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Environmental health is one of the factors that play a role in the level of health status of the population. Child mortality is one indicator of health status. The survival of children is very dependent on environmental conditions. The purpose of this article is to present a profile of the distribution of children under five years according to the health of the family's living environment and the child's mortality rate according to the characteristics and health of the environment. Data analysis of the 2017 IDHS used was toddlers who were born alive with de jure residence status. The variables studied were sources of drinking water, sanitation facilities, and main floor materials as well as mother's education, and place of residence. The descriptive analysis according to the classification of residence and the estimation of the calculation of the mortality rate for neonatal mortality rate, infant mortality rate, child mortality rate and under-five mortality rate using STATA 15 techniques. The results showed that 1 in 10 children under five in Indonesia lives in a household that does not have sanitation facilities. Most of the children under five live with families uses proper drinking water sources, and 8 out of 10 children under five live in houses with floors made of finished materials. Children under five who live in families with sanitation facilities, sources of proper drinking water and floors made of finished materials have a tendency for lower child mortality rates compared to other groups. It can be concluded that sanitation facilities and proper drinking water sources as well as floors made of finished materials support the survival of children under five years in Indonesia. Keywords: survival of children, child mortality rate, environmental health, sanitation, drinking water source ABSTRAK Kesehatan lingkungan merupakan salah satu faktor yang berperan dalam tingkat derajat kesehatan penduduk. Angka kematian anak merupakan salah satu indikator derajat kesehatan. Kelangsungan hidup anak sangat tergantung dari kondisi lingkungannya. Tujuan penulisan artikel adalah menyajikan profil distribusi balita menurut kesehatan lingkungan rumah tinggal keluarga serta tingkat kematian anak menurut karakteristik dan kesehatan lingkungannya. Analisis data SDKI 2017 yang digunakan adalah balita yang lahir hidup dengan status tempat tinggal de jure. Variabel yang diteliti adalah sumber air minum, fasilitas sanitasi, dan bahan lantai utama serta pendidikan ibu, dan tempat tinggal. Analisis secara deskripsi menurut klasifikasi tempat tinggal dan estimasi penghitungan angka kematian neonatal, angka kematian bayi, angka kematian anak balita dan angka kematian balita secara teknik langsung menggunakan STATA 15. Hasil menunjukkan terdapat 1 dari 10 balita di Indonesia tinggal di rumahtangga yang tidak memiliki fasilitas sanitasi. Sebagian besar balita tinggal dengan keluarga yang menggunakan sumber air minum layak, dan terdapat 8 dari 10 balita yang tinggal di rumah dengan lantai dari bahan jadi. Balita yang tinggal pada keluarga dengan fasilitas sanitasi, sumber air minum layak dan lantai dari bahan jadi mempunyai kecenderungan angka kematian anak yang lebih rendah dibanding dengan kelompok lainnya. Dapat disimpulkan bahwa fasilitas sanitasi dan sumber air minum yang layak serta lantai dari bahan jadi mendukung terhadap kelangsungan hidup balita di Indonesia. Kata kunci: kelangsungan hidup anak, angka kematian anak, kesehatan lingkungan, sanitasi, sumber air minum

The allocation for the use of Deconcentration Funds focuses on the seven priority health programs listed in the Regulation of the Minister of Health for the Republic of Indonesia. Therefore, this study aims to formulate a budget allocation for deconcentration funds in the health sector. Secondary data were analyzed using reports from the Ministry of Health for five years (2014-2018) on the Human Development Index (HDI), population, area, number of health workers, as well as amount and percentage for the realization of deconcentration funds. The results showed that the variables which had a significant effect were the number of districts/cities, the area, and HDI, while those without a significant effect were population, the number of health workers, and the percentage of budget realization. Political factors and regional commitment to implementing as well as using the budget were shown to also affect the deconcentration of funds both from the central and regional sources. Generally, deconcentration funds are used for non-physical tasks, including coordinating and synchronizing planning, facilitation, technical guidance, training, outreach, supervision, investigations and surveys, direction, and control. Based on the results, the budget allocation for deconcentration funds for health development needs to be calculated according to regional capacities by considering the number of districts/cities, land area, and the HDI.

