Media Kesehatan Masyarakat Indonesia (MKMI) is a scientific journal published by the Faculty of Public Health, Hasanuddin University since 2004. Media Kesehatan Masyarakat Indonesia obtained the identity serial number with pISSN 0216-2482 in 2007 and eISSN 2356-4067 in 2014. Media Kesehatan Masyarakat Indonesia accepts scientific papers in the form of research reports (original research papers), systematic literature reviews, meta-analyses with a focus on the development of public health issues problems in Indonesia, including the developments and main problems in the field of epidemiology; Health Promotion; Environmental Health, Occupational Health, and Safety, Health Administration and Policy, Biostatistics, Reproductive Health, Hospital Management, Nutrition Science, Health Information Systems in Regional of Indonesia. Media Kesehatan Masyarakat Indonesia collaborates with the Professional Organization of the Ikatan Ahli Kesehatan Masyarakat Indonesia (IAKMI) in terms of assisting the advancement of public health science and the dissemination of research results. Although focused on the Indonesia region, MKMI does not preclude manuscript beyond the region which has correlative and/or comparable issues within that geographical scope. Articles published in Media Kesehatan Masyarakat Indonesia go through a double-blind peer-review process. Therefore, the decision to accept scientific articles is in the right of the Editorial Board based on peer reviewers' recommendations.
Faculty of Public Health, Hasanuddin University, Makassar
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Job Stress and Organizational Resources as Predictors of Teachers Psychological Well-Being: A JD–R-Based Study in Semarang
Teacher Psychological Well-Being (PWB) is increasingly recognized as vital to educational effectiveness, yet empirical studies in low and middle-income countries remain limited. This study investigates the predictors of PWB among senior high school teachers in Semarang, Indonesia, using the Job Demands–Resources (JD–R) model. A cross-sectional analytic design was employed, involving all 290 teachers from six public schools. Data were collected through validated questionnaires measuring job stress, organizational climate, career development, working conditions, and well-being, alongside demographic variables. Descriptive statistics, Spearman correlations, and multivariate logistic regression were used to analyze the data. Results showed that over half of the participants experienced high job stress, and 46.2% reported low psychological well-being. Regression analysis identified job stress as the strongest negative predictor (OR = 6.521), while favorable organizational climate (OR = 2.849), career development opportunities (OR = 2.492), and supportive working conditions (OR = 2.422) were significant positive predictors. Gender and education also influenced well-being, with female teachers and those with lower levels of educational reporting poorer outcomes. The model explained 42.1% of the variance in well-being and demonstrated high classification accuracy (78.6%). These findings emphasize the importance of addressing systemic and organizational factors rather than focusing solely on individual coping in promoting teacher well-being. The study validates the JD–R framework in an Indonesian context and offers evidence-based insights for educational reform. These results highlight actionable levers for schools and policymakers, including workload rationalization, strengthening supportive climates, and institutionalizing equitable professional development to improve teacher well-being. Longitudinal research is recommended to assess the long-term impact of targeted interventions.
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Strengthening Community-Based NCD Prevention through Service Quality and Availability: Lessons from Banjarmasin City
The main cause of death both globally and nationally is Non-Communicable Diseases (NCDs). Integrated Non-Communicable Disease Posts (INCDs Posts) play a crucial role in early detection and control of NCD risk factors at the community acceptance of INCDs Posts services. This study aims to analyse the influence of accessibility, availability, and services on community acceptance of INCD Posts in Banjarmasin City. A cross-sectional design was used, with data analysed using Partial Least Squares-Structural Equation Modelling (PLS-SEM) on 654 respondents. The variables analysed included accessibility, availability, quality, and community acceptance of INCDs Post services. The results of the study indicate that service quality and availability have a positive and significant impact on community acceptance, while accessibility does not have a significant direct impact. Service quality also acts as a mediator between accessibility and acceptance, as well as between accessibility and availability. Overall, service quality and availability are the dominant factors influencing community acceptance. These findings recommend that health policies should shift from an access focused model to a quality-oriented framework. In particular, policymakers should prioritise capacity building and resource reliability over further infrastructure expansion in order to build public trust and ensure the long-term sustainability of community based non-communicable disease prevention programmes.
Prevalence and Risk Factors and Efforts to Reduce Dengue Fever and Dengue Hemorrhagic Fever Infections at PKU Muhammadiyah Gamping Hospital, Yogyakarta
The incidence of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) has increased sharply in recent decades, making these infections endemic in several parts of the world. The purpose of this study was to analyze the prevalence, risk factors, and efforts to reduce DF and DHF infections at PKU Muhammadiyah Gamping Hospital, Yogyakarta. This study employed an observational cross-sectional design. The study sample consisted of patients diagnosed with DF or DHF at general hospitals in Yogyakarta between January 2019 and December 2023 who met the inclusion and exclusion criteria. Patients with a DF or DHF diagnosis but incomplete data were excluded. Sampling was conducted using a consecutive sampling method, retrieving information from patient data recorded in medical records. The research obtained ethical approval from the PKU Muhammadiyah Gamping Hospital Ethics Committee under permit number 054/KEP-PKU/II/2024. A p-value of 0.005 indicates a correlation between the incidence of DF DHF and liver illness. The value of OR is 4.660. A p-value of 0.006 indicates a correlation between the occurrence of DF DHF and corticosteroid therapy. This study found that the incidence of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) was correlated with diabetes, hypertension, kidney disease, and asthma/chronic lung disease, which were protective factors. However, liver disease and a history of corticosteroid therapy were identified as significant risk factors. These findings suggest that impaired liver function and long-term corticosteroid use may impair the immune response, increasing susceptibility to dengue infection and its severe manifestations. Therefore, clinical management and prevention strategies should prioritize monitoring of patients with liver impairment or those undergoing corticosteroid therapy, especially in dengue-endemic areas.
