Public Health Status Research Articles

Introduce new paper-based outpatient morbidity recording system to outpatient departments of public hospitals in Sri Lanka: feasibility study

Background: Effective evaluation of public health status is reinforced by description of the current health status of the community, ability to detect changes in this status and prediction of trends. Morbidity and mortality are often recorded in patients presenting to hospitals. There are more than 1,100 government owned hospitals in Sri Lanka and these institutions have been providing services to average 50 million out-patients per annum. Morbidity data of patients attending Out Patient Department (OPD) of these health facilities are not routinely recorded. We developed a new paper based OPD morbidity recording system adapted with International Classification of Primary Care (ICPC-2) coding and tested its feasibility in various hospitals. Methods: We used an intervention study design composed of three phases. Pre-intervention was to develop the new paper based OPD morbidity recording system. During the second phase, new recording system was tested in 3 hospitals, which were selected randomly from each hospital level: a primary care hospital, a divisional hospital and a base hospital located in Colombo district. New recording system implemented for a month period in selected three hospitals. We measured the feasibility over the process and acceptability of participants for the new recording system in various aspects during the post-intervention phase. Results: New paper based OPD morbidity recording system consisted with an OPD form, an OPD return and a Tally sheet and data flow was outlined in the pre-intervention. Feasibility assessment showed high perceived satisfaction to layout (97%), timeliness (97.5%), technical competency (75%) and training & orientation provided (98%). All hospitals showed more than 90% of overall completeness for the new OPD at registration table. Although overall completeness of entries made at consultation table had shown more than 68% completeness, it is declining when hospital becomes larger. High accuracy (99%) is shown in direct entering ICPC-2 codes and 98% in overall satisfaction of MO/OPD implied that new OPD recording system is acceptable. The preparation of new OPD return and tally sheet was also well accepted by medical record officers (MRO). Conclusions: New paper based OPD morbidity recording system was accepted as user-friendly and feasible to be implemented in OPD settings and medical record offices in tested hospitals. The readiness of central medical statistic unit for large OPD data flow should be assessed and possibility of incorporating IT solutions in future is recommended.

Determinants of Infant Mortality in Bangladesh: A Nationally Surveyed Data Analysis

Background: It is well established that improving human health has direct obvious payoff on enhancing life expectancy along with economic growth. Infant mortality deliberately used to understand a countries overall public health status particularly child bearing mothers. But the prevalence of child mortality continues to be a prime public health concerns in Bangladesh. This study aims to investigate the impact of some geospatial, socioeconomic, demographic and health factors on infant mortality in Bangladesh. Methods: The study modeled infant mortality (aged 0-11 months) as the categorical dependent variable using 11 selected covariates from the 2014 Bangladesh Demographic and Health Survey (BDHS-2014) dataset. The Pearson-Chi square test and Binary Logistic Regression methods were utilized for the bivariate and multivariate analyses. Results: All the selected covariates were significantly associated with infant mortality in bivariate analysis. The results of the logistic regression revealed that illiterate father, household without toilet facility or having hanging toilet, multiple birth and small size at birth appeared at the significant risk factors for infant mortality. In contrast, receiving vitamin A dose and visiting in antenatal care revealed as protective factor for infant deaths. Conclusion: This study is uniquely addressed some several determinants which are the immediate cause of infant deaths. This evidence based empirical study suggests that more attention needs regarding to eliminate all kinds of child mortality in Bangladesh along with infant mortality.

Causal Linkage amongst Public Expenditure on Health, Health Status and Growth: New Empirical Evidence from Toda-Yamamoto Approach for Nigeria

This study investigates the causal linkages amongst public expenditure on health, health status and economic growth in Nigeria using the Toda-Yamamoto technique. The choice of the Toda-Yamamoto approach is predicated on its simplicity and the ability to overcome the shortcomings inherent in the conventional causality procedures by producing more robust results through the estimation of the augmented VAR that guarantees the asymptotic distribution of the Wald statistic. To this end, the study collected annual time series data from the Central Bank of Nigeria’s Statistical bulletin and the World Development Indicator on public expenditure on health, life expectancy, infant mortality and real gross domestic product spanning 38 years from 1981 to 2018. The result of the study’s empirical analysis based on the co-integration test indicates that public health expenditure, health status and economic growth have long-run association. Further, the Toda-Yamamoto causality test result reveals the absence of causality between health expenditure and health status. Similarly, health status and economic growth are not causally interdependent. On the basis of the findings, the paper vehemently concludes that efforts to stimulate economic growth by targeting health outcomes improvement through public expenditure will be futile. As such, there is the need to develop better national health policy and programmes such as compulsory national health insurance that is capable of resolving the fundamental problems in the health sector. This would help integrate healthcare into the mainstream of the Nigerian economy.

