The correlation between knowledge, body image perception and self efficacy with anxiety among perimenopausal women in Dauh Puri Klod Village, Bali

Background and purpose: Level of anxiety among women approaching menopause is often high. This is influenced by knowledge, education, culture and customs, body image perception and self-efficacy. This study aims to determine the relationship between knowledge, perception of body image and self-efficacy with anxiety in perimenopausal women.Methods: This study employed a cross sectional design with 87 perimenopausal women aged 45-55 years in Dauh Puri Klod Village, Denpasar City, Bali Province. Respondents were selected with systematic random sampling from 1,039 women aged 45-55 years recorded in Dauh Puri Klod Village. Interviews were conducted at each respondent's house in August 2018. Data collected included sociodemographic characteristics, knowledge, perception of body image, self-efficacy and anxiety levels among women approaching menopause. Bivariate analysis with chi square test and multivariate analysis with logistic regression were conducted to identify the association between variables.Results: The results of bivariate analysis showed that variables associated with anxiety were knowledge (p=0.001), perception of body image (p=0.012) and self-efficacy (p=0.001). The results of multivariate analysis with the backward method showed that the variables associated with anxiety were knowledge (AOR=10.83; 95%CI: 3.31-35.37) and self-efficacy (AOR=3.48; 95%CI: 1.09-11.14).Conclusion: Anxiety in women approaching menopause is associated with knowledge and self-efficacy, but is not associated with perceptions of body image. Knowledge plays the most dominant role in reducing anxiety. Education needs to be improved to reduce anxiety in women approaching menopause.

Perception of disaster preparedness and participation in training are associated with disaster preparedness among health workers

Background and purpose: Disaster preparedness is crucial for health workers in order to provide relief to communities affected by disasters quickly and precisely. However currently there are only few health workers who are prepared to face disasters. This study aims to determine the association between knowledge, perception, participation in training and experience in disaster management with disaster preparedness in health workers.Methods: A cross sectional survey was conducted among health workers at Petang and Abiansemal public health centres (PHCs). Of the six PHCs, four were randomly selected consisting of one PHC in Petang Sub-district and three PHCs in Abiansemal Sub-district. All health workers (271 people) in the four PHCs were selected as respondents. Individual face-to-face interviews were conducted by the first author during April 2018 in the workplaces of each respondent using a pre-tested questionnaire. Data collected consisted of socio-demographic characteristics, knowledge, perceptions, participation in training, experiences in disaster management and disaster preparedness. Questions consisted of three components namely knowledge (12 items), perception (32 items) and disaster preparedness (25 items). Bivariate analysis was conducted with chi square test and multivariate analysis with binary logistic regression to determine the association between knowledge, perception, participation in training and experience in disaster management with disaster preparedness.Results: The results showed that 70.9% of respondents had attended disaster training, 40.6% had good knowledge, 24.7% had participated in disaster management and 49.1% had a high level of disaster preparedness. The variables significantly associated with disaster preparedness were perceptions (AOR=6.40; 95%CI: 3.71-10.99) and participation in disaster training (AOR=2.68; 95%CI: 1.44-4.97).Conclusion: Perception and participation in training are significantly associated with disaster preparedness. Continuous training is needed to increase disaster preparedness among health workers.

Gestational weight gain is a risk factor of stunting among children aged 6-23 months in Bangli District, Bali, Indonesia

Background and purpose: Stunting in children is a chronic nutritional concern that has short-term and long-term health effects. Several studies have shown inconsistent results related to the association between stunting and anemia and increased maternal weight during pregnancy. This study aims to determine anemia during pregnancy, increased body weight and weight gain during pregnancy based on body mass index (BMI) before pregnancy stunting with.Method: A case control study was carried out using the baseline data of an intervention studyconducted from April to September to prevent stunting in children aged 6-23 months in nine villages in Bangli District, Bali Province. Baseline data collection was conducted from December 2017–February 2018 by interviews with 330 mothers of the children and observation of their ANC records. The number of samples for the case control study was 156 children aged 6-23 months consisting of 78 cases and 78 controls (1:1). Cases were selected by systematic random sampling from 82 children with stunting and controls were selected in the same way from 248 children without stunting. Data analyzed were maternal age at pregnancy, education, employment, number of children, family income, height, hemoglobin level and maternal body weight during pregnancy. Multivariate analysis with logistic regression was conducted to determine the adjusted odds ratio (AOR) of each risk factor.Results: The increase in maternal weight during pregnancy which is not in accordance with maternal BMI before pregnancy and an increase in maternal weight of <10 or >12.5 kilograms are significantly associated with stunting with AOR=3.53 (95%CI: 1,55-8.07) and AOR=3.31 (95%CI: 1.24-8.85). Hemoglobin <11gr/dL during pregnancy was not found to be significantly associated with stunting (AOR=5.02; 95%CI: 0.80–31.71).Conclusion: The increase of maternal weight during pregnancy which is not suitable with BMI before pregnancy and an increase in maternal weight of <10 or >12.5 kilograms are risk factors for stunting in children aged 6-23 months. In addition to monitoring the increase of maternal weight during pregnancy, it is important to consider the mother's BMI before pregnancy in order to reduce the risk of stunting.