The Effects of Consumption Habits of Vegetables Rich in Galactagogue on Breastfeeding Intensity
Providing breast milk to babies becomes one of the keys to growth and development. Breast milk contains various crucial nutrients needed for the growth and development period of babies. To analyze the effect of consuming local vegetables containing galactagogues on breastfeeding intensity. This study was a cross-sectional study conducted at 38 Community Health Centers in Tasikmalaya Regency in 2024. The population was 5971 people. The sampling technique is proportional sampling. The study sample was 450 breastfeeding mothers. The independent variables were consumption behaviros of galactagogue vegetables, such as katuk leaves, moringa, spinach, young papaya, and banana blossoms. The dependent variable was breastfeeding intensity measured by the frequency and duration of breastfeeding. Bivariate analysis used chi-square and multivariate analysis used multiple logistic regression. The results of the study showed that consumption of katuk leaves and banana flowers would increase the frequency of breastfeeding (aOR: 0.40; p value=0.000; 95%CI: 0.23 - 0.61 and aOR: 2.23; p value=0.004; 95%CI: 1.30 - 3.85) and extend the duration of breastfeeding (aOR: 3.67; p value=0.000; 95%CI: 1.99 - 6.77 and aOR: 3.01; p value = 0.026; 95%CI: 1.14 - 7.98). Breastfeeding mothers can consume local foods made from processed banana blossoms and katuk leaves in an effort to increase breast milk production by utilizing local foods.
The Effect of Pesticide Exposure on Metabolic Syndrome: An Epidemiological Analysis in an Agricultural Population
Metabolic syndrome, characterised by hyperglycaemia, dyslipi-daemia, hypertension, and central obesity, is a global health problem, and exposure to pesticides is an important risk factor for agricultural workers. This study aims to analyse the effects of pesticide exposure, sociodemographic factors, and Personal Protective Equipment (PPE) usage behaviour on glucose levels, HDL, and LDL in farmers in Kubu Raya District, West Kalimantan. A cross-sectional study was conducted on 60 farmers selected using stratified random sampling. Data were collected through structured interviews, fasting blood tests, and analysed using the chi-square test with a significance level of 95%. The results showed a high prevalence of high blood glucose (56.7%), low HDL (35.0%), and high LDL (55.0%). Pesticide exposure was significantly associated with glucose levels (p=0.043), with hypergly-caemia being higher in the high-exposure group (70.8%) compared to the low-exposure group (33.3%). Age was also significant for glucose (p = 0.046), with a higher prevalence in the ≥40 years group (65.8%) compared to the 40 years group (40.9%). The use of PPE showed a significant association with all metabolic parameters: higher glucose levels were more common in the non-routine PPE use group (70.6% vs. 38.5%; p = 0.012), lower HDL levels were higher in the non-routine group (44.1% vs. 23.1%; p=0.043), and higher LDL levels were more common in the non-routine group (64.7% vs. 42.3%; p = 0.046). These findings confirm that pesticide exposure, age, and APD usage behaviour contribute to metabolic disorders among farmers. Occupational health interventions emphasizing APD use, routine metabolic screening, and community-based education are needed to reduce the risk of metabolic syndrome in the agricultural population.
Rethinking School Nutrition via Community Engagement: A Review with Implications for Indonesia’s MBG Program
Community engagement has become a growing concern in the implementation of school nutrition programs, particularly in addressing issues of child malnutrition, food insecurity, and educational outcomes. However, definitions and levels of participation remain conceptually fragmented across various studies. This study aims to systematically review the scope, forms, and implications of community engagement in school-based nutrition programs. A Systematic Literature Review (SLR) was conducted on 89 Scopus-indexed publications from 1984 to 2025 using the PRISMA 2020 protocol. Thematic analysis was employed to identify the conceptual, methodological, and contextual variations of community involvement. Data were collected through document analysis of peer-reviewed journal articles focusing instead on qualitative synthesis. The study examined forms of engagement based on eight participation levels and five thematic domains. Results show that the relevance of the topic has increased significantly, especially in the last decade, with a marked rise in academic interest from diverse institutions. While collaborative practices such as cross-sector coordination, parental involvement, and grassroots food initiatives are often promoted, most programs operate at symbolic or consultative levels, rarely advancing to full empowerment. Contextual cases, such as Indonesia’s Free Nutritious Meals Program (MBG), illustrate both the promise and challenge of operationalizing community engagement at scale. This review concludes that future research must adopt a more theory-informed and practice-oriented approach to community participation, supported by clearer frameworks, inclusive governance models, and culturally adaptive implementation strategies.
Personalized Postpartum Interventions and Their Impact on Working Mothers
Exclusive breastfeeding is a critical determinant in maintaining infant health and nutritional status. However, its coverage remains low, particularly among postpartum working mothers. Limited maternal knowledge, lack of family especially spousal support, and low maternal satisfaction are reported key factors contributing to suboptimal breastfeeding practices. This quasi-experimental study employed a non-equivalent control group pre-test and post-test design. It was conducted from January to October 2024 in the working area of the Darussalam Primary Health Center in Medan, Indonesia. A total of 140 postpartum working mothers were purposively selected and divided into two groups: intervention (n=70) and control (n=70). The intervention group received PBE through a pocketbook, educational videos, and personalized counseling provided by trained midwives. They were followed up at day 7, month 1, month 3 and month 6 post-intervention. Data were analyzed using paired t-test, independent t-test, and repeated measure ANOVA. The exclusive breastfeeding adequacy score significantly increased in the intervention group (p=0.000; p<0.05), indicating meaningful differences across measurement periods. Between-group analysis showed a significant difference (F=11.040; p=0.002; p<0.05). Overall improvements were also significant in maternal knowledge (F=37.238; p= <0.001), maternal satisfaction (F=31.932; p=<0.001), and spousal support (F=26.083; p=<0.001). Personalized breastfeeding edu-cation effectively enhances exclusive breastfeeding adequacy, maternal knowledge and satisfaction, and as well as, and spousal support among postpartum working mothers. Primary health centers and Medan City Health Office are encouraged to integrate personalized breastfeeding education into antenatal and post-natal care programs, involve husbands as active companions, and provide adequate facilities as well as training for breastfeeding-supportive healthcare providers.
