Health Policy Commons^™

Environmental Perspective For System Dynamics Modeling Of Stunting Mitigation To Achieve The Sustainable Development Goals In West Sumatra, Indonesia, Elsa Yuniarti, Nabila Azzahra, Yulhendri Yulhendri, Heldi Heldi, Mery Delvina, Saskia Putri Azeli

Kesmas

This study developed a system dynamics model to simulate stunting reduction in West Sumatra Province, Indonesia, by integrating infant and toddler health, maternal health, and environmental determinants. Secondary data from 2020–2024 on low birth weight, immunization, malnutrition, exclusive breastfeeding, maternal chronic energy deficiency, iron and folic acid supplement distribution, sanitation, and safe drinking water access were compiled from West Sumatra Provincial Health Office and Statistics Indonesia, and validated through consultation with five stakeholder institutions. Causal Loop Diagrams mapped feedback relationships among determinants and were translated into Stock Flow Diagrams using Powersim Studio 10. The model was validated through structural verification, …

Complex Systems Mapping Of Fiscal Growth Dynamics At Strategic Maritime Chokepoints Using Time-Series Slopes, Rahul Balamurugan, Preethi Nanjundan, Avichal Sharma

Northeast Journal of Complex Systems (NEJCS)

This study examines how maritime and trading states allocate public resources between defence, health, and economic growth around three strategic chokepoints the Strait of Malacca, the Strait of Hormuz, and the Suez Canal. The analysis extends the classic “guns versus butter” framing by treating defence and health spending as co-evolving components of an interconnected fiscal-growth system. Using World Development Indicators data (1999-2024), trend slopes are estimated for military spending (% of GDP), healthcare spending (% of GDP), and GDP growth (annual %). Two derived indicators are computed, a defence-to-health slope ratio (military slope/health slope) and a fiscal-balance proxy (health slope …

Analysis Of Systematic Trade-Offs Between Military And Healthcare Expenditure Alongside Gdp Growth Of Select Asian And Western Exporting Economies In The 21st Century, Rahul Balamurugan, Carlos Gershenson, Preethi Nanjundan, Hiroki Sayama

Northeast Journal of Complex Systems (NEJCS)

This study explores the complexity in the trade-offs between military expenditure, healthcare expenditure, and GDP growth across select Asian nations and major weapon-exporting countries, examining how nations allocate finite resources between national security and human well-being over the past two decades. Using a systems science approach, the research integrates Granger causality testing to analyze temporal and directional relationships among GDP growth, military expenditure, and healthcare expenditure, uncovering their dynamic interdependencies. The methodology includes trend and slope analysis, Granger causality testing, outlier detection, and clustering to identify heterogeneity in resource allocation strategies. Developed, weapon-exporting nations exhibit complementary trends, with strong causality …

Effect Of Universal Health Coverage On Neonatal Mortality Rate In Sub-Saharan Africa: Addressing Missing Data In Health Indicators, Elizabeth Nalule Arihoona

Graduate Research Theses & Dissertations

This study utilizes two mixed-effects models to examine the effect of Universal Health Coverage on Neonatal Mortality Rate (NMR) in 30 countries of Sub-Saharan Africa from 2000-2019 while addressing the missing data in health indicators. Using natural cubic spline interpolation, I impute the missing values in the health coverage indices to preserve the location- specific trends of the data. Findings indicate that among the health Coverage indices, only Index1, which directly relates to coverage of maternal, newborn and child health services is significantly associated with reduced NMR. While higher Current Health Expenditure is associated with reduced NMR, a higher share …

Telemedicine Adoption In Developing Economies: A Systematic Review On The Enablers And Barriers, Zaidbren Macabato, Lemuel Clark Velasco, Art Brian Escabarte, Mae-Lanie Ong Poblete, Armando Isla Jr., Rentor Cafino, Sarah Lizette Aquino-Cafino, Frevy Teofilo-Orencia

Kesmas

Telemedicine’s adoption has been effective in certain contexts despite being controversial in certain settings because of its tendency to cause misdiagnosis and concerns about data privacy. This study aimed to synthesize the research findings on the factors leading to the adoption of telemedicine among developing economies. The study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology to analyze 27 related literature and the Unified Theory of Acceptance and Use of Technology to map out the factors considered enablers and barriers in adopting telemedicine. Results showed that performance expectancy, effort expectancy, social influence, and facilitating conditions were significant predictors. …

A Qualitative Study Exploring Graduated Medical Residents’ Research Experiences, Barriers To Publication And Strategies To Improve Publication Rates From Medical Residents, Dorothy Kamya, Brigette Macharia, Wangari Siika, Caroline Mbuba

Anaesthesiology, East Africa

Background: In Kenya, postgraduate medical residents must complete a research dissertation for their Master of Medicine studies. However, the subsequent publication rate is lower than in higher-income settings, limiting the availability of population-specific data. This study explored residents’ experiences with research, reasons for the low publication rate, and strategies to improve publication rates.

