scholarly journals Faktor-faktor yang mempengaruhi perilaku penatalaksanaan hipertensi oleh penderita di wilayah kerja puskesmas sekernan ilir kabupaten muaro jambi tahun 2018

2018 ◽  
Vol 5 (3) ◽  
pp. 224-232
Author(s):  
Netha Damayantie ◽  
Erna Heryani ◽  
Muazir Muazir

 ABSTRAK Hipertensi atau tekanan darah tinggi merupakan penyakit dengan tekanan sistolik ≥ 140 mmHg atau tekanan diastolik ≥ 90 mmHg. Faktor yang mempengaruhi perilaku penderita hipertensi diantaranya persepsi individu tentang penyakitnya, kelompok sosial, latar belakang budaya, ekonomi dan kemudahan akses pelayanan. Penelitian ini bertujuan untuk mengetahui beberapa faktor-faktor yang berhubungan dengan perilaku penatalaksanaan hipertensi oleh penderita di wilayah kerja Puskesmas Sekernan Ilir Kabupaten Muaro Jambi tahun 2018. Penelitian ini merupakan penelitian deskriptif kuantitatif dengan pendekatan desain penelitian cross sectional, jumlah sampel dalam penelitian ini sebanyak 68 responden. Pengambilan sampel menggunakan Proportional Random Sampling. Pengumpulan Data dengan wawancara menggunakan kuesioner. Data dianalisis secara univariat dan bivariat (T-Test Dependent). Hasil analisis bivariat menunjukan adanya hubungan antara persepsi sakit (p-value=0,001) dan dukungan keluarga (p-value=0,015) dengan perilaku penatalaksanaan hipertensi oleh penderita, dan tidak adanya hubungan antara akses pelayanan kesehatan (p-value=0,605) dengan perilaku penatalaksanaan hipertensi oleh penderita. Perawat memiliki peran dalam mengubah perilaku sakit penderita hipertensi. Pihak Puskesmas Sekernan Ilir diharapkan memberikan pendidikan kesehatan, melaksanakan PIS-PK dengan pendekatan keluarga untuk meningkatkan status kesehatan penderita hipertensi.  Bagi penelitian selanjutnya dapat menggunakan rancangan studi yang berbeda agar dapat melihat hubungan variabel yang lain.Kata kunci : Hipertensi, Perilaku, PenatalaksanaanAbstractHigh blood pressure or hypertension is a disease with a systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg. Factors that affect the behavior of hypertension sufferers include the individual's perception about his illness, social groups, cultural background, economic services and ease of access. This research aimed to know some of the factors related to the behavior of hypertension treatment by the sufferers in Puskesmas Sekernan Ilir Kabupaten Muaro Jambi in 2018.This research was quantitative descriptive research with cross sectional design  approach. The sample was 68 respondents. The sampling technique used Proportional Random Sampling. The data collection used interviews by questionnaire. The data was analyzed in univariate and bivariat analysis (T-Test Dependent). Bivariat analysis results showed a correlation between pain perception (p-value = 0.001) and family support (p-value = 0,015) with the behavior treatment of hypertension by sufferers, and the absence of a correlation between access to medical services (p-value = 0.605) with the behavior treatment of hypertension by sufferers. Nurses have a role in changing the behavior of sufferers hypertension. Puskesmas Sekernan Ilir is expected to provide health education, carry out PIS-PK to improving the health status of hypertension sufferers.  For further research, it is recommended to use different study designs in order to see the correlation of other variables can be.Keywords: hypertension, behavior, treatment

2018 ◽  
Vol 3 (3) ◽  
pp. 500
Author(s):  
Desmariyenti Desmariyenti ◽  
Nelfi Sarlis ◽  
Rima Fitriani