Prevalence and determinants of pentavalent booster immunization in children aged three to five years in Denpasar, Bali

Background and purpose: Pentavalent booster immunization coverage in Denpasar City is reported to be relatively low. This study aims to determine the prevalence and determinants of pentavalent immunization uptake.Methods: A cross-sectional study was conducted in one banjar (hamlet) which was selected purposively in the work area of Public Health Centre (PHC) I West Denpasar, Bali Province. Banjar was selected with consideration of the diversity of local residents and migrants. All mothers who had children aged 3-5 years (138 people) in the banjar were chosen as respondents. Interviews were conducted in each respondent's house with variables included age, education, employment, parity, region of origin, knowledge on immunization, perception of susceptibility to and severity of disease, perceptions of benefits and barriers to immunization, sources of information, family support and acceptance of immunization. Data analysis was performed with poisson regression to determine the determinants of pentavalent booster immunization.Results: The majority of respondents were aged <30 years, high school education or above, unemployed, had 1-2 children and were from Bali. The proportion of respondents who reported that their children had been given pentavalent immunization in children aged three to five years was found to be 78.3%. Immunization prevalence was found to be higher in the population that originated from Bali (82.1%). Determinants of pentavalent immunization are perceptions of benefits (APR=4.78; 95%CI: 1.35-16.96), and more sources of information (APR=1.21; 95%CI: 1.04-1.41).Conclusion: The prevalence of pentavalent booster immunization is found to be lower than the average prevalence of the Bali Province but higher than the reported coverage of Denpasar City. The determinants of immunization acceptance was perception of high benefits and more sources of information. Information dissemination on the benefits of pentavalent booster immunization in children needs to be enhanced through health workers and various media to increase the coverage of pentavalent immunization.

Time of colostrum discharge of more than six hours as a risk factor for physiological jaundice in neonates

Background and purpose: Neonatal jaundice is both a physiological and pathological condition. Neonatal physiological jaundice occurs within 3-5 days after the baby is born. Publications about colostrum and neonatal jaundice are still limited. This study aims to determine the risk of the onset of colostrum discharge of more than 6 hours to physiological jaundice in neonates.Methods: A case control study was conducted at the Sanglah General Hospital in Denpasar from August to December 2017. The number of cases was 55 neonates with physiological jaundice and the number of controls was 55 neonates without physiological jaundice. Cases and controls were selected by consecutive sampling. The occurrence of physiological jaundice was obtained by direct observation and the degree of jaundice was determined based on the division of Kramer's body zone. Neonates with the Kramer grades I and II at the age of 3-5 days were classified as experiencing physiological jaundice (as cases) and neonates with a Kramer grade of 0 at the age of 3-5 days were classified as not jaundice (as controls). Cases were matched with controls by sex and age of the neonates. Data on maternal socio-demographic characteristics, onset of colostrum discharge, early breastfeeding initiation and 24-hour breastfeeding frequency were obtained by interview; data on jaundice was obtained by observation while mode of delivery, parity, history of pre-eclampsia, prematurity, neonatal birth weight, history of birth trauma (cephalic hematoma), history of asphyxia and major congenital abnormalities were obtained from medical records. Multivariate analysis with binary logistic regression was carried out to determine the adjusted odds ratio (AOR) of the onset of colostrum discharge.Results: The characteristics of cases and controls were found to be similar in terms of maternal education, neonatal age and sex, parity and pre-eclampsia history. Significant outset of colostrum >6 hours was found to be associated with physiological jaundice with AOR=2.57 (95%CI: 1.04-6.37). In this study, variables that were not found to be the risk factors of physiological jaundice in neonates were: cesarean delivery (AOR=0.36; 95%CI: 0.09-1.41; p=0.14), breastfeeding frequency within 24 hours (AOR=2.20; 95%CI: 0.47-10.23; p=0.31) and early breastfeeding initiation (AOR=0.71; 95%CI: 0.19-2.59; p=0.60)Conclusion: Onset of colostrum discharge >6 hours is a risk factor for neonatal jaundice. Efforts should be made to accelerate the release of colostrum in order to prevent neonatal jaundice.