Cost-Effectiveness and Feasibility of Anemia Management in Pregnant Women: A Systematic Review
Anemia among expectant mothers is a major health issue worldwide, especially in developing countries, where prevalence reaches 37%. Various interventions, such as micronutrient supplementation and intravenous iron administration, have been widely implemented. However, limited systematic reviews have comprehensively evaluated both the cost-effectiveness and feasibility of such interventions in low- and middle-income countries (LMICs). This study aims to systematically evaluate recent evidence on the feasibility and cost-effectiveness of anemia management interventions for pregnant women in developing countries. The review followed the 2020 PRISMA guidelines and was registered in PROSPERO (CRD420251089753). Article searches were conducted across five primary databases (CINAHL, CENTRAL, PubMed, Wiley, and Taylor & Francis) for publications between 2015 and 2025. Study selection was performed independently by six authors. Seven studies meeting the inclusion criteria were analyzed narratively. The findings indicated that interventions such as Multiple Micronutrient Supplementation (MMS) and Intravenous Iron Sucrose (IVIS) were highly cost-effective, demonstrating Incremental Cost-Effectiveness Ratios (ICERs) substantially lower than the willingness-to-pay threshold (USD 653–1,792 per DALY) in developing nations, including Indonesia. Feasibility of implementation was influenced by healthcare system capacity, logistical resources, educational initiatives, and sociocultural contexts. Overall, MMS and IVIS interventions demonstrated superior efficiency and effectiveness compared to conventional therapies, though their success relies on system readiness and contextual adaptation. This review fills a critical evidence gap by jointly assessing cost-effectiveness and real-world feasibility, providing a strong foundation for designing sustainable, evidence-based strategies to manage anemia in resource-limited settings.
Multivariate Analysis of Risk Factors for Destructive Behavior in Children in Indonesia
Conduct disorders pose a significant global burden, affecting an estimated 5.75 million children and adolescents, especially boys. Conduct disorders involve repetitive behaviors that violate others rights and can jeopardize normal relationships between children and those around them. Major behavioral issues in children often occur in both school and family settings and are closely linked to the roles of parents and teachers as educators and guides. Additionally, children at a young age are highly curious and eager to explore new things; the rapid growth of technology introduces new challenges for them. Without parental guidance, considering factors such as parenting styles, education level, socioeconomic status, and occupation, children's social lives may be significantly impacted. This study aims to analyze various risk factors associated with disruptive behavior among children in Indonesia. This cross-sectional study used a guided questionnaire involving 301 parents/guardians of children aged 2-5 years. In this regard, the researchers were assisted by data enumerators residing at the study site. Data collection was conducted in two regions in Indonesia, Greater Jabodetabek (Jabodetabek) and Aceh, from October 2024 to January 2025. Bivariate analyses were performed using the Chi-square test, followed by binary logistic regression to determine factors independently associated with disruptive behavior. Bivariate analysis indicated that type of content (p = 0.017), screen time allocation (p = 0.018), and parenting pattern (p = 0.043) were significantly associated with disruptive behavior, while other variables such as parental education, domicile, occupation, marital status, and child’s age or gender showed no significant relationships. In the multivariate model, only type of content remained a significant predictor (p = 0.018). The study highlights that the quality of media content, rather than the amount of screen time, plays a key role in the emergence of disruptive behavior among children. Parental guidance and the selection of educational media content are essential preventive strategies. Interventions focusing on digital literacy and positive parenting may help mitigate the risk of behavioral problems in early childhood.
Developing The Community Outreach Effectiveness Model (COEM) for HIV Prevention Among Key Populations in Indonesia: Evidence from The IBBS
Indonesia continues to experience a concentrated HIV epidemic, with key populations female sex workers, men who have sex with men, transgender women, and people who inject drugs bearing a disproportionate burden, while uptake of HIV prevention services and sustained behavior change remain inadequate. Community outreach has been widely implemented to address these gaps; however, its effectiveness has not been comprehensively documented at the national level. This study aimed to assess the impact of community outreach interventions on HIV prevention uptake and behavioral outcomes among key populations in Indonesia using the Community Outreach Effectiveness Model (COEM). A quantitative retrospective study was conducted using secondary data from the Integrated Bio-Behavioral Survey (IBBS) collected across multiple districts in Indonesia. HIV prevention outcomes were compared between districts with and without community outreach interventions. The study population comprised key populations included in the IBBS, with sample sizes determined by the survey design. Data were collected through structured behavioral questionnaires and biological testing. Multivariable logistic regression analysis was applied to examine associations between exposure to outreach components and HIV testing uptake as well as consistent condom use, and the COEM was developed to operationalize outreach pathways linking inputs to outcomes. The results demonstrated that exposure to community outreach was strongly associated with higher HIV testing uptake across all key populations, with referral by outreach workers showing the greatest effect. Outreach exposure was also significantly associated with improved condom use, particularly through peer-delivered information, free condom distribution, and social media engagement. Combined exposure to multiple outreach components resulted in incremental improvements in both HIV testing uptake and consistent condom use. In conclusion, community outreach functions as a protective factor that strengthens HIV prevention behaviours among key populations in Indonesia, underscoring the need to institutionalize and scale up comprehensive, multi-component outreach strategies within national HIV policies and programs.
