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"Penyakit kusta masih menjadi masalah kesehatan masyarakat di Indonesia. Kabupaten Majalengka saiah satu daerah endemis kusta di Indonesia dengan angka kecacatan tingkat 2 tertinggi di Jawa Barat yang berhubungan dengan keterlambatan penemuan kasus baru dan pengobatan. Berdasarkan hal tersebut, maka diperlukan suatu penelitian yang mendalam mengenai pencarian pertolongan pengobatan pada penderita kusta. Tujuan penelitian ini adalah untuk memperoleh informasi yang mendalam mengenai pencarian pertolongan pengobatan penderita kusta serta faktor penghambat dan penunjangnya. Penelitian ini dilakukan di Kecamatan Sindangwangi, Argapura, dan Sumberjaya Kabupaten Majalengka dengan metode kualitatif yang pengumpulan datanya dilakukan dengan wawancara mendalam. Jumlah informan dalam penelitian ini sebanyak 31 orang yang meliputi informan penderita kusta dan informan kunci. Untuk menguji validitas hasil penelitian, dilakukan triangulasi sumber dan metode. Pengolahan data yang dilakukan terdiri dari mengumpulkan catatan hasil wawancara, membuat rekapitulasi hasil wawancara, membuat kategorisasi data, dan membuat matriks. Analisis yang dilakukan adalah analisis isi atau content analysis untuk melihat kecenderungan hubungan antar variabel. Hasil penelitian menunjukkan, bahwa pencarian pertolongan pengobatan memiliki kecenderungan berhubungan dengan persepsi keparahan dan bahaya penyakit, dorongan tokoh masyarakat, keluarga, media, dan penyuluhan petugas kesehatan. Pemilihan pelayanan kesehatan memiliki kecenderungan berhubungan dengan kebiasaan dan pengalaman berobat, sedangkan keteraturan berobat memiiiki kecenderungan berhubungan dengan persepsi terhadap kualitas pelayanan kesehatan. Keterlambatan mencari pertolongan pengobatan memiliki kecenderungan berhubungan dengan pengetahuan penderita kusta mengenai penyakit kusta yang rendah, ketidaktahuan penderita kusta kalau di Puskesmas terdapat pengobatan untuk kusta dan salah diagnosa. Untuk itu perlu dilakukan advokasi terhadap Pemerintah Daerah Kabupaten Majalengka dan Dinas Kesehatan Kabupaten Majalengka, meningkatkan promosi kesehatan dengan mengikutsertakan petugas promosi kesehatan di Puskesmas, menjalin kerjasama dengan lintas program dan Iintas sektor, pelatihan keterampiian deteksi tanda kusta bagi petugas puskesmas, sosialisasi tentang pengobatan kusta dan keterampilan deteksi tanda kusta bagi dokter praktek di wilayah kerja puskesmas, peiatihan (training of trainers) penyuluhan kusta, penyuluhan intensif dan pemberdayaan masyarakal.

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Leprosy disease is still become the problem for public health in Indonesia. This matter happened, caused by factor pursuing effort of early case finding and leprosy treatment directly and also indirectly. Based on these. hence it is needed a circumstantial research in health seeking behavior of leprosy patient. The objective this research is to obtain circumstantial information on heatlh seeking behavior of leprosy patient. This research was conducted in Sindangwangi, Argapura. and Sumberjaya Sub-distriets with qualitative method, which its data collecting conducted by indepth interview. The number of informants in this research is 31 people. which consisting of leprosy patient and key informant. To assess the validity of result of the research, it was conducted triangulation resources. The Data analysis consist of collect the record of interview results, made summary of the result of interview, made the transcript, made data categorization, and made matrix. The next step is content analysis to see the tendency of the relationship between those variables.

The result of this research show, that seeking help of medication have tendency relate to hard perception and the severeness of discase, motivation of community leader, family, media, and education of health service officer. Election of the health service have tendency relate to experience and habit of medication, while regularity of medication have tendency relate to perception to the quality of health service. The delay in seeking help of medication have tendency relate to knowledge of leprosy suspect on leprosy disease is still low, the lack of knowledge of leprosy patient, where in Community Health Center there is medical treatment for leprosy and wrong diagnosed. Thereby require to be conducted advocacy to Local Government of Majalengka District, and health service of Majalengka District for the allocation of fund and support Leprosy Program with curative and preventive priorities,improving health promotion by involve health promotion officer in Community Health Center, cooperation between cross section that is religion section, and education in order to apply the Leprosy Progrnm specially counseling, training about leprosy detection for health workers. socialization about leprosy treatment and leprosy sign for private doctors in Puskesmas area, training of trainers for leprosy IEC (information, education, and communication), intensive counseling with the target is leprosy patient, family member of leprosy patient, and also community, and enforce community participation in leprosy control."

