Provincial Health Office Research Articles

SPATIAL MODELING OF MATERNAL HEALTH: GEOGRAPHICALLY WEIGHTED POISSON REGRESSION ON MATERNAL MORTALITY FACTORS

Data from the 2021 West Java Provincial Health Profile Report, accessed from the official website of the West Java Provincial Health Office, reveals a significant surge in maternal mortality cases, rising from 165 in 2020 to 460 in 2021. In support of efforts to reduce maternal mortality rates, this study investigates the contributing factors to this phenomenon across various districts in West Java Province. The data used is from the year 2021. This study aims to evaluate the effectiveness of Poisson regression, negative binomial regression, and Geographically Weighted Poisson Regression (GWPR) models in capturing the variability of maternal deaths in the study area for that year. A comprehensive analysis revealed that the distribution of maternal mortality fits the Poisson model, displaying significant spatial heterogeneity. Acknowledging this variability, the GWPR approach using an Adaptive Kernel Bisquare weighting was selected due to its capability to produce localized parameter estimates, which more accurately reflect the specific conditions of each location. The analyzed independent variables include the number of community health centers, coverage of antenatal services at the first (K1) and fourth (K4) visits, management of obstetric complications, and coverage of iron supplementation for pregnant women. Of the five variables, only three showed statistically significant effects; therefore, the study proceeded using these three variables. The results indicate that GWPR provides the best explanation for the variability in maternal mortality rates, with an adjusted R² value of 63.17% and a MAPE of 37.70%.

Management of a Patient with Type 2 Diabetes Mellitus and Uncontrolled Hypertensive Urgency Using a Family Doctor Approach in a First-Level Health Facility in Indonesia: A Case Report

Noncommunicable diseases (NCDs) result from genetic, environmental, and behavioral factors. These diseases include cardiovascular conditions and diabetes. According to the Lampung Provincial Health Office in 2021, the prevalence of type 2 diabetes mellitus increased from 1.37% to 3.76% (equivalent to 88,518 cases), and the prevalence of hypertension rose from 15.10% to 17.35%. NCDs are chronic and affect quality of life and productivity, necessitating comprehensive management. The goal of a family medicine approach in treating patients with type 2 diabetes mellitus and hypertension is to identify clinical, psychological, and psychosocial factors. Primary data is collected through anamnesis, physical examination, and home visits to evaluate the physical environment. Patient Mrs. A, a 55-year-old farmer, reported complaints of headaches and frequent nighttime urination. She has a history of hypertension since 2022 and type 2 diabetes mellitus since 2023. Management was carried out holistically using a patient-centered, family-oriented, and community-based approach grounded in Evidence-Based Medicine. Interventions included both pharmacological and non-pharmacological via family conferences. Evaluation of the interventions showed improved knowledge among the patient and her family, a reduction in the patient’s blood pressure and blood glucose levels, and behavioral changes in the patient to consume meals aligned with recommended dietary allowances.

Community-driven Waste Management: Insights from an Action Research Trial in Yogyakarta, Indonesia

Background Yogyakarta is in a waste emergency period. Waste management poses a significant challenge in urban areas, necessitating innovative and sustainable solutions. This article explores the Community-Based Waste Management (CBWM) approach implemented in Yogyakarta City, Indonesia, shedding light on valuable lessons from this initiative. Yogyakarta City's experience is a case study for understanding the effectiveness of involving local communities in waste management efforts. Through participatory programs, residents have been empowered to actively contribute to waste reduction, recycling, and proper disposal practices. Objective This study seeks public health-oriented household waste management options and increases public awareness about trash management while keeping public health in mind to overcome Yogyakarta's waste emergency. Methods This study employs an action research design mixed with qualitative research. Participants were members of society, government authorities (environmental and health offices), and the Yogyakarta Provincial and City Health Offices. For the trial method, participants comprised four cycles utilizing a standard random sample procedure. An in-depth interview was conducted to evaluate the procedure, and questionnaires were used to determine performance indicators for the procedure. Results Community-based action research guarantees that waste management is improved by approaching it from a public health standpoint. Waste management innovations include implementing environmental sanitation, clean and healthy lifestyles, implementing occupational health and safety concepts, sorting organic and inorganic waste, as well as innovations in household waste management infrastructure. Conclusion Innovation in waste management considers that public health is necessary for society. Innovation refines waste processing techniques that were previously in use. This idea is suitable and adaptable to the circumstances of Yogyakarta City residents.

