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Risk Factors of Elevated Blood Pressure In Purworejo, Central Java Province, Indonesia: Preliminary Study

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Author: Nawi Ng
Abstract :
Background: Cardiovascular diseases (CVDs) have become the main cause of death in both developed and developing countries. The incidence of cardiovascular disease in developed countries has declined recently, partly because of improved knowledge on risk factors of CVDs which direct to preventive measure. On te other hand, developing countries still suffer from the double burden of both communicable and non-communicable diseases, especially cardiovascular disease. Many life-style related risk factors, such as hypertension, obesity, smoking, hypercholesterolemia, and lack of activity have been reported to increase the morbidity and mortality of cardiovascular disease. However, epidemiological study on these risk factors is rarely done Indonesia despite its important contribution.
Aim: To get general picture of CVDs risk factors in Purworejo District, Central Java Province, Indonesia.
Subject and Method: Data was taken from a ongoing surveillance in CHN-RL (Community Health and Nutrition Research Laboratory) research area in Purworejo district 2000 out of 31000 individuals over 35 years old were chosen. Sample was drawn randomly based on computer generated random numbers. Demographic data and data on smoking were collected using questionnaires. Blood pressure and anthropometric measurements such as body weight, body height, waist circumference, and hip circumference were performed by trained surveyor. Blood pressure above 140/90 mgHg were categorised as elevated blood pressure.
Result and Discussion: A higher proportion of elevation blood pressure was noted in women (38.5) compared to men (32.1%). Female tended to have higher blood pressure measurements. Overweight and obesity (body mass index (BMI) >= 25) was more common among women. Correlated with WHR (r=0.44, p<0.000). Smoking was common practice in men (54%) and only one hundredth in women. Smokers have lower systolic blood pressure compared to non-smoker, and heavy smoker groups had lower blood pressure reading. Obesity indices were weakly correlated (r=25 (OR=2.66, CI=1.22-5.77) and obesity based on waist circumference (OR=3.22, CI=2.22-4.69) increased the risk of elevated blood pressure. Elderly has 5.83 times (CI=4.41-7.70) risk of elevated blood pressure compared to 35-44 years old individuals.
Conclusion: Elevated blood pressure and obesity prevalence was high in research area. Females are more inclined to elevated blood pressure and obesity, but the smoking habit favours the women. The risk of elevated blood pressure increases with BMI and obesity indices. However, smoking does not appear to increase the risk of elevated blood pressure. Waist circumference can be used along with BMI and it can provide information about central obesity, which is more related to the risk of disease.

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Nutritional And Reproductive Health In Central Java, Indonesia An Epidemiological Approach

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Author: Detty Siti Nurdiati
Abstract :
Background: Indonesian maternal mortality rate is still high. Poor nutritional status of women is considered one of the major factors which contribute to the existing high rates of maternal mortality. However, the nutritional issues of women themselves are rarely investigated.
OBJECTIVES: To estimate and characterise the nutritional status in non-pregnant women as reflected by anthropometry and to explore the possible associations between reproductive, demographic and socio-economic factors and nutritional status.
METHODS: A cross-sectional study was carried out to estimate nutritional status among non-pregnant women of reproductive age in the Community Health and Nutrition Research Laboratory (CHN-RL) surveillance area, in the Purworejo district, Central Java, Indonesia. A sample of approximately 13.000 households was selected using the probability proportional to estimated size. The data on socio-economic, demographic and reproductive factors were taken from surveillance data collected in August – October 1995. The collection of anthropometric data including weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness on non-pregnant women took place between January – March 1996. The quality of data collection was monitored by a checking system.
