight (Wb) <30%, which means 70 years. that the data is normally distributed so that Table 7 shows that the CoV value of the value used is the mean value. the variable concentration (C), time of exposure (tE), frequency of exposure (fE), Table 1 Concentration of Sulfur Dioxide (S02) in Air in 2021 Yield No TLV (µg Coordinate Location (µg / Method . / Nm3) Nm3) S 040 02 '15.066 " 1 location 1 26.4 900 SNI 19-7119.7-2017 E 1220 40'02.200 " S 040 02 '20.239 " 2 location 2 22.1 900 SNI 19-7119.7-2017 E 1220 39'13,500 " S 040 03 '30,373 " 3 location 3 27.5 900 SNI 19-7119.7-2017 E 1220 38'52,297 " S 040 04 '08.426 " 4 Location 4 26.4 900 SNI 19-7119.7-2017 E 1220 38'42,469 " Source: Primary Data 2021 Table 2 Distribution of Length of Exposure Each Day, Year 2021 Percentage No. Exposure (Hour / Day) amount (%) 1 12 90 26.71 2 13 53 15.73 3 14 67 19.88 4 15 40 11.87 5 16 52 15.43 6 18 19 5.64 7 20 11 3.26 8 24 5 1.48 Total 337 100 Source: Primary Data 2021 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 198 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3 Distribution of Respondents Based on Frequency of Exposure in 2021 Frequency of exposure Percentage No. amount (Days / Years) (%) 1 240 166 49.26 2 288 155 45.99 3 365 16 4.75 Total 337 100 Source: Primary Data 2021 Table 4 Distribution of Respondents Based on Body Weight in 2021 No. Weight (Kg) amount Percentage (%) 1 40-44 38 11.28 2 45-49 48 14.24 3 50-54 73 21.66 4 55-59 56 16.62 5 60-64 0 0.00 6 65-69 100 29.67 7 70-74 0 0.00 8 75-79 22 6.53 Total 337 100 Source: Primary Data 2021 Table 5 Intake Concentration of Sulfur Dioxide (S02) in 2021 Intake (Ink) Intake (Ink) SO2 Intake (Ink) 70 PM2,5 30 30 Years Years SO2 Years Min Max Min Max Min Max Point 1 0.0022 0.0131 0.0001 0.0010 0.0051 0.0306 Point 2 0.0018 0.0110 0.0001 0.0010 0.0043 0.0256 Point 3 0.0023 0.0137 0.0002 0.0012 0.0053 0.0319 Point 4 0.0022 0.0131 0.0001 0.0010 0.0051 0.0306 Source: Primary Data 2021 Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 199 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 6 Risk Quetion Concentration of Sulfur Dioxide (S02) in 2021 Risk Quetion Risk Quetion Risk Quetion (RQ) SO2 30 (RQ) PM2,5 30 (RQ) SO2 70 Years Years Years Min Max Min Max Min Max Point 0.0852 0.5056 0.0172 0.1025 0.1989 1,1798 1 Point 0.0713 0.4233 0.0183 0.1090 0.1665 0.9877 2 Point 0.0888 0.5267 0.0206 0.1225 0.2072 1,2290 3 Point 0.0852 0.5056 0.0176 0.1045 0.1989 1,1798 4 Source: Primary Data 2021 Table 7 Variable data to calculate population intake Pollutant concentrat SCORE R tE Fe Wb Dt ion SO2 Mean 0.0256 14 268 57 Median 0.0264 14 288 58 standard 31.9 0.0024 11.25 deviation 2.33 4 30 0.83 and Minimum 0.0221 12 240 40 70 Maximum 0.0275 24 365 78 Coevisiens of 16.3 11.9 9.34 19.84 Varians 1 2 Source: Primary Data 2021 DISCUSSION to the ambient air, causing a decrease in ambient air quality(8). Concentration of Sulfur Dicoside (S02) The location chosen in making air Steam power plant (PLTU) is an measurements in this study is a location that industry that can change air quality with its is included in the area of waste gas main fuel depending on coal, diesel and contamination from PT. Dian Swastatika sand.(1). The PLTU operation process will Sentosa Power, which is within a radius of produce pollutants in the form of S02, NO2, 3000 meters from the emission source. The CO2 and PM. The emergence of S02 gas distribution of S02 concentration data was comes from the content of sulfur compounds collected in 4 air sample points, each (S) in coal. The emitted S02 gas will spread measuring 3 times using a spectophotometric instrument. Air quality measurement points Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 200 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 that are evenly distributed at each location into the ambient air. Other than that, S02 produce data that is normally distributed so concentrations in residential areas can that the mean value is used as the S02 increase if the company does not maintain concentration value. The mean value of S02 the preservation of protective forests around concentration is 0.0256 mg / m3 with a the factory area where the protective forest minimum value of 0.0221 mg / m3 and a functions as a noise damper due to the maximum value of 0.0275 mg / m3. For the production activities of the protective forest S02 concentration in ambient air in this factory as well as a medium to reduce air study, both the minimum, maximum and pollutants such as S02. Maintain forest concentration values, nothing that exceeds conditions in this case according to article 38 the quality standard stipulated by the of the Republic of Indonesia Government Government Regulation of the Republic of Regulation no. 142 of 2015 is one of the Indonesia No. 41 years old 1999, which is environmental management and monitoring 900 µg / Nm3 (0.9 mg / m3) for a that must be carried out by the company and measurement time of 1 hour. is supported by the Regulation of the The S02 concentration value in this Minister of Industry no. 35/2010 wherein an study was lower than the results of the industrial area is required to have a minimum research conducted by (4)around PT. PLN of 10% green open space as a form of the (Persero) Tello Sector with an average S02 company's efforts in realizing the value of 0.0445925 mg / m3. Other research environmental carrying capacity of industrial conducted in settlements around the PT. activities that PT. DSSP run. Pusri Palembang S02concentration is 0.246 mg / m3(7). The same is the case with Weight research conducted by(9) Around the Semen Individual body weight is an important Tonasa factory in Bungoro District, the anthropometric variable that greatly affects average S02 concentration in the morning the actual dose of a risk agent received by an and evening is 0.283 mg / m3 and 0.216 mg / individual because the greater the m3. individual's body weight, the smaller the The big difference in concentration internal dose received. Body weight has between this study and other studies is implications for the standard numerical value influenced by humidity, temperature and or quality standard as a form of risk wind speed at the time of sampling the control(10). ambient air at that location. The mean value of body weight was 57 The concentration of S02 in the kg which was obtained from direct weighing settlements around PT. This DSSP may from of each respondent. These results were time to time increase beyond the average obtained after testing for normality which S02concentration measured at the time of this resulted in normally distributed data so that research. This condition could have the mean value was used as a measure.Some happened if PT. DSSP increases the studies suggest that being overweight can production power of the factory from reduce a person's lifespan. Even an production activities in its normal state. In overweight person who doesn't smoke means addition, the S02 concentration can increase a healthier life(11). However, in contrast to if the power plant chimney, fuel heater and the intake of air pollutants,the large value of boiler operate simultaneously without risk is inversely proportional to the value of stopping. This is strengthened when PT. The body weight, so the greater the value of the DSSP does not maintain the physical respondent's body weight the smaller the condition of the waste gas filter in power value of the risk of the respondent. plant chimney towers, boilers and fuel According to research(12) which results in heaters where the waste gas is discharged respondents with body weight above the Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 201 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 average have a greater risk than respondents The frequency of exposure received by who have body weight below the average respondents in this study is quite high value. because 365 days / year is the maximum exposure received by humans in units of time Exposure Time of day / year, so if the exposure received by The time or length of exposure also the respondent is a maximum exposure it can affects the intake value. The results showed also increase the risk of health problems for that the data obtained in the field were the respondent because the respondent normally distributed so that the reference continuously exposed to air containing S02. was the mean value. The mean value of daily exposure time was 14 hours / day which was obtained from direct interviews with Results of Risk Level Analysis of Sulfur respondents. Dioxide (S02) Based on the results of interviews Sulfur Dioxide (S02) Risk Level when collecting data other than work, other This ARKL study examines the Risk things that cause respondents to leave the Quetient (RQ) according to the concentration settlement are daily activities such as taking of risk agents at 4 sampling points in the children to school and to the market. settlements around PT. DSSP is carried out Therefore, most of the time spent by on at-risk populations who live around the respondents who live in the vicinity of the PLTU area. Respondents were drawn based PT. DSSP is used for activities within the on the sampling area, namely people living research area itself. The exposure time of 24 within a radius of 3,000 meters from the hours / day is the maximum time of exposure emission center. in hours / day, so that if exposed in the The magnitude of the risk level is maximum time, the greater the chance that obtained from the comparison between the the respondent has a greater risk of being intake / intake and the reference dose value unsafe, such as research(13)which indicates issued by the IRIS EPA, with the that the longer a person is exposed to relationship that the greater the intake value ammonia the greater the acceptable health compared to the reference dose value (RfC), risk. This also applies to all other air the greater the health risk. The reference pollutants including S02. dose value (RfC) for S02 is 0.026 mg / kg / day ((14). Frequency of Exposure From the results of the calculation of The frequency of exposure is the the amount of risk for the duration of the number of days of S02 exposure received by next 30 years it is known that at this time the respondent in one year minus the length (realtime) there are no respondents who have of time the respondent leaves the research RQ≥1 because the value of the amount of location in units of days. The mean risk obtained is only 0.1461 mg / kg / day for frequency of exposure was 268 days / year. SO2. the risk magnitude value is 0.3423 mg / This is because most of the respondents in kg / day for S02. this study did not leave the research location However, from the results of the for 1 full day and also many respondents calculation of the level of risk (RQ) were original people from the research concentrationS02In the community of location so that during religious holidays or Wawatu Village and TanjungTiram Village, long holidays the respondents did not leave the RQ> 1 was obtained as many as 5 the research location for 1 full day because respondents. An RQ value> 1 indicates that their extended family was also live in an area they are underweight so that the amount of close to the research location. intake that enters their body is greater or in other words someone who is underweight Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 202 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 will have a higher risk of exposure to sulfur pollutants in the air and are more effective on dioxide. Apart from the weight factor, other broadleaf trees(5). In addition, every one factors that make the respondent have an hectare of green open space can produce 0.6 RQ> 1 are the time of exposure and the tons of oxygen per day. This can reduce the frequency of exposure. Where the concentrated concentration of dissolved respondents on average live 24 hours per day pollutants in the air(5). Government in 7 days a week so that the risk of exposure regulations also need to be tightened to will be even greater. implement residential locations in safe areas For example, one respondent who has of the center of the factory. Based on this a body weight