Analysis Of Factors Related to The Incidence of Stunting Toddlers in The Region Gambah Health Center

Stunting is a condition of growth failure that occurs in toddlers. The 2022 SSGI survey results show that stunting in Indonesia is at 21.6%. Data from the South Kalimantan Provincial Health Office in 2022 indicates a rate of 24.6%. Data from the HSS Health Office in 2022 shows a rate of 4.53%. Among the 21 Health Centers in the HSS area, the Gambah Health Center ranks first with the highest stunting rate at 11.60%. Stunting is not caused by a single factor but by multiple factors. The aim of this research is to analyze the factors associated with the incidence of stunting in toddlers. This research is a quantitative analysis using a case-control study method. The study employs chi-square tests and odds ratios. The sample consists of 120 toddlers, with 40 cases and 80 controls. The results of this study indicate that the factors associated with the incidence of stunting in toddlers are birth weight (p-value 0.022, OR 3.381), exclusive breastfeeding (p-value 0.000, OR 5.741), mother's education level (p-value 0.015, OR 5.444), history of pregnancy age (p-value 0.000, OR 9.736), and maternal nutritional status (p-value 0.006, OR 8.273). The conclusion of the research birth weight, exclusive breastfeeding, mother's education level, history of pregnancy age, and maternal nutritional status are factors that can cause the incidence of stunting in toddlers.

Implementation of the Universal Health Coverage (UHC) Program by the Riau Provincial Health Office

Universal Health Coverage (UHC) merupakan sistem penjamin kesehatan yang memastikan Setiap warga dalam populasi memiliki akses yang ada terhadap pelayanan kesehatan promotif, preventif, kuratif, dan rehabilitatif bermutu dengan biaya terjangkau. Dinas Kesehatan Provinsi Riau, BPJS Kesehatan, dan seluruh fasilitas pelayanan kesehatan di provinsi riau bekerjasama untuk mengoptimalkan percepatan program Universal Health Coverage (UHC) agar masyarakat mendapatkan pelayanan kesehatan yang mudah dan sederhana. Program Universal Health Coverage (UHC) bisa mencover 144 jenis penyakit dan Dinas Kesehatan Provinsi Riau tidak melakukan identifikasi data jumlah kasus yang telah ter cover oleh program ini. Tujuan penelitian ini untuk mendeskripsikan dan menganalisis implementasi program UHC serta mengidentifikasi dan menganalisis faktor penghambat dari implementasi program UHC di Dinas Kesehatan Provinsi Riau. Penelitian ini menggunakan teori implementasi dari Goerge C. Edward III yang menggunakan 4 indikator utama yaitu Komunikasi, Sumber Daya, Disposisi, dan Struktur Birokrasi. Metode penelitian yang digunakan adalah metode kualitatif. Dengan teknik pengumpulan data yaitu wawancara, observasi dan dokumentasi. Hasil penelitian menunjukkan bahwa Implementasi Program Universal Health Coverage (UHC) di Dinas Kesehatan Provinsi Riau belum berjalan maksimal, terutama komunikasi yang berjalan belum optimal dan sumber daya yang tidak efektif dan efisien dikarenakan ada beberapa faktor yang menghambat terlaksananya program tersebut yaitu tenaga kesehatan yang kurang, sarana prasarana dan dana anggaran yang kurang memadai. Demikian juga dengan kurangnya komitmen dan mispersepsi antar kepala daerah/pemerintah daerah.