RESULTS: Married women defined as being at risk of becoming pregnant were available for this study (n=8442) and 69.7% of these eligible women were included in the analyses (n=5817). The mean weight of the women in the study sample was 47.8 7.9 kg, mean height was 149.1 5.1 cm, mean MUAC was 25.8 2.9 cm, mean triceps skinfold thickness was 15.0 6.3 mm and mean body mass index (BMI) was 21.2 3.1. The BMI of the study sample was compared with the classification for chronic energy deficiency (CED) and obesity among adults (James et al., 1988; WHO, 1995). The total prevalence of CED was 17.0%. Further, CED grades III, II, I, normal, Obese I and Obese II were found among 1.2, 3.0, 12.8, 71.7, 10.0 and 1.4% of the women, respectively. Multivariate regression models that controlled for possible associated factors showed that occcupation was a significant factor which influenced the nutritional status of the women. The women working with agriculture or domestically were 40-48% more likely to be CED. Women with better economic status, as shown by the availability of drinking water, television and refrigerator ownership had better nutritional status. We found that status of using contraceptive methods was related to nutritional status. In multivariate analyses parity and family size were not significantly related with CED. However in univariate analyses these factors were significant; it could be that those are related to the background factors.
CONCLUSION: The results of this study suggest that 17% of non-pregnant women of reproductive age had CED, that 71.7% were normal and that 11.4% were obese. The major reasons for malnutrition, i.e., limited resources and poor socio-economic status of the population, need to be addressed to improve nutritional status of girls and women prior to and subsequent to pregnancy. Continuing research in the area of preconception nutrition is needed to ensure better health status and pregnancy outcomes. A more detailed understanding of the socio-economic determinants of malnutrition among women could help improve interventions.

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Pengaruh Penggunaan Kontrasepsi Hormonal Pil terhadap Pemberian ASI dan Durasi Amenore Postpartum

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Author : Trianawati
Pembimbing 1/2 : Prof.dr. Siswanto Agus Wilopo, SU,MSc.Sc/dr. Citra Indriati, MPH.
Penguji : dr. Lutfan Lazuardi, MKes,PhD.
Abstract :
Background: Lactation Amenorrhea Method (LAM) tend to increase birth spacing. Exclusive breastfeeding in Indonesia, 15.3% an effect on resumption of ovulation is quicker and the duration of postpartum amenorrhea is shorter, so we need additional contraception is safe for breastfeeding women. Progestin Only Pills (POP) are better choice, beside prolonged the duration of lactation amenorrhea. POP in generic as lynestrenol and levonorgestrel expected can produced in Indonesia cheaper cost and be nationaly family planning programme.
Objective: To identify effect of lynestrenol pill contraception and levonorgestrel (LNG) to breastfed quality, lactation and the duration of postpartum amenorrhea. Method: The study was a mixed randomized clinical trial with parallel design. Subject of the study were mothers that breastfed for 6 months after postpartum, 20-35 years old, pill family planning and pill non contraindication. Sample size was based on Log rank test median survival time and incidence rate drop out between hormonal and non hormonal contraception, divided into three groups with total samples of 107 respondents. Subjects were observed within 6 months, evaluated every month. Data analysis used chi square, oneway anova, survival analysis Kaplan-Meier method, log rank test and cox proportional hazard model. Result: Use of LNG pill contraception HR=1.46(95%CI=0.67-3.18) and lynestrenol pill HR=0.85(95%CI=0.37-1.97), lactation HR=1.23(95%CI=0.66- 2.31), casein HR=0.83(95%CI=0.38-1.82), lactose HR=0.87(95%CI=0.66-1.15), lipid HR=0.80(95%CI=0.62-1.04) and calcium HR=1.0(95%CI=0.98-1.02) were insignificant to the duration of postpartum amenorrhea than non hormonal contraception.
Conclusion: There is clinical effect duration of postpartum amenorrhea and duration of breastfeeding between use of lynestrenol pill and levonorgestrel pill than non hormonal contraception. There is clinical effect duration of postpartum amenorrhea to breastfed quality and lactation.