of 40 kg, sulfur dioxide study, a safe residential location from the concentration of 0.0256 mg / m3, who lives center of the factory should be above 2.5 km. for 24 hours / day, 365 days / year with an However, for other types of industry further RfC SO2 value of 0.026 mg / kg / day, S02 studies are needed. This is in accordance exposure is RQ.1.1423 mg / kg / day. This with the Regulation of the Minister of means that the residential areas around the Industry No. 35/2010 concerning Technical PT. DSSP with a S02 concentration of 0.0256 Guidelines for Industrial Estates that the mg / m3 is not safe (non-carcinogenic) for distance for settlements is at least 2 km from people with an inhalation rate of 0.83 / hour the industrial center. for 365 days / year who lives for 24 hours / day and weighs 40 kg in the next 70 years . CONCLUSION The average sulfur dioxide intake of Risk management respondents at point 1 has a mean of 0.0101, a) Risk Management Strategy at point 2 has a mean of 0.0084, at point 3 The risk management strategy is carried has a mean of 0.0105, and at point 4 has an out by establishing safe concentration average of 0.0101. Risk is influenced by limits and determining the duration of safe body weight, rate of inhalation, time of exposure. The safe concentration exposure, frequency of exposure, duration of calculation uses the RfC S02 value of exposure. Risk management is carried out by 0.026 mg / kg / day. Then the calculation reducing exposure time, planting trees that of the safe concentration is as follows: can absorb air pollution, maintaining Non-carcinogenic safe concentration endurance, implementing safe residential = locations from the center of the factory which should be above 2.5 km. It is = 0.0223 mg / m3 necessary to measure S02concentrations So that the truly safe concentration value routinely in community settlements around is below 0.0223 mg / m3 (<0.0223 mg / PT. Dian Swastatika Sentosa Power so that m3) = 0.0222 mg / m3. the air quality of people exposed to S02 can Determination of the duration of safe be monitored. exposure = REFERENCES = 61.18 = 61 years. So the duration of stay in a safe 1. Hutagaol EF. Improved quality of life in community is 61 years. patients with chronic renal failure b) Risk Management Method undergoing hemodialysis therapy Controlling pollutants in the air can through Psychological intervention in also be carried out by reforesting and the hemodialysis unit Rs royal prima developing green open spaces or planting medan in 2016. Jumantik (Scientific trees in industrial areas and community Journal of Health Research). 2017; 2 settlements. Trees can naturally absorb (1): 42-59. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 203 Dwianto, I., Sunarsih, & Jayadipraja, E. A. DOI: 10.36566/ijhsrd/Vol3.Iss1/77 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 2. Rial A. Advertorial: Gamasugen Super Journal of Technoscience. 2019; 5 (2): Fast Soybeans. Nu Tech is a popular 77-80. nuclear media. 2014; 4 (1). 12. Haryoto H, Setyono P, Masykuri M. 3. Fevria R. Analysis of Air Quality in the Fate Ammonia Gas Against the Risk of Bukit Tui Limestone Mining Area, Health Problems in Communities Padang Panjang City. Exact. 2017; 2: Around the Putri Cempo Garbage Final 31-7. Disposal Site (TPA), Surakarta. 4. Fahruddin MS. Biological Management Ecoscience. 2014; 6 (2). of Mining Waste: Biological 13. Miskah S, Suhirman L, Ramadhona HR. Management of Mining Waste (Ind Sub): Making biobriquettes from a mixture of Celebes Media Perkasa; 2018. peanut shell charcoal and sugarcane 5. Novirsa R, Achmadi UF. Analysis of the dregs charcoal with KMnO4 Risk of Exposure to PM2.5 in Daytime additives.Journal of Chemical Ambient Air to Communities in Cement Engineering. 2014; 20 (3). Industrial Areas. Public Health:National 14. Brownell FW, Antonson RS. Public Health Journal. 2012; 7 (4): 173- Implementing the New Eight-Hour 9. NAAQS for Ozone — What Happened 6. Yuligawati R. Relationship of sulfur to the 1990 Clean Air Act?Tulane dioxide (S02) concentrations in ambient Environmental Law Journal. 1998; 11 air and other factors with asthma (2): 355-73. symptoms in elementary school students aged 6-7 years in Ciputat Village 2014. 2014. 7. Solichin A. Web programming with PHP and MySQL: Budi Luhur Publisher; 2016. 8. Ramadan Wm. Study of Chimney Design Against PM10 and S02 Emissions Due to Coal Burning at PLTU PT. X. Environmental Research Journal. 2017; 5 (1). 9. Wahyuddin PP, Susilawaty A, Azriful A, Basri S. Risk of Sulfur Dioxide (S02) Exposure to Communities Living Around PT. PLN (Persero) Tello Sector 2014.HIGIENE: Journal of Environmental Health. 2016; 2 (1): 8- 14. 10. Ramdan IM, Adawiyah R, Firdaus AR. Risk Analysis of Sulfur Dioxide (S02) Exposure to Non-Carcinogenic Risks of Street Sweeper Workers in Samarinda City.Husada Mahakam: Journal of Health. 2018; 4 (5): 255-69. 11. Lestari AD, Gunawan LI, Syifa DJ, Wibowo RW, Safarizki HA. Improving the Quality of Concrete with Calcite Waste Mixtures as an Environmentally Friendly Alternative Material. Scientific Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 204 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access A STUDY ABOUT THE HEALTH REFERENCE INFORMATION SYSTEM IN THE CASE OF NON SPECIALISTICS IN KENDARI CITY PRIMARY HEALTH CARE Sartini Risky1*, Abdul Azis Harun2, Anry Hariadhin Depu3 1,2,3Universitas Mandala Waluya, in Kendari Southeast Sulawesi Province, Indonesia Corresponding Author : Sartini Risky Email : [email protected] Abstract Background: I Implementation of a reference information system will not work well when its implementation is not in accordance with the policy or guidelines. One of the problems in implementing the referral system is the health information system, in this case the referral guidelines and referral templates. Methods: This research uses qualitative method and it conducted the Kendari City Inpatient Primary health care form April 2020 to August 2020. The informants in the study were the Kendari branch of the health insurance officers, consisting of the Head of the Inpatient Community Health Center, the doctors of Inpatient Primary health care, the Head of Primary Bene fit Guarantee and 4 referral patients in the Inpatient Primary health care. Data analysis of interview data used a NVIVO QSR application 12. Results: There is a conceptual linkage between the Reference Guidelines, Referral Procedures, and Reference Patterns with the concept of implementing the referral system Conclusion: There is a conceptual linkage between the Reference Guidelines, Referral Procedures, and Reference Patterns with the concept of implementing the referral system. Key words: Referral, Guidelines, Procedures, Patterns, Information, Systems Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 205 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION PermaReference errors in Southeast Health is one of the things of global Sulawesi are still quite complex. Based on concern in order to improve the preliminary preliminary studies conducted development of a country. Therefore, by researchers at several health centers, it development in the health sector is very was found that there were several problems important. To realize global commitments related to human resources, time, services as mandated by the 58th World Health and costs, facilities and infrastructure. The Assembly (WHA) resolution 2005 in basic thing that was found was a lack of Geneva which wants health financing understanding of health workers regarding systems in many countries to be further the referral system guidelines as well as an developed to ensure access to the services understanding of the 144 diagnoses that needed while providing protection against became the competence of doctors. Kendari financial risks through the National Health City is a city in Southeast Sulawesi which Insurance program (JKN)(1). consists of 15 health centers. From the The goverment Indonesia made referral figures in Southeast Sulawesi, this serious efforts to develop health insurance area has a fairly high referral rate at the by issuing legal protection from Law no. Primary health care Nursing for non- 40/2004 on the issue of the National Social specialized cases compared to other Security System (SJSN).(2) On January 1, districts, namely 130 referrals for Kendari 2014, the Social Security Administering City.(6). Body for Health was established, BPJS The referral rate at the care Primary Kesehatan as the Implementing Body is a health care for non-specialized cases in public legal entity established to administer Kendari city has increased cases, namely in health insurance programs for all 2016 as many as 9 cases then increased in Indonesians(3). 2017 by 25 cases, and in 2018 it continued In the JKN Era, First Level Health to increase, namely 130 non-specialized Facilities became the vanguard in the health referral cases (BPJS Kesehatan Kendari service system. So that demands for Branch, 2019) . In addition to the reference excellent service facilities are important for figures above, the basis for the researchers FKTPs. One type of first level health service to take the area, namely that for Kendari facility is the Community Health Center . City as the representative of the mainland Primary health care is a health service areas in Southeast Sulawesi and for the facility that organizes public health efforts utilization of health services, it is more than and first-level individual health efforts, by the rural areas.(7). prioritizing promotive and preventive Implementation of a system will not efforts, to achieve the highest public health work well if its implementation is not in status in its working area.(4). accordance with the provisions of the policy Based on the Rancid Regulation of the or guidelines. One of the problems in Minister of Health of the Republic of implementing the referral system is the Indonesia Number 1 of 2012 concerning health information system, in this case the Individual Health Service Referral Systems referral guidelines and referral templates. explains that the referral system is a health This is in line with research conducted by service delivery that regulates the transfer of Doaly in 2016 which found several duties and responsibilities of health services problems in the implementation of the both vertically and horizontally. Health system at Dr. Sam Ratulangi Tondano's services are implemented in stages, referrals include a referral form that was not according to medical needs starting from the filled in by the doctor at the hospital, a first level of health services(5). return referral form was not returned to the doctor at the FKTP, the doctor's writing was Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 206 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 not readable by the doctor at the FKTP, and the implementation of the referral human resources (expert doctor, X-ray system, 21 information that states the administrators) did not stay in the hospital, relationship between the concept of so cases that could have been handled in the conformity of rules to the implementation of hospital were referred,( 8 ) . the referral system, there are 33 information Based on the description above, it is that states the relationship between the necessary to make efforts in structuring an concept of document availability. on the effective and structured referral system, so it implementation of the referral system and is necessary to conduct a study to examine there are 33 information that states the the health referral information system in relationship between the concept of non-specialized cases in Kendari City regionalization and the implementation of Health Center. the referral system. Figure 2 explains about the linkage METHOD between the referral procedure and the The method in this research is concept of implementing the referral system qualitative. Implemented at the Kendari City has a conceptual linkage. This can be seen Inpatient Health care in April 2020 until from several indicators of referral finished. The informants in the study were procedures, namely 21 information that the Kendari branch of the health insurance states the relationship between the concept of office consisting of the Head of Inpatient the referral mechanism and the Community Health Centers, Inpatient implementation of the referral system, and Health care Doctors, the Head of Primary 21 information that states the relationship Benefit Guarantee (PMP) and 4 referral between the concept of initial action before patients at the Inpatient Health care. Data referring to the implementation of the collection was collected through out referral system. documentation, behavioral observation, or Figure 3 shows about the relationship interviews with participants / informants. between the reference pattern and the Data analysis of interview data using the implementation concept of the referral QSR NVIVO 12 application. system has a conceptual linkage. This can be seen from several indicators of referral RESULTS patterns, namely there are 30 information Image 1 shows the relationship that states the relationship between the between the reference guide and the concept concept of request itself to the of implementing the referral system has a implementation of the referral system, and conceptual linkage. This can be seen from there are 21 information that states the several indicators of reference guidelines, relationship between the concept of doctor's namely 25 information that states the linkage attitude towards the implementation of the between the available reference applications referral system. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 207 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Image 1 Referral Guidelines with the Implementation of the Health Referral System Figure 2 Referral Procedure with Health Referral System Implementation Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 208 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Figure 3 Referral Patterns with the Implementation of the Health Referral System DISCUSSION services, the Primary health care is obliged to make a referral. Referral Reference Guidelines procedures carried out by Primary health 1. Document Availability care must meet standard procedures From the results of the study, that including: referring, receiving referrals, the BPJS referral system guidelines returning referrals, receiving reciprocal already exist and are held by all referrals, managing patients in an Puskesmas, these guidelines refer to the ambulance, and referral of special cases. regulations of the minister of health and The completeness of facilities and presidential regulations which must serve infrastructure at the Puskesmas will also as guidelines for Primary health care in influence doctors in providing referrals to carrying out referrals at Primary health patients(9). care. With the existence of a referral In several cases in the Primary guideline document, this proves that the health care, there were patients who did implementation of the health referral not come directly to the Primary health system at the Primary health care in care to get a referral, so only the Kendari City and Bau-Bau City is carried patient's family explained the patient's out based on established guidelines. medical condition to the puskesmas The referral procedure begins with medical staff and asked for a referral for the community who needs health services the patient. The real condition of and must be carried out by health patients who do not come directly to the personnel at the FKTP, in this case the Primary health care cannot be monitored puskesmas. If the Primary health care or checked first by the puskesmas does not have the ability and authority medical personnel. Based on in-depth and the patient needs further health interviews with Health care referral Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 209 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 officers regarding patients who did not interviews, it was found that the come directly to the puskesmas, the Puskesmas had SOPs regarding the Primary health care asked in advance stabilization of the condition of why the patient did not come and asked emergency patients to be referred, this the patient to come alone if the reason stabilization was carried out on patients for the patient's medical condition was who came in an emergency situation and still possible to come and be examined were given emergency assistance first at the Primary health care. according to the procedure. Based on the However, if the reason that the patient results of interviews with health center does not come to the Primary health care referral officers, it was concluded that in person is really due to the patient's the patient met the requirements for medical condition which makes it referral. Preparation of referral patients impossible to come directly to the based on the results of direct observation Primary health care, then the exception in the service, it is known that the is that the puskesmas can provide a Primary health care has provided clear referral. However, in some cases, such explanations to patients / families as an extension of the referral letter, it is regarding the referrals to be given to usually the patient's family who asks for patients, but did not provide informed a referral letter to the Primary health consent forms to patients. care without being accompanied by the The Primary health care has not patient who will be referred due to the yet contacted the referral destination patient's medical condition. health facility service unit whether the Referral Clinical Procedures patient can be accepted at the referral The implementation of the referral destination health facility when referring system at the Primary health care in a patient, based on the results of the Kendari City and Bau-Bau City in interview, this is because the number of clinical procedures is in accordance with patients referred is large so they do not the National Referral System have time to contact the referral hospital Guidelines, the procedure has followed a for each patient to be referred. Research predetermined routine procedure. Based conducted(11) It is known that the on the research conducted(10)states that Tambakrejo and Tanah Kali Kedinding the referral system implementation Surabaya Primary health care before mechanism will be implemented through making a referral for childbirth contact an initial examination by the puskesmas the destination hospital first, and submit doctor if the patient has met one of the the case to be referred to ensure the criteria for a patient who can be referred availability of a place at the hospital. and cannot be handled by the Effective referral requires puskesmas, then a referral is necessary. communication between facilities, the If a case is found that cannot be handled goal is that the referred facility knows according to the doctor's authority, the the patient's condition and can prepare patient is immediately sent to a health early on the care the patient needs as service unit that has the ability to soon as the patient arrives at the overcome the problem, namely a hospital.(11). However, for certain hospital.(10). hospitals the Primary health care register Based on the results of online first so that patients get a queue observations and interviews, it is known number without needing to come to pick that several Puskesmas do not yet have up a queue number. Before the JKN era, SOPs regarding referral of non- not all cases to be referred were emergency cases. Based on in-depth confirmed in the Regional Unit Hospital, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 210 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 but in the JKN era, with the increasingly JKN patients . This recording can be stringent regulations regarding referral used as recording data and reporting of indications, communication before referred patients. However, if there is referring patients was intensified to negligence in recording patient referral maintain continuity of service as data, it will result in invalid and expected in JKN.(12). incomplete recording and reporting of Referral Administrative Procedures referrals. Administrative procedures for 2. Regionalization System referral of Primary health care in From the results of the study, that Kendari City and Kota Bau-bau have each Primary health care has been carried out in line with technical implemented SOPs based on the procedures for patients. Based on the regionalization system made by the results of direct observation at the health department. The regionalization Puskesmas, it is known that the Primary system in question is a referral flow health care has completed the medical arrangement that adapts to the records of the patients to be referred and availability of advanced health facilities stabilization measures, completeness in within the scope of the area, which is the form of patient diagnosis, diagnosis designed to make it easier for the code, and Poli and Hospital to be community to reach health facilities. referred for referral. Based on the results Based on the results of the of in-depth interviews, it is known that research we have done, there are several there is no informed consent sheet given obstacles in implementing the health to patients at the Primary health care to referral system in Kendari City and Bau- sign the consent, so there is no informed Bau City, namely the limited ability of consent in the medical records of the health workers to handle emergencies referred patient. The informed consent due to limited facilities and infrastructure format is one of the documents that must as well as medicines, limitations of be included in recording the medical modern transportation facilities and records of the referral patient delays in collection. decisions by the concerned(5). family. To overcome this, a Recording and reporting of the regionalization development of health referral system must be done properly in service facilities, both Primary health order to evaluate the operation of the care and transportation facilities, was referral system(12). Based on the results made, so as to speed up handling and of direct observation, it is known that the save on transportation costs. health center has recorded patient Regionalization in Bau-Bau City, referrals in the patient referral register especially in the Bungi Community which is filled in regularly every day Health Center was developed due to and the administration of patient limited health service facilities with delivery has been completed when the adequate facilities, limited human patient will be referred immediately. resources (HR) who can handle Referral sheets are not printed in emergency cases and make the referral duplicate, but patient data has been system closer to communities in remote recorded in the patient's medical record areas. This is due to the geographical which includes ICD-X code data, conditions of Bungi District which is a diagnosis and destination health mountainous area, as well as the distance facilities and data has been entered in and road infrastructure that does not SIMPUS and recorded in the referral support reaching health service facilities register book, as well as in P-Care for quickly, especially to the Bau-Bau City Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 211 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Hospital which is quite far from Bungi The data listed in the HFIS includes the District. This regionalization is intended address of health facilities, the person in to make it easier for people to access charge, the number of doctors and other health service facilities, especially those health workers, hours of practice, who live in remote areas. medical technology, and others. For 3. Application health facilities, the Health Facilities From the research, that in carrying Information System (HFIS) application out the health referral process for can speed up and simplify the administrative staff in each Primary collaboration process with BPJS health care using the health insurance Kesehatan. Through this application, online-based HFIS application, the BPJS partners can apply for an extension application is managed by the Pcare of cooperation while monitoring and