The effectiveness of WhatsApp video to increase knowledge of pneumonia early detection among mothers of children under five years

Background and purpose: Number of people in Indonesia who have access to smartphones is quite high, but their use for health education media specifically for the detection of pneumonia is still limited. This study aims to determine the effectiveness of use of video information through the WhatsApp (WA) application compared to leaflets in order to increase maternal knowledge about early detection of pneumonia among under-five children.Methods: A pretest-posttest randomized control trial was conducted in three of the six sub-villages (called banjar) in the Gelgel Village, Klungkung District. Banjar was selected purposively by considering the distance between banjar. As many as 30 mothers were selected as samples from around 45-50 mothers of children under five in each banjar. The intervention was conducted randomly where one banjar was given intervention with videos through WA, one banjar with leaflets and one banjar as a control group. The intervention was carried out for three weeks (August-September 2018). Data were collected before and after the intervention through face-to-face interviews with the mothers in their homes which included social demographics, mother's knowledge about pneumonia detection and educational media preferences. Bivariate data analysis was conducted with paired t-test and multivariate analysis with General Linear Model.Results: Characteristics of respondents in all three groups were similar in terms of age, education, employment and parity. The results of interviews on educational media choices showed that most respondents (64%) preferred WA media. The increase in mean knowledge score after the intervention was significantly higher in the WA group which was 6.93 (95%CI: 6.38-7.49) and leaflet 5.90 (95%CI: 5.49-6.44) compared to the control group 1.87 (95%CI: 1.26-2.47). There was no significant difference between the WA and the leaflet group. The results of multivariate analysis showed that educational media (F=110.99; p<0.001) and education (F=16.69: p<0.001) were significantly associated with the increase in knowledge after adjustments were made based on age, employment and parity.Conclusion: WA videos and leaflets were found to be effective in increasing maternal knowledge about early detection of pneumonia in under-five children. Because the use of WA application is increasing, efforts to increase health knowledge with WA videos need to be enhanced.

Weight gain during pregnancy and low birth weight babies: a retrospective cohort study in Gianyar District, Bali

Background and purpose: Low birth weight (LBW) is a major causal factor for neonatal and perinatal mortality. The aim of this study is to determine the risk of LBW incidence in pregnant women with weight gain not in accordance with the Institute of Medicine (IOM) standards.Methods: This study used a retrospective cohort design with data obtained from three Public Health Centres (PHCs) in Gianyar District over the period of January-December 2017. Samples in this study were 186 pregnant women with the following criteria: complete data on the mother’s medical record, had an antenatal care visit in the first trimester and at the end of the third trimester, at term delivery, not giving birth to twins and no complications during pregnancy. The sample size was determined with 95% confidence level, 80% power, the proportion of LBW in the group of inadequate weight gain of 26%, the proportion of LBW in the group of adequate weight gain of 9% and a relative risk (RR) estimate of 3.0. Data extracted from medical record consisted of weight gain, pre-pregnancy weight, height, upper arm circumference, hemoglobin level, employment, age, parity and birth weight. The cumulative incidence of LBW was calculated to determine the RR. Multivariate analysis with binary logistic regression was conducted to determine the adjusted RR (ARR).Results: The incidence of LBW in the group whose weight gain during pregnancy not in accordance with IOM standards was 59%, while those in accordance with the standards were 8.2% with RR=7.22 (95%CI: 3.96–13.19). The ARR for those with weight gain during pregnancy not in accordance with IOM standards was 15.33 (95%CI: 5.82-40.38). The incidence of LBW in the anemia group was 49% and not anemia group was 10%. The RR and ARR values for LBW in the anemia group were 4.72 (95%CI: 2.66-8.36) and 6.66 (95%CI: 2.53-17.53) respectively.Conclusion: Mothers experiencing weight gain during pregnancy that was not in accordance with IOM standards and anemia were found to increase the risk of LBW. Monitoring of weight gain during pregnancy should be implemented using the IOM standards and anemia prevention among pregnant mothers should be enhanced.