Investigating the Causal Relationship between Public Health Expenditure and Health Status; Panel Vector Self-Regression Model

Investigating the Causal Relationship between Public Health Expenditure and Health Status; Panel Vector Self-Regression Model

Assessment of public health systems focussing on infrastructure & human resources for health, at rural facility level in Arunachal Pradesh, India

Introduction: This paper is an attempt to get an in depth knowledge of the public health status of the state and the challenges being faced by the state. Adequate public health Infrastructure and Human Resources are the two main components that helps in ensuring proper delivery of health services to the society. This paper will focus mainly on these two components at the community level i.e at Sub centre (SC), Primary Health Centres (PHCs) and Community Health Centres (CHCs). This is an effort to enable and help medical practitioners, healthcare providers and other stakeholders to identify the need and to ensure optimum utilization of available resources to improve health status of the community and the state. Materials and Methods: Desk Review of the available literature and analysis of the secondary data available in public domain was carried out. Results: In spite of showing progress in various health indicators like IMR, Institutional deliveries, ANC etc. there is lot yet to be achieved. In terms of presence of SC, PHC & CHC there are enough number of facilities present in the state but the condition has been appalling in terms of quality of health care services & availability of specialist and well trained manpower. Conclusion: Due to identified bottlenecks in the paper the healthcare delivery system of state is not of high quality which takes a toll on performance of the state. A roadmap needs to be developed and adhered to in order to achieve the desirable and sustainable health system with adequate HRH and quality infrastructure in the state. Keywords: Health systems, Health Infrastructure, Human resources for health, North east public health, Rural healthcare, Community health accessibility.

DYNAMICS FOR MORBIDITY OF THE CIRCULATION SYSTEM DISEASES IN ADULT POPULATION OF THE MOSCOW REGION

Circulatory System Diseases (CSD) are the leading causes of high morbidity and mortality of the adult population in many countries, including in the Russian Federation and largely determine public health status. The aim of the work is to analyze the dynamics of the general and primary morbidity of CSD and coronary heart disease (CHD) in the adult population of the Moscow Region for 2008–2016. We used the data of Rosstat for 2008–2016. The indicators of the total and primary morbidity of CSD and CHD of the adult population were determined. A high level and dynamics of an increase in the morbidity of CSD and CHD in the Moscow Region for the 2008 – 2016 period, which determine the high need for endovascular care, especially for patients with acute coronary syndrome, have been established.

LOW BIRTH WEIGHT IS A RISK FACTOR OF MALNUTRITION IN CHILDREN UNDER FIVE YEARS OLD IN COASTAL AREAS

Background: Malnutrition is a public health problem, especially in developing countries. Malnutrition of children can affect brain development during growth and increase morbidity and mortality. Low birth weight (LBW) plays an important role in child morbidity and mortality. The prevalence of malnutrition in children under five years old and LBW in Indonesia are still high.Objective: This study aimed to assess the risk of LBW on the incidence of malnutrition in children under five years old in coastal areas.Method: This was an observational analytic study with case control approach. The study was conducted on 64 respondents in the coastal area of Kendari City, Southeast Sulawesi on November to December 2018. Case group (n=16) was children under five years old who experienced malnutrition in the working area of Abeli, Mata and Benu-Benua Health Center in October 2018. Control group (n=48) was taken by measuring body weight and then adjusted to the category and threshold of nutritional status based on the body weight index according to age. Sixteen respondents of case group were recruited using total sampling. Forty-eight respondents of control group were also recruited using purposive sampling with non-matching method according to the inclusion and exclusion criteria. The Odd Ratio (OR) statistical test was used with a 2x2 contingency table and a 95% confidence level with a significance level of α = 0.05.Results: The majority of respondents were 25-48 months old, and maternal age was mostly 36-45 years old in the case group (37.5%) and 26-35 years old in the control group (50.0%). The majority of maternal education level was junior high school in the case group (43.7%) and high school in the control group (47.9%). The statistical test results were obtained OR = 5.923 (CI=95%) with Lower Limit (1.724) and Upper Limit (20.346). Conclusion: Infants with LBW had a 5 times higher risk for experiencing malnutrition in childhood in coastal areas. Therefore, knowledge of LBW and malnutrition is needed to improve public health status.

Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia.

Background The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD. Objective This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN). Method This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20. Result We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs. Conclusion The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.

Spatiotemporal Variations in Gastric Cancer Mortality and Their Relations to Influencing Factors in S County, China.

Increasingly stricter and wider official efforts have been made by multilevel Chinese governments for seeking the improvements of the environment and public health status. However, the contributions of these efforts to environmental changes and spatiotemporal variations in some environmental diseases have been seldom explored and evaluated. Gastric cancer mortality (GCM) data in two periods (I: 2004–2006 and II: 2012–2015) was collected for the analysis of its spatiotemporal variations on the grid scale across S County in Central China. Some environmental and socioeconomic factors, including river, farmlands, topographic condition, population density, and gross domestic products (GDP) were obtained for the exploration of their changes and their relationships with GCM’s spatiotemporal variations through a powerful tool (GeoDetector, GD). During 2004–2015, S County achieved environmental improvement and socioeconomic development, as well as a clear decline of the age-standardized mortality rate of gastric cancer from 35.66/105 to 23.44/105. Moreover, the GCM spatial patterns changed on the grid scale, which was spatially associated with the selected influencing factors. Due to the improvement of rivers’ water quality, the distance from rivers posed relatively larger but reversed impacts on the gridded GCM. In addition, higher population density and higher economic level (GDP) acted as important protective factors, whereas the percentage of farmlands tended to have adverse effects on the gridded GCM in period II. It can be concluded that the decline of GCM in S County was spatiotemporally associated with increasingly strengthened environmental managements and socioeconomic developments over the past decade. Additionally, we suggest that more attentions should be paid to the potential pollution caused by excessive pesticides and fertilizers on the farmlands in S County. This study provided a useful clue for local authorities adopting more targeted measures to improve environment and public health in the regions similar to S County.

Analysis of health risks using geomedical mapping in landslide prone areas in Ponorogo East Java

Ponorogo Regency is an area prone to landslides, as happened on April 1, 2017, which had impacted 28 fatalities, declining public health status, and losses in the economic sector to hundreds of millions of rupiah. This research is a preventive step that aims to analyze the public health risks by geomedical mapping covering 21 sub-districts prone to landslide disasters in Ponorogo Regency. Geomedical mapping is an utilization of Geographic Information Systems (GIS) on disaster mitigation. Health risk analysis is carried out by weighting and scoring methods on variables from the hazard, vulnerabilities, and capacities to obtain the level of risk for each sub-district. The results show that 28.6% of all sub-districts in Ponorogo Regency have a high potential for landslide disasters while 71.4% are potentially moderate. The vulnerability of the community to landslide disasters varies from low (33%), moderate (43%) to high (24%). The capacity of communities facing landslides shows that 19% of all sub-districts are classified as medium and 81% others are low. Based on the identification of hazards, vulnerabilities, and capacities of communities in each sub-district in Ponorogo Regency, it was concluded that only 1 sub-district had a low risk of landslides, 2 sub-districts were at moderate risk, while 18 other sub-districts had a high health risk. The results of the analysis are described in spatial mapping with ArcGIS software. Hopefully, this output can be a reference in setting priority areas for reducing the risk of landslide disasters in Ponorogo Regency.