INTISARI: 
Latar Belakang: Metode Amenore Laktasi (MAL) penting dalam mengatur jarak kelahiran. Rendahnya cakupan ASI eksklusif di Indonesia (15.3%) terkait dengan kembalinya ovulasi lebih cepat dan durasi amenore postpartum lebih singkat, sehingga ibu postpartum perlu metode kontrasepsi lain yang aman selama menyusui. Progestin Only Pills (POP) merupakan pilihan yang tepat, disamping dapat memperpanjang amenore laktasi postpartum. Dengan demikian POP dalam bentuk generik lynestrenol dan levonorgestrel diharapkan dapat diproduksi di Indonesia dengan harga terjangkau dan menjadi program KB nasional.
Tujuan: Mengetahui pengaruh kontrasepsi pil lynestrenol dan LNG terhadap kualitas dan pemberian ASI serta durasi amenore pospartum. Metode: Jenis penelitian menggunakan mixed randomized clinical trial rancangan paralel. Subjek penelitian adalah ibu 6 minggu postpartum dan menyusui, usia 20-35 tahun, ingin KB pil dan tidak kontraindikasi pil. Besar sampel menggunakan logrank test median survival time dan incidence rate drop out antara KB hormonal dan non hormonal, dibagi 3 kelompok dengan sampel 107 responden. Subjek diikuti sampai 6 bulan ke depan, dievaluasi setiap bulannya. Analisis menggunakan Chi Square, Oneway Anova, Survival Analysis metode Kaplan-Meier, Log-rank test dan Cox proportional hazard model. Hasil: Penggunaan pil LNG HR=1.46(95%CI=0.67-3.18) dan pil lynestrenol HR=0.85(95%CI=0.37-1.97), status pemberian ASI HR=1.23(95%CI=0.66-2.31), kadar kasein HR=0.83(95%CI=0.38-1.82), laktosa HR=0.87(95%CI=0.66-1.15), lemak HR=0.80(95%CI=0.62-1.04) dan kalsium HR=1.0(95%CI=0.98-1.02) tidak memperpanjang durasi amenore postpartum dibanding non hormonal/IUD.
Kesimpulan: Ada perbedaan klinis durasi amenore postpartum dan durasi pemberian ASI saja antara pengguna pil LNG dan lynestrenol dibandingkan non hormonal/IUD. Ada perbedaan klinis durasi amenore postpartum berdasarkan kualitas dan pemberian ASI.

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Pengaruh Penggunaan Kontrasepsi Hormonal (PIL) terhadap Pertumbuhan Bayi pada Periode 6 Bulan Pertama (Umur 0-6 Bulan)

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Author : Sri Mujianto
Pembimbing 1/2 : Prof.dr. Siswanto Agus Wilopo, SU,MSc.Sc/Prof.dr. Djauhar Ismail, SpA(K),MPH,PhD.
Penguji : Prof.Dr.dr. Soebijanto
Abstract :
Background: Giving too early complementary feeding effect on the duration of amenorrhea during lactation so that the resumption of postpartum ovulation sooner. Lactation Amenorrhea Method was no longer effective and secure, so be required an effective postpartum contraception and did not interfere the quality of breast milk and infant growth. Objective: To determine the influence of hormonal contraceptive (pills) use on the infants growth in the first 6 months period. Research methods: The non-randomized controlled trials and longitudinal research. Subjects were 6-8 weeks postpartum mothers, 20-35 years old and still breastfeeding. Total sample: 90 respondents, divided into 2 groups, the intervention group and control group. The place of study was in Sleman and Yogyakarta city. Bivariable analysis was using Chi Square, t-test and linear regression. Multivariable analysis was using Linear Regression. Results: Multivariable analysis showed that women taking hormonal contraceptives (pills), the changes in infant’s body weight and body length was 115,96 g higher (R2 = 0,1996% CI = -320,35-552,27) and 0,03 cm lower (R2 = 0,4179 95% CI = -1,04-0,97) than the non-hormonal contraception. Other factors were the variable quality of the milk, the breast milk quantity, breastfeeding status, disease in infants, babies parenting and social insurance/maternity insurance (Jamkesmas /Jampersal) membership. Conclusion: The use of hormonal contraceptives (pills) did not affect the infant’s growth in the first 6 months period.