"Waria merupakan salah satu kelompok masyarakat yang mempunyai resiko tinggi tertular IMS di mana profesi waria merupakan salah satu faktor yang mendorong timbulnya gka IMS. Anal merupakan media bagi waria dalam memberikan pelayanan seksual kepada pemakai waria.Keberhasilan penanggulangan IMS tidak banya bergantung pada mutu pelayanan yang diterima tetapi juga bergantung Kepada perilaku perilaku pencegahan dan pencarian pengobatan. Oleh karena itu, kegiatan pencegahan dan penanggulangan IMS lebih dititikberatkan pada penemuan penderita secara dini dan-segera diobati.Penelitian ini dilakukan untuk mendapatkan gambaran perilaku waria dalam pencarian pengobatan yang biasa mejeng atau melakukan transaksi seksual di Gelanggang Olahiaga Remaja Kota Bekasi. Penelitian didesain sebagai penelitian kualitatif dengan menggunakan pendekatan grounded research theory."

"Latar belakang : Kusta merupakan penyakit menular yang disebabkan oleh kuman kusta (Mycobacterium leprae). Salah satu dampak dari penyakit kusta adalah kecacatan yang dapat berupa cacat tingkat 0, tingkat 1 dan tingkat 2. Tahun 2010, di Kabupaten Lamongan terdapat 10,64% penderita baru mengalami cacat tingkat 2. Beberapa penelitian menunjukkan cacat tingkat 2 lebih banyak terdapat pada penderita laki-laki dari pada perempuan dengan variasi tingkat hubungan antara jenis kelamin dan kejadian cacat tingkat 2. Tujuan penelitian : Penelitian ini bertujuan untuk mengetahui apakah ada hubungan antara jenis kelamin dengan kejadian cacat tingkat 2 pada penderita kusta di Kabupaten Lamongan tahun 2011-2012 setelah dikontrol dengan variabel umur, pekerjaan, keteraturan berobat, perawatan diri, riwayat reaksi, tipe kusta dan lama gejala. Metode penelitian : Jenis penelitian ini adalah observasional dengan rancangan kasus kontrol. Subjek penelitian ini adalah penderita kusta yang telah selesai atau sedang menjalani pengobatan sekurang-kurangnya 6 bulan. Jumlah sampel sebanyak 154 orang terdiri dari 77 kasus dan 77 kontrol. Kasus adalah penderita kusta dengan cacat tingkat 2, dan kontrol adalah penderita kusta dengan cacat tingkat 0 atau 1. Data diperoleh melalui kartu penderita kusta di puskesmas tempat respoden menjalani pengobatan. Data dianalisis dengan statistik univariat, bivariat dan multivariat. Hasil Penelitian: Hasil analisis menunjukkan bahwa penderita kusta laki-laki 1,9 kali lebih berisiko mengalami kejadian cacat tingkat 2 dari pada penderita perempuan dengan nilai OR=1,90 (95% CI: 0,86-4,23) namun tidak bermakna secara statistik (nilai p=0,114) setelah dikontrol dengan variabel pekerjaan dan lama gejala sebelum didiagnosis menderita kusta. Diskusi : Pekerjaan dan lama mengalami gejala sebelum didiagnosis menderita kusta merupakan confounder bagi hubungan antara jenis kelamin dengan kejadian cacat tingkat 2 pada penderita kusta di Kabupaten Lamongan tahun 2011-2012.

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Background : Leprosy is an infectious disease caused by Mycobacterium leprae. One of the effects of leprosy is a disability which may be a defect grade 0, grade 1 and grade 2. In 2010, in Lamongan District, there are 10,64% of new leprosy patients with grade 2 disabilities. In 2010, at Lamongan District, 10.64% of new patients are detected with disability level 2. Some research shows the occurence of grade 2 disability more in male patients than women with varying degrees of relationship between gender and occurence of grade 2 disability.

Objective : This study aims to determine the association of gender and the occurence of grade 2 disability in leprosy patients in Lamongan District in 2011-2012 after controlling the variables age, work, regularity of treatment, self care, history of reaction, leprosy type and duration of symptoms.