PENGARUH PROFESIONALISME KERJA, KOMPETENSI DAN LINGKUNGAN KERJA TERHADAP KINERJA KARYAWAN PADA DINAS KESEHATAN PROVINSI MALUKU

The purpose of the study was to determine the effect of Work Professionalism, Competence and Non-Physical Work Environment simultaneously on the performance of employees of the Maluku Provincial Health Office. The population in this study amounted to 116. Determination of the number of samples using probality random sampling techniques with the Slovin formula obtained 54 respondents, the analytical test tool used was SPSS 24. Data processing techniques carried out using quantitative methods with descriptive analysis. The results of this study indicate that Work Professionalism has a negative and significant effect on employee performance, while Competence and Non-Physical Work Environment have a positive and significant effect on employee performance.

Risk Factors Analysis of Diabetes Prevalence in Wetland Area: A Study from Borneo Wetland Study on Diabetes

Background: National Basic Health Survey held by the Ministry of Health Republic of Indonesia shows the prevalence of Diabetes Mellitus increased from 6.9% to 8.5% in 2018. Wetland is an area covered by shallow water on the surface, which represents a unique ecosystem. Aim: This study investigated the association between various risk factors and DM prevalence in South Kalimantan Wetlands, Indonesia. Early identification and management of risk factors may prevent progression into diabetes mellitus. Methods: We conducted the Borneo Wetland Study on Diabetes (Best-Diab 1) with a cross-sectional study approach using the latest health survey data conducted by the South Kalimantan Provincial Health Office from the primary health center visit from January 2020 to March 2022. Using Proportionate Random Sampling, we divided samples into two groups; 6.010 in the DM group, and 6.010 non DM group. Results: Gender, age, BMI, blood pressure, and blood glucose level were significantly correlated with diabetes mellitus prevalence (p<0.001). Family history of DM surprisingly has a significant impact on DM prevalence (PR, 3.16; 95% CI, 2.80-3.57, p<0.001). The prevalence of DM in the smoking group was 0.78 times less than in non-smoking individuals (PR, 0.78; 95% CI, 0.74-0.82; p<0.001). Excess sugar was the greatest risk factor for diabetes mellitus, with the prevalence of DM 4.72 times greater than normal sugar intake (PR, 4.72; 95% CI, 4.29-5.2; p<0.001). Excess salt intake also seemed to be a significant risk factor among DM patients (PR, 1.24; 95% CI, 1.17-1.30, p<0.001. Conclusion: Females, older age, higher BMI, and family history of DM were significant risk factors for diabetes mellitus prevalence in this study. Further studies are needed to determine how those factors impacted diabetes mellitus. Keywords: risk factors, prevalence, diabetes mellitus, wetland, South Kalimantan

The Effects of Giving Moringa Leaf Tea for Increasing Hemoglobin Levels in Adolescent Girls

Anemia is a condition in which the number of red blood cells is insufficient to meet the physiological needs of the body due to the rapid growth rate combined with the depletion of iron stores and an inadequate diet. Based on data from the East Java Provincial Health Office in 2020 the prevalence of female adolescents in East Java who have anemia is 42%, including Sidoarjo Regency is ranked first in East Java with a prevalence of 32.9%. The purpose of this study was to determine the effect of giving moringa leaf tea on increasing hemoglobin levels in female adolescents. Pre Experimental research method with pretest-posttest design one group design . The population of this study were all young women at the Youth Posyandu in Putat Tanggulangin Village Sidoarjo and as many samples 19 young women (calculations attached) who met the inclusion and exclusion criteria . Research data were analyzed using data analysis Univariate was tested by paired t-test with a significant level of p.value <0.05 . Got results that there was a significant difference between hemoglobin levels before and after administration of moringa leaf tea (p<0.05).