INTISARI: 
Latar belakang: ASI merupakan makanan paling ideal baik secara fisiologis maupun biologis untuk bayi diawal kehidupannya. Pemberian MP-ASI terlalu dini berpengaruh pada lamanya amenorrhea selama laktasi sehingga kembalinya ovulasi pasca melahirkan semakin cepat. Lactation Amenorrhea Method tidak lagi efektif dan aman sehingga diperlukan kontrasepsi postpartum yang efektif, aman dan tidak mengganggu kualitas ASI maupun pertumbuhan bayi.
Tujuan: Mengetahui pengaruh penggunaan kontrasepsi hormonal (pil) terhadap pertumbuhan bayi periode 6 bulan pertama (0-6 bulan). Metode penelitian: Jenis penelitian adalah non randomized controlled trial dan bersifat longitudinal (diikuti selama 6 bulan). Subjek adalah ibu postpartum 6-8 minggu, usia 20-35 tahun dan masih menyusui. Jumlah sampel 90 responden dan dibagi 2 kelompok, kelompok intervensi (diberi pil) dan kelompok kontrol (aseptor IUD). Tempat penelitian di wilayah Kabupaten Sleman dan Kota Yogyakarta. Analisis bivariabel menggunakan Chi Square, t test dan regresi linier. Analisis multivariabel menggunakan Regresi Linier. Pada analisis, variabel umur bayi secara polinomial, berat badan lahir, jenis kelamin dimasukkan sebagai kontrol tetap.
Hasil penelitian: Analisis multivariabel menunjukkan wanita pengguna kontrasepsi hormonal (pil), perubahan berat badan dan panjang badan bayi lebih tinggi 115,96 gram (R2=0,1996% CI=-320,35-552,27) dan lebih rendah 0,03 cm (R2=0,4179 95% CI=-1,04-0,97) dibandingkan yang non-hormonal. Faktor lain yang diperhitungkan variabel kualitas ASI (kadar kasein), kuantitas ASI, status pemberian ASI, penyakit pada bayi, pola asuh bayi dan kepesertaan jamkesmas/jampersal. Kesimpulan: Penggunaan kontrasepsi hormonal (pil) tidak mempengaruhi pertumbuhan bayi (berat badan dan panjang badan bayi) pada periode 6 bulan pertama (0-6 bulan)
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Hubungan Artritis dengan Keterbatasan Aktivitas Fisik pada Individu Usia 50 Tahun Ke Atas di Kabupaten Purworejo

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Author : Juana Linda Simbolon
Pembimbing 1/2 : Prof.dr. Djaswadi Dasuki, MPH,SpOG(K)/Prof. dr. Mohammad Hakimi,SpOG, Ph.D
Penguji : Dr.dr. Radjiman
Abstract :
Background: Arthritis is a condition related to pain or inflammation of the joints. It is a familiar chronic disease and often happens during the last period of life. There are 100 types of arthritis and the most popular is osteoarthritis. Age is one of risk factors of arthritis, therefore it is understandable of someone who gets older will be most likely have arthritis. Increasing life expectancy in Indonesia, i.e. from 67.8 years in 2000 – 2005 to 73.6 years in 2020 – 2025 and greater number of the elderly (there are 18.671 or 24.11% of elderly people over 50 years old in Purworejo) require particular attention in order that they can undergo their aging process happily and successfully.