Optimising Drugs and Vaccines Management Utilizing 5 M Method: The Case of Riau Islands, Indonesia
A resilient health system should include the ability to access essential drugs and vaccines in all locations. This study aims to perform root cause analysis and develop recommendations to optimize drugs and vaccines management for Riau Islands Province, Indonesia. This study used qualitative approaches which included interviews and group discussions with key stakeholders (n=6) as well as an expert panel (n=4). Data on the underlying causes of problems and recommendations were structured into 5M (Man, Money, Machine, Method, Material). Problems related to Man (limited human resources) were identified for most management stages. Other problems reported: Planning – Money (inefficient budget management), Material (inaccurate data on local needs); Receival (unqualified delivery couriers); Storage - Machine (lack of infrastructure and cold chain assurance); Distribution – Material (urgent supply requests), Money (high cost of transportation), Machine (unqualified (cold chain) delivery couriers); Disposal – Machine (limited capacity); Documentation – Machine (unintegrated information system), and Material (mismatched data). Recommendations included improving human resources and budget management; improving infrastructure, especially to enhance cold chain assurance; scheduled distribution; and integrating the internal information system into the national system to provide real-time stock data. Findings from this study should provide a model for optimising pharmaceutical management in low-resource settings.
Clustering Community Risk Behaviors for Non-Communicable Diseases in Indonesia: Based on Indonesian Health Survey Data
Non-communicable Diseases (NCDs) such as hypertension, stroke, diabetes mellitus, and heart disease are major causes of morbidity and mortality in Indonesia. Community behaviors, including smoking, low physical activity, and unhealthy diets, significantly influence NCD incidence. To analyze associations between behavioral risk factors (daily smoking, physical inactivity, consumption of sugary foods and drinks, salty foods, fatty foods, soft drinks, and inadequate fruit intake) and the prevalence of NCDs, and to classify regions based on risk factors and disease prevalence. A cross-sectional study was conducted using secondary data from the 2023 Indonesian Health Survey (IHS), encompassing 345,000 households across 39 provinces. The Ministry of Health collected the data through standardized interviews and health examinations conducted by trained surveyors. Data analysis employed descriptive statistics, Pearson correlation, and K-Means Clustering. Daily smoking correlated positively with hypertension, stroke, and diabetes. Fatty food consumption showed strong positive associations with the same diseases (r = 0.45–0.48, p < 0.01). Soft drink consumption demonstrated a significant negative correlation, especially with stroke (r = -0.66, p < 0.001). Hypertension (7.2%) and stroke (7.1%) were more prevalent than diabetes (2.0%) and heart disease (0.76%). North Maluku showed the highest behavioral risks, Bali the lowest. DI Yogyakarta and DKI Jakarta had the highest NCD prevalence, while the Papua Mountains had the lowest. K-Means clustering grouped provinces into low, medium, and high-risk clusters. Community behaviors, particularly smoking and fatty food intake, significantly affect NCD prevalence. Public health programs should target smoking cessation, healthy diet promotion, and increased physical activity to reduce the NCD burden.
Indoor Air Quality and Sick Building Syndrome in Selected Public Buildings in Shah Alam, Selangor
Indoor Air Quality (IAQ) is always associated with Sick Building Syndromes (SBS) despite the age of the buildings, particularly in buildings where indoor air pollutants may affect occupants’ health and productivity. This study assessed IAQ parameters and SBS symptoms in five selected public buildings aged 10 and above in Shah Alam, Selangor. Physical, chemical and biological parameters were measured, while structured questionnaires were completed by 87 respondents occupying the buildings. Most IAQ parameters were within the ranges of the Industry Code of Practice on IAQ (ICOP IAQ 2010), except for air velocity, formaldehyde and Total Volatile Organic Compound (TVOC) in two buildings. Statistical analyses showed no association between the building type and SBS occurrence, and no significant differences (p > 0.05) in air velocity, TVOC, CO2 or fungal count among the buildings. In order to reduce SBS risks and enhance SBS, the source of contaminants should be tackled and regular monitoring should be implemented to ensure compliance with IAQ limits.
Factors Associated with Coexisting Forms of Malnutrition (Stunting and Wasting) in Under-Five in Southeast Sulawesi
The presence of more than one type of nutritional disorder in a person's body is called Coexisting Forms of Malnutrition (CFM). Children with CFM, such as those experiencing stunting, wasting, and underweight, 12.3 fold risk of death (CI=7.67-19.28) compared to healthy children. Southeast Sulawesi has the tenth highest prevalence of these cases. This study used secondary data based on the Indonesian Nutrition Status Survey (SSGI) 2022 with a cross-sectional design using complex sample analysis. The sample was children under five from Southeast Sulawesi Province, with a final sample size of 8,518 children analyzed. The median age of the sample was 32 months, most of them were male (50.5%), the median birth weight was 3,128.8 grams, and most of their nutritional intake was not diverse (92.1%). Bivariate analysis used chi-square, and multivariate analysis used logistic regression with a full model approach. 3.1% of children had CFM (stunting and wasting). Factors associated with this case based on bivariate analysis (p-value <0.05) were child age, sex, mother's education, mother's occupation, food security, sanitation, socioeconomic status, weight measurement, and vitamin A administration. Factors associated with this case based on multivariate analysis were child age 36-47 months (OR=4.027; 95% CI=1.838-8.825; p-value=0.001), male (OR=1.832; CI=1.324-2.536; p< 0.000), child with Low Birth Weight (LBW) (OR=3.061; CI=1.879-4.986; p<0.000), and poorest socioeconomic status (quintile 1) (OR=3.109; CI=1.641-5.890; p<0.001).
