District Health Department Research Articles

Mitigating dengue incidence through advanced Aedes larval surveillance and control: A successful experience from Pakistan.

Dengue fever is a viral disease caused by one of four dengue stereotypes (Flavivirus: Flaviviridae) that are primarily transmitted by Aedes albopictus (Skuse) and Aedes aegypti (L.). To safeguard public health, it is crucial to conduct surveys that examine the factors favouring the presence of these species. Our study surveyed 42 councils across four towns within the Bhakkar district of Punjab Province, by inspecting man-made or natural habitats containing standing water. First, door-to-door surveillance teams from the district health department were assigned to each council to surveillance Aedes species and dengue cases. Second, data collection through surveillance efforts, and validation procedures were implemented, and the verified data was uploaded onto the Dengue Tracking System by Third Party Validation teams. Third, data were analysed to identify factors influencing dengue fever cases. The findings demonstrated the following: (1) Predominantly, instances were discerned among individuals who had a documented history of having travelled beyond the confines of the province. (2) Containers associated with evaporative air coolers and tyre shops were responsible for approximately 30% of the Aedes developmental sites. (4) Variability in temperature was responsible for approximately 45% of the observed differences in the quantity of recorded Aedes mosquito developmental sites. (5) Implementation of dengue prevention initiatives precipitated a 50% reduction in Aedes-positive containers, alongside a notable 70% decline in reported cases of dengue fever during the period spanning 2019 to 2020, while the majority of reported cases were of external origin. Aedes control measures substantially curtailed mosquito populations and lowered vector-virus interactions. Notably, local dengue transmission was eliminated through advanced and effective Aedes control efforts, emphasising the need for persistent surveillance and eradication of larval habitats in affected regions.

Трудный путь возрождения пермской медицины (1919–1923)

The article is devoted to the most difficult period in the history of Perm medicine, associated with the recovery after the devastating civil war. It turned out to be the least studied in the historical discourse, although it was filled with tragic events: the destruction of urban infrastructure, including in the field of healthcare, the practical absence of medical personnel, the catastrophic epidemic situation in the city and countryside. Returning the situation to normal was complicated by the food and fuel crisis. And in 1921, the famous famine began in the Volga region, which also captured a number of districts of the Perm province and had a great impact on the state of medical care. Based on archival sources that have not previously been introduced into scientific circulation, newspaper materials, and publications of that time, a description is given of the activities of doctors and paramedics in overcoming enormous difficulties in providing a minimum level of medical care to the population. The role of the Soviet and party leadership of the Perm province, provincial and district health departments in overcoming the most acute organizational and personnel problems in this area is revealed. Attention is drawn to the difficulties and unresolved problems in the fight against mass epidemic diseases and the dedicated work of medical personnel in these difficult historical conditions. Of undoubted interest is the initial period of formation of the pediatric service system in the province, the contribution of scientists and practitioners in providing medical care to newborns, young mothers and infants. The role and significance of the Faculty of Medicine of Perm University in the training of medical personnel, the work of teachers and students in practical healthcare is analyzed. A special place is given to the analysis of the state of medical care in the initial period of the NEP. The main directions of implementation of these principles in the field of health care, their contradictory nature and the difficulties of their implementation on the territory of the Perm province until the end of 1923, when the zoning of the Urals took place, led to the liquidation of this territorial entity.

Strengthening breast cancer screening program through health education of women and capacity building of primary healthcare providers.