Objective: This study was undertaken to analyze relationship between arthritis and physical activity limitation of the elderly over 50 years old at District of Purworejo. Method: The study was an observational with cross sectional design. Subjects were individual over 50 years old (13,890 people). Data were obtained using questionnaire of Study on Global Aging and Adult HealthWorld Health Organization (SAGE-WHO) and International Network for the Continuous Demographic Evaluation of Population and Their Health in Developing Countries (INDEPTH) distributed by 63 interviewers and 7 field coordinators. Data analysis used uni-variable, bi-variable and multinomial logistic regression statistical test, Odds Ratio(OR), Confidence interval (CI) (95%) at significance level p
INTISARI :
Latar belakang: Artritis adalah suatu kondisi yang berhubungan dengan rasa nyeri pada sendi ataupun radang pada sendi, merupakan penyakit kronis yang familier dan sering terjadi pada periode akhir kehidupan. Artritis meliputi 100 jenis, artritis yang paling sering dijumpai adalah osteoartritis. Usia merupakan salah satu faktor resiko artritis, maka dapat dipahami jika makin bertambah usia, makin tinggi kemungkinan untuk terkena artritis. Seiring dengan meningkatnya usia harapan hidup di Indonesia yaitu 67,8 tahun pada periode 2000-2005 menjadi 73,6 tahun pada periode 2020-2025 dan tingginya peningkatan jumlah penduduk usia 50 tahun keatas di Indonesia, khususnya di Kabupaten Purworejo 50 tahun keatas sebesar 186.671 jiwa (24,11%) sehingga perlu mendapat perhatian secara khusus agar dapat menjalani proses penuaan dengan sukses dan bahagia.
Tujuan: Menganalisa hubungan artritis dengan keterbatasan aktivitas fisik pada individu laki-laki dan perempuan usia 50 tahun ke atas di Kabupaten Purworejo.
Metode: Jenis penelitian adalah observasional dengan rancangan crosssectional. Subjek penelitian adalah individu yang berusia 50 tahun keatas yang berjumlah kurang lebih 13890 jiwa. Data dikumpulkan dengan mengunakan instrumen berupa kuesioner SAGE-WHO dan INDEPTH oleh 63 petugas pewawancara dengan 7 pengawas lapangan. Analisis yang digunakan dalam penelitian ini adalah univariabel, bivariabel dan multinomial logistic regression dengan perhitungan Odds Ratio(OR), Confidence interval (CI) (95%) dan tingkat kemaknaan p<0,05
Hasil penelitian: Prevalensi artritis pada individu 50 tahun ke atas lebih tinggi pada perempuan daripada laki-laki. Prevalensi untuk perempuan sebesar (18,8%) dan laki-laki sebesar (17,1%). Hasil uji analisis bivariabel dan multivariabel menunjukkan ada hubungan yang bermakna antara artritis dengan keterbatasan aktivitas fisik berat perempuan dan laki-laki OR=2,2 (95%CI=1,8-2,6). Bila dibandingkan dengan individu yang tidak mengalami keterbatasan aktivitas fisik, Individu perempuan dan laki-laki dengan artritis akan beresiko 2,2 kali untuk mengalami keterbatasan aktivitas fisik berat dibandingkan dengan individu yang tidak artritis.
Kesimpulan: Ada hubungan yang yang bermakna antara artritis dengan keterbatasan aktivitas fisik pada individu lima puluh tahun ke atas.
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Hubungan Gangguan Tidur dengan Gangguan Affek pada Individu Usia 50 Tahun Ke Atas, Di Kabupaten Purworejo, Propinsi Jawa Tengah

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Author : Ni Wayan Dwi Rosmalawati
Pembimbing 1/2 : Prof.dr. Djaswadi Dasuki, MPH, Sp.OG (K)/dr Nawi Ng, MPH, Ph.D
Penguji : dr. Mubasysyr Hasanbasri, MA
Abstract :
Background:
The process of aging causes hormonal, physical and mental changes. Some problems occur due to the process of aging. One of these problems is sleep disorders as an impact of hormonal decrease and the other aging processes, and if it is ignored for a long time, it will cause affect disorders such as depression, anxiety, and anger. Objective: The study aimed to identify the relationship between sleep disorders and affect disorders of the elderly over 50 years old.
Method: The study was observational with cross sectional design. Subjects of the study were all the elderly of over 50 years old from the data of the household of Community Health and Nutrition Research Laboratory of The Faculty of Medicine, Gadjah Mada University. Univariable analysis used frequency distribution, bi-variable analysis used chi square and multi-variable analysis used logistic regression.