Methode : This study uses case-control design. The subjects of this study were leprosy patients who have completed or are undergoing treatment at least 6 months. The number of sample are 154 people consisting of 77 cases and 77 controls. Cases were leprosy patients with grade 2 disability and controls were leprosy patients with grade 0 or 1 disability. Data was obtained from the patient record in primary health care where the leprosy patients got the treatment. Data were analyzed with univariate, bivariate and multivariate statistics.

Result: The analysis showed there were a male leprosy patient had probability 1,9 more then women to occured grade 2 disability with a value of OR=1,90 (95% CI: 0,86 to 4,23) but not statistically significant (p value = 0,114) after controlled by work and duration of symptoms before being diagnosed as leprosy patient.

Discussion : Work and duration of symptoms before being diagnosed as leprosy patient are confounder for the assocation between gender and the occurence of grade 2 disability in leprosy patient in Lamongan District in 2011-2012."

"Infeksi Menular Seksual (IMS)adalah infeksi yang utamanya ditularkan melalui hubungan seksual (Kemenkes, 2023), kelompok remaja dan dewasa muda (usia 15 -24 tahun) merupakan kelompok umur yang berisiko paling tinggi untuk tertular IMS (Kemenkes, 2016). Bandung merupakan kota dengan prevalensi IMS terbanyak di Indonesia dengan gonorhea 37,4%, chlamydia 34,5% dan syphilis 25,2%. Estimasi jumlah PSP di Indonesia 230.000 orang, (Organisasi Perubahan Sosial Indonesia, 2019). Estimasi jumlah PSP di Jawa Barat adalah 31.375 orang, sedangkan jumlah PSP Kota Bandung : 3211 orang, 1710 PSP terjangkau, 54 % akses ke klinik. Jumlah PSP remaja kurang dari 24 tahun sebanyak 104 orang (3 %). PSP yang terinfeksi IMS, akan berupaya untuk mencari pengobatan. Tujuan penelitian ini untuk melihat fenomena Health Seeking Behavior IMS pada remaja PSP di Kota Bandung yang dipengaruhi oleh pemikiran dan perasaan (thoughts and feeling), pengalaman orang lain (personal reference), sumber daya (resources), dan  kebudayaan (culture).

Metode penelitian menggunakan metode kualitatif, desain phenomenology. Informan penelitian 8 orang, 5 informan utama remaja PSP online (apartemen dan kost) dan offline (lokalisasi, tempat hiburan, jalanan) berusia 10-24 tahun, serta 3 orang informan kunci yaitu mucikari, penghubung dan petugas lapangan. Pengumpulan data dengan wawancara mendalam. Hasil penelitian menunjukkan informan tidak mengetahui dengan baik gejala dan penularan IMS, IMS merupakan hal yang menakutkan tetapi merupakan risiko pekerjaan. PSP memilih no action dan self-treatment jika gejala yang dirasakan ringan. Dukungan mucikari cukup membantu dengan syarat tidak merugikan mucikari. Pengaruh orang lain (personal reference) sangat besar bagi PSP mendorong upaya pengobatan sendiri (self-treatment). Sumber daya yang tidak dimiliki oleh PSP menjadi hambatan bagi PSP offline, yaitu dana yang terbatas, waktu buka layanan kesehatan formal yang tidak sesuai dengan jam kerja PSP, perlakuan stigma dan diskriminasi dari tenaga kesehatan klinik. Sedangkan bagi PSP online, hambatannya adalah kekurangan dana dan ketergantungan terhadap orang yang mengantar ke klinik. Budaya pengobatan turun temurun seperti jamu-jamuan atau ke dukun menjadi hambatan bagi PSP online dan offline.

Rekomendasi: meningkatkan KIE (komunikasi, informasi dan edukasi) pada remaja PSP, mucikari dan penghubung mengenai IMS, pengobatan yang benar dan pengunaan kondom; memperbaiki kualitas layanan IMS; evaluasi berkala terhadap layanan dan Petugas Lapangan PSP dalam program pencegahan IMS.

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Sexually Transmitted Infections (STIs) are infections that are mainly transmitted through sexual contact (Ministry of Health, 2023), teenagers and young adults (aged 15 -24 years) are the age group at highest risk of contracting STIs (Ministry of Health, 2016). Bandung is the city with the highest prevalence of STIs in Indonesia with gonorrhea 37.4%, chlamydia 34.5% and syphilis 25.2%. Estimated 230,000 people Female Sex Worker (FSW) in Indonesia, (Indonesian Social Change Organization, 2019). The estimated number of FSWs in West Java is 31,375 people, in Bandung City is: 3211 people, 1710 FSWs are reach, and 54% have access to clinics. The number of FSW less than 24 years old was 104 people (3%). FSW who are infected with STIs will try to seek treatment. The aim of this research is to look at Health Seeking Behavior for STI among adolescents FSW in Bandung which is influenced by thoughts and feelings, personal references, resources and culture.