<p><em>Good weaning time is done at the age of the child reaches 2 years. Weaning at less</em><em> </em><em>than 2 years of age can cause problems in children such as incidence of infectious diseases, especially increased diarrhea, nutritional effects that lead to malnutrition in children and cause the relationship of children and mothers is reduced </em><em>closeness </em><em>because bounding attachment process is disrupted. This study aims to determine the relationship between knowledge  and  attitude  of  the  mother  with  the  decision  of  weaning  time  in</em><em> </em><em>Tangkerang Timur Work Area Puskesmas Tenayan Raya. This research was conducted in </em><em>Mei</em><em>-</em><em>J</em><em>uni 2017 and this research using research type is quantitative data with research design  using  cross  sectional.  Sampling  technique  using  Stratified  random  sampling, population in this study amounted to 368 people and samples 18</em><em>4</em><em> p</em><em>e</em><em>ople in East Tangkerang Village. The analysis used is univariate and bivariate. The result of this research is can be concluded that there is significant relation between knowledge with time weaning (p-value 0,000 &lt;0,05), there is significant relation between attitude with time weaning (p-value 0,000 &lt;0,05). Mothers exclusively breastfeed to their babies until 6 months of age and and continue with breastfeeding until 24 months of age.</em><em></em></p><p> </p><p>Waktu penyapihan yang baik dilakukan pada usia anak mencapai 2 tahun. Penyapihan yang dilakukan pada usia kurang dari 2 tahun dapat menyebabkan masalah pada anak seperti insiden penyakit infeksi terutama diare meningkat, pengaruh gizi yang mengakibatkan malnutrisi  pada  anak  dan  menyebabkan  hubungan  anak  dan  ibu  berkurang  keeratannya karena proses bounding attachment terganggu. Penelitian ini bertujuan untuk mengetahui hubungan antara pengetahuan dan sikap ibu dengan keputusan waktu penyapihan di Keluraan Tangkerang Timur Wilayah Kerja Puskesmas Tenayan Raya. Penelitian ini dilakukan pada bulan Mei-Juni tahum 2017 dan penelitian ini menggunakan jenis penelitian adalah data kuantitatif dengan  desain penelitian menggunakan  cross sectional. Teknik sampling menggunakan Stratified random sampling, Populasi dalam penelitian ini berjumlah 368 orang dan sampel 184 orang di Kelurahan Tangkerang Timur. Analisa yang diunakan adalah univariat dan bivariat. Hasil penelitian didapatkan bahwa ada hubungan bermakna antara pengetahuan dengan waktu penyapihan (p-value 0,000&lt; 0,05), ada   hubungan   bermakna   antara   sikap   dengan   waktu   penyapihan   (p-value   0,000   &lt;0,05). Diharapkan ibu memberikan ASI eksklusif pada bayinya sampai usia 6 bulan dan dan dilanjutkan dengan MPASI sampai usia 24 bulan.</p>


2018 ◽  
Vol 1 (1) ◽  
pp. 12
Author(s):  
Menik Kustriyani ◽  
Ivana Probo Kaeksi ◽  
Tamrin Tamrin

Joint Commission International ( JCI ) required the achievement of 100% five moment hand hygiene for the nurses who have provided care to patients. The adherence of five moments hand hygiene has been done to reduce the incidence of nosocomial infections. The adherence of five moments hand hygiene has been determined by inside and outside factors, and one of the inside factors is the motivation. The research is a qualitative research with cross sectional approach. The number of sample is 153 nurses with the proportionate random sampling technique at the Public Hospital of Loekmono Hadi Kudus. The research instruments used the questionaire and observation sheet. The research showed the result of Rank Spearman test p value = 0,000 with r value = 0.296, positive correlation means that the higher the nurse motivation, the higher the nurse aderence of five moment hand hygiene.


2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Rivanli Polii ◽  
Joice N.A. Engka ◽  
Ivonny M. Sapulete