Result: Of 12,459 respondents, 4,605 (37.22%) suffered from affect disorders, that occurred commonly in female (2,684). Meanwhile, 7,220 (58.18%) suffered from sleep disorders and it commonly happened in female (4,104). Sleep disorders increased the risk of affect disorders with odds ratio 2.56 (95%CI; 2.27-2.89) and 2.92 (95%CI; 2.62-3.36) in male and female respectively.
Conclusion: The prevalence of sleep disorders in Purworejo District is higher than that in WHO. There is an increase in the prevalence of affect disorders compared to the previous research. More women suffer from both affect and sleep disorders than men, in fact, sleep disorders increase the risk of affect disorders for both male and female over 50 years old.
INTISARI
Latar Belakang: Dengan proses menua menimbulkan perubahan hormonal, perubahan fisik serta perubahan mental. Beberapa permasalahan akan muncul sejalan dengan proses menua tersebut. Salah satunya adalah terjadi gangguan tidur sebagai dampak menurunnya hormon dan proses menua yang lain, bila dibiarkan dalam jangka waktu yang lama akan menimbulkan gangguan affek seperti depresi/tertekan, cemas, khawatir dan marah.
Tujuan Penelitian: Penelitian bertujuan mengetahui hubungan gangguan tidur dengan gangguan affek pada individu usia 50 tahun ke atas. Metode Penelitian: Penelitian ini adalah penelitian observasional dengan rancangan Cross-sectional. Subjek penelitian ini adalah semua individu yang berumur 50 tahun ke atas dari data Rumah Tangga Laboratorium Penelitian Kesehatan dan Gizi Masyarakat (LPKGM)-FK UGM. Analisis univariabel dengan distribusi frekuensi, analisis bivariabel dengan chisquare dan analisis multivariabel dengan regresi logistik.
Hasil: Dari 12.459 responden menunjukkan gangguan affek sebanyak 4.606 orang (37,22%), paling banyak dialami oleh perempuan sejumlah 2.684 orang (40,37%), sedangkan gangguan tidur sebanyak 7.220 orang (58,18%), paling banyak juga terjadi pada perempuan sejumlah 4.106 orang (61,53%). Gangguan tidur meningkatkan risiko gangguan affek dengan OR 2,56 (95%CI: 2,27-2,89) pada laki-laki dan pada perempuan dengan OR 2,92 ( 95% CI: 2,62-3,26).
Kesimpulan: Prevalensi gangguan tidur di Kabupaten Purworejo adalah lebih besar dibandingkan dengan prevalensi WHO. Prevalensi gangguan affek pada penelitian ini adalah lebih besar dibanding dengan penelitian sebelumnya. Gangguan tidur dan gangguan affek lebih banyak terjadi pada perempuan dan gangguan tidur meningkatkan risiko terjadinya gangguan affek baik pada laki-laki dan perempuan usia di atas 50 tahun.