The research method used qualitative methods, with phenomenology design. The research informants were 8 people, 5 main informants were adolescent FSW who work online (apartments and boarding houses) and offline (localization, entertainment, and streets) aged 10- 24 years, and 3 key informants, pimps, liaisons and outreach worker. Data collection using in- depth interviews. The research results showed that informants did not know well the symptoms and transmission of STIs, STIs are terrible thing as an occupational risk. FSW chooses no action and self-treatment if the symptoms not serious. Pimps support is quite helpful as long as it doesn't cause harm. Personal reference influenced self-treatment for FSW.   The resources that FSWs do not have are obstacles for offline FSWs, namely limited funds, formal health service operational hours, stigmatized and discriminatory treatment from clinical providers. Meanwhile, for online FSW, the obstacles are lack of funds and dependence on people who accompany them to the clinic. The culture of traditional treatments such as herbal medicine or going to shamans is an obstacle for online and offline FSW.

Recommendations: improve IEC (communication, information and education) among adolescent FSW, pimps and liaisons regarding STIs, correct treatment and condoms use; improving the quality of STI services; continuous evaluation of services and FSW’s outreach worker in STI prevention program."

"ABSTRAKPerilaku pencarian pengobatan pada waria lansia binaan rumah singah waria diketahui melalui pola pengobatan penyakit terakhir yang diderita, penyakit yang tergolong parah, dan penyakit menular seksual. Penelitian ini adalah penelitian studi kualitatif dengan pendekatan studi kasus dengan tujuan mendalami perilaku pencarian pengobatan pada waria lansia binaan melalui identifikasi hal-hal yang berperan dalam pembentukan persepsi kesehatan, deskripsi persepsi ancaman penyakit, deskripsi persepsi efektivitas pengobatan, penundaan perilaku pengobatan, dan akhirnya bermuara pada perilaku pengobatan yang dilakukan. Hasil penelitian menyarankan perlunya advokasi oleh rumah singgah terkait bantuan dari pemerintah setempat dalam pelaksanaan baik program kesejahteraan maupun kesehatan untuk binaannya. Selain itu perlu adanya peningkatan kesadaran dari pemerintah setempat untuk lebih sensitif dalam memenuhi hak kesehatan secara menyeluruh termasuk hak kesehatan populasi LGBT yaitu waria lansia.

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ABSTRACT

Health seeking behavior of transgender-waria elderly who are fostered by Rumah Singgah Waria is known through health seeking behavior pattern of illness suffered currently, diseases classified severe, and sexually transmitted diseases. This research is a qualitative study with a case study approach with the aim of knowing deeply about health seeking behavior from identify some aspect which affect formation of health perceptions, perceived threat of disease, perceived treatment effectiveness, treatment delay behavior and end up with treatment behavior. The result of the study suggest the need for advocacy from shelter about local government support in implementation whether welfare or health programs for their fostered. In addtion, there need of increasing awareness of local government to be more sensitive in fulfilling overall health rights including the LGBT population right, especially elderly transgender."

"ABSTRAK

Penelitian dilakukan mengenai Perilaku Pencarian Pengobatan IMS Pada WUS di Wilayah Perkotaan Indonesia berdasarkan Analisis Data SDKI 2012. Responden merupakan WUS menikah maupun pernah menikah yang memiliki gejala terkait IMS. Sumber data yang digunakan ialah data sekunder kuesioner Survei Demografi Kesehatan Indonesia (SDKI) 2012. Desain Studi Cross-Sectional. Analisis dilakukan secra univariat dan bivariat dengan jumlah sampel 1594 responden. Dari hasil analisis didapatkan : 68,6% responden tidak mencari pengobatan atau melakukan pengobatan non medis, dan pengobatan medis 31,4%. Karakteristik berdasarkan faktor predisposisi: responden berusia 25-49 tahun (83,2%), dengan rata-rata umur 32,48 tahun, berpendidikan menengah (60,9%), memiliki pengetahuan rendah mengenai gejala IMS (96,4%), bekerja (53,5%), status ekonomi berada pada level atas (50,6%), melakukan hubungan seksual pertama kali pada usia kurang 21 tahun (54%), dan tidak