Understanding Cardiovascular Risk: Insights From Coastal Communities in Southeast Sulawesi
Cardiovascular Disease (CVD) remains the leading cause of death worldwide, with a greater impact on low- and middle-income countries, particularly coastal communities that depend on fragile ecosystems. This study explores the effects of sociodemographic, behavioral, and metabolic factors on CVD incidence among the coastal population of Soropia, Konawe, Southeast Sulawesi. This research employs a quantitative approach with a cross-sectional design and applies Structural Equation Modeling (SEM) using Smart PLS software. Data collection was conducted through standardized questionnaires and physical examinations. The findings reveal that age significantly reduces CVD risk (p = 0.043, Exp(B) = 0.378), while gender and occupation show no significant impact. Among behavioral factors, a history of Non-Communicable Diseases (NCDs) significantly lowers CVD risk (p = 0.024, Exp(B) = 0.158), whereas smoking, alcohol consumption, and physical activity are not associated with CVD Risk. In the metabolic group, Low-Density Lipoprotein (LDL) is the only significant factor influencing metabolic risk (p = 0.026, Exp(B) = 0.615). Other metabolic markers, including waist circumference and blood glucose, show weak associations. These results highlight the critical role of addressing behavioral and metabolic risk factors in reducing CVD burden, particularly through targeted public health interventions tailored to the unique challenges faced by coastal populations. The study underscores the importance of integrating behavioral modifications and metabolic risk management in health programs to mitigate CVD risks effectively.
Dynamic Model of Stunting Incidents and Policies in Padang City
Stunting remains a significant public health challenge with complex, interconnected causative factors. Traditional static approaches fail to capture the dynamic relationships between environmental, health, and socioeconomic determinants. Dynamic modeling is essential for understanding these multifaceted interactions and developing effective prevention policies. Despite declining trends, Padang City's high prevalance of stunting necessitates urgent, targeted interventions to achieve national targets. This study aims to develop a dynamic model analyzing stunting factors in Padang City and formulate effective prevention policies. A quantitative descriptive method with a dynamic systems approach was employed. Primary data were obtained through stakeholder questionnaires, while secondary data were obtained from the Padang City Health Office and Statistical Reports (2018-2023). Analysis utilized PowerSim Studio 10 for dynamic systems modeling and Interpretative Structural Modeling (ISM) for policy strategy development. Seven main factors influencing stunting were identified: low birth weight, maternal health, immunization, diarrhea, living in slum areas, access to clean water access, and household sanitation. Simulation modeling demonstrated that improving environmental conditions, increasing immunization coverage, and administering iron tablets could reduce stunting rates by 50% over 25 years. ISM analysis revealed environmental factors (sanitation, waste management, and access clean water) as key elements with the highest driving force. Consistent immunization coverage could reduce stunting prevalence from 24.2% to 12% within the projection period, while improved sanitation programs may lower prevalence by 15%. The research provides an integrated approach prioritizing basic infrastructure improvement, environmental sanitation enhancement, cross-sector coordination, and community capacity building. This dynamic modeling framework offers valuable insights for comprehensive stunting prevention strategies. However, limitations include a modeling-only scope requiring field validation for implementation effectiveness.
Understanding the Impact of Pictorial Health Warnings on Smoking Behavior Among Adolescents
Smoking behavior remains a health challenge in Indonesian society. Riskesdas data shows an increase in smoking prevalence in adolescent groups. One of the control efforts is the implementation of PHW (Pictorial Health Warnings) on cigarette packs in accordance with Permenkes RI No. 28 of 2013. This study aims to determine the effectiveness of cigarette packs in influencing smoking intention and behavior PHW among adolescents in Tanah Bumbu Regency, Banjarbaru City and Banjarmasin City. The study used a quantitative method with a cross-sectional design. Samples were obtained through an accidental sampling technique, obtaining 315 smoking adolescents and 62 non-smoking adolescents. The instrument was a modified version of the Global Youth Tobacco Survey questionnaire. The analysis used was a linear regression test. The results further showed that 64.5% of respondents who did not smoke stated that their intention was very likely due to fear (89.03%) after seeing the warning and the image of smoking causing lung cancer, hence they did not smoke. Furthermore, there is a relationship between pictorial warnings on cigarette packaging with fear (p-value = 0.0001, r = 0.430) with a positive influence of 16.3%. In adolescent smokers, smoking pictures causing throat cancer 2 caused the most fear (71.3%) and the highest urge to quit smoking (66.48%). There is a relationship between pictorial warnings with fear (p-value = 0.0001, r = 0.195) and smoking cessation intensity (p-value = 0.0001, r = 0.728). The positive effect on fear was 3.5% and smoking cessation intensity was 52.9%.
Psychosocial Factors and Prevalence of Stress in Early Pregnancy: A Study in Makassar City
Stress during pregnancy can negatively impact the health of both the mother and the fetus, especially in the first trimester, which is a period of intense physical and emotional adaptation. This study aims to determine the prevalence and psychosocial factors associated with the occurrence of stress in first-trimester pregnant women in Makassar City. This study uses a cross-sectional design involving 256 first-trimester pregnant women from five public health centers in the suburban areas of Makassar City. Data were collected through interviews using a structured questionnaire. The Edinburgh Postnatal Depression Scale (EPDS10) instrument was used to measure stress levels. Analysis was conducted bivariately and multivariately using logistic regression. The prevalence of severe stress among pregnant women in the first trimester was 36.72%. Multivariate analysis revealed two factors significantly associated with severe stress: low family income (adjusted Prevalence Ratio (aPR) = 2.32; 95% CI: 1.15–4.66; p = 0.018) and poor interpersonal relationships with parents or in-laws (adjusted Prevalence Ratio (aPR) = 4.63; 95% CI: 1.53–14.02; p = 0.007). Socioeconomic factors and interpersonal relationships with parents/in-laws influence the high levels of stress experienced by first-trimester pregnant women. Early intervention that considers the family's economic aspects and social support from the surrounding environment is critical in preventing stress during pregnancy.