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Hubungan Nyeri dengan Gangguan Aktivitas Interpersonal Pada Individu Usia 50 Tahun Ke Atas Di Kabupaten Purworejo

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Author : Kartini
Pembimbing 1/2 : Prof.dr. Djaswadi Dasuki, MPH,SpOG(K)/dr. Nawi Ng, MPH,PhD
Penguji : dr. Mubasysyr Hasanbasri, MA
Abstract :
Background:
Increasing life expectancy every year followed by increasing number of the elderly from 1990 – 2025 (41.4%) requires particular attention in order that the elderly can spend their live in optimum ways. Purworejo District has higher rate of the elderly numbers (11%) than that in Central Java (6%). Changes that occur during ageing have caused some health problems such as pain. As much as 25% – 50% of the elderly suffer from pain. Thes brings about negative impacts to quality of life of the elderly, one of which is interpersonal activity consisting of relationship with others and social participation. The elderly suffering from pain often withdraw themselves from social activity because they feel incapable and they are afraid of become the burden of others leading to social tense if they cannot cope the problem and have difficulties in social participation. Objective: The study was conducted to identify the relationship between pain and interpersonal activity disorder among the elderly over 50 years old. Method: This was an observational study with cross sectional design. There were as many as 13,890 elderly people over 50 years old as the subjects of the study. Data were obtained using questionnaire of Study on Global Ageing and Adult Health-World Health Organization (SAGE-WHO) and International Network for the Continuous Demographic Evaluation of Population and Their Health in Developing Countries (INDEPTH) distributed by 63 interviewers and 7 field coordinators. Data analysis used univariable technique and multivariable technique with multinominal logistic regression test and the significance level (p) was
INTISARI :
Latar Belakang:
Meningkatnya usia harapan hidup dari tahun ke tahun yang disertai dengan meningkatnya jumlah usia lanjut dari tahun 1990 hingga 2025 sebesar 41.4% menyebabkan perlunya perhatian khusus agar usia lanjut dapat menjalani masa tuanya secara optimal. Purworejo merupakan salah satu kabupaten yang memiliki jumlah usia lanjut lebih tinggi sebesar 11% dibandingkan jumlah usia lanjut di Jawa Tengah. Terjadinya berbagai perubahan pada proses menua menyebabkan terjadi beberapa masalah kesehatan diantaranya adalah nyeri. Usia lanjut yang mengalami nyeri sebesar 25-50%. Nyeri memberikan dampak negatif bagi kualitas hidup usia lanjut, salah satunya terhadap aktivitas interpersonal yang mencakup hubungan dengan orang lain dan partisipasi sosial. Usia lanjut yang mengalami nyeri seringkali menarik diri dari kegiatan sosialnya karena merasa tidak mampu dan menjadi beban bagi orang lain dan ketegangan sosial dapat terjadi bila koping terhadap nyeri pasif serta mengalami kesulitan dalam melakukan partisipasi sosial. Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui hubungan nyeri dengan gangguan aktivitas interpersonal pada individu usia 50 tahun ke atas. Metode Penelitian: Jenis penelitian adalah observasional dengan rancangan cross-sectional. Subjek penelitian adalah individu usia 50 tahun ke atas yang berjumlah kurang lebih 13 890 jiwa. Data dikumpulkan dengan mengunakan instrumen berupa kuesioner SAGE-WHO dan INDEPTH oleh 63 petugas pewawancara dengan 7 pengawas lapangan. Analisis data yang digunakan adalah analisis univariabel dan multivariabel menggunakan analisis chi-square dan multinomial logistic regression dengan tingkat kemaknaan p
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Pusat pengamatan dan penanggulangan dampak krisis terhadap status kesehatan dan gizi di kabupaten Purworejo

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Author : Diah Rumekti Hadiati, Djaswadi Dasuki, Sururi
Abstract :
Objective: First is to establish crisis center at district level in order to monitor health impacts of economic crisis. The second is to select effective indicators for monitoring the health impacts of the crisis. The third is to plan a preventive intervention based on the data analysis.
Method: Qualitative study is done through panel discussion and focus group discussion for establishing crisis center. The second panel discussion is to asses and select health policy indicators, social economics indicator, indicators of the provision of health, and health status indicator. Quantive study is to asses the longitudinal surveillance data at district Purworejo which is based on selected indicators.
Population study is based on the population sample of longitudinal study at district Purworejo, which consisted of cross-sectional and clycic data.
Result of the Study: Crisis center is established through the first panel discussion and the focus group discussion. Partnership and coordination among Health Department, BKKBN, Department of agricultural, Department of Economic, Bappeda at district level and University are established. In the second panel discussion social economics indicators, indicators of the provision of health, and health status indicator have been selected. The proposed indicator for monitoring health impacts of the crisis included socio-economic indicator, health care indicators, and health and nutrition status indicator. The most prominent health impacts of the crisis have to be over come consist of under nutrition and diseases of the under-five children and pregnant women. There are no policy indicators how to over come emergency or complication of the disease caused by the economic crisis and they are no intervention and prevention program in order to overcome the health impact of the crisis. The budget to overcome the prominent health impact of the crisis should be shared among the institution or through social safety support.