Emotional support is the only social support associated with the quality of life of people living with HIV

Background and purpose: The quality of life of people living with HIV is influenced by many factors, one of which is social support. Social support consists of four elements, namely information, instrumental, emotional and appraisal supports. Publication on the association between the quality of life of people living with HIV and the four elements of social support shows inconsistent results. The purpose of this study is to determine the association between the four elements of social support and the quality of life of people living with HIV.Methods: A cross-sectional survey was carried out at the WM Medika Clinic, Kerti Praja Foundation, Denpasar, Bali. Samples were people living with HIV who came to the clinic between July-August 2018 to take antiretroviral (ARV) drugs. The total number of samples was 92 patients selected through the convenience sampling. Data was collected by conducting individual interviews and consisted of respondent characteristics, quality of life, information, instrumental, emotional and appraisal supports. Data were analyzed using logistic regression to determine the association between social support and quality of life of people living with HIV.Results: Emotional support was the only element of social support found to be significantly associated with quality of life of people living with HIV with AOR=4.918 (95%CI: 1.268-19.082). Whereas the other three elements were not found to be related to the quality of life of people living with HIV, these were instrumental support (AOR=0.865; 95%CI: 0.228-3.278); information support (AOR=0.949; 95%CI: 0.248-3.637); and appraisal support (AOR=0.317; 95%CI: 0.095-1.057).Conclusion: The quality of life of people living with HIV is found to be related to emotional support and is not found to be related to information, instrumental and appraisal supports. Emotional support needs to be addressed in order to further improve the quality of life of people living with HIV.

Stigma and discrimination: Barrier for ending AIDS by 2030 and achieving the 90-90-90 targets by 2020

The Joint United Nations Programme on HIV-AIDS (UNAIDS) put forward an ambitious vision of “three zero” which consisted of zero new HIV infections, zero discrimination and zero AIDS-related deaths. In other words, it is envisaged there will be no new HIV infections, no more discrimination towards people living with HIV and no more AIDS-related deaths. UNAIDS also set the target of “ending AIDS” as a public health threat by 2030. In order to end the HIV epidemic by 2030, in 2014 UNAIDS established a fast tract strategy namely "90-90-90" which means by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained access to antiretroviral therapy (ART) and 90% of all people receiving antiretroviral therapy will achieve viral suppression. If this target of "90-90-90" is achieved, it is estimated that by 2020 at least 73% of all people living with HIV worldwide will experience viral suppression; further modeling suggests that if this target is achieved this will bring about the “end of AIDS” by 2030.

Barriers to mental health services at public health centers: Providers’ perspectives

Background and purpose: The disparity between the increasing prevalence of mental health (MH) illness and the availability of treatment in Indonesia remains high, despite the campaign to provide MH services at public health centers (PHCs) initiated by the government in 2014. This study explored barriers to provide MH services at PHCs in Denpasar, Bali, Indonesia in order to identify priorities to improve the services.Methods: This qualitative study was conducted from March to December 2015 and employed in-depth interviews and focus group discussions (FGDs). In-depth interviews were conducted with the Head of Denpasar City Health Office to explore the barriers of MH services provision at PHCs in the scope of policy and services management. Interviews with general practitioners (GPs) from 4 PHCs in Denpasar were conducted in order to explore the experiences and barriers of MH services in the PHC clinics. To explore further the MH services implementation in the community, two FGDs were conducted with the MH program managers and community health workers (CHWs). The interviews and FGDs were recorded, and the verbatim transcripts were analyzed using a thematic framework analyses.Results: Barriers to MH service provision identified in our study are poor dissemination of the national policy to the local government and PHCs; low prioritization of MH issues; organization workforce issues; funding concerns; poor coordination and supervision; poor management and recording system; scarcity of ancillary facilities and other resources such as psychotropic medicines.Conclusion: The findings of this study highlight the importance of national policy dissemination and collaboration between local government, health providers and CHWs to overcome the barriers in providing MH services at PHC level.