menggunakan kondom saat terakhir kali berhubungan seksual (94,7%). Berdasarkan faktor pemungkin menunjukan 57,5% responden tidak memiliki asuransi kesehatan. Berdasarkan faktor pendukung: responden mengambil keputusan mengenai pemeriksaan kesehatan bersama dengan pasangan 48,3%. Tidak pernah terpapar sumber informasi IMS (69,7%) sumber informasi mengenai IMS terbanyak didapatkan dari teman (30,94%). Analisis hubungan faktor predisposisi menunjukan faktor pendidikan (p-value = 0,006), status ekonomi (p-value = 0,000), penggunaan kondom (p-value = 0,000) terbukti secara statistik memiliki hubungan signifikan dengan perilaku pencarian pengobatan IMS. pada faktor pemungkin terlihat bahwa

kepemilikan asuransi kesehatan terbukti memiliki hubungan dengan perilaku pencarian pengobatan IMS (p-value = 0,013). Sedangkan pada faktor pendukung menunjukan variabel keterpaparan sumber informasi terbukti secara statistik memiliki hubungan signifikan dengan perilaku pencarian pengobatan IMS (p-value = 0,001). Peningkatan pendidikan, ekonomi, kepemilikan asuransi sangat penting untuk meningkatkan akses pengobatan IMS ke pelayanan kesehatan medis oleh WUS, Selain itu pemberian pengetahuan mengenai gejala IMS dan penggunaan kondom pada WUS dirasa penting untuk meningkatkan kewaspadaan WUS mengenai IMS.

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ABSTRACT

Research conducted on STI treatment seeking behavior on Women in reproductive age at Indonesian Urban Areas. As per the analysis of SDKI 2012 Data, this research was conducted on Female in reproductive Age who is or was married have symptoms related to STIs. Data source used is from questionnaires in Indonesia Health Demographic Survey (SDKI) 2012, with Cross-Sectional Design Study,

with univariate and bivariat analycist used. The sample used is 1594 Female in reproductive Age that meets sample criteria. From the analysis result, it is found that the proportions of treatment seeking behavior of Women during reproductive age in Indonesian urban area are as: 68.6% did not seek treatment or non medical treatment and 31.4% was seeking medical treatment. Characteristics based on

predisposing Factor indicated that the respondents were mostly aged 25 -49 years 83,2% with an average age of 32,48 years, 60,9% respondents were mediumeducated, 99.9% respondent had low knowledge of STI symptoms, 53.5% respondent were working or had a job and 50,6% of the respondent were on the top status of economic level. 54% of the respondent had their first sexual intercourse at age less than 21 years and 94,7% did not use condom during last sexual intercourse with partner. Characteristics based on enabling Factor shows that 57,5% respondents did not have health insurance. Characteristics based on the reinforcing Factor shows that 48.3% respondents make decision about health examination with husband or partner and most of the respondents were never exposed to any source of information on STIs, whereas 30.94% of the respondent obtained the information on STIs from their friends. Analysis of the relationship between predisposing Factor and treatment seeking behavior, the relationships proved statistically are: educational Factor (p-value = 0,006), economic status (p-value = 0,000) and the use of condoms (p-value = 0,000). The result of the relationship analysis between enabling Factor shows that the ownership of health insurance has been proven statistically related to STI treatment seeking behavior (p-value = 0,013). Also based on analysis result of correlation between reinforcing factor with STI treatment seeking behavior, it is seen as the only variable of exposure to the information

source of STI. Statistically it is proven that the exposure source have significant relation with treatment seeking behavior of STI (p-value = 0,001). Increased education, economics, insurance ownership is essential to improve access to STI treatment to medical services. In addition, the provision of knowledge about STI symptoms and condom use in is also important to increase awareness of STIs."

"TB dan HIV masih menjadi isu kesehatan global. Tujuan penelitian ini untuk mengindetifikasi hubungan antara pengetahuan HIV, pengetahuan HIV, stigma HIV, stigma TB terhadap perilaku pencarian pengobatan pada ODHA koinfeksi TB di Kota Jakarta. Menggunakan desain cross sectional dengan teknik porpusive sampling pada responden yang berkunjung ke poli VCT RS di Jakarta dengan melibatkan 115 ODHA koinfeksi TB. Menggunakn 4 instrumen yakni: Brief HIV-Knowledge Questionnaire (HIV-KQ-18), Knowledge survey Questionnaire, Berger HIV stigma Scale, tuberculosis-related stigma scale. Terdapat hubungan yang signifikan antara pengetahuan TB dengan dengan perilaku pencarian pengobatan (p value: 0,042) dan antara stigma TB dengan perilaku pencarian pengobatan (p value: 0,026). Perawat perlu meningkatkan edukasi tentang pengetahuan TB dan stigma TB. Selain itu, diperlukan konseling HIV tentang komplikasi TB pada ODHA serta upaya menurunkan stigma.