officer of each Heatlh care and reporting on any developments that occur monitored directly by BPJS as the in these health facilities, including the application provider. With this availability of rooms for BPJS patients. application, the patient referral process is In terms of service, HFIS will easier and faster to do and easier to make it easier for officers at first-level evaluate because it is data-based. health facilities (FKTP) to refer patients Social Security Administering to advanced referral health facilities Bodies are legal entities established to (FKRTL). Officers can easily find the administer social security programs. nearest FKRTL, there are not too many Social Security is a form of social queues, and most importantly have the protection to ensure that all people can health services needed by patients. fulfill their basic needs for a decent life. Meanwhile, for patients, HFIS which is Health insurance participants must first connected to the 'Applications' service get a referral if they want to get service at can provide transparency of room the intended hospital. Previously, the availability for BPJS participants. The references used were tiered. Health availability of inpatient rooms is itself insurance participants must get referrals one of the most complaints made by from first-level services to get second- BPJS users. level services and so on. At the first level of health services, Efforts to speed up and simplify Health BPJS strengthens the first tier the collaboration process between Health health facility network by building a insurance and Health Facilities is by Primary Care (P-Care) application. P- providing the Health Facilies Informaon Care is a patient service information System (HFIS) application, this HFIS system for Health insurance participants, application is an application that can be computer-based and online via the used by all potential health facilities that internet. Basically, P-Care has 2 major will collaborate with Health insurance. functions, namely registration by This HFI application is an application registration officers and patient services based on a website that can be used via where data entry is carried out by doctors the public internet by all health facilities or treatment center officers, in which candidates who will collaborate with there is also a referral creation feature BPJS Kesehatan on the Health insurance where the data can be read directly at the website www.bpjs-kkes.go.id. referral health facility.(13). HFIS is an acronym for Health In reducing the number of Facilities Information System, which is a inappropriate referrals, it is necessary to site-based application for monitoring and make appropriate and effective decision- reporting health facilities profiling data. making procedures in implementing Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 212 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 referrals, where by using P-Care it is increase in services at the FKTP, because hoped that the Primary health care can the infrastructure was still limited screen for referrals that are not in However, the completeness of the accordance with the stages of problem referral letter is still problematic. identification, relevant data collection, Although all referral letters are filled in, alternative development, alternative many are not filled. This resulted in evaluation. and selection of the best incomplete data and information received alternative. Decision making involves a at FKTL. In fact, this data and continuous reciprocal action in dealing information is needed by health workers with a problem. With this appropriate at FKTL to take medical action and effective referral decision making, appropriately and accurately. the referral rate will decrease so that it The most crucial data such as the will restore the function of the Primary results of the diagnosis, physical health care as a gatekeeper and reduce examination, history taking, and therapy the accumulation of patients in the that have been given are the information hospital. that should be filled in the referral letter. 4. Compliance with Rules However, most of the data and From the results of the research, information are not filled in. The absence that all Primary health care run a referral of such data causes health workers at the system as much as possible based on the FKTL to not get accurate information to existing referral guidelines, but in certain take action on patients. cases that are actually included in 144 In some cases of chronic diseases diseases that must be completed at the of the return referral program, such as Primary health care level but because the asthma and hypertension, primary care facilities are not available at the Primary doctors are of the opinion that there are health care, health workers are forced to still some specialists who do not want to refer not based on from the referral refer patients back. As a result, FKTP guidelines set by the BPJS. This is doctors had to write monthly referrals to because there is a regulation from Health the hospital so that patients could get insurance which requires 144 types of medicine because there were drugs that diseases to be completed at the Primary were not available in the FKTP. The health care level, so that the referral behavior of specialists who kept patients option for these 144 types of diseases is in the hospital caused the process in the not available in the HFIS application. referral system to not go well. This may Increased access to health services be due to the perception of specialist since the existence of JKN has not been doctors who consider primary care accompanied by improvements in the doctors to be less competent in dealing service system, especially in referral with return referral program diseases. services. The application of a tiered This also causes doctors in puskesmas to referral system is actually aimed at run a health referral system that is not in controlling the quality of service to make accordance with the rules because it it more optimal. However, the should be in the process of returning a implementation was not as expected. In referral, the tiered referral system, the role of the It must be admitted, the tiered FKTP is very vital. FKTP is the first referral system has not run optimally. In health facility to provide services, before terms of management procedures, this being referred to in stages. As a result, system is good. However, the the number of patients has increased. implementation is still problematic. This increase was not matched by an Therefore, improvements need to be Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 213 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 made at the FKTP. The high rate of communication between facilities, the patient visits at the FKTP must be goal is that the referred facility knows the balanced with improvements in human patient's condition and can prepare early resources and service infrastructure. The on the care the patient needs as soon as government needs to improve human the patient arrives at the hospital.(9). resources and infrastructure in the FKTP. The Primary health care may refer These improvements are not only in patients to a higher level of health care quantity but also in quality. So that the provided that the patient requires service can be better and the level of specialized / subspecialistic health community satisfaction is high services. Referrers can provide health services according to patient needs due to Referral Procedure limited facilities, equipment and 1. Referral Mechanism manpower. Patients outside these criteria Based on the results of the study, it should not be referred to a higher level of can be obtained that the procedure flow health care. for referring patients is as follows: (1) The informant stated that the Registered patients, (2) examined by implementation started from the nurses, (3) entered into polyclinic, (4) registration counter, then the patient referrals are directed to advanced health chose the part they wanted, then the facilities according to levels. With patient would be examined by a doctor regards to control patients, in this case which included a physical examination, the patient is referred back from the diagnosis and therapy, if this was not hospital, the patient must follow the possible at the Primary health care then procedure from the start, namely the list they would be referred to a type C to the examination in the poly and cannot hospital, from type C, if you can't afford just take a referral. it, you will be referred to a type B Referral is the transfer of hospital, and from type B if you can't, responsibility from one health service to you will be referred to a type A hospital. another. The referral system is a health However, in the referral procedure there service network that allows the reciprocal are often various kinds of problems, one assignment of responsibility for the of which is the problem with the internet emergence of problems from a case or which likes errors, This resulted in the public health problem both vertically and primarycare (p-care) application being horizontally to those who are more difficult to open, coupled with the pile of competent, affordable and carried out patients queuing up, so doctors would rationally. The referral system is usually provide a manual referral letter. organized with the aim of providing Regulation of the Minister of quality health services, so that service Health of the Republic of Indonesia objectives are achieved without having to Number 1 of 2012 concerning Individual use expensive costs. Referral is a system Health Service Referral Systems explains in which coordination is the main that the referral system is a health service element that is multi-sector in nature and delivery that regulates the assignment there must be support from various and responsibility of health services both multi-disciplinary and multi-professional vertically and horizontally. Health professions to carry out and organize an services are implemented in stages, integrated form of service for emergency according to medical needs starting from patients both in everyday situations and the first level of health services. The in situations of disasters and events. referral system is compulsory for patients extraordinary. Effective referral requires who are participants of health insurance Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 214 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 or social health insurance and health treatment are carried out if the patient service providers(5). feels that his health condition is The referral system regulates the controlled by the hospital doctor, so that flow from where and where to go for a the patient's treatment is returned to the person with certain health problems to puskesmas. have their health checked(14). The In providing referrals, puskesmas referral system means that it aims to run officers also make cover letters that are effectively and efficiently, which means handed over to patients. The cover letter reduced waiting time in the referral for patient referral must at least contain process and less unnecessary referrals the patient's identity, the results of the because they can actually be handled at examination (history, physical the FKTP. The era of the National Health examination and supporting Insurance applies a tiered referral system, examinations) that have been carried out, where health services begin at the first work diagnosis, therapy / actions that level health facilities(13). The have been given, the purpose of the implementation of a tiered referral referral, the name and signature of the system requires BPJS patients to health worker providing the service. prioritize treatment at a health center, (Article 15)(5). Referral cover letters which is a primary service facility. If a provided by the Primary health care patient cannot be treated in a primary Kendari city and Kota Bau-Bau are in care facility, then the patient will be accordance with the referral line which is referred to a secondary service facility systemized automatically in Primary (ex: hospital). Care, namely in the form of an official A vertical referral from a higher referral letter from Health BPJS. level of service to a lower level of service 2. Initial Action Before Referring can be done if the patient's health From the results of the study, that problems can be handled by a lower level before the patient was referred, the health of health care according to their worker at the Primary health care had competence and authority, the first taken the patient's initial action, competence and authority of the first or namely by examining, then providing second level of service is better in therapy, and if there was still no change handling the patient. patients need further in the patient's health status, then the new services that can be handled by lower patient would be referred to the facility. levels of health care and for reasons of advanced health care providers who are convenience, efficiency and long-term considered more capable of dealing with service and / or referrers cannot provide patient health problems. health services according to patient needs Every health care provider is due to limited facilities, infrastructure, obliged to refer patients when a disease equipment and / or personnel (Article condition or health problem requires it, 10)(5). The implementation of vertical except for the reason that the patient referrals from higher service levels to cannot be transported for medical, return to services at the Puskesmas Kota resource or geographic reasons and has Kendari and Kota Bau-Bau has also been the consent of the patient or his family. carried out in accordance with statutory To make a referral, it is necessary to regulations. Based on the results of in- attach an explanation such as: diagnosis depth interviews with referral officers, it and therapy and / or medical action is known that patients who are referred required, reason and purpose for the back from a higher health service facility referral, risks that can arise if the referral to return to the health center for is not made, referral transportation, and Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 215 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 risks or complications that may arise still quite high. Based on the 2007 and during the trip. According to the 2010 Basic Health Research (Riskesdas), Regulation of the Minister of Health of most of the diseases with the most cases the Republic of Indonesia Number 001 of in Indonesia are included in criterion 4a 2012, before making a referral, it is (doctors are able to diagnose the disease necessary to take the following actions: properly and are able to manage properly 1) Perform first aid and / or stabilization and correctly) by emphasizing ability of the patient's condition according level 4 (doctors have the ability to to medical indications and in completed 144 disease diagnoses in accordance with the ability for puskesmas). If the patient has patient safety purposes during the complications, severity of illness, other referral. difficult chronic diseases and patients 2) Communicating with referral with decreased immunity, all of which recipients and ensuring that referral require further treatment, recipients can receive patients in the Based on the Primary health care event of an emergency patient. Standard book (2013), it is stated that 3) Create a referral cover letter to be emergency services are important submitted to the referral recipient. services and must be available at the The cover letter for the reference Primary health care so that some should at least contain: patient's Puskesmas that do not yet have identity, results of examinations emergency services are important to (history, physical examination and increase their resources so that they can supporting examinations) that have provide emergency services according to been carried out, work diagnosis, community needs. therapy and / or actions that have Based on the JKN Socialization been given, the purpose of the Handbook, it is also explained that referral, and the name and signature emergency services are mandatory of the health worker. give service. services that must be available in health Referral is a series of activities in facilities including Primary health care to response to the inability of a health provide first care for patients and then if service center or health facility to carry the Primary health care is unable to out medical action against patients. The serve, referrals can be made. Therefore it referral system is a mechanism for is important to have an emergency room transferring or transferring patients that in every Puskesmas, because a Primary occur within or between health facilities health care that has emergency services that are in a network. Referral in a can provide assistance needs to patients broader sense, can be started from the so that patients do not need referral community level to the tertiary health services to hospitals when they need service level and vice versa ("two-way service quickly while Primary health care referral") as well as inter-institutional that do not have emergency services referrals within the health facility. The when there are patients in critical results referred from the referral system condition, referrals will be carried out can be the patient himself or other immediately without going through prior supporting services(5). treatment so that it is possible to make The current condition in the higher referrals to the hospital. Primary health care which is the object of Based on the research results research, referral cases to secondary obtained by the researcher, for the health services for cases that should be referral flow, namely starting from the able to be completed in primary care is patient arriving then registering and Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 216 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 being examined by the doctor, then doing required by the patient, the reasons and anamnesa, physical examination and purpose for the referral, the risks that can medic supporting examinations, then arise if the referral is not made, referral determining the patient's diagnosis. If the transportation, and the risks or patient comes in an emergency situation complications that may arise during the and requires emergency medical trip (Article 12)(5). The Primary health assistance, the officer immediately care Kendari city and Bau-bau city have performs immediate help (life saving also explained to patients or their procedure) to stabilize the patient's families about the patient's medical condition. After being diagnosed, if condition, the actions needed, the reasons indeed the patient's condition requires the and goals for the referral, and the risks if patient to be referred and has met the the referral was not made. The existing referral requirements, the patient explanation regarding referral will be referred to get the treatment transportation is explained in general needed. about the public transportation that the Whereas for referral administrative patient can use to get to the referral procedures at the Primary health care, place. The explanation by the Primary namely after stabilizing the condition of health care is in a language that the the pre-referral patient, the officer patient or the patient's family can completes the patient's medical record, understand, usually in Indonesian or the informed consent format is stored in local languages. the patient's medical record, then records and reports are carried out in the patient Reference Pattern referral register book. Administration of 1. Own Request patient dispatch must be completed From the results of the study, that immediately when the patient is to be there are always patients who take the referred immediately. choice of health services, because they The results of the research are already accustomed to the old system obtained by researchers with the that allows choosing a referral place, or guidelines for the national referral system want to choose a referral place that is have conformity, namely the closer to where the patient lives, there requirements for referring patients are the are also patients who do not believe in patients who will be referred are the facilities and capabilities of the examined first, and then it is concluded Primary health care thus asking for that the patient's condition is feasible and referrals to other, more reliable facilities. meets one of the requirements to be There are many reasons patients referred, then a referral will be made. ask to be referred, both for outpatient The referral clinical and administrative and hospitalization. A patient or patient's procedures carried out in the sample family chooses a referral hospital based Primary health care were carried out on recommendations from lower health jointly and were in accordance with the facilities, or by location, based on the referral clinical and administrative completeness of health facilities, based procedures in the national referral system on service costs, or based on the guidelines. patient's severity level. Referral must obtain the consent of At the Lepo-lepo Public Health the patient and / or his family, and the Center Kendari City and the Bukit authorized health worker must provide an Wolio Indah Health Center, Bau-Bau explanation to the patient regarding the City, there are still many patients who diagnosis and therapy or medical action ask to be referred for various reasons, Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 217 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 including suggestions from patients who Patients demanded a referral because trust the competence of specialist they lacked confidence in health services doctors even though the disease is only at the first level of health facilities, so minor ailments that can be handled at even though it was repeatedly explained the FKTP. Lack of trust of patients with that the disease could be treated at the the competence of Health care doctors in Primary health care, they insisted on providing health services both in terms asking for a referral by threatening to of doctors, examinations carried out and leave the Primary health care. drugs given, characteristics of people in Based on the results of the FGD urban environments who are smart, with patients at Primary health care idealistic, and include the upper middle Abeli and Primary health care Lepo- class so that patients underestimate the lepo, the reason they asked for a referral ability of doctors, patient habits for letter was because the facilities they control to certain specialists, patients needed at the Primary health care were who have been treated but without not available, such as inpatient treatment success, and the patient's level of insight for heart disease, eye pain, ENT. There about a disease is low. were also those who argued that the The referral system is organized services at the Primary health care were with the aim of providing quality, less pleasant for them because the staff effective and efficient health services, so were less friendly, less communicative, that the goal of health services is some felt less trust in the services at the achieved without the use of expensive puskesmas and had more confidence in costs. However, if the referral system in the services at the hospital. Indonesia does not operate in According to the researchers, the accordance with existing regulations it results of this study indicate that patient will have a negative impact on the knowledge has a significant effect on government, society and health service referrals to advanced health facilities at providers, namely an increase in the cost Pancur Batu Health Center. Patients who of claims in secondary service facilities have good knowledge of referral will and an increase in the workload of tend to choose to be referred if they officers in secondary health care suffer from illness that cannot be treated facilities due to their duties and at the Primary health care. But if the responsibilities. officers in primary disease can be handled at the Health health facilities that should be able to be