Abstract: Sodium is an extracellular fluid cation which is the highest in amount, 35-40% sodium (Na) is found in the body skeleton. The function of sodium is the regulation of fluid volume, the regulation of fluid balance, the regulation of osmolarity, and the regulation of blood pressure. Blood pressure is the force that is needed to keep the blood flowing inside the blood vessel and circulates to reach all the tissues in human body. Blood pressure consists of two components, the systolic pressure and diastolic pressure. According to the study conducted by Riset Kesehatan Dasar on 2007, it was found that the Natuna Islands (coastal areas) has the highest prevalence of hypertension, which is 53,3%, while the highlands of Jayawijaya has the lowest prevalence of hypertension, which is 6,8%. The North Bolaang Mongondow regency, especially West Bolangitang district is an area which is conditioned around the coastal areas. Adolescents, according to WHO, are those aged 12-24 years old. This was an analytical descriptive research is conducted with a cross sectional study design. Afterward, the collected datas are processed using the help of SPSS software. The population is all of the students in SMAN 1 Bolangitang Barat, North Bolaang Mongondow regency and the samples were collected with purposive sampling technique. The results showed that the number of respondents who follow the research were 60 students, consisting 16 boy and 44 girl by spearman’s correlation statistical test.This study shows no correlation between the levels of sodium and blood pressure on adolescents in West Bolangitang district North Bolaang Mongondow regency. Conclusion: there is no correlation between the levels of sodium and blood pressure on adolescents in West Bolangitang district, North Bolaang Mongondow regency. Keywords: sodium, blood pressure, adolescent Abstrak: Natrium ialah kation terbanyak dalam cairan ekstrasel , 35-40% natrium (Na) ada didalam kerangka tubuh. Fungsi natrium untuk mengatur volume cairan, mengatur keseimbangan cairan, mengatur osmolaritas, dan mengatur tekanan darah. Tekanan darah adalah kekuatan yang diperlukan agar darah dapat mengalir di dalam pembuluh darah dan beredar mencapai semua jaringan tubuh manusia. Tekanan darah terdiri atas 2 bagian tekanan sistolik dan tekanan diastolik. Berdasarkan data yang dilakukan Riset Kesehatan Dasar tahun 2007 didapatakan bahwa prevalensi hipertensi tertinggi di Kepulauan Natuna (wilayah pantai) sebanyak 53,3 % sedangkan prevalensi hipertensi terendah di pegunungan jayawijaya sebanyak 6,8%. Kabupaten Bolaang mongondow utara khususnya Kecamatan Bolangitang Barat merupakan suatu wilayah yang terletak disekitaran pesisir pantai, Remaja menurut WHO adalah mereka yang berumur 12-24 tahun. Jenis penelitian ialah deskriptif analitik dengan desain potong lintang. Data diolah dengan menggunakan program SPSS. Populasi ialah semua siswa/i SMAN 1 Bolangitang Barat Kabupaten Bolaang Mongondow Utara dan sampel diambil dengan cara purposive sampling. Hasil uji korelasi Spearman menunjukkan tidak terdapat hubungan antara kadar natrium dengan tekanan darah pada remaja di Kecamatan Bolangitang Barat Kabupaten Bolaang Mongondow Utara. Simpulan: Tidak terdapat hubungan antara kadar natrium dengan tekanan darah pada remaja di Kecamatan Bolangitang Barat Kabupaten Bolaang Mongondow Utara.Kata kunci: natrium, tekanan darah, remaja


Author(s):  
Eva Imania Eliasa ◽  
Ilfiandra Ilfiandra ◽  
Syamsu Yusuf

This study aims to determine the trend of student religiosity in terms of gender and background majors. The research approach uses a quantitative approach to the type of cross-sectional survey. Participants numbered 292 (58 male and 234 female) students in the Faculty of Education taken with non-probability random sampling technique. The data collection technique used a scale. The research instrument used Religiosity Scale for Youth from Hernandez. The test of validity, using the Pearson product-moment correlation, with 37 items that valid and reliability using Cronbach Alpha test with 0893. Data were analyzed using quantitative descriptive technique and Two Way Anova. The results showed that the trend of religiosity students Including a high category in the aspect of religious belief, and the category is quite high in the aspect of religious activity. The overall dynamics of the diversity of students in the category is quite high, and the majors PLB, PLS, PGSD has a higher category. There is no difference between the gender with religiosity, but female students are higher than males.


2017 ◽  
Vol 7 (2) ◽  
pp. 93
Author(s):  
Deny Kurniawan ◽  
Ratna Yuliawati ◽  
Ari Hamdani

The rehabilitation centers BNN Tanah Merah incerease in rehabilitated drug users since 2013 from 5 people to 68 people in 2016. This study is intend to research is to determine correlation between a family situation with drugs relapse behavior to resident in Rehabilitation centers BNN Tanah Merah Samarinda. This research using Cross Sectional research design and the sampling technique used probability sampling with simple random sampling type.This research using a Chi Square statistic test. Based on the result, a good family situation respondents but still experience the relapse are 18.9% and a bad family situation respondents and still experience the relapse are 19,0%. Statistically obtained p-value 1.00 (p<0.05). it can be concluded that there is no correlation between a Family Situation with drugs relapse behavior to resident at Rehabilitation centers BNN Tanah Merah Samarinda.Keywords : Family situation, Relapse, Drugs, Resident.  