CORRELATION BETWEEN MATERNAL EDUCATION AND EMPLOYMENT STATUS WITH EXCLUSIVE BREASTFEEDING HISTORY

Background: In 2022, the sole lactation coverage rate in Indonesia was recorded at 67.96%. According to the East Java Provincial Health Office, 67.54% of women in the province of East Java were exclusively nursing in 2022. This falls very short of the 80% goal set by the Republic of Indonesia's Ministry of Health in 2020. Infants require breast milk and adequate nutrition to increase their nutrient levels during growth. Exclusive breastfeeding cannot be optimally provided due to various factors such as maternal education history, which influences the mother's limited knowledge about the importance of exclusive breastfeeding maternal employment. These two factors affect the provision of exclusive breastfeeding to infants. Given the foregoing context, the study's goal was to discover how a mother's job description affected her history of exclusive breastfeeding. Method: The study employed a cross-sectional strategy and a quantitative, analytical observational design. Purposive sampling was used to choose 111 participants for the study, who were all mothers with infants between the ages of 6 and 12 months. The study will be carried out in Madiun City's Public health Service Tawangrejo East Java, Indonesia. operational region. This study was conducted from February to April 2024. Data collection utilizes questionnaires. The chi-square test was used to analyze the data. Result: The p-value is 0.03 or less than 0.05, showing that the history of exclusive breastfeeding was significantly correlated with the mother's employment position and educational attainment. Mothers with a history of exclusive breastfeeding have a poor association between their employment status and education, as indicated by their correlation coefficient (R) value of 0.362. Conclusion : there is a relationship between education, employment level, and history of exclusive breastfeeding at the Tawangrejo Community Health Center in Madiun, East Java, Indonesia.

Analysis of the Management of Incoming Letters at the South Sulawesi Provincial Health Office

This study aims to find out the analysis of the management of incoming mail at the South Sulawesi Provincial Health Office. This research is qualitative, using data collection techniques through observation, interviews and documentation. The research informants were 3 employees of the South Sulawesi Provincial Health Office. The results of this study show that the management of incoming letters at the South Sulawesi Provincial Health Office is running "well". Judging from the aspect of receiving letters, namely receiving letters is done manually by paying attention to the purpose of the sender, sorting to distinguish between personal and official letters, checking that the letters are correct and not damaged, and ensuring that the letters are well received by the relevant fields. The aspect of directing incoming letters, namely directing incoming letters, is carried out by including a disposition sheet that records the instructions of the leadership After being received in the administration section, the letter is put into the agenda book and sent to the head of the agency. Original mail can be sent or distributed. In the case of recording incoming mail, incoming mail is recorded in a notebook and the officer uses an agenda stamp as proof that the letter has been recorded. The storage aspect includes storing incoming mail manually, i.e. it is physically stored in the mail. To do this, a folder is used to store the letter in the refrigerator. From the aspect of submission, the incoming letter is submitted to the relevant parties based on the disposition of the leadership by including two introductory sheets that must be paraphrased as a receipt.

A Study of the Effects of Toxic Leadership and Person-Organization Fit on Organizational Commitment and Employee Performance

Objective - It is projected that organisational commitment as a mediating variable will diminish the effect of toxic leadership on employee performance and increase the effect of P-O Fit. A study comparing the effects of Toxic Leadership on decreasing performance and P-O Fit on enhancing performance, both mediated by organisational commitment. Methodology/Technique - The time dimension makes this study cross-sectional. Only Bengkulu Provincial Health Office personnel received the questionnaire, which used the census approach to sample all 311 respondents. This study uses SEM to test concept validity (convergent and discriminant) and reliability. Using SmartPLS 3.0, respondent profile statistical descriptions, hypothesis testing with path analysis, and indirect impact testing are explained. Findings – Research shows that toxic leaders hurt employee performance, not organisational commitment. Even while P-O fit has little influence on organisational commitment or performance mediated by it, it can boost employee performance. Organisational commitment affects employee performance. The employee's organisational commitment is supposed to be ongoing and based on his desire for a decent wage and a job. This makes someone ignore the leader's poisonous leadership style and compatibility with the organisation if it pays well and has good facilities. Novelty - The research model we examine provides a more complete picture of how organizational commitment can reduce or increase employee performance influenced by toxic leadership and person-organization fit. Based on the research that has been conducted, we believe that leaders with a toxic leadership style can neglect their followers' acceptance and reduce constant performance. On the other hand, person-organization fit helps increase employee commitment and performance. Type of Paper: Empirical JEL Classification: J24, J28 Keywords: Employee Performance; Organizational Commitment; P-O Fit; Toxic Leadership Reference to this paper should be made as follows: Praningrum; Suryosukmono, G; Afrizal; Dewi, R.K; Pefriyadi. (2024). A Study of the Effects of Toxic Leadership and Person-Organization Fit on Organizational Commitment and Employee Performance, J. Mgt. Mkt. Review, 9(3), 140 – 147. https://doi.org/10.35609/jmmr.2024.9.3(5)