Background: Maternal and neonatal mortality rates are still a problem in Indonesia. Various efforts have been made, such as training and placing midwives in villages, increasing the number of deliveries performed in health facilities. There is a consensus that an important intervention is to provide appropriate health facilities managed by trained health workers who assist in childbirth, including midwives and doctors. One of the means of infrastructure that needs to be considered available at the community health center (puskesmas) is an ultrasound device to detect pregnancy complications. Objective: The purpose of this study was to determine the effect of the use of ultrasound devices to increase antenatal care (ANC) to health centers. Method: the study design was a quasi-experiment conducted at 20 puskesmas in Bogor district. Analyses was conducted in descriptive, the total sample participating in the study was 4,049 cases, but only 3,314 cases were analysed. Result: The results of the study prove that the availability of USG at the puskesmas increases ANC visits to the puskesmas. The availability of ultrasound and the use of ultrasound affect the number of ANC visits to health facilities, especially to puskesmas. As an attraction for screening and ANC during pregnancy, the government needs to provide an ultrasound device at puskesmas. Key words: Ultrasoundgraphic, antenatal care, Puskesmas, midwives, pregnancy complication Abstrak Latar belakang: Angka kematian ibu dan neonatal masih merupakan masalah di Indonesia. Berbagai upaya telah dilakukan, seperti melatih dan menempatkan bidan di desa, meningkatkan jumlah persalinan yang dilakukan di fasilitas kesehatan. Ada konsensus yang menyatakan bahwa intervensi yang penting dilakukan adalah memberikan fasilitas kesehatan yang layak dikelola oleh tenaga kesehatan terlatih yang menolong persalinan, antara lain bidan dan dokter. Salah satu sarana prasarana yang perlu dipertimbangkan tersedia di puskesmas adalah alat ultrasound untuk mendeteksi komplikasi kehamilan. Tujuan: mengetahui pengaruh penggunaan alat USG terhadap peningkatan antenatal care (ANC) ke puskesmas. Metode: disain penelitian adalah quasi eksperimen yang dilakukan pada 20 puskesmas di kabupaten Bogor. Analisis dilakukan secara deskriptif, total sampel yang berpatisipasi dalam penelitian 4.049 kasus, namun yang di analisis hanya 3.314 kasus. Hasil: Ketersedian USG di puskesmas meningkatkan kunjungan ANC ke puskesmas. Ketersediaan USG dan penggunaan USG mempengaruhi jumlah kunjungan ANC ke fasilitas kesehatan, khususnya ke puskesmas. Sebagai daya Tarik untuk melakukanskrining dan ANC pada saat kehamilan, maka pemerintah perlu menyediakan alat USG di puskesmas. Kata kunci: Ultrasound, Antenatal Care, Puskesmas, Bidan, Komplikasi Kehamilan

Maternal mortality and infant mortality are important indicators to state the social welfare andpublic health status of country. The both are correlated with health status of pregnant woment, knowledgeof women and family of antenatal care; delivery assistant and accessibility of health facility. The objectiveof this study is to identify the practice of ANC and utilization of delivery assisstant. The study usedqualitative methode with indepth interview and focus group discussion (FGD) to pregnant women,neonatus's mother, key persons, traditional birth attendants (TBA) and midwife villages. The result of thisstudy showed that the community have the ANC awareness but some of them still prefer to ask TBA whendelivery. Factors influence TBA's preference were 1) economics; 2) culture; 3) geography reason; 4)psycology; 5) pragmatis; 6) Service satifaction.Keywords: maternal mortality, neonatal mortality, ANC, health services, midwive village, makingpregancy safer (MPS)

Latar belakang: Praktik sunat perempuan di Indonesia masih terjadi dalam berbagai tipe. Sunat perempuan hingga saat ini belum terbukti bermanfaat bagi kesehatan. Tujuan: Penelitian ini bertujuan untuk mengetahui faktor sosio-demografi yang berhubungan dengan praktik sunat perempuan di Indonesia. Metode: Penelitian ini menggunakan data Riset Kesehatan Dasar (RISKESDAS) tahun 2013 dengan desain potong lintang. Sampel dalam penelitian ini meliputi anak umur0-11 tahun, berjumlah 114.993 anak. Analisis menggunakan metode multivariat regresi logistik metode backward. Hasil: Prevalensi sunat perempuan di Indonesia sebesar 51,2%. Tingkat pendidikan kepala rumah tangga memiliki hubungan negatif terhadap praktik sunat perempuan (AOR = 0,83; 95% CI = 0,81-0,87). Kepala rumah tangga yang berumur lebih dari 40 tahun memiliki risiko 16% lebih rendah untuk melakukan sunat perempuan (AOR = 0,84; 95% CI = 0,81-0,87). Selain itu, status sosial-ekonomi memiliki hubungan positif terhadap sunat perempuan. Kesimpulan:Kepala rumah tangga denganpendidikan rendah dan tinggal di perkotaan cenderung untuk menyunatkan anak perempuannya. Oleh sebab itu, promosi dan edukasi khususnya pada masyarakat berpendidikan rendah diperlukan untuk mengurangi praktik sunat perempuan di Indonesia.