Mapping Trends and Patterns in Tuberculosis and Tobacco Use: Insights from a Bibliometric Analysis of 25 Years of Research
Tuberculosis (TB) and tobacco use represent two of the most pervasive global health challenges, with a particularly profound impact in Low and Middle-Income Countries (LMICs). Although numerous reviews have explored the clinical and epidemiological associations between TB and smoking. A systematic analysis of publication trends is lacking. This study aims to address this gap by providing a comprehensive bibliometric analysis of the intersection between TB and tobacco use, mapping its evolution, key research themes, collaboration networks, and underexplored areas. This study utilized a bibliometric method. Data from 13,876 articles indexed in Scopus were analyzed using RStudio, VOSViewer, and OpenRefine. PLOS ONE emerged as the most prolific journal, with Wang Y being the leading author, having published 178 articles. The University of California was identified as the leading institution with 707 publications. Emerging research topics include mathematical modeling and numerical simulation, reflecting increasing attention to computational approaches in respiratory disease research. Country collaboration networks revealed the United States as the dominant contributor, with significant partnerships with African countries. These findings emphasize the importance of smoking prevention in TB control strategies, offering insights to inform public health policies and guide future research on TB and smoking’s health impacts.
Lifestyle Activities That Contribute to The Risk of Stroke in Indonesia: Smoking, Consuming Fatty Foods and Soft Drinks
Stroke is the leading cause of death and disability in Indonesia, with a high prevalence reported in the Indonesian Health Survey (IHS) 2023. Smoking, consumption of fatty foods, and intake of soft drinks are major risk factors contributing to the increasing incidence of both ischemic and hemorrhagic stroke. This study aims to analyze the effects of smoking habits, fatty food consump-tion, and soft drink intake on stroke incidence in Indonesia using secondary data from IHS 2023. A quantitative design was applied, with chi-square test analysis performed using SPSS. The study population comprised all individuals recorded in the IHS 2023, which covered 38 provinces in Indonesia. Results showed that the age group 65–74 years had the highest incidence of stroke (35.4%), with a higher prevalence among men (8.8%) compared to women (7.9%). Education level and type of occupation were also associated with stroke prevalence. Statistical analysis demonstrated that smoking (p = 0.013), fatty food consumption (p = 0.003), and soft drink intake (p = 0.002) were significantly associated with stroke incidence. Among these, soft drink con-sumption was the strongest predictor (p = 0.001; OR = 3.717). In conclusion, smoking, fatty food consumption, and soft drink intake significantly affect stroke incidence in Indonesia, with soft drink consumption being the most influential factor.
Relationship Between Cadres Knowledge and Ability to Document Arumdalu Integrated Service Posts (Posyandu) Information System Reports
The high demands of administration and activities report at Integrated Service Posts (Posyandu) requiring cadres skills in documenting data accurately. In this field, the reality shows that many cadres lack adequate knowledge regarding. The Posyandu information system, especially the Arumdalu Posyandu. Therefore, this study aimed to determine the relationship between cadres' knowledge and ability to document reports on the Arumdalu Posyandu information system. The quantitative analytical research design used a cross-sectional, longitudinal (pre-post digital training), and mixed methods approach, complemented by Social Network Analysis (SNA). The research sample consisted of 60 Posyandu cadres at the Arumdalu Posyandu in the Sanggrahan Health Center working area, Sukoharjo Regency. Analysis was conducted univariately, bivariately using the Spearman Rank correlation test, multivariate with logistic regression, pre-post training test with Wilcoxon, qualitatively through FGDs, and SNA to map interactions between cadres. The results showed a significant relationship between cadres' knowledge and their ability to document reports (p = 0.003; r = 0.421). Multivariate analysis showed a significant effect of knowledge (OR = 3.42; 95% CI: 1.45–8.06), and education was also significant (OR = 2.87; 95% CI: 1.12–7.39). Longitudinal testing showed an average 22% increase in documentation skills after digital training (p < 0.001). Qualitative analysis identified motivation, workload, and institutional support as important factors, while SNA found the presence of key cadres as centers for information dissemination. In conclusion, increasing cadre capacity through digital training, supervision, institutional support, and utilizing cadres social networks is crucial for improving the quality of Posyandu cadres reporting.
Determinants of Food Management Behavior on Food Waste Reduction and Household Food Security through Expenditure Efficiency and Energy Consumption
Food Waste (FW) in urban households remains a serious issue as it contributes to economic losses, reduced dietary quality, and weakened food security. This study aims to identify the dominant factors influencing food management behavior, FW generation, and their implications for household food security in urban settings. A cross-sectional design was applied with urban households as the study population, and samples were selected using purposive sampling. Data were analyzed using Structural Equation Modeling (SEM) within the framework of the Theory of Planned Behavior (TPB) and Nudge Theory. The results indicate that attitude (β = 0.42; p < 0.01), subjective norm (β = 0.31; p < 0.05), and perceived behavioral control (β = 0.36; p < 0.01) significantly influence intention toward food management. Furthermore, intention strongly predicts actual food management behavior (β = 0.55; p < 0.001), which subsequently reduces FW (β = –0.47; p < 0.001). Reduced FW positively affects both food expenditure efficiency (β = 0.39; p < 0.01) and energy intake adequacy (β = 0.34; p < 0.05), two critical indicators of urban household food security. Behavioral factors play a crucial role in reducing FW and strengthening food security in urban households. Therefore, behavior-based interventions using TPB and Nudge Theory are recommended to be integrated into food education programs, household assistance, and urban food security policies to ensure effectiveness and sustainability.