Globally and in India, breast cancer is a prevalent malignancy. India saw 178,361 new cases and 90,000 deaths in 2020. Timely detection is vital, highlighting the importance of Breast Self-Examination (BSE), especially in low-income settings. Strengthening BSE in awareness and screening efforts is urgent. Despite awareness, practical application lags due to women's reluctance. Effective execution demands partnerships, a multi-sectoral strategy, and training grassroots workers. To address these challenges, the present study aims to strengthen the breast cancer screening program using BSE strategy and adopting a referral mechanism for the diagnosis and treatment of suspect cases. A community-based study occurred in specific districts of Rajasthan (2017-2022), enhancing breast cancer screening for women aged 30-65. It involved healthcare providers and local women, utilizing tools like the MT-DM-GP6620 Breast Inspection Model, educational booklets, and semi-structured schedules. The strategy encompassed knowledge assessment, capacity building for healthcare providers, BSE training, increasing women's breast cancer awareness, suspect case referrals, and phone-based follow-up. Our study encompassed 157,225 women aged 30-65 in Jodhpur, Jalore, and Pali districts. Initial breast self-examination (BSE) awareness was below 1%. BSE training reached 218,978 women using booklets and demonstrations, with 72% aged 30-65 and the rest 15-30. Follow-ups reinforced BSE, leading to 745 identified suspect breast cancer cases, mostly due to painless lumps (332 cases). Capacity-building workshops involving 824 medical and paramedical staff strengthened early breast cancer detection in Jodhpur and Jalore, in collaboration with the district health department. The study model's success suggests its applicability in other Rajasthan districts, Indian states, and global breast cancer prevention programs. While positive outcomes were evident, challenges related to culture, cost, and benefits warrant consideration. The approach prioritized early detection through community engagement, reducing patient and government burdens. Community involvement and healthcare engagement were pivotal, with breast self-examination proving effective for enhancing awareness and early detection. Promoting BSE education can significantly enhance breast cancer awareness and early detection.

Evaluation of Pharmaceutical Services in Public Hospital Pharmacies of Federal District - Brazil

ObjectiveTo evaluate pharmaceutical services in public hospital pharmacies of the Federal District Health Department - Brazil (Secretaria de Saúde do Distrito Federal, SES-DF). MethodA cross-sectional evaluative study involving the 15 public hospitals under the SES-DF management. Hospitals were characterized and classified into four hierarchical strata. The pharmaceutical services related to programming (quantity of medication to order), acquisition, storage, distribution, management, selection, information, pharmacotechnical component, pharmacotherapy follow-up, teaching and research were evaluated using validated indicators. Next, algorithms were applied and the approximation percentages of service compliance were calculated, then correlated to variables that could influence their results through linear regression analysis. ResultsOnly four hospital pharmacies presented good compliance with the evaluated services, three of them belonging to less complex hospitals. Only the storage and management services presented good performance. The variables that most influenced the performance of the services were managerial aspects related to pharmacists and non pharmacists' workload per bed, the existence of a program for human resources qualification, planning goals and targets and a manual of norms and procedures, as well as professional qualification and adequacy of the area in which the services were performed (p < 0.01). ConclusionsThe evaluated hospital pharmacies had average performance for services compared to the ideal and better performance in logistics activities. Pharmaceutical services require constant evaluation for rational interventions that increase the proportion of executed health care activities and local management capacity to make such actions more effective, efficient, qualified and safe in the context of the SES-DF hospital network.

Assessment of fall-associated risk factors in the Muslim community-dwelling older adults of Peshawar, Khyber Pakhtunkhwa, Pakistan

BackgroundFalls are the third-leading cause of disability among the elderly population worldwide. It is multifactorial, and the occurrence of falls depends on different factors, which can be different from context to context, and individual to individual. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. The study aimed to identify fall-related risk factors in Pakistani healthy older adults at risk of developing physical disabilities. It also aimed to create a risk-predictive model for fall occurrence, offering evidence for preventive strategies.MethodsData were collected from 140 Muslim older adults from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after obtaining permission from the Zhengzhou University Ethical Review Board (ZZUIRB #202,254), and the District Health Department Office (DHO #14,207). Participants were informed, and consent was obtained before data collection. Data were collected using the Time Up and Go Test (TUGT) checklist, the Cognitive Screening Scores (CS-10) checklist, interviews regarding the prayer practice, fall history in the last six months, visual equity questions, and demographic variables.ResultsFactors associated with falls were; age, gender, education, cognitive status, poor walking speed, lack of physical activity, poor vision, and history of falls in the last six months, with a significant P value of (P. < 0.05) in the Pearson correlation coefficient test. Poor cognition, low visual equity, poor walking speed, and lack of exercise increase the risk of falling in the future, with a prediction value of (P < 0.005) in Omnibus, Lemeshow score of (0.77).ConclusionHence, our study provides a road map for future risk assessment of falls by adding the four mentioned risk factors in the proposed model to facilitate timely action to prevent fall-related infirmities in Pakistani healthy older adults.