Objectives The study aimed to examine the influence of Indonesian women's decision-making within the household regarding the use of maternal health services. It explored whether women who had high involvement in household decision-making experienced a higher likelihood of using antenatal care services, delivery services assisted by skilled birth attendance, and facility-based delivery compared to those with limited autonomy. Methods The study used the individual subset data on women from the 2017 Indonesia Demographic and Health Survey, which included 3435 women of reproductive age (15–49 years) who had given birth within one year preceding the survey. The study also used the Women's Participation Index to measure women's decision-making autonomy in the household. Descriptive statistics and multiple logistic regression analyses were conducted to identify the association of women's autonomy with the use of three key maternal health services. Results The Women's Participation Index had a significant positive relationship to adequate antenatal care service use, but no effect on the use of skilled birth attendance and facility-based delivery, after adjusting for maternal and sociodemographic variables. Women with more autonomy experienced 1.7 (95% confidence interval: 1.17–2.45) times higher odds of using adequate antenatal care services. In addition, the likelihood of the utilization of adequate antenatal care services, skilled birth attendance, and facility-based delivery was higher among women who were age ≥35 years at birth, attained a higher education level, and were in the richest quintile compared to their respective counterparts. Conclusion Women's decision-making autonomy had a significant effect on the use of adequate antenatal care services only. Initiatives that are more gender-sensitive to promote husband involvement should be conducted to increase men's awareness of the importance of maternal health services.

Background: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. Objectives: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. Methods: Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. Results: While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. Conclusions: There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development.

Angka kematian merupakan indikator yang sensitif untuk menilai keberhasilan program kesehatan. Angka ini didapat dari berbagai sumber data termasuk dari survei, registrasi, dan sensus penduduk, namun umumnya perhitungan secara langsung tersebut akan mendapatkan angka kematian yang under reported, untuk itu perlu dilakukan koreksi. Completeness dapat menjadi angka koreksi yang merupakan perhitungan dari dua metode pengumpulan data yang saling independen, dalam hal ini registrasi dan sensus penduduk. Penelitian ini dilakukan dengan mengumpulkan data registrasi kematian di empat daerah yaitu Kota Metro, Surakarta, Kabupaten Pekalongan, dan Gorontalo, yang kemudian dilakukan pula matching dengan Sensus Penduduk 2010 untuk mendapatkan completeness. Diketahui bahwa completeness dari sistem registrasi kematian di empat daerah tersebut bervariasi, untuk Kota Metro 66% sehingga angka kematian harus dikoreksi dengan 1,5, Kota Surakarta 74% (koreksi 1,35), Kabupaten Pekalongan 40% (koreksi 2,5) dan Kabupaten Gorontalo sebesar 53% (koreksi 1,9). Pada kelompok umur 50 tahun ke atas nilai completeness semakin tinggi, yang berarti sistem pelaporan dan pencatatan kematian lebih baik dari kelompok umur yang lain. Penggunaan angka koreksi dalam melakukan kajian angka kematian masih perlu dilakukan, upaya lebih lanjut perlu dilakukan pula pada kajian angka kematian karena sebab yang spesifik.

Background: Among ASEAN countries, Indonesia is the country with high maternal mortality ratio (MMR) and unable to reach target of reduction of MMR. In order to reduce the MMR target, the government of Indonesia needs evidence to evaluate and design the maternal health program. Objective: The study aims to answers specific issues of who, when, where and why maternal death occurred in Indonesia in order to understand the effective policy and health program decisions. Methods: The 2010 Indonesia Population Census identified pregnancy-related deaths occurring in the household from 1 January 2009 until the date of census (May 2010). The follow-up study revisited almost half of households reporting pregnancy-related deaths to be accounted as samples (4167 of 8464). Basic information related to cause of death were collected by trained data collector using verbal autopsy approach. The information was converted to cause of death defined by medical doctor using WHO ICD-10 rules. The underlying cause of death was later analysed. Result: The highest risk of maternal death was adolescents who were pregnant under 15 years old. The maternal death mostly occurred at postpartum period (56%), 57 percent occurred at hospitals and 31.3 percent at home. Oedema, proteinuria and hypertensive disorder in pregnancy were at 27 percent, whereas complication during labour and delivery problems were accounted for 26 percent. The pattern of maternal causes of death varies between regions. Conclusion: Maternal health program has not been considered as general plan of intervention. It is imperative to consider considered by pattern of characteristics and cause of maternal death and region for effective interventions.