Methods: In-depth interviews were conducted with 9 faculty members and non-academic support staff, as well as 18 Master of Medicine graduates who had successfully completed their research projects, to investigate their experiences with conducting, supervising, and publishing research. The interview data was analysed using inductive …

Risk Factors For Cognitive Impairment In Adult Population Of Coastal Area: A Cross-Sectional Study In Maringkik Island, Indonesia, Herpan Syafii Harahap, Arina Windri Rivarti, Nurhidayati Nurhidayati, Fitriannisa Faradina Zubaidi, Dini Suryani, Legis Ocktaviana Saputri, Yanna Indrayana, Athalita Andhera, Muhammad Hilam, Abiyyu Didar Haq

Kesmas

Cognitive impairment is a medical condition commonly found in elderly populations, which can be due to vascular risk factors in patients. There remains limited data on risk factors for cognitive impairment among coastal region populations. This study aimed to investigate risk factors for cognitive impairment in the adult population of Maringkik Island, West Nusa Tenggara Province, Indonesia. Data collected were age, sex, education level, hypertension, antihypertensive treatment, diabetes mellitus, cigarette smoking, and body mass index status. A total of 114 participants were recruited using a consecutive sampling method. The participants’ cognitive function assessment used the Mini-Cog instrument. The cognitive impairment …

Exploration Of Positive Deviance In Prevention Of Underweight In The Under-Five: A Qualitative Study On Low-Income Urban Families, Irwan Budiono, Lukman Fauzi, Dewi Sari Rochmayani

Kesmas

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme …

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

Implementation Of Digital Health In Addressing Global Threats: Lessons From The Use Of Technology During Covid-19 Pandemic In Indonesia, Naili Shifa, Anisa Tiasari, Kemal N. Siregar

Kesmas

This research conducted a systematic literature review to explore the implementation of digital health in Indonesia, focusing on the digital health policies, usage during the COVID-19 pandemic, benefits, and lessons learned. The study identified 10 relevant journals through database searches and analyzed the trends in publication, productive journals, and top institutions involved in digital health research. The findings revealed an increasing interest in digital health, with a growing number of published articles from 2021 to 2023. ScienceDirect emerged as the most productive journal, followed by PubMed and MDPI. The University of Indonesia and the University of Gajah Mada were the …

Patterns Into Pathways For Improving Safety Culture: Refined Latent Class Analysis Informs Tailored Decision Support For South Carolina Dss Safety Culture Improvements, Michaela Voit

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The rising prevalence of exposures to adverse childhood experiences (ACEs) demands a coordinated public health response, as a significant body of research details the cumulative impact of ACEs on chronic morbidities contributing to reduced life expectancy. Child welfare workers (CWW) are embedded in this public health effort, tasked with preventing and mitigating the impacts of ACEs through family and prevention services. The National Partnership for Child Safety (NPCS) may improve the wellbeing of CWWs and the effectiveness of Child Welfare (CW) services by improving the quality of safety culture within CW organizations. To inform NPCS quality improvement efforts, our project …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Editorial: The Public Health Scholars As The Health Leaders, Al Asyary, Meita Veruswati, Putri Bungsu Machmud, Indri Hapsari Susilowati

Kesmas

1. Achmadi UF. Kesehatan Masyarakat: Teori dan Aplikasi. Jakarta: Rajawali Pers; 2014.

2. Asyary A. Editorial. Kesmas. 2023; 18 (Special Issue 1): 1-3. DOI: 10.21109/kesmas.v18isp1.7201

3. Badan Kebijakan Pembangunan Kesehatan. Pembangunan Kesehatan di Indonesia melalui Kesinambungan Finansial Jaminan Kesehatan serta Meningkatkan Kualitas Layanan dengan Integrasi Data. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.