SARS-CoV-2 wastewater monitoring in rural and small metropolitan communities in Central Michigan

Central Michigan University (CMU) participated in a state-wide SARS-CoV-2 wastewater monitoring program throughout the 2021–2022 academic year. Wastewater samples were collected weekly from ten on-campus sites and nine off-campus wastewater treatment plants servicing small metropolitan and rural communities. SARS-CoV-2 genome copies were quantified using droplet digital PCR. Case data reported by Central Michigan District Health Department and CMU were collected and compared with wastewater data. During the delta wave, wastewater detection and on-campus case reports increased rapidly with the start of the academic semester and peaked quickly, compared with a more gradual and prolonged increase in detection and case reports off-campus. During the omicron wave, transmission dynamics were similar on-campus and off-campus. Normalization of on-campus and off-campus wastewater data with pepper mild mottle virus gene expression suggested lower SARS-CoV-2 shedding per person in on-campus compared to off-campus samples during the delta wave, but no difference in virus shedding during the omicron wave. We discuss the possibility that a higher on-campus vaccination rate may have reduced virus shedding per person during the delta wave, but that this effect was lost with the omicron variant. This study suggests that wastewater monitoring is effective in rural and small metropolitan communities when used in conjunction with case reports to understand regional transmission dynamics and the impact of public health policies at a public university on virus shedding in the community.

Patient-Centered Outcomes Associated With a Novel Office-Based Opioid Treatment Program in a District Health Department: Mixed Methods Pilot Study.

Granville and Vance counties have some of the highest opioid-related death rates in North Carolina, and have significant unmet needs with regard to opioid treatment. Medication for opioid use disorder (MOUD) is the most effective evidence-based approach to address opioid use disorder. Despite demonstrated efficacy and substantial need, access to MOUD is still insufficient in many parts of the United States. In order to connect patients with needed MOUD services, the district health department, Granville Vance Public Health (GVPH), established an office-based opioid treatment (OBOT) program. In this formative pilot study, we sought to describe patients' goals and outcomes in a program delivered at a rural local health department using an integrated care approach. We used a mixed methods concurrent nested research design. The primary method of investigation was one-on-one qualitative interviews with active OBOT patients (n=7) focused on patients' goals and perceived impacts of the program. Trained interviewers followed a semistructured interview guide developed iteratively by the study team. The secondary method was a descriptive quantitative analysis (79 patients; 1478 visits over 2.5 years) of treatment retention and patient-reported outcomes (anxiety and depression). Participants in the OBOT program were 39.6 years of age on average, and 25.3% (20/79) were uninsured. The average retention in the program was 18.4 months. The proportion of individuals in the program with moderate to severe depression (Patient Health Questionnaire-9 scores ≥10) decreased between program initiation (66%, 23/35) and at the most recent assessment (34%, 11/32). In qualitative interviews, participants credited the OBOT program for reducing or stopping the use of opioids and other substances (eg, marijuana, cocaine, and benzodiazepines). Many participants noted how the program helped them manage withdrawal symptoms and cravings, which helped them feel more in control of their use. Participants also attributed improvements in quality of life to the OBOT program, such as improved relationships with loved ones, improved mental and physical health, and improved financial stability. Initial data show promising patient outcomes for active GVPH OBOT participants, including reduction in opioid use and improvements in quality of life. As a pilot study, a limitation of this study is a lack of a comparison group. However, this formative project demonstrates promising patient-centered outcome improvements for GVPH OBOT participants.

Perceived Benefits and Barriers of a COVID-19 Test to Stay Program in a School District Serving Black or African American People With Low Income, December 2021.