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TB and HIV are still global health issues. Aim of this study was to identify the relationship between HIV knowledge, TB knowledge, HIV stigma, TB stigma and health seeking behavior in PLWHA coinfected TB in the city in Jakarta. Used a cross-sectional design with a purposive sampling technique on respondents who visited the VCT clinic hospital in Jakarta involving 115 PLWHA coinfected TB. This research uses 4 instruments, namely: Brief HIV-Knowledge Questionnaire (HIV-KQ-18), Knowledge survey Questionnaire, HIV stigma Scale, tuberculosis-related stigma scale. This study shows that there is a significant correlation between TB knowledge and health seeking behavior (p value: 0.042) and between TB stigma and health seeking behavior (p value: 0.026). Nurses need to improve education about TB knowledge and TB stigma. Besides, it also need HIV counseling about TB complications in PLWHA and efforts to reduce stigma."

"Angka kesakitan dan kematian karena ISPA pada kelompok umur balita di Indonesia masih tinggi, maka penatalaksanaan program dititik beratkan kepada penanggulangan pneumonia pada balita. Pada akhir-akhir ini salah satu upaya menurunkan angka kesakitan dan kematian tersebut adalah dengan adanya peningkatan pengetahuan ibu tentang ISPA , sikap dan perilaku pencarian pengobatan, serta praktek pengobatan oleh para petugas kesehatan setempat.Penelitian ini bertujuan untuk meneliti hubungan antara pengetahuan dan sikap dengan pencarian pengobatan pertama penderita pneumonia pada balita di Kabupaten Majalengka tahun 2003.Penelitian ini menggunakan desain studi kasus kontrol, dengan menggunakan data penderita pneumonia pada balita yang pencarian pengobatan pertama tidak ke fasilitas kesehatan ( kasus ), dan penderita pneumonia pada balita yang pencarian pengobatan pertama ke fasilitas kesehatan ( kontrol ). Adapun untuk pemilihan kasus dan kontrol adalah seluruh balita penderita pneumonia yang berobat ke puskesmas (16 puskesmas ) pada bulan Juni 2003.Dari basil penelitian ini menunjukkan pengetahuan kurang baik (OR = 3,592 ; dan 95 % CI 2,054 ; 6.282 ), sedangkan sikap yang negatif ( OR = 2,166 ; dan 95 % CI 1,230 ; 3,815 ) merupakan faktor risiko yang berhubungan dengan pencarian pengobatan pertama penderita pneumonia pada balita.Dari hasil penelitian ini terlihat masih sangat diperlukannya kegiatan-kegiatan dari petugas kesehatan, terutama kegiatan penyuluhan mengenai penyakit pneumonia pada ibu-ibu yang memiliki balita terutama pada tanda bahaya penyakit pneumonia, sehingga apabila balitanya menderita pneumonia langsung dibawa berobat ke fasilitas kesehatan.Daftar Pustaka : 35 ( 1975 - 2002 )

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Morbidity and mortality rates of ARI among under fives in Indonesia is still very high, thus program management is emphasized on efforts to overcome pneumonia among under fives. At the present time, one effort to reduce morbidity and mortality rates of pneumonia among under fives is by improving mother's knowledge about ARI, improving mother's attitude and health seeking behavior, and improving medication practices provided by local health personnel.

This study aimed to investigate the relationship between knowledge and attitude with health seeking behavior among under fives with pneumonia in Majalengka District in 2003.

This study employed case-control study design with under fives with pneumonia whose first health seeking behavior was not directed to health facility as cases and under fives with pneumonia whose first health seeking behavior was directed to health facility as controls. Those cases and controls were all under fives with pneumonia who went to community health center for medication (16 CHCs) during June 2003.

The study showed that poor knowledge (OR=3.592; 95% CI 2:054:6.282) and negative attitude (OR=2.166; 95% CI 1.230:3.815) were risk factors related to first health seeking behavior among under fives with pneumonia.