care, he prefers to seek treatment at the resolved are borne by officers in Primary health care. The level of secondary service facilities. knowledge of the respondents is also The implementation of referrals related to their level of education. that occurs in the field shows that some Education is a factor that indirectly referrals occur at the request of the influences the mindset, understanding, patient, the patient also determines the and knowledge so that it will also affect provision of referrals(14). However, it is families in using the puskesmas. not uncommon for the Puskesmas to The choice of using referrals or have patients who insist on asking for not using referrals to advanced health referral even though their health facilities is a tangible form related to the condition does not require a referral, so knowledge held by patients at the it is not uncommon for doctors and Primary health care. Based on the FGD referral officers to argue with patients in this study, there are still respondents who ask for referrals at their own who think that patients can directly refer request. Research conducted(15) to themselves if they feel they are not Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 218 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 suitable for services at the Puskesmas. carried out more intensive examinations The truth is that patients are not allowed at the Puskesmas and only at advanced to determine the place of referral health facilities. Likewise with other themselves, and it must be based on the diseases, heart disease, kidney problems, doctor's consideration as well as the and others. Apart from equipment, the condition of the equipment at the health medicines available at the Primary center whether it is suitable for the health care are also considered to be not disease they are suffering from. good enough, because the community According to Alawi, the distance often experiences confusion, patients factor plays a very important role in the with different types of diseases receive utilization of health services. In terms of the same types of drugs. the high number of referral non- Based on the results of the FGD, specialized cases in Sukabumi District, it many patients have never received could be caused by the proximity of the information about referral service Primary health care to the referral procedures and the flow of referral facility so that patients prefer to take implementation. As determined by the advantage of health services at referral Health insurance, it is known that facilities that are closer to where they referral service procedures must be in live. This can be seen in patients at the accordance with the referral Primary health care Lepo-lepo, Kendari implementation flow so as not to cause City who choose to be referred to a high referral rates at primary health Provincial Hospital which is located services and also do not experience a very close to the Primary health care, buildup of health services at the compared to being referred to a City secondary level, namely hospitals. The Hospital which is located further away. lack of information received by patients The same thing happened to the patients about what diseases can be referred of the Bukit Wolio Indah Community causes patients to prefer to go to Health Center, whose place of residence secondary level services due to the low was closer to the city hospital than the level of patient confidence in seeking location of the Primary health care. treatment at primary health According to the researcher, based services.(16). on the results of this study it is evident According to researchers, the that the availability of infrastructure results of this study indicate that health affects the referral of Health insurance information affects the referral of Health user patients to advanced health insurance users to advanced health facilities. The more complete facilities. This is because correct and infrastructure at the referral site is one of accurate information will make Health the reasons patients were referred to the BPJS user patients better understand the FKTL. In general, Health insurance tiered referral flow at puskesmas to users feel happier if they get treatment at advanced health facilities. But in fact, the hospital (advanced health facilities) some respondents stated that they did even though the disease can still be not get adequate information about handled at the Puskesmas. This is due to referrals and the right referral path. the fact that the facilities at advanced Information about Health insurance health facilities are more complete than patient referral flow is important for all those at the Primary health care. Health BPJS users to know so that they Incomplete facilities and infrastructure do not ask for referrals and places for at the Puskesmas, for example for referrals based on the patient's wishes patients with eye disease, cannot be but are determined by the Primary health Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 219 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 care or hospital or the provisions of the diagnosing problems, namely identifying Health insurance itself. (identifying) and determining (defining) 2. Attitude the problem, collecting relevant data, From the results of the study, that namely determining what data will be for patients who are not eligible for needed to make the right decisions and referral, the health worker will be given then obtaining this information, education first, if they continue to insist, developing alternatives, namely finding the requested referral will not be given solutions. potential for these problems in by the doctor and allowed directly to order to obtain information so that it can advanced health facilities without being be developed into possible alternatives, given a letter. referral, then alternative evaluation, namely automatically all medical expenses will evaluating to assess the effectiveness of not be borne by Health insurance, in the each alternative by looking at the sense that the patient uses personal funds positive and negative impacts, selecting when checking himself in at an the best alternative, namely solving advanced health facility. problems in order to achieve previously One of the obstacles for doctors planned goals,implementation of not being able to handle the disease decisions, namely testing decisions by completely is the factor in the patient's looking at the behavior of people who request to be referred to the hospital are affected by that decision as well as without medical indication. The control and evaluation, namely change, tendency of patients to be referred is if necessary, the solution chosen is made usually done by patients who participate at the time of implementation, or if the in ex-Askes. Doctors have explained to initial goal is deemed not achieved. patients that the disease can be handled The best alternative that is mostly by primary care doctors, but some still chosen by health workers at the Health want to get health services at the care is education and motivation where hospital. education and motivation are given to Most of the patients who asked for provide knowledge to the community referral had been given an explanation about referrals. This is in accordance beforehand by the doctor. From the with research which states that the explanation given by the doctor to the various wishes of Health insurance patient who asked to be referred, there patients when asking for referrals to were patients who understood but some puskesmas doctors start from their own still asked to be referred. For patients wishes, for fun and there are also who still ask to be referred, there are referrals given on the advice of doctors. doctors who will remain in their stance The patient's request for a referral is a not to provide referrals and advise very big influence when a doctor makes patients to directly visit the FKRTL a decision to make a referral. The high without a referral letter, but in some desire of the patient in making referrals, cases, doctors end up referring the the best solution given in this study is patient because the doctor is reluctant to education and motivation where argue with the patient even though in education and motivation are given in fact, despite the service health is the order to provide knowledge to the public right of the patient, but the one who is about referrals. authorized to provide a referral is still a Therefore, it can be concluded that doctor. Health care should follow up in reducing The basic process of decision the referral rate in the form of outreach making includes identifying and to cross-sectors and the community Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 220 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 regarding the availability of human 4. Peraturan Presiden Republik Indonesia resources in the form of doctors and nomor 12 tahun 2013 Tentang Jaminan medical personnel as well as available Kesehatan, (2013). medicines needed by the community. It 5. KemenKes R. Profil data kesehatan is hoped that the Primary health care Indonesia tahun 2011. Jakarta: will not only disseminate information to Kementerian Kesehatan Republik the community but also provide quality Indonesia. 2012. human resources, facilities and 6. BPJS Kesehatan Cabang Kendari. infrastructure as well as medicines for Laporan BPJS Kesehatan Kota the community so that patients are Kendari. Sulawesi Tenggara2019. served at the Primary health care without 7. Anhar A, Ismail CS. Studi Komparatif having to be referred. Pemanfaatan Pelayanan Kesehatan pada Masyarakat Pedesaan di Wilayah Kerja Puskesmas Poleang Barat CONCLUSION dengan Masyarakat Perkotaan di There is a conceptual linkage between Wilayah Kerja Puskesmas Lepo-lepo the Reference Guidelines, Referral Tahun 2015. Jurnal Ilmiah Mahasiswa Procedures, and Reference Patterns with the Kesehatan Masyarakat. 2016;1(2). concept of implementing the referral system. 8. Doaly G, Kandou GD, Abeng TD. So thatthe need for coordination to build an Analisis Pelaksanaan Sistem Rujukan integrated health center information system Pasien di Rumah Sakit Umum Daerah between Pcare and Simpus (Primary health (RSUD) Dr. Sam Ratulangi Tondano care Information System), especially to Kabupaten Minahasa. Community include information on reasons for referrals Health. 2018;2(5). in patient databases. This information will 9. Ratnasari D. Analisis Pelaksanaan later become the basis for assessing reference Sistem Rujukan Berjenjang Bagi figures that can be used as a reference in Peserta JKN di Puskesmas X Kota calculating capitation based on fulfilling Surabaya. Jurnal Administrasi commitments Kesehatan Indonesia. 2017;5(2):145- 54. 10. Susilowati Amrullah P. Asuhan REFERENCES Keperawatan Pada Pasien Dengan Gangguan Kebutuhan Oksigenasi 1. Health WHODoM, Abuse S, Akibat Patologi Sistem Pernapasan: Tb Organization WH, Health WHODoM, Paru Di RSUD Wakatobi: Jurusan Health SAM, Evidence WHOMH, et Keperawatan; 2019. al. Mental health atlas 2005: World 11. Rukmini R. Pelaksanaan Sistem Health Organization; 2005. Rujukan Maternal di Puskesmas 2. Akbar MI. Studi Implementasi Tambakrejo dan Tanah Kali Kedinding Program Jaminan Kesehatan Nasional Kota Surabaya. Buletin Penelitian Di Kabupaten Muna. Jurnal Kesehatan Sistem Kesehatan. 2015;18(4):365-75. Masyarakat Celebes. 2020;1(03):21 7- 12. Primasari KL. Analisis Sistem Rujukan 7. Jaminan Kesehatan Nasional RSUD. 3. Rumengan DS, Umboh J, Kandou G. Dr. Adjidarmo Kabupaten Lebak. Faktor-faktor yang berhubungan Jurnal Administrasi Rumah Sakit dengan pemanfaatan pelayanan Indonesia. 2015;1(2). kesehatan pada peserta BPJS kesehatan 13. BPJS Kesehatan. Panduan Praktis di Puskesmas Paniki Bawah Sistem Rujukan Berjenjang. Jakarta: Kecamatan Mapanget Kota Manado. Indonesia; 2014. Jikmu. 2015;5(2). Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 221 Risky, S., Harun, A. A., & Depu, A. H. DOI: 10.36566/ijhsrd/Vol3.Iss1/79 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 14. Hamzah N. Rujukan berjenjang dalam pelayanan rumah sakit ditinjau dari segi hukum. Jurnal Hukum Bisnis. 2020;4(1):376-87. 