Quarantine after exposure to COVID-19 has resulted in substantial loss of in-person learning in schools from prekindergarten through grade 12. Test to Stay (TTS), a strategy that limits the spread of SARS-CoV-2 while prioritizing in-person learning, requires substantial investment in resources. The objective of this study was to assess the perceived benefits, barriers, and facilitators of implementing TTS in an urban school district in the Midwest serving primarily Black or African American people with low income. In December 2021, we used a concurrent mixed-methods approach to understand perceived benefits, barriers, and facilitators of implementing TTS by combining quantitative analysis of telephone surveys conducted with parents (n = 124) and a qualitative inquiry involving key informants from the school district and local health department (n = 22). We analyzed quantitative data using descriptive statistics. We used thematic analysis to analyze qualitative data. Quantitative findings showed that parents supported TTS because it was convenient (n = 83, 97%) and effective (n = 82, 95%) in keeping students learning in person (n = 82, 95%) and preventing the spread of COVID-19 (n = 80, 93%). Qualitative interviews with informants found that having a clear protocol and assigning staff to specified tasks allowed for successful TTS implementation. However, insufficient staffing and testing resources, parent mistrust of testing, and lack of communication from schools were perceived barriers. The school community strongly supported TTS despite the many implementation challenges faced. This study emphasized the importance of ensuring resources for equitable implementation of COVID-19 prevention strategies and the critical role of communication.

Gambaran Karakteristik dan Praktik Petugas Puskesmas Dalam Penemuan Kasus Tuberkulosis Paru di Kabupaten Magelang

Case Detection Rate of pulmonary Tuberculosis in Magelang District still low. The purpose of this research is to gain characteristics and practices of Public Health Center on case finding of pulmonary tuberculosis in Magelang District in terms of aspects of age, gender, level of education, level of knowledge, length of employment, perception of workload, training history, contact tracing, counseling, networking and practical cases of laboratory officer. This research is a descriptive study. The population is all Pulmonary tuberculosis programs officers in 29 Public Health Center in Magelang District. The total samples are 87 officers, consist of 29 P2TB officers, 29 laboratory officers, 29 medics and paramedics. The sampling technique is purposive sampling. Median of age of P2TB officers is 44 years, mean of medics and paramedics is 39.2 years, and median of laboratory officer is 30 years. Most of respondents are female and background in college-level education. Mean of the length of working for P2TB officer is 9.7 years, median for laboratory officer is 4 years, and median for medical officer and paramedics are 4 years. 79.3% of P2TB officers and 93.1% of medical officers and paramedical had a training history of &lt; 2 training. The level of knowledge of P2TB officer 51.7% in poor category. Contact tracing of P2TB officer 41.4% in poor category. Counseling of P2TB officers 41.4% in poor category. The entire laboratory officer practice fixation and staining in both categories. Networking cases of medical and paramedical staff 51.7% in poor category. Perception workload of medical and paramedical officer 51.7% in weight category. Suggestions for Magelang District health department is that the department should expand networking case by cooperating with private practice doctors and give a priority for officers who have been trained yet to be included in the training on Tuberculosis.

Impacto del confinamiento por COVID-19 en la prescripción de benzodiacepinas

ObjectiveTo evaluate the effect of COVID-19 lockdown on the prescription of benzodiazepines by gender, age and district health departments. DesignLongitudinal observational study. LocationPrimary care. Asturias (Spain) health district V. ParticipantsPeople over 15 years of age with filled benzodiazepine prescriptions in between 2017 and 2020. Main measurementsBenzodiazepine DHD (defined daily dose per 1000 habitants) mean difference between the period defined as pre-lockdown and lockdown. Additionally, the difference was adjusted for gender, sex and district health department and also with the interaction among them. ResultsDHD mean pre-lockdown was 131.3 and 139.5 in the lockdown; this difference was significant in the global analysis (95% CI: 4.1–12.1). There was an increase in the DHD mean in the 60–74 age group (95% CI: 2.28–21.42), in the group over 90 years old (95% CI: 21.31–40.63) and in women (95% CI: 3.51–14.59). Finally, a decrease in the DHD mean of V11 (95% CI: -29 to -0.66) and V14 (95% CI: -54.28 to -25.04) district health departments was observed. ConclusionsCertain subgroups show a change in the pattern of benzodiazepine prescription without being able to relate this to the lockdown. We believe that there could be some inertia in the prescription of psychiatric medication according to the biopsychosocial characteristics of the patients; it is important to detect this in order to avoid the medicalization of psychological disorders.

Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021

A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH. To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population. This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments. The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas. Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population. These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making.

Lincoln Trail District Health Department's Innovative Shift to Public Health 3.0.

The Lincoln Trail District Health Department's (LTDHD) transformation into the Public Health 3.0 model was applied from frameworks established through public health accreditation standards and innovative strategies. The awareness of strengths and weaknesses discovered through strategic planning and a culture of quality improvement built over time has created numerous performance improvement opportunities. Those opportunities established greater collaboration and transparency between departments. The shift to the Public Health 3.0 and focus on Foundational Public Health Services model made for an easier transition into Kentucky's larger plan for public health transformation. LTDHD continues to provide public health protection by preventing the spread of disease, ensuring the safety of food, air, and water quality, supporting maternal and child health, improving access to clinical care services, and preventing chronic disease and injury.

End-User Need Assessment for Developing Electronic Integrated Antenatal Care (e-iANC).

Electronic Integrated Antenatal Care is a web-based application for antenatal care (ANC) data and information management for independent practice midwives. This study aimed to assess the end-user needs for e-iANC development. Their needs for data and information were represented by a use case diagram. Five key stakeholders were identified related to the development of an e-iANC. Interviewing representatives of each informant provided the functions, and information content and flows for each function. The Extended e-iANC needs and promoted insight among all of the actors' perspectives. The use-case scenario for extended e-iANC includes all of the elements of midwifery care include antenatal care, childbirth, puerperium, immunization, and family planning. The deployment of integrated information of extended e-iANC with the primary healthcare applications and the district health department is necessary for comprehensive information on maternal and child care innovation.

EVALUASI IMPLEMENTASI DANA BOK DI PUSKESMAS WILAYAH KERJA DINAS KESEHATAN KOTA BIMA TAHUN 2015

Background: Health Operational Cost (Bantuan Operasional Kesehatan/BOK) is government aids for local government to accelerating achievement of national priority programs, especially health aspect in Millennium Development Goal’s (MDG), through improvement performances of Public Health Centers (PHC) and the networks.&#x0D; Funding of Health Operational Cost to support PHC on providing promotive and preventive programs to community due to PHC services in district are likely to be directed on curative measures.&#x0D; Funding allocation of Health Operational Cost has been decreasing in Bima from IDR.1.412.500.000 on 2014 became IDR.521.464.000 on 2015. Therefore, evaluation of program implemetation by funding of Health Operational Cost on 2015 in Bima are needed to be examined.&#x0D; Objective: To find out the achievement implemetation of Health Operational Cost program in Public Health Center under District Health Office in Bima at 2015.&#x0D; Methods: The study design was qualitative and quantitative using descriptive case study. Tehnique of sample selection by using purposive sampling. Data analysis was conducted by descriptive qualitative.&#x0D; Results: Decreasing allocation funding of Health Operational Cost affected to planning and implementation of program, while Health Operational Cost became main sources of fund to external program in PHC due to lack of financial support from Regional government budget. Health Operational Cost have not been able to support achievement of Minimas Services Standar in Bima. Many head of PHC still less understanding to technical guide of Health Operational Cost so affected on decision-making of program and lack of monitoring and evaluation by District Health Department.&#x0D; Conclusion: The implementation of BOK program in Bima City is not the best enough especially in supporting SPM target in 2015.&#x0D;

Collaborative Research: Partnering with the community to improve the science and its impact