Evaluation of the Water Ambulance Service Program at the Health Crisis and Emergency Center Province Health Office of DKI Jakarta in 2023

Evaluation of the Water Ambulance Service Program at the Health Crisis and Emergency Center Province Health Office of DKI Jakarta in 2023

EVALUATION OF POLIO IMMUNIZATION COVERAGE AND ACUTE FLACCID PARALYSIS SURVEILLANCE IN EAST JAVA, INDONESIA, 2018-2022

Background: Indonesia has successfully eradicated wild poliovirus since 2005 using robust immunization and AFP surveillance programs. However, circulating vaccine-derived poliovirus type 2 has challenged these commitments, followed by the 2024 outbreak in East Java. Purpose: The study aims to analyze the polio eradication initiative by assessing polio immunization coverage and AFP surveillance in East Java. Methods: A descriptive, quantitative study design and retrospective analysis of polio immunization coverage and AFP surveillance indicators from the Provincial Health Office, East Java, from 2018–2022. The data was collected and analyzed using Excel, EpiInfo7, and Health Mapper software. Results: OPV4 coverage ranged from 89.95% to 100.76%, while IPV coverage ranged from 73.98 % to 94.18% from 2018 to 2020; the proportion of districts and cities for IPV coverage increased from 0% in 2018 to 44.74% in 2022, below the 95% WHO target. Of the 826 cases of AFP reported, 820 (99.27%) were actual AFP cases <15 years of age, with most (49.02%) being <5 years of age. Non-polio AFP rates ranged from 0.80 in 2020 to 2.59 in 2022 per 100,1000 <15 years of age, with the proportion of districts and cities slightly declining from 55.26% in 2018 to 50% in 2022. The annual mean percentage of AFP-adequate specimens is 61.15%, with the proportion of districts and cities significantly declining from 31.58% in 2018 to 10.53% in 2022, below the 80% target. Conclusion: IPV immunization coverage and AFP surveillance indicators are below the WHO-recommended targets across districts and cities in East Java.

Evaluation of Nutrition Supplementation and Nutrition Education Program in Preventing Malnutrition in Toddlers

Malnutrition in children under five is a serious global health problem, especially in developing countries. In Indonesia, the prevalence of stunting in 2020 reached 31.8%, which is second in Southeast Asia after Timor Leste. However, this figure has decreased to 21.6% in 2022, according to data from the Indonesian Ministry of Health. This study aims to evaluate the effectiveness of nutrition supplementation and nutrition education programs in preventing malnutrition in children under five. This research design is an evaluative design with a cross-sectional approach to obtain an overview at one time of the nutritional status of children under five years of age, program implementation, and results achieved. The input of the number of nutrition workers is lacking, the Puskesmas needs 1 community health worker, the equipment owned is still lacking in the laboratory section and must request procurement from the City or Provincial Health Office and funds for MT distribution are not yet available, the output is not yet on target and the program coverage has not yet reached the set achievement indicators. Suggestions for the Padang City government, especially the Padang City Health to procure facilities and infrastructure that are lacking in puskesmas, while for the Padang Health Center must conduct counseling on the importance of PMT-P so that the MT provided right on target.