Adaptation of Moringa Leaf Extract on Hemoglobin and Arm Circumference in Adolescent Girls Semarang
Adolescent malnutrition, particularly anemia, remains a major public health challenge in developing countries, including Indonesia, as it increases the risk of growth retardation, developmental disorders, poor pregnancy outcomes, and infectious diseases. Nutritional interventions during adolescence are crutial for improving health and breaking the intergenerational cycle of malnutrition. This study aimed to analyze the effect of Moringa oleifera capsules on hemoglobin (Hb) levels and Mid-Upper Arm Circumference (MUAC) among adolescent girls in Semarang. A quasi-experimental study with a pretest–posttest control group design was conducted in two junior high schools in Semarang (SMPN 39 and SMPN 8), involving 102 female students aged 13–15 years, who were selected using purposive sampling. Participants were assigned to an intervention group (n = 51) receiving 300 mg of Moringa oleifera capsules twice weekly for 6 months under teacher supervision, and a control group (n = 51) receiving no supplementation. Data were collected at baseline and after the intervention, including Hb measurement (Hemocue analyzer) and MUAC. Data were analyzed using paired t-tests and independent t-tests. Results showed a significant improvement in Hb levels in the intervention group (mean pretest 11.58±0.87 g/dL; posttest 13.65±0.89 g/dL; p<0.001), whereas no significant change was found in the control group (p = 0.132). MUAC also increased significantly in the intervention group (pretest 25.50±4.06 cm; posttest 26.21±4.94 cm; p = 0.002), with a greater improvement compared to the control group (p = 0.002). In conclusion, supplementation with Moringa oleifera effectively improved Hb levels and MUAC among adolescent girls. This intervention has potential as a practical and affordable strategy for preventing anemia and improving nutritional status in adolescents.
Evaluation of Anthropometric Data Quality for Children from Electronic-Based Nutrition Surveillance: A Case Study in Magelang Regency, Central Java, Indonesia
Data quality regarding the nutritional status of children under five is crucial for developing strategies to address nutritional issues. This study aims to develop indicators and assess the quality of anthropometric data from community-based nutrition surveillance using the EPPGBM application in Magelang Regency. The research employed an observational design with a quantitative approach. Data quality indicators were defined based on expert consensus using the Delphi method. These indicators were also used to construct an anthropometric data quality index (IKDA). The WPS Office spreadsheet was utilized to assess data quality and perform IKDA calculations. Nine data quality indicators were identified, categorized into four domains: representation, completeness, accuracy, and external consistency. Evaluation of the EPPGBM data revealed that indicators for representation and completeness were categorized as good quality. In contrast, within the accuracy domain, only the z-score accuracy indicator met the “good” standard, while the digit preference indicator showed poor quality. Specifically, digit preference accounted for 24.2% of weight measurements and 62.8% of height measurements, with clustering around digits 0 and 5. In the external consistency domain, the stunting prevalence from the EPPGBM results was lower than the 2022 SSGI results. The IKDA score for the data was 85.8. Overall, the evaluation identified that the EPPGBM data quality in Magelang Regency demonstrated strong representation and completeness but exhibited limitations in accuracy and external consistency. To improve data accuracy, relevant stakeholders should implement targeted interventions, including capacity-building through training of cadres, standardization of measurement procedures and instruments, and reinforcement of supervisory mechanisms.
Risk Analysis of Pesticide Exposure Associated with Reduced Cholinesterase Levels in Indonesian Farm Workers: A Meta-Analysis
Pesticide exposure remains a major occupational health problem, with the World Health Organization (WHO) reporting between 1 and 5 million cases of pesticide poisoning annually among agricultural workers. This study aimed to analyze the risk factors associated with pesticide poisoning by conducting a meta-analysis of published research. The meta-analysis was performed in four stages: data abstraction, statistical analysis using JASP Version 0.18.3, heterogeneity testing, and publication bias assessment. The random-effects model was applied to the variables of Personal Protective Equipment (PPE) use and length of work, as the heterogeneity test indicated significant variation between studies (p = 0.001). In contrast, the fixed-effects model was used for individual hygiene (p = 0.006). Egger’s test showed no indication of publication bias for PPE use (p = 0.356) and length of work (p = 0.395). The results revealed that PPE use increased the risk of decreased cholinesterase levels by 1.584 times, poor individual hygiene by 1.954 times, and working more than 5 hours by 1.665 times. In conclusion, individual hygiene was identified as the most significant risk factor. Farmers who neglect personal hygiene practices, such as bathing after spraying or changing clothes immediately, face a substantially greater risk of reduced cholinesterase levels due to pesticide poisoning.
Improving Work Motivation of Nutrition Implementers in Health Centers: Analysis of the Influence of Work Experience, Competence, and Rewards
Success in addressing nutritional problems can be achieved when nutrition implementers possess strong abilities and skills in executing nutritional service program activities at community health centers. High work motivation among nutrition implementers significantly contributes to the successful implementation of these programs. This study aims to analyze the influence of work experience, competence, and reward provision on the work motivation of nutrition implementers. This research employs a quantitative approach with a cross-sectional design. The population consists of all nutrition implementers in South Kalimantan Community Health Centers' work area in Indonesia. A sample of 253 respondents was selected using purposive sampling. The research instrument utilized was a questionnaire, and data analysis involved simple linear regression analysis. The findings indicate a significant effect of work experience on work motivation, with a significance value of .00 < .05. However, competence does not have a significant impact on work motivation, as its significance value is .098 > .05. Similarly, reward provision does not significantly influence work motivation, with a significance value of .439 > .05. In conclusion, work experience significantly affects the work motivation of nutrition implementers. Therefore, efforts to enhance the motivation of nutrition implementers are essential, as they will ultimately improve the effectiveness of nutrition service programs in health centers, contributing to the prevention of stunting and the overall enhancement of public health.