Applying Structural Equation Modeling To Better Understand The Relationship Between Stressors, Social Support And Wellbeing In The Lives Of Spouse Dementia Caregivers, Craig Holden

Dissertations, Theses, and Capstone Projects

Applying Structural Equation Modeling to Better Understand the Relationship Between Stressors, Social Support and Wellbeing in the Lives of Spouse Dementia Caregivers considers the utility of Pearlin et al.’s (1990) stress process model in understanding the needs of spouse caregivers. Data were drawn from eight biennial waves of the University of Michigan Health and Retirement Study (HRS) and analyzed using structural equation modeling. The final study sample comprised 774 spouses, average age 73, who were categorized based on Alzheimer’s Disease and Related Dementia (ADRD) and non-ADRD caregiver status. Results showed that for the study sample as a whole, social support …

Editorial, Al Asyary

Kesmas

No abstract provided.

Drug Ideologies Of The United States, Macy Montgomery

Helm's School of Government Conference - 2021-2024

The United States has been increasingly creating lenient drug policies. Seventeen states and Washington, the District of Columbia, legalized marijuana, and Oregon decriminalized certain drugs, including methamphetamine, heroin, and cocaine. The medical community has proven that drugs, including marijuana, have myriad adverse health side effects. This leads to two questions: Why does the United States government continue to create lenient drug policies, and what reasons do citizens give for legalizing drugs when the medical community has proven them harmful? The paper hypothesizes that the disadvantages of drug legalization outweigh its benefits because of the numerous harms it causes, such as …

Presidential Vote Share And Covid-19 Vaccination Rate In Indonesia: A District-Level Cross-Sectional Ecological Study, Gede Benny Setia Wirawan, Ni Luh Zallila Gustina, Ivy Cerelia Valerie, I Gusti Ayu Indah Pradnyani Rs, Muchamad Zaenal Arifin, Pande Putu Januraga

Kesmas

Political affiliation has been reported as a determinant of COVID-19 vaccine acceptance in some countries, although few studies have examined the Asian context. This study aims to fill this gap by employing an ecological study design using Indonesian regions as data points. Political affiliation was represented by incumbent President Jokowi’s vote share in the 2019 presidential election. Potential confounders included population density, human development index, availability of hospitals and primary health care, 2019–2020 economic growth, COVID-19 mortality rate, and proportion of Muslims in the population. The final analysis included 201 out of 501 districts and cities in Indonesia. Controlling for …

Oxidative Stress Levels Of Fine Particulate Matter (Pm2.5) And Urinary Glutathione Of Microbus Drivers, Purnama Sidebang, Agustin Kusumayati, Budi Haryanto

Kesmas

Urinary glutathione levels are known to be an early indicator of oxidative stress in travelers. This study analyzed the association between particulate matter (PM2.5) exposure on the road and urine glutathione levels in Jakarta’s microbus drivers. This cross-sectional study involved 96 microbuses (one of Jakarta’s public transportations) drivers of nine routes in Kampung Melayu Bus Station, Jakarta, Indonesia. An anthropometric assessment and a structured questionnaire were employed. Along with the participants driving on the road, real-time personal equipment measuring PM2.5 exposure concentrations was used. Total glutathione levels were measured using a colorimetric method. A correlation test and linear regression analysis …

Information-Motivation-Behavioral Skill In Diabetes Self-Management Using Structural Equation Modeling Analysis, Dien Kurtanty, Adang Bachtiar, Cicilya Candi, Alya Pramesti, Almira Fanny Rahmasari

Kesmas

Diabetes is the “mother” of various diseases increasing the risk of morbidity and mortality. Diabetes self-management, an effort made by patients to control blood sugar levels, is an important part of the management strategy. Therefore, this study analyzed information, motivation, and behavioral skills associated with diabetes self-management. Data were collected in the Special Capital Region of Jakarta, with 277 diabetic patients selected using a questionnaire by a systematic random sampling method. The analyzed variables were information (with indicator variables of information on physical activity, nutritional intake, drug consumption, and blood sugar monitoring); sociodemographic (age, sex, occupation, education level, and duration …

Job Satisfaction Model Of Primary Health Care Midwives Based On Indonesian Workforce Research In The Health Sector, Mieska Despitasari, Adang Bachtiar, Harimat Hendarwan, Besral Besral, Yuyun Yuniar