15. Goniwala G. Gambaran Pelaksanaan Rujukan Peserta BPJS Kesehatan di Puskesmas Tikala Baru dan Puskesmas Teling Atas di Kota Manado. Manado: Universitas Sam Ratulangi. 2017. 16. Sihombing IN. Analisis Pelaksanaan Program Rujuk Balik (Studi Kasus Pelaksanaan Program Rujuk Balik Pada Program Jaminan Kesehatan Nasional di Puskesmas Pancur Batu Kabupaten Deli Serdang Tahun 2017. 2018. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 222 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Research Article Open Access THE CORRELATION BETWEEN INDIVIDUAL CHARACTERISTICS AND SMEAR-POSITIVE PULMONARY TUBERCULOSIS IN PUUWATU HEALTH CENTER, KENDARI CITY Fitri Rachmillah Fadmi1, La Djabo Buton2 1,2Public Health Studies Program, Universitas Mandala Waluya, In Kendari City, Southeast Sulawesi Province, Indonesia Corresponding Author : Fitri Rachmillah Fadmi Email : fitri.rachmillahfadmi@@gmail.com Abstract Background: Pulmonary tuberculosis is still a health problem in Kendari City, especially for several health care centres areas with the highest number of cases in 2019. The number of cases in Puuwatu Health Center area in the last two years has decreased by 14.5% but still ranks first with The highest number of pulmonary tuberculosis cases was in Kendari City.The aim of this study was to analyze the correlation between individual characteristics and smear- positive pulmonary in Puuwatu health center, Kendari City. Met hods:This research is analytic observational using a Case Control Study design, with a matching procedure using a retrospective approach.The population in this study were all 59 patients with pulmonary TB smear (+) registered in Puuwatu Health Center of Kendari City in 2019 with a total sample size of 37 case samples and 37 control samples selected by simple random sampling technique. Results: The results showed that gender, education and job were risk factors for tuberculosis (Odds ratio 3.83; 3.43; 5.95>1) and age was not a risk factor (Odds ratio 0.94<1).Furthermore, there is a relationship between the individual characteristics of age, sex, education and job with the incidence of pulmonary tuberculosis (p-value 0.002; 0.01; 0.002; 0.001<α (0.05). Conclus ion:The conclusion in this research is that it is expected that all people in the Puuwatu Community Health Center job area to always improve their hygiene and healthy living habits.Government agencies can provide outreach on community prevention. Key words : Tuberculosis, Age, Sex, Education, Job. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 223 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION 1.3 times than in females.In each province Tuberculosis or Pulmonary throughout Indonesia, more cases occur in tuberkulosis is an infectious disease caused men than women(4). by Mycobacterium tuberculosis, which can Tuberculosis cases in Southeast attack the lungs and other Sulawesi Province showed that in 2016 organs.Tuberculosis is still a public health 3,105 new BTA positive cases (BTA +) were problem that causes high morbidity, found, an increase compared to 2017 with disability, and mortality, so it is necessary to 2,587 cases.However, in 2018 there were do prevention efforts.One of the national 3,965 cases (59% men and 41% women).The strategies for controlling pulmonary distribution of cases by district / city shows tuberculosis is controlling the risk factors for that the number of new BTA positive cases pulmonary tuberculosis.Control of risk reported in 2018 came from 5 districts / factors for pulmonary tuberculosis is aimed cities, namely Kendari City 668 cases, Muna at preventing, reducing transmission and Regency 510 cases, Konawe Regency 444 incidence of pulmonary tuberculosis(1). cases, Bau-Bau City 363 cases, and Kolaka Control of pulmonary tuberkulosis risk Regency300 cases(5).Data on tuberculosis factors is carried out by cultivating a clean cases in Kendari City in the last 2 years has and healthy lifestyle, cultivating ethical decreased, where in 2016 the number of coughing behavior, maintaining and pulmonary tuberkulosis cases was 583 cases, improving the quality of housing and its in 2017 there were 545 cases, in 2018 there environment in accordance with healthy were 676 cases and in 2019 it increased to home standards(2). 711 cases.Thus the problem of pulmonary Tuberculosis is a major global health tuberculosis is still a health problem in problem as the leading cause of death for Kendari City, especially for several millions of people every year worldwide puskesmasjob areas with the highest number after Human Immunodeviciency Virus of cases in Kendari City in 2019, namely (HIV).In 2015, there were an estimated 10.4 health centerPuuwatu, Kemaraya and million incidents of new tuberkulosis cases Poasia.(6) . worldwide, of which 5.9 million (56%) were The number of cases in Puuwatu men, 3.5 million (34%) occurred in women Health Centerjobing area in the last three and 1 million (10%)occurs in years shows that in 2017 there were 76 children.Tuberculosis is one of the top 10 sufferers, in 2018 it decreased to 69 sufferers causes of death worldwide in 2020, it is and in 2019 there were 59 people with estimated that there are 1.4 million deaths pulmonary tuberkulosis.Although in the last due to tuberculosis(3) three years the number of tuberkulosis cases Data from the Ministry of Health in in Puuwatu Health Centerjob area has 2018, the number of tuberculosis cases found decreased, it is still a health problem because was 566,623 cases, an increase when the Puuwatu Community Health Center compared to all tuberculosis cases found in Work Area is the puskesmasjobing area with 2017 which amounted to 446,732 the highest pulmonary tuberculosis cases in cases.Pulmonary tuberculosis can attack all Kendari City.(7).Exposure to tuberculosis in ages, not only old age, but also young age a person is influenced by socio-economic and productive age.According to the age factors, nutritional status, age and group, most tuberculosis cases were found in gender(8).Meanwhile, according the 45-54 years age group, namely 14.2%, to(9)Several possible factors that are at risk followed by the 25-34 years age group at of pulmonary tuberculosis include 13.8% and in the 35-44 years age group population factors (age, gender, nutritional 13.4%.The number of tuberculosis cases in status, family role, occupation, education males was higher than in females, namely level), home environmental factors (area of Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 224 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 ventilation, occupancy density, lighting with a ratio of 1: 1 so that the number of intensity, floor type, humidityhouse, possible samples in this study is 74 samples. temperature, and type of wall), behaviors The case sample was positive Lung include sleeping habits of tuberculosis tuberculosis (AFB) patients while the control sufferers, sleeping habits of mattresses, sample was not positive lung tuberculosis habits of expelling saliva or phlegm, habits (AFB) patients but had the same of opening bedroom windows, smoking characteristics. The sampling technique in habits and contact history.This study aims to this study was simple random sampling. The analyze the correlation between individual data were analyzed by using the Odd ratio to characteristics with smear-positive determine the amount of risk and Chi-Square pulmonary tuberculosis in Puuwatu health to determine the relationship between center, Kendari City. individual characteristics and the incidence of tuberculosis. METHOD This research is an analytic RESULT observational study using a Case Control The results of the descriptive analysis Study design, with a matching procedure show that of the 74 respondents, the most using a retrospective approach. Case control age categories were in the age range 17-25 is a study conducted by comparing two years, as many as 22 respondents (29.7%), groups, namely the case group and the 32 respondents (43.2%) were the most control group based on their exposure status gendered category, the highest level of (10).The population in this study were all 59 education was high school. totaled 44 patients with pulmonary tuberculosis smear respondents (59.4) and the largest occupation (+) registered in Puuwatu Health Center was self-employed, amounting to 32 Kendari City in 2019 with a total sample size respondents. of 37 case samples and 37 control samples Table 1. The results of the analysis of the relationship between individual characteristics and the incidence of smear-positivepulmonary tuberculosis Pulmonary Tuberculosis Lower Limit p-value Individual Odds Case Control (LL) -Upper Characteristics Ratio n % n % Limit (UP) Age Non 14 37,8 2 5,4 0,94 LL = 0,019 0,002 ProductifProductif 23 62,2 35 94,6 UL = 0,452 Sex Man 23 62,2 11 29,7 LL = 1,474 0,010 3,883 Woman 14 37,8 26 70,3 UL = 10,230 Educatio Low 18 48,6 8 21,6 LL = 1,246 0,028 3,434 High 19 51,4 29 78,4 UL = 9,467 Job Hadjob 25 78,4 14 37,8 LL = 2,133 0,001 5,955 Not have job 8 21,6 23 62,2 UL = 16,626 Table 1 shows that of the 37 age. Meanwhile, of the 37 respondents in the respondents in the case group, 23 (62.2%) control group, 35 (94.6%) were respondents were respondents with non-productive age with non-productive age and 2 (5.4%) and 14 (37.8%) respondents with productive respondents with productive age. Based on Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 225 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 gender in the case group, 23 (62.2%) 5.955 which is greater than Daein 1 (LL = respondents were male and 14 (37.8%) 2.133 - UL = 16.626) and the p-value (0.001) female respondents. Meanwhile, of the 37 is smaller than α (0.05) so H0 is rejected, respondents in the control group, 11 (29.7%) meaning that at the 95% confidence level were male and 26 (70.3%) were female. work is a risk factor and a determinant factor Based on the education in the case group, 18 of new smear positive pulmonary (48.6%) respondents had a low level of tuberculosis in the Puuwatu Community education and 19 (51.4%) respondents had a Health Center Work Area. high level of education. Meanwhile, of the 37 respondents in the control group, 8 DISCUSSION (21.6%) respondents had a low level of Tuberculosis is a direct infectious education and 29 (78.4%) respondents had a disease caused by the tuberculosis germ high level of education. Furthermore, based (Mycobacterium tuberculosis). It is estimated on work in the case group, 29 (78.4%) that one third of the world's population has respondents had a job and 8 (21.6%) been infected by Mycobacterium respondents did not have a job. Meanwhile, tuberculosis and 75% of tuberculosis patients of the 37 respondents in the control group, are in the economically productive age group 14 (37.8%) respondents had a job and 23 (15-50) years. The results showed that age (62.6%) respondents did not have a job. was not a risk factor but a cause of The results of statistical tests on the tuberculosis. Respondents with more 95% confidence interval obtained an Odds productive age suffer from pulmonary Ratio value of 0.94 (LL = 0.019 - UL = tuberculosis. The results of this study are in 0.452) because the Odds Ratio value does line with (4)Tuberculosis is a direct not include number 1 and the p-value (0.002) infectious disease caused by the tuberculosis is smaller than α (0.05) then H0 is rejected, germ (Mycobacterium tuberculosis). It is meaning that at the level of confidence 95% estimated that one third of the world's age is not a risk factor for new smear population has been infected by positive pulmonary tuberculosis but a new Mycobacterium tuberculosis and 75% of positive smear pulmonary tuberculosis in the tuberculosis patients are in the economically Puuwatu Community Health Center Work productive age group (15-50) years. The Area. In the gender variable, the Odds Ratio results showed that age was not a risk factor value is 3.883 (LL = 1.474 - UL = 10.230) but a cause of tuberculosis. Respondents because the Odds Ratio value is greater than with more productive age suffer from 1 and the p-value (0.010) is smaller than α pulmonary tuberculosis. The results of this (0.05) so H0 is rejected, meaning that at level study are in line with(11, 12)that the rate or of confidence 95% gender is a risk factor and degree of transmission of this disease a determinant factor of new smear positive depends on the number of tuberculosis pulmonary tuberculosis in the Puuwatu bacilli in the sputum, upper virulence, bacilli Community Health Center Work Area. In the and the chance of air pollution from education variable, the Odds Ratio value is coughing, sneezing and speaking loudly. 