2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Ester Verninde ◽  
I Gede Mustika ◽  
Purwaningtyas Kusumaningsih

ABSTRAK<br />Sumber daya manusia (SDM) adalah salah satu factor utama yang diperlukan dalam melaksanakan pembangunan nasional. Dua diantaranya yang berperan penting yaitu factor kesehatan dan gizi. Tingkat prestasi pada anak SD di pengaruhi oleh faktor internal dan eksternal. Tujuan penelitian ini adalah untuk mengetahui pengaruh kebiasaan sarapan, pedidikan ibu dan status gizi terhadap tingkat prestasi anak kelas IV dan V SD Inpres Weetebula II. Desain Cross Sectional yang dilakukan pada bulan Mei-Juni 2018 dengan teknik pengambilan sampel menggunakan probability sampling dengan cara simple random sampling pada siswa kelas IV dan V (37 responden). Data kebiasaan sarapan menggunakan kuesioner, pendidikan ibu menggunakan data sekolah, status gizi menggunakan pengukuran antropometri, sedangkan tingkat prestasi menggunakan nilai raport. Hasil penelitian ini menunjukkan bahwa kebiasaan sarapan pagi terhadap status gizi berpengaruh (nilai p=0,000), pendidikan ibu terhadap status gizi tidak berpengaruh (nilai p=0,520), status gizi tidak berpengaruh terhadap tingkat prestasi (nilai p=0,638), kebiasaan sarapan berpengaruh terhadap tingkat prestasi (nilai p=0,044), pendidikan ibu tidak berpengaruh terhadap tingkat prestasi (nilai p=0,334). Penelitian ini menunjukkan ada pengaruh antara kebiasaan sarapan terhadap status gizi dan tingkat prestasi dan tidak ada pengaruh antara kebiasaan sarapan, pendidikan ibu dan status gizi terhadap tingkat prestasi.<br />Kata kunci :kebiasaan sarapan, pendidikan ibu, status gizi dan tingkat prestasi. Siswa SD<br />ABSTRACT Human resources (HR) are one of the main factors needed in carrying out national development. Two of them have important roles, namely health and nutrition factors. The level of achievement in elementary school children is influenced by internal and external factors. The purpose of this study was to determine the effect of breakfast habits, maternal education and nutritional status on the level of achievement of grade IV and V children of SD Inpres Weetebula II. Cross Sectional Design conducted in May-June 2018 with a sampling technique using probability sampling by means of simple random sampling for students in grades IV and V (37 respondents). Data on breakfast habits using questionnaires, maternal education using school data, nutritional status using anthropometric measurements, while the achievement level uses report cards. The results of this study indicate that the habit of breakfast to nutritional status has an effect (p value = 0,000), maternal education on nutritional status has no effect (p value = 0.520), nutritional status does not affect the level of achievement (p value = 0.638), influential breakfast habits towards the level of achievement (p value = 0.044), maternal education does not affect the level of achievement (p value = 0.334). This study shows that there is an influence between breakfast habits on nutritional status and level of achievement and no influence between breakfast habits, maternal education and nutritional status on achievement levels.<br />Keywords: breakfast habits, maternal education, nutritional status and level of achievement. Elementary students


2018 ◽  
Vol 11 (1) ◽  
pp. 37-44
Author(s):  
Septina Riyansari ◽  
Irdawati Irdawati

One of the jobs that is vulnerable to skin disorders is farmers. So that research is needed to see patterns of personal hygiene in farmers. The purpose of this study was to determine the relationship between patterns of personal hygiene with the occurrence of skin disorders in rice farmers in the Nanggulan Village Work Area Cawas I Health Center, Cawas District, Klaten Regency. This research is non-experimental quantitative research that is an analytic survey with cross-sectional design. The population in this study was 767 people and the sample obtained by 89 respondents. Sampling is done by stratified random sampling technique by proportional random sampling. From the results showed a significant relationship between patterns of personal hygiene with the occurrence of skin disorders with a P-value of 0.001 and = 10.426. The conclusion of this study is that there is a relationship between patterns of personal hygiene with the occurrence of skin disorders in rice farmers in the Nanggulan