Kesmas

Promotive, preventive, curative, and rehabilitative efforts that are comprehensive, integrated, and sustainable are employed to enhance the health state of the global population. Within this context, however, the quality of primary health care depends on job satisfaction, which leads to the happiness of human resources in the health sector. Therefore, this study aimed to analyze and formulate a job satisfaction model among primary health care midwives in Indonesia. This study was an advanced secondary data analysis of a cross-sectional study conducted in 2017 by the National Institute of Health Research and Development, Ministry of Health of the Republic of Indonesia. …

The Effect Of Covid-19-Related Occupational Stress And Burnout In Referral Hospital Nurses, Yulastri Arif, Masyithah Fadhani

Kesmas

Nurses' continuous contribution to patient health makes them prone to occupational stress, which has been exacerbated during the COVID-19 pandemic. Occupational stress that lasts for a long time and is not resolved may cause burnout. Burnout experienced by nurses can impact patients, hospital services, and themselves. This study aimed to determine the effect of occupational stress on the incidence of nurse burnout during the COVID-19 pandemic. It used a quantitative approach with a cross-sectional design. The study sample was 235 nurses in six COVID-19 referral hospitals in West Sumatra from a proportional random sampling technique. Data were collected using a …

Developing A New Tool For Early Detection Of The Nutritional And Health Risk Factors Of Urban Workers’ Productivity, Hildagardis Meliyani Erista Nai, Arimbi Karunia Estri, Christina Ririn Widianti

Kesmas

Nutrition and health play vital roles in work productivity. This study aimed to develop a risk self-assessment tool called Early Detection of the Nutritional and Health Risk Factors on the productivity of urban workers. This study was conducted in two stages: 1) the development of the tool to determine the nutritional and health risk factors that affect productivity based on literature reviews and scoring systems and 2) the testing of validity and reliability. Finally, the tool contained 63 items, including 28 items on nutritional risk factors and 35 on health risk factors. The validity of the tool was assessed using …

Obesity And Asthma Risk In Indonesian Adults: Findings From The 2018 Indonesia Basic Health Research, Hoirun Nisa

Kesmas

Obesity and asthma are both global public health challenges. Mounting evidence suggests that obesity may increase asthma risk in adults; however, the association by sex remains uncertain. This study examined the association of obesity with asthma risk in Indonesian adult men and women. Data were obtained from the 2018 Indonesia Basic Health Research. The analysis included 299,837 men and 333,218 women aged ≥18 years. Asthma was identified by the self-report of a doctor’s diagnosis. Obesity was defined as a body mass index ≥30 kg/m2. A logistic regression was used for data analysis. Asthma prevalence was 2.7% (2.5% in men and …

Maternal And Child Health Handbook Utilization, Quantity And Quality Of Antenatal Services, And Maternal Emergency Rates In Padang City In 2022, Rena Afri Ningsih, Yusrawati Yusrawati, Joserizal Serudji

Kesmas

This study analyzed the relationship between the utilization of the Indonesian Ministry of Health’s Maternal and Child Health Handbook and the quantity and quality of antenatal care to maternal emergency levels. This study applied mixed methods with a consecutive sampling technique and included 108 mothers undergoing maternal emergencies at a central general hospital (quantitative) and eight mothers, seven midwives, and five cadres at primary health cares (qualitative) as informants. The result showed a relationship between the utilization of the Maternal and Child Health Care Handbook (p-value = 0.043), the quantity of antenatal care (p-value

The Determinants Of Stunting In The Under-Five In Three Municipalities In The Special Capital Region Of Jakarta, Tria Astika Endah Permatasari, Chairunnisa Chairunnisa, Hernani Djarir, Lily Herlina, Munaya Fauziah, Andriyani Andriyani, Yudi Chadirin

Kesmas

The COVID-19 pandemic has impacted the global decline in public health status. This study aimed to analyze the determinants of stunting in the under-five in three municipalities in the Special Capital Region of Jakarta, Indonesia. A cross-sectional study was conducted in August-December 2020 with 460 pairs of mothers and children selected by simple random sampling. Stunting was measured using a conventional anthropometric index (length/height-for-age), and anthropometric failure was measured using the Composite Index of Anthropometric Failure. The prevalence of stunting, underweight, and wasting was 41.5%,35%, and 19.8%, respectively, and 62% of the under-five experienced anthropometric failure. The dominant factor associated …