Peran Suami dalam Perawatan Kehamilan Istri di Kelurahan Mulyorejo

National health development strategy has resulted in improved public health status. One of indicators public health is Maternal Mortality Rate (MMR). Maternal Mortality Rate is a health problem that still many still occur in Indonesia. One factor contributing to high incidence of maternal mortality is lack of antenatal care attention. Antenatal care is an important and mandatory thing done by mother during pregnancy because it can maintain the health of mother and fetus until the birth process. Antenatal care can identify the risk of complications experienced by the mother during pregnancy. Participation of antenatal care not only from wife, but participation of pregnancy care can also be from support of the closest person is husband. Husband role is needed in the care of pregnancy because wife needs a lot of biological and psychological support. Purpose of research is to know characteristics husband to antenatal care in Mulyorejo. Type of research is descriptive with cross sectional using qualitative method. Techniques data collection using questionnaires with the sample number of respondents is 20 husbands who have pregnant wives. Respondent is taken from Mulyorejo Health Center data. Analysis Method with descriptive statistics by displaying the frequency in the form of tables showing the categories of characteristics husband. This study lasted for one month in October to November 2017. The results showed that characteristics of husbands in antenatal care in Mulyorejo is sufficient category. Knowledge of husband is 14 people (70%), husband attitude is 10 people (50%), and husband behavior is 13 people (65%).

HUBUNGAN AGRESSIVE DRIVING BEHAVIOR PENGEMUDI SEPEDA MOTOR DENGAN KECELAKAAN LALU LINTAS (STUDI PADA SISWA SMA DI KABUPATEN SIDOARJO)

Road traffic accident was the public health problem that can decrease public health status. Most of the road traffic acccident involving motorcyclist and mostly among people around 15-19 years old. Agressive driving behavior was one of the factors causing road traffic accidents. The aim of this study to analize the relationship between motorcyclist’s agressive driving behavior with road traffic accidents. This research was analytic observational research with case-control design. The population was senior high school student who riding motorcycle aged ≥ 17 years old in Kabupaten Sidoarjo. Population were divided into two groups, namely case group and control group. Case group were respondents who had road traffic accidents while control group were respondents who never had a road traffic accidents in the last year. The number of respondens were involved 24 respondents in case group and 48 respondents in control group. Sampling were purposive sample in case group and matching sampling in control group by age and sex. The result of analysis using chi-square test (α = 5 %) showed that agressive driving behavior in motorcyclist has significant relationship of road traffic accidents (p= 0,0006; OR= 5,320). Senior high school students were encouraged to managed time and more prioritised safety while driving to avoid traffic accidents.

Perbandingan Sistem Kesehatan di Negara Berkembang dan Negara Maju

The health system is a term that includes personal, institutions, financing, information, commodities and Government governance strategy in providing prevention and treatment services to the community. The health system was created with the aim of can respond to the needs and expectations of the community-owned healthcare in fulfillment of a fair and equitable. Then, good healthcare in developing countries as well as developed countries do need a reform, reorientation, and revitalization. This study aimed to know the comparison of health systems in developed and developing countries. Analysis study of the writing is done through literature review. Developing countries and developed countries experienced many challenges in building a strong health system and reliable. Health systems in developed countries look better compared to developing countries, it can be seen from the public health status and health problems. Health systems in each country vary greatly, but one has the same objective namely to enhance public health degrees extended. Every developed country or developing country has pros and cons of each of any health system that has been applied. The success of a health system of a country depends on the spirit, dedication, perseverance, hard work, good teamwork, ability (Human Resources, facilities), the sincerity of the organizers, as well as the participation of the community in order to achieve Universal Health Coverage in increasing degrees of better public health.

INOVASI LAYANAN KESEHATAN BERBASIS E-GOVERNMENT (Studi pada Puskesmas Kecamatan Kepanjen Kabupaten Malang)

Health is considered an investment for the development of Indonesian people resources. Health is one of the important aspects of a country. Health becomes one of the welfare benchmarks in a country. Health is an obligation of every person to participate in realizing, maintaining and improving public health status as high as possible. The public is entitled to obtain optimal health services in accordance with the needs of the Government and health facilities is an obligation to be able to control and improve the health services available to the community. But now the public service in the field of health has not been said to be good. Until now the government is still improving to provide public services in the field of optimal health. There needs to be a link between government, business sector and society in creating an optimal service based on e-goverment. Because of these demands Puskesmas Kecamatan Kepanjen, Malang Regency to create and implement innovation programs related to health services applied ICT namely Sutera Emas Program