The study showed the importance and the necessity of improving health personnel activities, mainly those related to extension and community education about pneumonia targeted to mothers with under fives, particularly those with pneumonia danger signs. Therefore, whenever the child is getting sick, the mother would seek for health care to health facility at the first time."

"Sebagian besar pasien dengan gangguan mental emosional pertama-tama belum berobat ke fasilitas pelayanan kesehatan jiwa. Pasien gangguan mental emosional yang berobat ke Puskesmas wilayah Jakarta Timur hanya 1,88 % dari kasus yang ada di masyarakat dengan rata-rata kunjungan 1,31 kali pada tahun 1994. Agar gangguan tersebut tidak menjadi berat atau menjadi penyakit lain, maka diperlukan pengobatan sedini mungkin. Untuk mencapai maksud tersebut, yang menjadi masalah penelitian ini adalah bagaimana pola perilaku pencarian pengobatan dari pasien gangguan mental emosional dan faktor-faktor apa yang berhubungan dengan perilaku tersebut. Jenis disain penelitian ini adalah crossectional, namun menggunakan analisis yang lazim digunakan pada studi case control pada penduduk dewasa (17 tahun ke atas) yang mengalami gangguan mental emosional. Gangguan mental emosional ditetapkan berdasarkan pengisian instrumen Self Reporting Questionnaire (SRQ) dengan cut-off points 6. Pengambilan sampel dilakukan secara systematic random sampling dengan sampling fraction 9. Unit sampel adalah rumah tangga dengan jumlah 650 KK yang meliputi 1950 penduduk dewasa sehat. Sampel pasien gangguan mental emosional yang diteliti berjumlah 446 kasus. Untuk mengetahui hubungan faktor dengan perilaku pengobatan dilakukan perhitungan Odds ratio melalui analisis regresi logistik multivariat. Hasil penelitian menunjukan bahwa pola perilaku pengobatan pertama pasien gangguan mental emmosional di Kelurahan Pulogadung adalah melakukan pengobatan sandhi 27,8 %, ke dokter umum 18,4 %, tidak mencari pengobatan 17,4 %, ke Puskesmas 13,2 %, ke pengobat tradisional 8,7 %, ke rumah sakit umum 6,1 %, ke spesialis penyakit dalarn 5,8 % dan ke psikiater 2,5 %. Pasien yang melakukan kegiatan rujukan adalah 23,6 %. Sebagian besar pasien yang melakukan rujukan dan pasien yang melakukan pengobatan selanjutnya tidak berobat ke fasilitas pelayanan kesehatan jiwa. Pasien gangguan mental emosional lebih mungkin tidak mencari pengobatan apabila pasien tidak merasa terganggu akibat gangguan mental emosional yang dialaminya (OR 0,01 ; 95% Cl 1,5E-03 - 0,02), kurang mendapatkan informasi pelayanan kesehatan jiwa (OR 0,49 ; 95% CI 0,25 - 0,95) dan apabila pasien malu berobat ke psikiater (OR 2,24 ; 95% 1,02 - 4,85). Pelayanan kesehatan jiwa di masyarakat diharapkan tidak hanya menunggu pasien datang berobat ke fasilitas kesehatan jiwa. Kegiatan pelayanan kesehatan jiwa di Puskesmas perlu dikembangkan dalam kegiatan Puskesmas lainnya (Taruna Husada, Sala Shakti Husada dan sebagainya). Pelayanan prevensi sekunder (mendorong pasien berobat) melalui peningkatan pengetahuan gangguan mental emosional dan fasilitas pengobatannya perlu lebih diprioritaskan. Penyegaran pengetahuan gangguan mental emosional terhadap dokter umum perlu dilakukan secara periodik. Peningkatan mutu pelayanan jiwa di Puskesmas dan pembinaan pengobat tradisional perlu lebih diperhatikan. Disamping itu perlu juga dipertimbangkan tentang perubahan konsep figur psikiater di masyarakat.

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Most patients with mental emotional disorder didn't visit health facility with mental health service at the first treatment. There is only 1,8 % of people with mental emotional disorder who visited Puskesmas at East Jakarta with average 1.31 visit in 1994. To prevent the disturbance become more severe or to become another illness, early treatment is needed. To reach the purpose, the problem of this study is to identify health seeking treatment pattern of patient with mental emotional disturbance and to find factors which was associated with the behavior treatment.