Pendahuluan: Angka kematian ibu di Indonesia masih tinggi jika dibandingkan dengan Negara ASEAN lainnya. Salah satu faktor yang mempengaruhi angka kematian ibu adalah faktor perilaku pencarian pelayanan kesehatan ibu. Tujuan: Mendeskripsikan pelayanan kesehatan ibu yang diterima pada kasus kematian ibu. Metode: Populasi adalah kasus pregnancy related death (Kematian seorang wanita selama kehamilan atau 60 hari setelah terminasi kehamilan, tanpa mempedulikan penyebab kematiannya) dari hasil Sensus Penduduk 2010 (SP 2010). Sampel yang digunakan sebanyak 4167 dari 8484 kasus. Studi tindak lanjut ini menggunakan instrument verbal autopsi oleh petugas Badan Pusat Statistik (BPS). Hasil analisis lebih dari 60 persen kematian ibu yang dilaporkan mendapatkan K4. Terdapat 27 persen kematian ibu ditolong oleh tenaga non nakes dan 40 persen masih melahirkan di rumah. Hasil: Hasil pemeriksaan Postnatal care di Indonesia sebanyak 79,9 persen dan tertinggi terdapat di Daerah Jawa Bali sebanyak 85,2 persen . Kesimpulan: Pada kasus kematian maternal di Indonesia pada tiap region lebih banyak kasus yang mendapatkan pelayanan kesehatan ibu daripada yang tidak mendapat. Penelitian ini merekomendasikan bahwa untuk menurunkan angka kematian ibu diperlukan pelayanan kesehatan ibu yang berkualitas disamping cakupan pelayanan yang tinggi. Kata kunci: Kematian ibu, Pelayanan kesehatan ibu, Pregnancy related death, Sensus Penduduk.

Anak perempuan akan menjalani siklus reproduksi dari masa pubertas, pernikahan dan kehamilan. Status kesehatan ibu khususnya status gizi saat sebelum konsepsi dan saat hamil akan mempengaruhi kualitas anak yang dilahirkannya. Perkawinan dini dan fertilitas pada usia anak-anak merupakan risiko terhadap kualitas anak di kemudian hari. Sumber data adalah data Riset Kesehatan Dasar (Riskesdas) 2010, desain potong lintang, unit analisis anak perempuan pernah kawin 10-18 tahun. Hasil menunjukkan adanya pernikahan dini pada anak perempuan yang tinggal di perdesaan, tidak bekerja dan strata ekonomi miskin. Pernikahan dini dapat mempengaruhi status gizi anaknya yang lahir dan tumbuh kembang nya sehingga menjadi dapat anak pendek. Hasil analisis Riskesdas 2010 menunjukkan bahwa persentase anak pendek meningkat pada ibu yang menikah pada usia dini. Pernikahan dini dan kemiskinan dikhawatirkan menyebabkan terjadinya intergeneration cycle of growth failure di Indonesia. Perlu adanya upaya komprehensif dari berbagai lintas program untuk pemberdayaan perempuan agar status perempuan lebih berdaya, agar anak perempuannya mempunyai status gizi yang lebih baik. Kata kunci : usia perkawinan pertama, adolecense pregnancy, kesehatan reproduksi, status gizi