BACKGROUND AND AIM: The Michigan PBB Research Registry consists of ~7,000 people exposed to polybrominated biphenyls (PBB) following its accidental introduction into Michigan’s animal feed. After nearly forty years, the PBB Registry was transferred to Emory University, allowing the research team to engage this community. METHODS: Community engagement (CE) activities were initiated with goals of disseminating research findings to those affected, responding to educational needs, incorporating community input, and facilitating research participation. CE methods include community meetings, where research results are shared with the affected community and questions/concerns are addressed and documented. At the first community meeting, we asked for volunteers for the Citizens Advisory Board (CAB) to guide us in research and engagement efforts. The CAB joined forces with the Pine River Superfund Citizen Task Force, a community advisory group focused on the remediation of the Superfund sites left from the PBB manufacturer, and the Mid-Michigan District Health Department. RESULTS:These efforts have evolved into a community-research partnership, where the community identified research questions, helped develop the research approach, and is an integral part of research decision-making. This partnership has led to significant changes in outreach activities, research protocols, and research priorities: community health concerns were added to surveys, the age range for participation was expanded, and chemical workers/family who were removed from the Registry (1990s) due to multiple exposures were re-enrolled with exposome methods to evaluate their complex exposures. Community concerns regarding multi-generational effects and continued high-levels of PBB body burden led to a multi-generational epigenetics study, a clinical trial aimed at accelerating PBB elimination, and an oral history study documenting the lived experience of those affected using qualitative methods. This work will be translated in an online continuing medical education course for healthcare providers. CONCLUSIONS:The community-research partnership has enhanced the science and its relevancy and potential benefit to the impacted community. KEYWORDS: Community-engaged research, science communication, exposome, environmental epidemiology, environmental justice

Assessing Public Health Workforce Informatics Competencies: A Study of 3 District Health Departments in Georgia.

Despite the increased recognition of the importance of having informatics-competent public health professionals, the competency level of the public health workforce in public health informatics (PHI) has not been examined extensively in the literature. The purpose of this study was to assess public health workforce informatics competencies in select Georgia health districts and determine the correlates of PHI proficiency. This study is based on a cross-sectional quantitative study design. We conducted an online self-administered survey of employees from 3 selected district health departments to assess proficiency in foundational PHI competency domains. Three hundred thirty-three respondents completed the survey, with a response rate of 32.5%. A gap score was calculated as a proxy to identify informatics training needs. A path analysis was conducted to assess the relationships among contextual factors and foundational PHI competency domains. The public health employees participating in this study reported relatively high proficiency in foundational PHI competency. Psychometric testing of the competency assessment instrument revealed 2 foundational informatics competency domains-effective information technology (IT) use and effective use of information. The effective use of IT mediated the relationship between employee-level factors of age and past informatics training and the effective use of information. The study highlights the importance of improving the ability of public health professionals to leverage IT and information to advance population health. Periodic assessment of staff PHI competencies can help proactively identify competency gaps and address needs for additional training. Short assessment tools, such as presented in this study, can be validated and used for such assessments.

Kepuasan Kerja Karyawan di Dinas Kesehatan Kabupaten X Provinsi Jawa Timur Saat Pandemi Covid-19

In 2020, the world will experience a global pandemic due to the Covid-19 disease. In Southeast Asia, Indonesia has become one of the highest numbers of confirmed positive Covid-19 cases at the regional level. One of the provinces in Indonesia with the highest distribution of Covid-19 cases is East Java. The Health Department is one of the stakeholders handling Covid-19. The heavy handling of covid-19 puts a separate burden on Health Service employees, especially in terms of psychology, namely employee job satisfaction. This study aimed to determine employee job satisfaction during the Covid-19 pandemic Health Department District X East Java, and analyze the relationship between age, gender, employment status, and tenure on employee job satisfaction. The research design used in this study was cross-sectional with the Spearman analysis test. The research sample consisted of 33 employees who worked at the Health Department District X, East Java. The time of the research was conducted from April to May 2020, right when the Covid-19 pandemic occurred. The results showed that most of the District Health Department X East Java employees experienced job satisfaction, which was classified as ambivalent. The analysis showed that there was a significant correlation between age (p-value=0,018), working period (p-value=0,019), and job status (p-value=0,013) on job satisfaction, while gender (p-value=0,717) was not significantly correlated with job satisfaction.