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Validating the Malay Version of Adolescent Sexual and Reproductive Health Knowledge and Attitudes Questionnaires
Adolescent Sexual and Reproductive Health (SRH) knowledge is crucial for informed decision-making, yet cultural barriers in Malaysia limit open discussions, creating significant knowledge gaps. This study validated the Malay version of the Adolescent SRH Knowledge and Attitudes Questionnaire to address this need. The validation process included expert content review (6 panelists), face validity testing (30 respondents), and psychometric analysis among 100 adolescents in Sarawak. The questionnaire demonstrated excellent content validity as rated by the experts and strong face validity among adolescents. The knowledge domain showed high internal consistency (α = 0.935), while the attitude domain had moderate reliability (α = 0.682), with refinements improving item alignment. The validated questionnaire provides a culturally adapted tool for assessing SRH among Malaysian adolescents, supporting targeted interventions. Future studies should expand validation to diverse populations and the assess longitudinal stability.
Multiple Path Particle Dosimetry (MPPD) Model Total Dust Among Mineral Ore Processing Workers
Mineral ore processing generates dust, which poses a significant health risk to workers due to prolonged exposure. The aerodynamic properties of this dust allow it to be inhaled and deposited deep within the respiratory tract, increasing the risk of impaired respiratory function. This study aimed to quantify and assess the health risk associated with respirable dust exposure among workers in mineral ore processing areas using the Multiple Path Particle Dosimetry (MPPD) Model. The MPPD model was used to estimate the deposition of dust particles in various regions of the respiratory tract. A constant scenario with the average respirable dust concentration values was used. The values of breathing parameters, such as upper respiratory tract volume, functional residual capacity, breathing frequency, and tidal volume, refer to The International Commission on Radiological Protection (ICRP). Personal respirable dust monitoring data from 2021 to 2024 were analyzed to calculate the total deposition, regional deposition, and deposition fraction for each generation of airways. A cross sectional analysis was conducted on a cohort of 30 male laborers, designated as the directly exposed group. Instruments and procedures used for assessing personal exposure to respirable dust were executed by the NIOSH 0600 standard methodology, employing an SKC Cyclone in conjunction with a personal air sampler, characterized by an airflow rate of approximately 1.9 to 2.0 lpm. The average personal respirable monitoring concentration over the past four years (2021 -2024) was 0,2391 mg/m3, with annual averages of 0,2835 mg/m3, 0,2626 mg/m3, 0,1441 mg/m3, and 0,2661 mg/m3, generally within the permissible exposure limit (PEL). The MPPD model simulation results for 2021 showed a maximum mass deposition rate of 2,74 x 10-3 μg/min and a maximum mass deposition per area of 7,374 x 10-3 μg/m2. Particle size, shape, density, and airflow velocity were identified as the key factors influencing dust deposition. Understanding dust distribution within the respiratory tract can provide more effective recommendations for controlling dust exposure and implementing a respiratory protection program (RPP) for workers in the mineral ore processing industry.
Understanding the Barriers to Exclusive Breastfeeding Among Urban Indonesian Mothers
Despite WHO recommendations advocating for Exclusive Breastfeeding (EBF) for the initial six months, EBF rates remain low in many countries, including Indonesia. This study identifies psychosocial, socioeconomic, and demographic factors influencing EBF practices in Semarang City. Methods: A quasi-experimental design involved 157 participants (98 mother-infant pairs and 49 peers) recruited from various public health centres from December 2023 to June 2024. The Kaplan-Meier survival curve, in conjunction with the log-rank test, was employed to assess the disparities in survival and the observed practices of EBF. The determinants of EBF duration were found using the cox proportional hazard ratio. Results: The mean duration of EBF was 18 weeks, a number of 33.7% of mothers did not complete full six months. Key findings reveal that peer support, maternal knowledge, attitudes, skills, education level, and employment status significantly influence EBF duration. Mothers who received peer support had greater EBF resilience compared to those who did not received peer support (HR 0,32, CI:0.197,0.528). Practical skill, favourable attitudes, and high knowledge were also important indicators of sustained EBF. Conversely, being a working mother and having lower education level increased the risk of early EBF cessation. Conclusions: The results emphasize the necessity of focused, context-specific interventions to promote EBF in urban areas. These insights carry implications for policy and program development aimed to enhance health consequences for mother and children. Further research in diverse socio-demographic contexts is recommended to better understand and support effective EBF practices.
Urban School Nutrition: Student and Teacher Perspectives on Creating a Healthier Food Environment
Changes in lifestyle and eating habits can affect food choices for adolescents, impacting their nutritional intake. Schools are pivotal in shaping healthy eating behaviors. This qualitative study explores the perspectives of secondary school students and teachers on strategies to improve the healthy food environment in an urban school. Two focus group discussions with students and one with teachers, along with one in-depth interview with the school principal, were conducted at a junior high school in Makassar city. The audio recordings were transcribed and analyzed thematically to identify key themes. Students appeared to be aware of the importance of healthy eating habits; however, they lacked a full understanding of which healthier choices to make. Focus group discussions and interviews revealed that all groups recognize the importance of promoting healthier choices through regulation, education, and accessible nutritious foods. The study highlights actionable strategies for implementing school-based interventions to foster sustainable healthy eating behaviors.