Background: Increasing blood pressure often has no symptoms, people are not aware the incidenee of hypertension. Various studies have shown the prevalence of hypertension continues to rise and tend at younger age groups, thus causing hypertension is public health problems. The purpose of this study is to determine risk factors related to hypertension and develop intervention model for hypertension. Methods: The study was conducted in Lebak district, Banten Province. It design was analyses of secondary data from the Baseline Health Research (Riskesdas) 2007 and qualitative study Results: The analysis shows, the intervention model for Lebak districts needs to focus on healthy behavior and environmental pollution. Health behavior is reflected in the emotional disorders, abdominal circumference at risk. Although the factors of age and marital status were contribute to increased blood pressure. Statistic model is -3.025 + 0.993* Age 35-60 year + 0.663* Marrital status + 0.881 * mental disorder + 0,679* obese central + 0.429* environmental exposure. Qualitative results showed a lack of knowledge about the causes, symptoms, prevention, and how to detect or treat of hypertension that require long and continuous. This is supported from the implementing recognition programs, the placement of non-communicable diseases program which is a huge umbrella of prevention of hypertension remains unclear. So in the implementation of prevention is still passive. Availability for drugs at health facilities for treatment of non-communicable diseases is not enough; this is a problem in the program to reduce the prevalence of hypertension diseases. So it needs the support of decree of the issue of hypertension by Ministry of Health on inter-sector coordination. Key words: hypertension, risk factors, Lebak District ABSTRAK Meningkatnya tekanan darah sering tidak menunjukkan gejala, sehingga penderita tidak menyadari atas kejadian hipertensi. Berbagai penelitian menunjukkan prevalensi hipertensi terus meningkat dan cenderung mengenai kelompok umur muda, sehingga menyebabkan hipertensi merupakan masalah kesehatan masyarakat. Tujuan penelitian untuk mengetahui faktor risiko yang berhubungan dengan terjadinya hipertensi dan mendapatkan model intervensi terjadinya hipertensi. Penelitian dilakukan di Kabupaten Lebak Provinsi Banten. Metode penelitian merupakan analisis lanjut data Riskesdas 2007 dan penelitian kualitatif. Sedangkan disain penelitian potong lintang. Hasil analisis menunjukkan, model intervensi untuk kabupaten Lebak perlu difokuskan pada perilaku hidup sehat dan pencemaran lingkungan. Perilaku hidup sehat yang tercermin dalam gangguan mental emosional dan lingkar perut berisiko. Walaupun faktor umur dan status kawin turut berkontribusi dalam meningkatkan tekanan darah. Secara statistik, model intervensi Kabupaten Lebak yaitu -3.025 + 0,993* Umur 35-60 tahun + 0,663* st. kawin atau cerai + 0,881 * gangguan mental + 0,679* lingkar perut berisiko + 0,429* lingkungan tercemar. Hasil kualitatif menunjukkan kurangnya pengetahuan informan tentang penyebab terjadinya hipertensi, gejala hipertensi, upaya pencegahan, cara mendeteksi atau pengobatan hipertensi yang membutuhkan waktu lama dan berkesinambungan. Hal ini didukung dari pengakuan pelaksana program, bahwa penempatan program penyakit tidak menular yang merupakan payung besar dari pencegahan hipertensi masih belum jelas. Sehingga dalam pelaksanaan pencegahan masih bersifat pasif. Ketersediaan obat di fasilitas kesehatan untuk pengobatan penyakit tidak menular masih jauh dari cukup, hal ini merupakan kendala dalam program menurunkan prevalensi penyakit tidak menular. Sehingga perlu adanya dukungan Surat Keputusan Kemenkes dengan bekerja sama lintas sektor dalam menangani permasalahan tersebut. Kata kunci; hipertensi, faktor risiko, Provinsi Lebak

DETERMINAN PERILAKU PENCARIAN PENGOBATAN INFEKSI SALURAN PERNAFASAN ATAS (ISPA) PADA BALITA

Trend and Disparity of Infant Mortality Rate (IMR), Child Mortality Rate (CMR) and Under Five Mortality Rate (USMR) and Social Economic Statusin Indonesia in 1998, 2001 and 2003.Infant Mortality Rate (IMR), Child Mortality Rate (CMR) and Under Five Mortality rate(U5MR), especially IMR, are important as welfare indicators. IMR and U5MR are The Healthy Indonesia 2010 Indicators (IS 2010). The IMR and CMR are the MDG indicators. Due to inadequate registration system in Indonesia, estimation of various parameters of population, still rely upon survey data. Frequently,IMR and U5MR are estimated indirectly from population Census (SP), the Intercensal Population Survey (Supas), The National Socio-Economic Survey (Susenas), and the Indonesia Demographic and Health Survey (SDKI). The analysis objectives are to find the trend of IMR. CMR and U5MR, and its pattern by the social economic background and as well as the disparities. The Source data are the 1998, 2001 and2003 Susenas. The data cover all provinces except Nanggroe Aceh Darussalam, Maluku and Papua. The variables are children survival (mean of children ever born and mean of children survival), urban rural, regional, education background and quintile of strata economics. Analyses were done with indirect technique analysis with Brass-Trussel Method West Model. The analysis shows that trends of all indicators are fluctuative. The estimates of IMR and U5MR for the five-year period prior to the survey indicated aslightly increase from the I998 Susenas (49 and 65) to the 2001 Susenas (51 and 65), then decreased in the 2003 Susenas (42 and 52). All indicators show that the mortality by social economics background are highest in the poorest family, less educated mothers, live in the rural area and in the East of Indonesia Region. The results also show that the 2003 Susenas U5MR is exceeding the IS 2010 target (58/1000) and almost reach the IMR IS 2010 target (40/1000).Keywords: trend, disparity, infant mortality rate, child mortality rate, under five mortality rate