Analisis Limbah Medis Layanan Kesehatan Gigi Mandiri dan Potensi Pencemarannya di Kota Pekanbaru

Healthcare development contributing positive outcome on public health status, but on the other side, medical waste existence become a troublesome as long as increased medical healthcare quantity particularly private dental healthcare. The amount of improperly managed medical wastes become accumulated and causing widespread pollution. The roblem of this study is improperly managed medical waste getting more increased causing widespread pollution. Even though 15-25 % of this contamination were categorized as hazardous waste, the risk is much greater. The purpose of this study was to analyze the number and types of private healthcare medical waste and its potential pollution. This study used descriptive qualitative with interviews and observations after conducting a survey of calculating the number and identification of medical waste types produced by private dental healthcare in Pekanbaru. The results showed 69% of infectious, 27% toxic, and 4% radioactive wastes. The presence of this medical waste has the potential to polluting water and soil environment, triggering health problems for health workers and high risk communities, and disrupting social and economic aspects of residents at nearby waste disposal. It is recommended that private dental healthcare to reduce generated medical wastes and to use safe and eco-friendly materials and tools for dental and oral care.

A new approach to improving Traffic literacy and social capital for behavioral modification, using Advocacy, Social marketing, Campaigns and Social mobilization techniques, with TOT strategy. (SHEPMODEL)

Background: The weakness of the health sector in providing homogeneous and suitable educational content for public and lack of a systematic approach to implementing programs at the national level to province and county levels with the aim of modifying the individual and Traffic related behaviors. Local setting: In Iran, the Ministry of Health and Medical Education (MOH) is responsible for maintaining and improving public health status. Transferring health knowledge to people is one of the duties of the health staff in all occupational and professional branches. Methods: This educational model has three phases: assessment, implementation and evaluation. Related changes: In this study, which is one of the first surveys of its kind, 470 MOH staff and NGOs representatives from different provinces participated in training workshops based on the Systematic Comprehensive Health Education and Promotion model (SHEPmodel) traffic accidents, and evaluated the effectiveness and satisfaction level of the model. Results: One of the most important lessons learned from the educational programs of this model is the sense of satisfaction the trainers gained from the translated scientific health contents into the intelligible public language along with the existence of a systematic implementation structure. Furthermore, reports and studies conducted over more than a decade of implementation of programs are indicative of the empowerment of trainers with four techniques and seven educational and communicational skills to use in public health interventions for modifying public health behavior. Conclusion: The results of the present study showed that the effectiveness of SHEPmodel was higher than the traditional methods; so that 86% of the participants attending the trainer workshop evaluated this model as highly effective.

ANALISIS FAKTOR PENENTU KEPUASAN KERJA KARYAWAN DAN DAMPAKNYA TERHADAP PELAYANAN PUBLIK PADA RUMAH SAKIT DI KABUPATEN JEMBRANA

Hospitals as one of the health facilities that provide health services to the community have a very strategic role in accelerating the improvement of public health status. Therefore, hospitals are required to provide quality services in accordance with established standards and can reach all levels of society.This study aims to analyze organizational culture, leadership, motivation and employee job satisfaction influence on hospital public service, and analyze employee job satisfaction can mediate between organizational culture, leadership, and motivation to public service of hospital through job satisfaction of hospital employee in Regency Jembrana, analyzed by partial least square (PLS). The location of the research was conducted in Jembrana District. The type of data used in this study is quantitative and qualitative. Sources of data used in this study is the primary data from the results of questionnaires to respondents.The result of analysis shows that organizational culture and motivation directly have a positive and significant effect on employee job satisfaction, while leadership has no significant effect to the work satisfaction of hospital employees. Leadership, motivation, and job satisfaction of employees directly have a positive and significant impact on public services, but organizational culture has no significant effect on hospital public services. Employee job satisfaction mediates significantly the influence of organizational culture and motivation on public services, but mediates insignificantly the influence of leadership on public service hospitals in Jembrana District. It is recommended that hospital management in Jembrana District need to provide leadership training.