The Influence of the Reward and Punishment System on Improving Service Quality at the BPJS Health Office

This research aims to determine the influence of the reward and punishment system on improving service quality at the Gorontalo Province Health BPJS Office. The analytical method used is a quantitative method, with primary data sources and secondary data and uses a deductive approach. The population in this study were all employees of the BPJS Health Office of Gorontalo Province with a total of 42 respondents. The sampling technique used a saturated sampling technique. Based on the results of the analysis, it can be seen that the t count of the Reward Variable is obtained t count 5.419 > t table 1.682 and with a significance level of 0.000 < 0.05, so in this case the Ha1 hypothesis is accepted, which means that Rewards have a significant effect on improving the quality of service at the Gorontalo Province Health BPJS Office. Meanwhile, giving punishment has no significant effect on improving the quality of services at the Gorontalo Province BPJS Health Office. This is proven by the tcount of 0.311 which is smaller than the ttable value of 1.682 indicating a significance level value of 0.757 which is greater than 0.05, so the hypothesis (Ha2) is rejected. which means that the Punishment system has no significant effect on the level of Service Quality at the Gorontalo Province Health BPJS Office. Based on the results of the ANOVA test, the calculated F value was 10.535 with a significance level of 0.000. The Fcount value is compared with the Ftable value, namely 3.23 so that Fcount > Ftable is obtained or by paying attention to the significance level F=0.000 which means ≥ 0.05, which means there is a simultaneous influence between Reward and Punishment on Improving Employee Quality at the Provincial BPJS Health Office Gorontalo.

Establishment, Implementation, Initial Outcomes, and Lessons Learned from Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection Among Persons Newly Diagnosed With HIV in Thailand: Implementation Study.

A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand as a small-scale pilot project in October 2020. We aimed to describe the lessons learned and initial outcomes obtained after the establishment of the nationwide recent HIV infection surveillance project from April through August 2022. We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the Asanté HIV-1 Rapid Recency Assay. The duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 counts <200 cells/mm3 or those having opportunistic infections were classified as RITA-CS-long-term. Individuals testing RTRI-recent with CD4 counts >200 cells/mm3, no opportunistic infections, and not on antiretroviral treatment were classified as RITA-CS-recent. Two hundred and one hospitals in 14 high-burden HIV provinces participated in the surveillance. Of these, 69 reported ≥1 HIV diagnosis during the surveillance period. Of 1053 newly diagnosed cases, 64 (6.1%) were classified as RITA-CS-recent. On multivariate analysis, self-reporting as transgender women (adjusted odds ratio [AOR] 7.41, 95% CI 1.59-34.53) and men who have sex with men (AOR 2.59, 95% CI 1.02-6.56) compared to heterosexual men, and students compared to office workers or employers (AOR 3.76, 95% CI 1.25-11.35) were associated with RITA-CS-recent infection. The proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow-up and supervision visits were the most commonly cited lessons learned to inform the next surveillance phase. Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. The key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HIV testing service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices.

Purchase Profile of Hypertension Drugs of Calcium Channel Blocker Group Amlodipine Doses of 5 mg and 10 mg in Several Gorontalo City Pharmacies January - March period in 2024

Hypertension is one of the most common diseases in Indonesia, one of which in the province of Gorontalo is included in the top 10 largest diseases. According to the health data profile from the Gorontalo provincial health office in 2022, the level of hypertension in Gorontalo city reached 2,325 cases, or around 4.6%. High cases of hypertension must be balanced with the provision of hypertension drugs, one of which is the calcium channel blocker (CCB) hypertension drug, amlodipine. The purpose of this study was to see the profile of purchasing hypertension drugs from the Calcium Channel Blocker (CCB) Amlodipine group in the community in Gorontalo City, especially in pharmacy and pharmaceutical service facilities. The research method uses a random sampling observation method, namely to see drug purchases in three Gorontalo city pharmacies located in different sub-districts. Purchase tracking was carried out in January, February, and March 2024. The results showed the purchase of amlodipine drugs in the three pharmacies in different amounts. Pharmacy B dominated the purchase of drugs compared to Pharmacy A and Pharmacy C at the 5 mg and 10 mg doses, respectively. Based on the results obtained, these differences are influenced by several indicators, including drug availability, drug completeness, pharmacy strategic location, and customer satisfaction.