PERILAKU PENCARIAN PENGOBATAN DIARE PADA BALITA

A remote area is the districts (urban/rural) which have geographic factors criteria. Indonesiaconsist 377 districts i.e. 190 districts remote areas and 187 districts non remote areas. Childhood mortality (Infant mortality rate, child mortality rate and under five mortality rate) are important indicator, especially infant mortality rate (IMR) to show the welfare and community health status. Due to inadequate registration system in Indonesia, estimation of childhood mortality still relies upon census and survey data. National Socio-Economic Survey (NSES) or Susenas provide the variable childhood survival which use to indirect technique childhood mortality estimation. The objection of the analysis is to know mortality status in remote areas. Data source of analysis is 2004 NSES Core. Unit analysis is women reproductive aged between in remote and non remote areas. Means of the childhood survival by age group of women reproductive aged are based of analysis by Brass-Trussel Model Equation. The result shows that IMR, CMR and U5MR in National are 31 per 1000, 7 per 1000 and 38 per 1000, and show that IMR, CMR and U5MR in remote areas are 42 per 1000, 12 per 1000 and 54 per 1000. This mortality is higher than in non remote areas (27 per 1000, 6 per 1000 and 32 per 1000). The childhood mortality of male is higher than female. Disparity between in remote areas and National is higher than disparity between in non remote areas and National. Childhood mortality of remote areas is higher than National, and childhood mortality ofin remote areas is lowest than National. Based on the endogen and exogenous factors of cause of deathchild mortality, Bourgeous-Pichat quoted that reduction of IMR have three categories i.e. soft rock (IMR >70 and CMR > 8), intermediate rock (IMR 30-70) and hard rock (IMR Keywords: child mortality rate, health status, infant mortality rate, under five mortality rates, remote areas

Statistik kematian sangat penting untuk memberikan informasi dasar tentang kesehatan masyarakat. Di Indonesia, pencatatan dan pelaporan penyebab kematian masih merupakan masalah, disebabkan antara lain belum adanya standardisasi pelaporan kejadian kematian di rumah sakit (RS) dan di rumah. Pada tahun 2005, Badan Litbangkes berkolaborasi dengan WHO dan SPH, University of Queensland mengembangkan Sertifikat Medis Penyebab Kematian(SMPK) untuk Provinsi DKI Jakarta berdasarkan ICD-10. Penggunaan SMPK oleh rumah sakit ditetapkan dengan Surat Keputusan Kepala Dinas Kesehatan Propinsi DKI Jakarta No. 3942/2006. Uji coba dilakukan dengan melatih dokter mengenai konsep underlying cause of death (UCOD) untuk mengisi SMPK, dan memeriksa setiap SMPK dari pasien rawat inap yang meninggal di RS Saint Carolus dan Pasar Rebo sepanjang tahun 2007. Pemeriksaan terhadap jumlah kelengkapan, dan keakuratan pengisian SMPK oleh dokter dilakukan oleh peneliti Badan Litbangkes. Hasil menunjukkan bahwa tanggapan dokter mengisi SMPK di Saint Carolus lebih baik daripada di Pasar Rebo (791 vs 321 SMPK). Dikedua RS kira-kira90 persen keterangan tentang selang waktu sakit sampai meninggal tidak diisi. Beberapa hal yang tidak akurat seperti mode of dying yaitu respiratory failure (J96.9), cardiac arrest (146. 9), dan pneumonia unspecified (J18) dicatat sebagai penyebab kematian. Untuk meningkatkan kualitas pencatatan penyebab kematian, semua dokter harus diberikan pelatihan penyegaran, dan diinformasikan mengenai hal-hal yang tidak akurat yang harus dihindari sebagai UCOD sesuai konsepICD-10. Perekam medis juga harus dilatih khusus untuk pengkodean dan penentuan UCOD final dengan menggunakan Medical Mortality Data System. Kata kunci: Uji Coba, Sertifikat Medis Penyebab Kematian