The Potential Of Private Health Insurance Ownership Based On The 2018-2020 National Socioeconomic Survey Data, Arief Rosyid Hasan, Adang Bachtiar, Cicilya Candi

Kesmas

In 2014, the Indonesian Government introduced a social security program in the health sector. However, Indonesia’s out-of-pocket expenses remain high due to a lack of public interest in National Health Insurance services. Financing expensive health services with high out-of-pocket expenses has the potential to cause poverty. Private health insurance is considered a solution to this problem. This study aimed to determine the socioeconomic factors of private health insurance ownership and its potential in Indonesia. This study used secondary data from the 2018, 2019, and 2020 National Socioeconomic Surveys. Logistic regression analysis showed that the variables related to private health insurance …

Spatial Analysis For Enhancing The Use Of Health Data Availability From Different Sources To Help The Decision-Making Process, Tris Eryando

Kesmas

Spatial analysis in public health has become a common method used by researchers to understand the distribution of public health aspects related to the surrounding environment. It can also be used to analyze individual information in the form of a dot and the location or line of aggregated information in a specific area of study. Another benefit is the possibility of using different data sources to be analyzed in one statistical model analysis, as long as the identification area is sufficiently clear as a key variable. Spatial analysis can show an object's distribution on a locational map and explain the …

Sars-Cov-2 Antibody Seroprevalence In Jakarta, Indonesia, Iwan Ariawan, Hafizah Jusril, Muhammad N Farid, Pandu Riono, Wiji Wahyuningsih, Widyastuti Widyastuti, Dwi Oktavia T L Handayani, Endang Sri Wahyuningsih, Rebekka Daulay, Retno Henderiawati, Safarina G. Malik, Rintis Noviyanti, Leily Trianty, Nadia Fadila, Khin Saw Aye Myint, Frilasita A. Yudhaputri, Neeraja Venkateswaran, Kodumudi Venkateswaran, Venkatachalam Udhayakumar, William A. Hawley, Juliette Morgan, Paul M. Pronyk

Kesmas

The SARS-CoV-2 transmission dynamics in low- and middle-income countries remain poorly understood. This study aimed to estimate the SARS-CoV-2 antibodies seroprevalence in Jakarta, Indonesia, and to increase knowledge of SARS-CoV-2 transmission in urban settings. A population-based serosurvey among individuals aged one year or older was conducted in Jakarta. Employing a multistage sampling design, samples were stratified by district, slum, and non-slum residency, sex, and age group. Blood samples were tested for IgG against three different SARS-CoV-2 antigens. Seroprevalence was estimated after applying sample weights and adjusting for cluster characteristics. In March 2021, this study collected 4,919 respondents. The weighted estimate …

A Stunting Prevention Risk Factors Pathway Model For Indonesian Districts/Cities With A Stunting Prevalence Of ≥30%, Nina Fentiana, Endang L. Achadi, Besral Besral, Abram Kamiza, Trini Sudiarti

Kesmas

The prevalence of stunting in Indonesian children aged 0-23 months is a public health problem caused by direct and indirect factors. This study aimed to discover the path of the relationship between various risk factors and the stunting prevalence of ≥30% in 165 districts/cities in Indonesia. Data were obtained from the 2018 National Basic Health Research, National Socioeconomic Survey, and the Statistics Indonesia with a cross-sectional approach. The secondary data on stunting and risk factors were aggregated at the district/city level from individual data; children aged 0-23 months. The path analysis used to determine a stunting prevention model showed that …

Determinants Of Type 2 Diabetes Mellitus Among Passive Smokers, Adinda Rahma Triyaniarta, Santi Martini, Kurnia Dwi Artanti, Sri Widati, Rizma Dwi Nastiti

Kesmas

Type 2 diabetes mellitus (T2DM) leads to complications of other diseases. The modifiable risk factors for T2DM are overweight, physical activity, hypertension, unhealthy diet, and smoking. This study aimed to analyze determinants of T2DM incidence in passive smokers among various factors. This study was conducted at Hospital X in Surabaya City, East Java Province, Indonesia, from September 2019 to April 2020. The variables were univariate, bivariate, and multivariate. Case samples were T2DM patients and passive smokers, while control samples were non-T2DM patients and passive smokers, with 52 respondents per group, of 104 total respondents. Variables statistically significant related to the …