Statistical Models for Outbreak Detection of Measles in North Cotabato, Philippines

A measles outbreak occurs when the number of cases of measles in the population exceeds the typical level. Outbreaks that are not detected and managed early can increase mortality and morbidity and incur costs from activities responding to these events. The number of measles cases in the Province of North Cotabato, Philippines, was used in this study. Weekly reported cases of measles from January 2016 to December 2021 were provided by the Epidemiology and Surveillance Unit of the North Cotabato Provincial Health Office. Several integer-valued autoregressive (INAR) time series models were used to explore the possibility of detecting and identifying measles outbreaks in the province along with the classical ARIMA model. These models were evaluated based on goodness of fit, measles outbreak detection accuracy, and timeliness. The results of this study confirmed that INAR models have the conceptual advantage over ARIMA since the latter produces non-integer forecasts, which are not realistic for count data such as measles cases. Among the INAR models, the ZINGINAR (1) model was recommended for having a good model fit and timely and accurate detection of outbreaks. Furthermore, policymakers and decision-makers from relevant government agencies can use the ZINGINAR (1) model to improve disease surveillance and implement preventive measures against contagious diseases beforehand.

NAVIGATING BARRIERS: THE NEED FOR INTEGRATED HEALTH INFORMATION SYSTEM FOR TUBERCULOSIS-DIABETES CO-SCREENING

Background: Tuberculosis-diabetes mellitus (TB-DM) is a co-epidemic condition representing a double burden for high TB burden countries like Indonesia. Private primary care (PPC) in Indonesia was newly reintroduced to the TB program. Aims: This study explores the challenges PPC healthcare workers (HCWs) face in implementing TB-DM bi-directional screening and strategies to improve it. Methods: An explorative qualitative method was used by conducting two-round focus group discussions (FGDs) with HCWs (n=15) from five private clinics in Yogyakarta Special Region Province Indonesia and triangulated with 10 DM patients and the TB program manager from the provincial health office. The data were audio recorded, transcribed verbatim, and subjected to thematic analysis. Results: HCWs face complex barriers in TB-DM co-screening implementation from patients, HCWs, and health system aspects. An integrated system to remind, support decision-making, report, reduce documentation duplication, monitor, and evaluate co-screening implementation emerged as a potential strategy, although some challenges to deploy. Conclusion: Albeit HIS is promising in enhancing integrated TB-DM screening and management, a comprehensive approach and multisector roles are still needed to overcome impediments to TB-DM bidirectional screening in PPCs. Keywords: diabetes mellitus, health information system, screening, tuberculosis

Determinants of Depression Levels in Breast Cancer Survivors

Background: Breast cancer is one type of malignancy in breast tissue that is experienced by many women throughout the world, including in Indonesia. Breast cancer shows high morbidity and mortality rates. The East Java Provincial Health Office noted that breast cancer cases have increased from year to year. The conditions and the process of cancer treatment can lead to psychological problems, including depression.Objective: This research aims to analyze the determinant factors that influence depression levels in breast cancer survivors.Methods: This study utilized the correlation method. The study was conducted in East Java. 158 respondents were selected using a purposive sampling technique. The instrument used in this research was a questionnaire that has been tested for validity and reliability. The data collection method used was face-to-face. Data analysis was carried out using SPSS software, including cross-tabulation and multivariate linear regression test with alpha 0.05.Results: Research findings show that marital status (p=0.021) is related to social support (p=0.002), physical condition (p=0.003), and the level of depression, but there was no relationship between age (p=0.281), the level of education (p=0.752) and the length of illness (p=0.265) and depression levels in breast cancer survivors.Conclusion: It is concluded that the determinants of factors that influence the level of depression are marital status, social support, and physical condition in survivors of breast cancer. Breast cancer survivors are expected to maintain their enthusiasm and not give up to avoid depression, which can reduce their health status.