TREN ANGKA KEMATIAN BAYI DAN ANGKA KEMATIAN ANAK BALITA DI INDONESIA

KECENDERUNGAN PENYAKIT PENYEBAB KEMATIAN BAYI DAN ANAK BALITA DI INDONESIA : 1992-2001

Environmental Health and Child Mortality in Indonesia Based on Susenas Data of 1998, 2001 and 2003.Environmental health related disease are still problem in Indonesia and these factors are importence in the public daily life. Childhood mortality rate which include Infant Mortality Rate (IMR), Child Mortality Rate (CMR) and Under five Mortality Rate have been used as social welfare and public health indicators. Registration system for death in lndonesia not good enough, so we count number of death using indirect methode so we used data survey. National Social and Economics Survey (NSES/Susenas) as one of data survey which every year collected can used to analysis and count the environmental health related with number of death include childhood mortality rate. Data used for this analysis is NSES Modul 1998, 2001 and 2003 and the analysis unit is house hold. The scoring of healthy housing based upon the total scoring of 8 parameters and divided into 3 categories e.g good, moderate, and bad. The result showed that the factor of environment health 'bad' categories produced IMR, CMR, and Under live Mortality rate was higest. Environmental health 'good' categories in Indonesia contributed for decreasing CMR (age 1-4 years), in Java Bali especially to decreasing for Under five Mortality Rate (age 1-59 months). But in East Indonesian Area for five years (1998-2003) or 'good' categories there are increasing tor IMR, CMR, and Under five Mortality Rate. In urban or rural area there are not different environmental health 'good' categories will be contributed for decreasing death, exepted for CMR (age 1-4 years) in urban area there are the same for 'good' categories or 'moderate' categories. The trend of IMR,CMR and Under five Mortality Rate increasing in 2001 but decreasing in 2003. Indonesian IMR in 2001 at seven grade in ASEAN after Singapore, Malaysia, Brunei Darussalam, Thailand, The Philippines, and Vietnam.Keywords: Enviromental health, Infant Mortality Rate, Childhood Mortality Rate

Death reporting is base of mortality rate calculation. The mortality rate is importance indicator and should be decreased in the well-being develop plan. To find a good death reporting, local goverment in Indonesia were developing registration systems for some region in Indonesia. Surakarta City and Pekalongan District have been developing registration with repairing cause of death report, this is the first time in Indonesia for cause of death registration system. To know completeness of the registration system we match with survey data. The survey sould be independent with registration and visiting all household to ask death event from house hold members. The sample from Surakarta City is 13 village (15.340 household) and Pekalongan District 12 village (10.444 household). Every house hold was asked for the death event from 1 Januari until 30 Juni 2007. The result is completeness of Surakarta City 61% and Pekalongan District 81%, this result is high to get good registration. Keywords: Completeness, mortality, registration

Maternal health is a key for the next generation. Maternal death is an indicator for maternal health status. Some maternal health services indicator such as Antenatal Care (ANC) and delivery assistant, while pregnancy/delivery complications and Maternal Mortality Ratio (MMRatio) are the key indicators that reflect maternal health condition. The objections of this article are discussing the achievement of maternal health status such as ANC, birth attendant, place delivery, pregnancy/delivery complications and cause of maternal death. Analyze of trend of coverage maternal health service programme and maternalmorbidity used the Indonesia Demography Health Survey (IDHS) 1991-2007 data. The analyzed of MMRatio used 2002-03 and 2007 IDHS data which are calculated with Proportion of Maternal of Death Female (PMDF) approach. The analysis of maternal cause of death used mortality data from Household Health Survey in 2001 and Baseline Health Survey data in 2007. The result in 16 years, showed that the antenatal care of pregnant women in first trimester has been increased twice. Delivery in home decreased from 79% to 53%. The most pregnancy complication is haemorrage and the most delivery complication is long labor. The MMRatio with PMDF calculation in 2003 is 413 per 100.000 live birth and in 2007 is 270 per 100.000 live birth. To come up the MMRatio that targeted 125 per 100.000 in 2010, the Basic Emergency Obstetric Neonatal Care (BEONC) and Comprehensive Emergency Obstetric Neonatal Care (CEONC) implementation must be done in good quality and there is no tie up to reach the closest health facility. Keywords: Maternal health, achievement, challenge