Barriers and support to exclusive breastfeeding in Sukoharjo district, Central Java province, Indonesia: a qualitative study

PurposeThe World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a child's life. However, while the national coverage was 61.33%, the coverage in Sukoharjo was 39.33%. Effective intervention is needed to promote the importance of exclusive breastfeeding, and this requires knowledge of the barriers and support structures in place. This study analyzed the supports and barriers of exclusive breastfeeding in Sukoharjo, Central Java, Indonesia.Design/methodology/approachThis qualitative study used in-depth interviews conducted from December 2017 to March 2018. The population consisted of 33 informants (29 mothers with babies over six months of age, a pregnant mother, two midwives working in the community health center and a staff member in the district health department).FindingsThere were barriers to and support for exclusive breastfeeding in Sukoharjo, Central Java province, Indonesia. The district already has support systems in place, while the barriers emerge from society, the baby's condition, environmental and other sources. The government has tried to overcome the barriers.Research limitations/implicationsThe limitation of this study was that the triangulation method was not utilized. However, the use of various informants strengthened the findings.Practical implicationsThe district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home.Social implicationsThe district government, especially the health department, needs to establish a program to evaluate existing exclusive breastfeeding support programs thoroughly. Smarter and more comprehensive interventions may be needed, for example, by integrating various supports into one activity. For researchers, the findings of this study imply that they can conduct experimental community research using the framework of the two aforementioned theories of behavior change. For example, investigation of combining the support of trained peers with the presence of family members such as the grandmothers of the babies. If both types of support are conducted concurrently, it may strengthen support and reduce barriers from either inside or outside the home.Originality/valueThere are barriers to exclusive breastfeeding in Sukoharjo, but the government has made effective attempts to overcome them. The support systems in place were in line with the theory of planned behavior (TPB) and social cognitive theory (SCT).

PENGARUH DISIPLIN, LINGKUNGAN ORGANISASI DAN LOYALITAS TERHADAP KINERJA PEGAWAI DINAS KESEHATAN KABUPATEN ACEH TAMIANG

The formulation of this research is whether there is an influence of discipline, environment and loyalty work to the performance of officers in the health Department of Aceh Tamiang District, and the purpose of this research is to know and analyze the influence of discipline, Environmental organization and loyalty to the performance of officers in the Health office of Aceh Tamiang District. The method used in this research is the method of quantitative scriptive analysis using multiple linear regression with the measurement of Likert scale. The samples used in this study amounted to 33 employees. The results showed that simultaneously the variable discipline, organizational environment, loyalty has significant effect on performance with a significance value of 0.001 B. The discipline has a significant impact on the performance of officers at the Aceh Tamiang District health Office with significance value of 0.000. The organizational environment has a significant effect on the performance of employees at the Aceh Tamiang District Health Department with significance value of 0.000. Further, the work loyalty has a significant effect on the performance of officers in Aceh Tamiang District Health Department with significance value of 0.000 Simultaneously

Power of 1 Malaysian Ringgit: A Low-Cost Prescription Cost-Sharing Model in Malaysia

ObjectivesTo calculate the total revenue under a hypothetical 1 Malaysian Ringgit (MYR) prescription cost sharing model in government healthcare facilities in Pahang, Malaysia. MethodsA cross-sectional study was conducted at outpatient pharmacy in all government healthcare facilities in Pahang from year 2013 to 2017. Each dispensed medication was calculated as 1 MYR and contributed to the total revenue. ResultsA total of 11 hospitals and 81 health clinics were recruited into the study. A hospital could generate 0.311 million MYR per year, and a district health department could generate 0.623 million MYR per year, giving a total of 10.268 million MYR revenue every year in Pahang, Malaysia. Under the prescription medicines cost sharing scheme, it was shown that an average of 9.4% of the total pharmaceutical spending could be recovered. The recovery percentage was approximately fourfold higher in health clinics (16.5%-21.7%) when compared with that in hospitals (4.3%-5.2%). ConclusionAn estimated 10 million MYR or 10% from the total Ministry of Health pharmaceutical spending could be collected under the proposed 1 MYR prescription cost sharing model.