Analisis Angka Harapan Hidup di Jawa Timur Tahun 2015

Life expectancy is one of the indicators to calculate the Human Development Index (HDI) which determined by infants’ health, toddlers’ health, frequency of liveborn children and death rate in the community. East Java Province has four dominant cultural areas such as Mataraman including the western part of the border of Central Java to Kediri, Madura including Bangkalan to Pamekasan, Arek including north coast of Surabaya to Malang and Tapal Kuda including Pasuruan, Probolinggo, Situbondo, Bondowoso, Lumajang and Jember. Those four cultural areas have different characteristic that can affect public health status especially life expectancy in East Java Province. The analysis aimed to know the correlation between infant mortality rate and life expectancy and to know the differences of life expectancy among four cultural areas in East Java year 2015. This analysis used secondary data obtained from Central Bureau of Statistic of East Java on May, 2017. The data were life expectancy as dependent variable, infant mortality rate as independent variable and cultural areas in East Java as grouping variables. The result showed that there was correlation between infant mortality rate with life expectancy (p=0.000) and there was different in life expectancy among four cultural areas in East Java year 2015 (p=0.000) such as cultural areas Mataraman-Madura, Mataraman-Tapal Kuda and Arek-Tapal Kuda. It suggested the government to continue improving the socio-economic welfare of the community and public health improvement in the Tapal Kuda area which had high infant mortality rate and low life expectancy.

The Public Health Status and Foresight report 2014: Four normative perspectives on a healthier Netherlands in 2040

Policy-oriented foresight reports aim to inform and advise decision-makers. In value-laden areas such as public health and healthcare, deliberative scenario methods are clearly needed. For the sixth Dutch Public Health Status and Forecasts-report (PHSF-2014), a new approach of co-creation was developed aiming to incorporate different societal norms and values in the description of possible future developments. The major future trends in the Netherlands were used as a starting point for a deliberative dialogue with stakeholders to identify the most important societal challenges for public health and healthcare. Four societal challenges were identified: 1) To keep people healthy as long as possible and cure illness promptly, 2) To support vulnerable people and enable social participation, 3) To promote individual autonomy and freedom of choice, and 4) To keep health care affordable. Working with stakeholders, we expanded these societal challenges into four corresponding normative scenarios. In a survey the normative scenarios were found to be recognizable and sufficiently distinctive. We organized meetings with experts to explore how engagement and policy strategies in each scenario would affect the other three societal challenges. Possible synergies and trade-offs between the four scenarios were identified. Public health foresight based on a business-as-usual scenario and normative scenarios is clearly practicable. The process and the outcomes support and elucidate a wide range of strategic discussions in public health.

DETERMINAN PEMANFAATAN PELAYANAN PUSKESMAS OLEH MASYARAKAT DI WILAYAH KERJA PUSKESMAS NAMORAMBE, KABUPATEN DELI SERDANG

Many factors cause the public health status in Indonesia is still low, including the community has not utilized health service facilities optimally, including the Namorambe Health Center is one of the health centers in Deli Serdang Namorambe Regency with the lowest number of visits and fluctuates every year from 2016-2018. . The type of research used is a survey with an explanatory research type to explain the influence of predisposing factors (knowledge, attitudes, and health beliefs), enabling factors (distance), and reinforcing factors (attitudes of health workers) towards the utilization of Community Health Centers in the working area of ​​the Namorambe Health Center, Namorambe District, Deli Serdang Regency in 2020. The population is all heads of families who live in the working area of ​​the Namorambe Health Center as many as 4,069 families. A sample of 93 families was taken using simple random sampling technique. Data were collected using a questionnaire and analyzed using a logistic regression test. The results showed that as many as 13 respondents (14.0%) used the Puskesmas and 80 respondents (86.0%) did not use the Namorambe Health Center. Based on the bivariate test in this study, it showed that the variables of knowledge (p = 0.001), attitude (p = 0.030) and health beliefs (p = 0.041) Namorambe Health Center, Deli Serdang Regency 2020. Suggestions are expected for employees and health workers at the puskesmas to improve and maintain good services to increase public perceptions of the available health service system.