Rapid assessment has been done in Tangerang Distric Health Office to assess the availability and quality of routine facility-based data for Sub-National Health System Performance Assessment (SNHSPA) indicators. Also to assess the need of community based swvey as a complementary data and attendance to organize Surkesda.Metodology: Assessment activities composed of 2-day workshop, dan field visits (3-4 days), and analysis. The workshop was used to introduce the conceptual framework of SNHSPA to the potential users of SNHSPA. The workshop also served as an opportunity to receive feedback on the framework as well as indicators to be used for the SNHSPA in Distric Health Offices of Tangerang. During the field visit, assessment was conducted in 1 public hospital, 1 private hospital and 6 Health Centers with different stages of development (good, fair and poor). Assessment was conducted on data availability and reliability and consistency. The result indicated there were not available data from private health practices on outpatient visits, pneumonia, and tuberculosis (TB) in all health centers visited. All of staff stated that subordinate health facilities' data on outpatient visit and pneumonia were available. In the case of lB, half of staff indicated that the data on TB were not available from the sub-ordinate facilities. The quality of the data is questionable. Not all the patient with suspect TB sent to Health Centers. Hence, the data of TB can not reflect situation on community. From 6 health centers, half of the staff stated the different number of TB cases among forms. It indicated inconsistency between form of "SP3" (Sistim Pencatatan dan Pelaporan Puskesmas/"LBl" (Laporan Bulanan 1) report and form "TB01 " (Tuberculosis 1). All of health center staff stated that the pneumonia data and outpatient visit data showed the number of cases in all health center districts, except data from private health practices. One of six health centers reported inconsistency data among the number of pneumonia cases, and 5 of them stated that only once a month counted the new cases of pneumonia. It means that the quality of data was low. There are different numbers of health facility and village, which was reported by head of health centers and which was received by district health offices. The private and public hospitals sent report routinely to district health office, but not routinely to regional government. Keywords: SNHSPA, facility-based data

STATUS GIZI WANITA USIA SUBUR (WUS) DAN BALITA DI INDONESIA MENURUT DATA SKRT 2001

As the number of aging population increases there is a corresponding rise in the number of the elderly with disabilities in social, physical, mental or psychological. Generally, most of the elderly suffers from chronic diseases, which may change to acute exacerbation. In addition, some progressive diseases could cause prolong potential disabilities prior to death. This elderly people requite regular medical check up to reduce dependencies and disabilities. For older people there are numerous barriers to have effective sociomedical care. This work was conducted to study the correlation between disturbing symptoms in daily activities, and social economic status, and access to medical care, and self treatment for elderly people. Data for the analysis was obtained from Natiorzal Social economic survey 2001. The analysis revealed that the common symptoms found in elderly group were cough, common cold and hard breathing. In urban area, the highest percentage of symptoms found in high income group (35%), while in rural area it was found in low income group (28%). The percentage of health seeking behaviors was slightly higher among old men comparing with old women. But there was no different between an old men and old women for self treatment. however it was also found that there was a tendency that higher income of elderly has higher percentage of health seeking behaviours, compared to 61 percent and 45 percent, and for the educated group that higher education of the elderly has lower percentage for self treatment, compwed to 45 percent and 57 percent. Key word : aging, health seeking behavior

Surkesda NAD 2006 collected birth history data reported by ever married women of the householdsamples. Birth history data were used to estimate childhood mortality for Nanggroe Aceh Darussalam(NAD). Both direct and indirect estimation of childhood mortality were applied. Indirect estimationused Coale Demeny West model (Trussel equations) and UN general model (Palloni-Heligmanequations). Both direct and indirect estimation of childhood mortality surprisingly gave similarestimates of Infant Mortality Rate (IMR). Child Mortality Rate (CMR) or Under-five Mortality Rate(U5MR) for the period about five years before survey. Estimates of IMR. CMR and U5MR wererespectively 48 per 1000, 15 per WOO and 62 per 1000. The estimate of IMR of 48 per 1000 is muchhigher than estimate for NAD based on BPS Population Projection, i.e. 39-40 per 1000 for 2000-2005. Life expectancy at birth for NAD derived from Coale Demeny West model for IMR 48 per 1000 ormortality level of about 20. was 65.5 years. This figure is lower than BPS projection of life expectancyat birth for NAD which was 67.2 years. Direct estimation approach indicated the rise of childhoodmortality recently, which may be due to the impact of earth quake/tsunami that hit NAD in 2004. Therise of childhood mortality could not be recognized by indirect estimation approach. The rise ofmortality recently may be true since disaster of earth quake/tsunami had hampered the availability ofhealth personnel (doctors and midwives) and household environment (accessibility to safe water or safetoilet). There is an indication of the negative relationship between availability of doctors and midwives,or accessibility of safe water and safe toilet with childhood survivorship in NAD. Keyword: IMR, CMR, U5MR, life expectency