Conclussions: The effective indactors for monitoring the health impact of the crisis consist of socio economic indicators, health provision indicators, and health and nutrition status indicators among vulnerable and disadvantages group, pregnant women and children under-five. They are no policy indicators that can be used to monitor and to overcome the health impact of the crissis, specifically associated with an intervention and prevention programs.
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Tingkat, Tren dan Diferensial Kematian Bayi dan Anak Serta Angka Harapan Hidup di Kabupaten Purworejo : Metode Tidak Langsung

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Author : Siswanto Agus Wilopo, Abdul Wahab, Hari Kusnanto, Harun Rusito, Lina Kurniawati
Abstract :
This study aims to examine the level, trend and determinants of infant and child mortality and the life expectancy at birth in the District of Purworejo. The study uses baseline data collected by CHN-RL Gadjah Mada University. An indirect technique was used by applying data on children ever born and children surviving according to the motber’s age and the duration of marriage to West mortality model. There were 12,648 women at reproductive ages who contributed to this measurement. The infant and child mortality show a substantial decline during the last 15 years. The 1976 IMR was around 70 per 1000 births and the 1990’s IMR was declining to around 45 per 1000 births. For the probability of dying between ages ] to 4 are 30 per 1000 children in 1976 and 13 per 1000 in 1993. A female mortality is slightly lower than male infant mortality but probability of dying between age 1 to 4 is slightly higher among male children. The life expectancy decline is a consistent with the IMR trend. It is suggested that the indirect techniques should use the duration marriage data when the mother’s age data is a defective.
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Peningkatan vitalitas posyandu sebagai akibat dampak krisis

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Author : Abdul Wahab, Yati Soenarto, Punik Mumpuni, Lina Kurniawati
Abstract :
Krisis moneter yang terjadi di Indonesia sejak pertengahan tahun 1997 telah berlanjut pada krisis ekonomi berkepanjangan. Kondisi ini antara lain telah mengakibatkan penurunan secara drastis kemampuan pelayanan kesehatan dan pemenuhan kebutuhan gizi. Kelompok yang paling menderita akibat situasi ini adalah ibu dan anak.
Guna mengatasi dampak krisis tersebut perlu adanya kerjasama yang baik antara pemerintah dengan masyarakat secara aktif. Wadah peran serta masyarakat untuk memperoleh pelayanan kesehatan dasar yang tersebar luas di seluruh pelosok tanah air adalah Posyandu (Pos Pelayanan Terpadu). Sebagai salah satu sistem penyelenggaraan pelayanan pemenuhan kebutuhan dasar, peningkatan kualitas manusia yang secara empirik telah dapat memeratakan pelayanan bidang kesehatan, seperti imunisasi, pendidikan gizi masyarakat serta pelayanan kesehatan ibu dan anak. Posyandu juga merupakan perpanjangan tangan Puskesmas untuk pelayanan dan pemantauan kesehatan secara terpadu di tingkat desa, yang merupakan kegiatan “oleh” dan “untuk” masyarakat setempat.
Diakui bahwa dalam beberapa tahun terakhir, fungsi dan kinerja Posyandu belum optimal. Dari hasil survailan Longitudinal di LPKGM dapat diketahui rendahnya pemanfaatan dan kualitas pelayanan Posyandu. Menurut Depdagri (1999) hal tersebut disebabkan oleh berbagai faktor antara lain pembinaan program sektor yang kurang, keterbatasan kemampuan petugas kesehatan, jumlah kader yang kurang dibandingkan dengan beban kerja yang harus dilakukan dan terpengaruh oleh dampak krisis ekonomi yang sedang dihadapi saat ini. Menurut hasil survailan longitudinal LPKGM (1999), bahwa permasalahan yang mengakibatkan kelesuan Posyandu disebabkan oleh beberapa faktor antara lain : terjadinya kebosanan adanya kegiatan Posyandu, kadernya pindah, sistem pelayanan dan sistem rujukan belum berjalan dengan baik.
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