2018 ◽  
Vol 2 (1) ◽  
pp. 45-53
Author(s):  
Milya Novera ◽  
Diana Arianti ◽  
Dela Septianingsih

Abstract Adolescence is one of the stages in an individual's life to reach adulthood. The problem of sexuality is very visible among teenagers. Based ond SKRRI 2012 survei,  between 51-75% students in Padang City done devation of sexsual behavior. The purpose of this study is to determine the influence of counseling on the level of knowledge and attitudes of teens about premarital sex. This research is a quantitative research method that is pre-experimental design with one group of pretest-posttest design. The populations of this study are 589 students from XI grade of  SMK, used cluster random sampling  technique with the number of samples are 58 female students. This study was conducted at SMKN 8 Padang in 2017. The analysis was using dependent T-test. The result showed an increase in knowledge and attitudes of teens about premarital sex before and after getting the counseling with p value = 0,000 from it was 70.7% of adolescents had low level became 8.6%, 22,4% of adolescents had low medium level became 13,8% and also 6,6% of adolescents had high knowledge became 77,6% after being given the counseling, and The adolescent attitudes was 44,8% negative and was 55,2% positive before giving counseling became decreased became was 34.5% negative and was 65,5% positive after being given counseling. It can be concluded that there is an influence of counseling to level of knowledge and attitude of adolescents before and after getting the counseling about premarital sex. It is expected that the school for provide information and counseling program for youth through cooperation with local health agencies that health center care to increase knowledge and attitudes of adolescents about health  specially the premarital sex that activities such as counseling at school for every month a specially since the beginning of the school orientation. Keywords:  Knowledge, Attitude, Premarital ,sex, Adolescence ABSTRAK Remaja merupakan salah satu tahap dalam kehidupan individu untuk mencapai dewasa. Survei SKRRI 2012,  siswa/i SMAN di Kota Padang melakukan penyimpangan perilaku seksual. Tujuan penelitian untuk mengetahui pengaruh penyuluhan terhadap tingkat pengetahuan dan sikap remaja tentang seks pranikah. Penelitian ini kuantitatif dengan menggunakan metode pre-eksperimental desaign dengan rancangan one group pretest-posttest design. Populasi penelitian siswa kelas XI SMK Negeri 8 Padang, teknik pengambilan sampel cluster random sampling dengan jumlah sampel 58 siswa. Penelitian dilaksanakan di SMK Negeri 8 Padang pada bulan Januari s/d Juli tahun 2017. Analisa secara univariat dan bivariat menggunakan uji T- test dependen. Hasil penelitian terdapat perbedaan pengetahuan dan sikap remaja tentang seks pranikah sebelum dan sesudah penyuluhan dengan p=0,0007,7% tingkat pengetahuan rendah menjadi 8,6%, 22,4% tingkat pengetahuan sedang menjadi  13,8% dan 6,9% tingkat pengetahuan tinggi menjadi 77,6% setelah diberikan penyuluhan. Sikap remaja 44,8% negatif dan positif 55,2% sebelum penyuluhan mengalami penurunan menjadi 34,5% bersikap negatif dan 65,5% bersikap positif sesudah diberikan penyuluhan. Dapat disimpulkan, ada pengaruh penyuluhan terhadap tingkat pengetahuan dan sikap remaja sebelum dan sesudah dilakukan penyuluhan tentang seks pranikah. Disarankan pihak sekolah untuk memberikan informasi atau penyuluhan  lebih lanjut melalui kerjasama dengan instansi kesehatan setempat seperti puskesmas dan klinik swasta tentang kesehatan khususnya pencegahan seks pranikah sejak awal orientasi sekolah dan menjadi kegiatan rutin setiap bulan.