3,433 (LL = 1.246 - UL = 9.467), because And this disease is very sensitive and the Odds Ratio value is more than 1 and the indiscriminate at all ages, whether babies, p-value is 0.028, then H0 is rejected, toddlers, old or young. This finding is in line meaning that at the 95% confidence level with research conducted by (13, 14)states education is a risk factor and a determinant that the productive age has a greater risk of factor. new smear positive pulmonary transmission of pulmonary tuberculosis than tuberculosis in the Puuwatu Community the unproductive age, besides that the Health Center Work Area. Furthermore, the proportion of respondents at productive age job variable obtained an Odds Ratio value of tends to be 76.7% higher. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 226 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 The results showed that gender was the develop the potentials of both physical and cause of tuberculosis, where men were 3.8 spiritual inheritance in accordance with the times more likely to suffer from tuberculosis values that exist in society. (22, 23). The than women. It is in accordance with (4, level of education will affect a person's 15)which states that the number of knowledge, including about things related to tuberculosis cases in men is 1.5 times more health, for example about tuberculosis, so than that of women. One of the causes of that with good knowledge, someone will differences in the frequency of pulmonary behave in a healthy life. (24-26). The level of tuberculosis between men and women is education has a significant relationship with differences in life habits. The possible pulmonary tuberculosis prevention behavior. difference in life habits is smoking and A person's education level will affect one's drinking alcohol. Where more men smoke knowledge, including about health, so that and drink alcohol than women, smoking and with sufficient knowledge, someone will try alcohol can lower the body's immunity so to have a healthy lifestyle (27, 28). Other that it is more susceptible to pulmonary supporting research shows that there is a tuberculosis. (16, 17). This theory is in line significant influence or relationship between with research conducted by (18)who say that the level of education and the behavior to the prevalence of smoking is much higher for prevent the transmission of pulmonary men than women. More than 20% of adult tuberculosis. In addition, other research males are active smokers and the incidence results indicate that there are differences in of tuberculosis of 100 per 100,000 behavior between levels of education. This population per year occurs mostly in men explains that limited opportunities for aged over 65 years. The results of the education are factors that can affect health research which are in line show that there is levels and disease prevention efforts (29, 30). a significant relationship between sex and the The results also show that work is the incidence of pulmonary tuberculosis. This cause of the incidence of tuberculosis, where study shows that men are more likely to respondents who work are 5.9 times more suffer from pulmonary tuberculosis than likely to suffer from tuberculosis than those women(19, 20). Observation who do not work. According to (31)the type result(21)Pulmonary tuberculosis sufferers of work determines the risk factors that each have a habit of not closing their mouths individual must face. When workers work in when coughing, which can cause a dusty environment, exposure to dust tuberculosis to be transmitted to healthy particles will affect the occurrence of people around them and an increase in cases respiratory tract disorders. Chronic exposure of pulmonary tuberculosis is influenced by to polluted air can increase morbidity, endurance, nutritional status, and individual especially the occurrence of respiratory personal hygiene. Differences in the diseases and especially pulmonary incidence of disease according to sex can tuberculosis (32, 33). Research that explains arise due to different anatomical, occupational variables related to pulmonary physiological and hormonal systems. tuberculosis prevention behavior shows that The results of the study showed that respondents who have good preventive education was a factor causing the incidence behavior are mostly respondents who have of pulmonary tuberculosis with a large risk jobs compared to those who do not work. In of transmission 3.4 times among respondents addition, work will affect the use of health with low education. In theory, education services, besides that a person's job will shows the quality of human resources which reflect the amount of information received, will greatly affect human productivity. In a including information about health services simple and general sense the meaning of (34-36). education is a human effort to cultivate and Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 227 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 CONCLUSIONS Raya Pekanbaru. Photon: Journal of Age is not a risk factor but a cause of Science and Health. 2015; 5 (2): 111-8. tuberculosis incidence, where respondents 10. Yusuf AM. Quantitative, qualitative & with more productive age suffer from combined research methods: Prenada pulmonary tuberculosis. Gender is associated Media; 2016. with the incidence of tuberculosis and is a 11. Mertaniasih NM. Textbook of risk factor with a greater risk of 3.8 times for Microbiological Diagnostic male gender. For the education variable it is Tuberculosis: Airlangga University related to the incidence of pulmonary Press; 2019. tuberculosis and is a risk factor with a large 12. Kesek JF, Sugeng CE, Polii EB. risk of 3.4 times for low-educated Description of Productive Age respondents. For occupational variables Pulmonary Tuberculosis Patients at Prof. related to the incidence of pulmonary Dr. RD Kandou Manado Period 2014- tuberculosis and is a risk factor with a large 2015. Medical Scope Journal. 2019; 1 risk of 5.9 times the respondents who work. (1). 13. Dodd PJ, Looker C, Plumb ID, Bond V, Schaap A, Shanaube K, et al. Age-and REFERENCES sex-specific social contact patterns and incidence of Mycobacterium tuberculosis 1. Ministry of Health R. Tuberculosis. infection. American journal of Jakarta: Center for Data and Information epidemiology. 2016; 183 (2): 156-66. of the Indonesian Ministry of Health. 14. Purwati UD, Riyudha F, Tasman H. 2018. Optimal control of a discrete age- 2. Deaf BC. Tuberculosis of the skeletal structured model for tuberculosis system: JP Medical Ltd; 2016. transmission. Heliyon. 2020; 6 (1): 3. WH organization. WHO treatment e03030. guidelines for drug-resistant tuberculosis: 15. Sembiring SPK. Tuberculosis-free World Health Organization; 2016. Indonesia: CV Trace (Footprint 4. Ministry of Health R. Data and Publisher); 2019. information center: Tuberculosis. South 16. Kurniasari RAS, Cahyo K. Risk Factors Jakarta: Ministry of Health of the for Pulmonary Tuberculosis in Baturetno Republic of Indonesia. 2018. District, Wonogiri Regency. Indonesian 5. Southeast DKPS. Southeast Sulawesi Public Health Media. 2012; 11 (2): 198- Provincial Health Profile 2018. Kendari: 204. Southeast Sulawesi Provincial Health 17. Ismah Z, Novita E. Study of Office. 2019. Tuberculosis Patient Characteristics at 6. Kendari DKK. Kendari City Health Seberang Ulu 1 Public Health Center Office Profile. 2018. Palembang. Unnes Journal of Public 7. Puuwatu P. Profile of Puuwatu Health. 2017; 6 (4): 218-24. Community Health Center in 2018.2019. 18. Wijaya I. Pulmonary tuberculosis in 8. Ihram MA. Relationship between people with diabetes mellitus. Mirror of Oxygen Circulation Level and Individual the World of Medicine. 2015; 42 (6): Characteristics with Incidence of 412-7. Pulmonary TB in Productive Age Groups 19. Puspita E, Christianto E, Yovi I. at Pondok Pucung Health Center 2013. Overview of nutritional status in 2013. pulmonary tuberculosis (pulmonary TB) 9. KN TS, Norlita W, Novita R. patients undergoing outpatient care at Characteristics Of Tuberculosis Patients, Arifin Achmad General Hospital 2011-2012 At Health Center Harapan Pekanbaru: Riau University; 2016. Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 228 Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol3.Iss1/80 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 20. Chen M, Kwaku AB, Chen Y, Huang X, Drug Drinking In Patients With Lung Tan H, Wen SW. Gender and regional Tuberculosis In The Working Area Of disparities of tuberculosis in Hunan, Health Center Sampara. Journal of China. International Journal for Equity in Preventive Health. 2018; 8 (7): 26-42.30. Health. 2014; 13 (1): 1-6. Palupi DLM. Pengaruh pendidikan 21. Manalu Ly. Description Of Uric Acid kesehatan terhadap perubahan Levels In Lung Tuberculosis Patients pengetahuan, sikap dan perilaku Who Consume Anti Tuberculosis (Oat) penderita tuberculosis yang berobat di Medicine In A Special Lung Hospital, wilayah kerja puskesmas surakarta: UNS Medan City. 2019. (Sebelas Maret University); 2013. 22. Sunaengsih C. Education management 30. Raharjo ST. Social Work Knowledge textbook: UPI Sumedang Press; 2017. Base. Bandung: Unpad Press; 2015. 23. Setiawati E, Bahri AS, Firmadani F, 31. Ariani NW, Rattu A, Ratag B. Factors Safari M, Pramanik PD, Nuramila N, et Related to Regular Drinking of al. Character building. 2020. Pulmonary Tuberculosis Patients in the 24. Maghfiroh L, Pratama ANW, Work Area of Modayag Health Center, Rachmawati E. The Effect of Education Bolaang Mongondow Timur Regency. Using Handbooks with Picture and JIKMU. 2015; 5 (2). Madurese Language on Knowledge 32. Fadmi FR. The Risk Of Knowledge, Levels of Patients and Supervisors of Smoking And Patient's Contact On Ingesting Pulmonary Tuberculosis (The Tuberculosis Disease In Puuwatu Health Effect of A Pictorial Booklet with Center In Kendari City: The Risks Of Madurese Language on Level of Tuberculosis Disease. Indonesian Journal Knowledge among Tuber. Health Library Of Health Sciences Research And . 2017; 5 (3): 420-4. Development (IJHSRD). 2020; 2 (1): 46- 25. Fadmi FR. The Effect Of Health 53. Counciling On Knowledge Of Personal 33. Wulandari A, Syah NA, Ernawati T. Hygiene In Students Of Smpn 5 Factors Affecting Compliance of Kulisusu, Buton Utara District. Miracle Independent Participants in Payment of Journal Of Public Health. 2020; 3 (1): National Health Insurance Program 117-22. Contribution in Solok City. Andalas 26. Fadmi FR. Comparison Of Knowledge Health Journal. 2020; 9 (1): 7-17. Level Before And After Health 34. Desissa F, Workineh T, Beyene T. Risk Counseling About Scabies Disease In factors for the occurrence of multidrug- Class Vii Santri, Pesantren Darul resistant tuberculosis among patients Mukhlisis. Journal of Preventive Health. undergoing multidrug-resistant 2019; 9 (8): 68-102. tuberculosis treatment in East Shoa, 27. Faccini M, Codecasa LR, Ciconali G, Ethiopia. BMC Public Health. 2018; 18 Cammarata S, Borriello CR, De Gioia C, (1): 1-6. et al. Tuberculosis outbreak in a primary 35. Gupta P, Zhao D, Guallar E, Ko F, school, Milan, Italy. Emerging Infectious Boland MV, Friedman DS. Prevalence of Diseases. 2013; 19 (3): 485. glaucoma in the United States: the 2005– 28. M'imunya JM, Kredo T, Volmink J. 2008 national health and nutrition Patient education and counseling for examination survey. Investigative promoting adherence to treatment for ophthalmology & visual science. 2016; tuberculosis. Cochrane database of 57 (6): 2905-13. systematic reviews. 2012 (5). 29. Fadmi FR. Analysis Of Linier Regression Factors Of Compliance With Indonesian Journal Of Health Sciences Research and Development Vol. 3, No.1, March 2021 229