2018 ◽  
Vol 5 (2) ◽  
pp. 134-142
Author(s):  
Rai Wiwik Dwi Astari ◽  
Ni Ketut Ayu Mirayanti ◽  
I Made Arisusana

Pendahuluan: Usia produktif dengan rentang usia dari 18-45 tahun, merupakan usia dimana manusia sudah matang secara fisik dan biologis. Tidak sedikit masyrakat dengan usia produktif yang sudah merasakan beberapa gejala adanya penyakit degeneratif yaitu contohnya penyakit asam urat. Penyakit asam urat adalah jenis arthiritis yang sangat menyakitkan yang disebabkan oleh penumpukan kristal persendian. Tujuan Penelitian mengetahui faktor–faktor yang mempengaruhi kadar asam urat darah pada usia produktif di Desa Nongan, Kabupaten Karangasem. Metode: Jenis penelitian ini adalah korelasional dan pendekatan yang digunakan adalah cross-sectional. Jumlah sampel pada penelitian ini adalah 58 responden dengan Non- probability sample yaitu dengan Random sampling. Hasil: Hasil  analisis statistik dengan menggunakan rank spearman menunjukan bahwa dari 4 variabel yaitu makanan dengan p value = 0,000, aktifitas fisik dengan p value = 0,001, tingkat pengetahuan dengan p value = 0,000, jenis kelamin dengan p value = 0,000 lebih kecil dari pada 0,05 maka ada hubungan yang bermakna antara makanan, tingkat pengetahuan, aktifitas fisik, jenis kelamin dengan Kadar Asam Urat pada Usia Produktif di Desa Nongan.   Kata Kunci: asam urat, usia produktif   ABSTRACT Introduction: Productive age with age range from 18-45 years old, is the age which is human are mature physically and biologidally. Not afew peoples with productive age who al ready feel some sign of degenative disease for example uric acid disease. Uric acid disease is the arthritis type that very painfull uaused by cumulation of crystal joint. The purpose of this study to know factors that influence blood uric acid levels in productive age at Nongan village, Kabupaten Karangasem. Method: The type of this study is cross – sectional. The amount sample of this study is 58 respondents with Non –probability sample thatis Random sampling technique. Result: Statistical analysis results using rank spearman show that from 4 variables that is food with p value = 0,000 , physical activity with p value = 0,001, knowledge levels with p value = 0,000 , gender with p value = 0,000 smaller than 0,05 so there is a meaning ful correlation between food, knowledge levels, physical activity, gender with Uric acid levels in productive age at Nongan village.   Keywords: uric acid, productive age


2020 ◽  
Vol 9 (2) ◽  
pp. 88-93
Author(s):  
Yeti Septiasari

Perbedaan Hemoglobin Remaja Putri Yang Mendapatkan Dengan Yang Tidak Mendapatkan Tablet Tambah Darah Pemerintah Kabupaten Pringsewu saat ini telah menjalankan program PPAGB untuk menanggulangi anemia pada remaja. Salah satu Puskesmas yang menjalankannya adalah Puskesmas Ambarawa. Tujuan penelitian ini adalah mengetahui Perbedaan Kadar Hemoglobin Pada Remaja Putri Yang Mendapatkan Tablet Tambah Darah Pemerintah Di SMA Wilayah Kerja  Puskesmas Ambarawa. penelitian ini peneliti menggunakan metode observasional analitik dengan pendekatan cross sectional. Penelitian ini memiliki dua variabel  independen (bebas) yaitu perbedaan kadar hemoglobin remaja putri yang di SMA Ambarawa  yang mendapat TTD Pemerintah dan yang tidak mendapatkan TTD Pemerintah di SMA Ambarawa. Jadi total sampel adalah 50 orang. Metode sampling yang digunakan adalah random sampling. instrument pengukuran kadar hemoglobin dengan menggunakan rapid test. Analisis data menggunakan uji T-test independent tidak berpasangan dengan tingkat kepercayaan 95%. Hasil penelitian didapatkan remaja yang rutin mendapatkan tablet fe sebanyak 52%. Rata-rata kadar hemoglobin pada remaja yang mendapatkan suplementasi fe adalah 11,5(1,79) gr/dl. rata-rata kadar hemoglobin pada remaja yang mendapatkan suplementasi fe adalah 11,5(1,79) gr/dl. Didapatkan nilai Mean Difference sebesar -0,2298,  Hasil uji statistik didapatkan p value 0,657. Hal ini berarti Ho diterima dan Ha ditolak sehingga dapat disimpulkan tidak ada perbedaan Kadar Hemoglobin remaja putri yang mendapatkan program intervensi suplementasi Fe dengan yang tidak mendapatkan suplementasi fe di SMA wilayah kerja Puskesmas Ambarawa


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