The study design is cross sectional study but method of analysis is case control. Sample of the study are adult (17 years or more) who experience mental emotional disorder. The criteria of mental emotional disorder is based on answers of Self Reporting Questionnaire (SRQ) with cut-off 6. Sampling method is systematic random sampling with sampling fraction of 9. Sampling unit is household with totally 650 household which include 1950 adult with good health. Sample of patient with mental emotional disorder are 446 cases. To identify relationship between factors with health seeking treatment, logistic regression with odds ratio is applied.

The result showed that for the first treatment there is 27,8% of the mental emotional disorder patients performing self medication, 18,4% visit medical doctor, 17,4 % didn't seek any treatment, 13,2 % visit Puskesmas, 8,7 % going to traditional healer, 6,1% to general hospital, 5,8% visit internist and 2,5% visit psychiatrist. There where 23,6 patient who were given referral. Most of the patients who were referred or patient who continue the treatment didn't visit health facility with mental health service.

Patients with mental emotional disorder probably not seek any treatment if they didn't feel uncomfortable with the disturbance they experienced (OR 0,01 ; 95% CI 1,5E-03 - 0,02), did not obtained enough information about mental health service (OR 0,49 ; 95% CI 0,25 - 0,95), or if the patient was ashamed to visit psichiatrist (OR 2,24 ; 95% CI 1,02 - 4,85).

Patients with mental emotional disorder probably would performed self medication if their social economic status is low (OR moderat 0,52 ; 95% CI 0,06-0,83; OR high 0,45 ; 95% CI 0,04-0,62), if they were not bothered by the disturbance they experienced (OR 0,47; 95% CI 0,03-0,91), didn't consider the disturbance as severe (OR 0,54 ; 95% CI 0,07-0,91), didn't obtained enough information on the mental health service (OR 0,52 ; 95% CI 0,06-0,79), were not suggested to have treatment (OR 0,45 ; 95 % CI 0,04-0,57), they have no work (OR 0,35 ; 95 %CI 0,17-0,67) and if they are Askes member (OR 2,48 ; 95% CI 2,40-17,54).

Patients with mental emotional disorder will probably visit traditional healer if they have expectation that the treatment not only give drug (OR 8,76 ; 95% CI 1,86 - 42,26), have supernatural believe (OR 7,53; 95% CI 3,15-40,22), and have enough knowledge on the traditional healer service (OR. 6,67; 95% CI 1.86-23,57), did not feel comfortable with the disturbance they experienced (OR 8,84; 95% CI 3,00 - 26,05), their knowledge on the mental emotional disorder was not good (OR 0,12;95% CI 0,03-0,56), and have no information on the mental emotional service (OR. 0,25; 95% CI 0,06-0,98).

Patients with mental emotional disorder will probably visit mental health service if they felt disturbed (OR 4,43 ; 95% CI 1,76 - 11,13), did not have senior high school or more education (OR 0,36 ; 95% CI 0,16 - 0,81), expected to be given more than just drug (OR 5,93 ; 95% CI 1,93 - 18,17), feeling that the high cost of the treatment influence the effort to seek treatment (OR 7,17 ; 95 % CI 2,83 - 17,81), obtained enough information on the mental health service (OR 5,22 ; 95% CI 2,34 - 11,59), and did not feel ashamed to visit psychiatrist (OR 0,43; 95% CI 0,18 - 0,99).

Patients with mental emotional disorder will probably visit Puskesmas if they feel bothered (OR 14,41 ; 95% CI 4,14 - 50,40), feeling the cost of the treatment influence the effort of seeking treatment (OR. 4,28 ; 95% CI 1,39 - 13,06), their social economic status is low (OR high 0,11 ; 95 % CI 0,03 - 0,37), lived near to Puskesmas (OR 0,21 ; 95% CI 0,06 - 0,77), realize that there is mental health service in the Puskesmas (OR 14,31 ; 95 % CI 4,09 - 49,89), did not know about traditional service (OR 0,05 ; 95 % CI 0,01 - 0,25), did not have knowledge about the general health service (OR 0,23; 95% CI 0,07 - 077), and the healer attitude did not influence the choice of treatment (OR 0,35 ; 95 % CI 0,14 - 0,88).

Mental health service in the public is expected not only waited patients to visit the mental health service. Mental health service at the Puskesmas needs to be integrated and to be developed with the other Puskesmas activity (Taruna Husada, Bhakti Husada, Karang Werdha). Secondary prevention thru knowledge development on the mental emotional disorder, treatment facility and early detection should be give more priority. Knowledge refreshment on the mental emotional disorder to medical doctor needed to be in force periodically. Quality improvement of health service in Puskesmas' and education of traditional healer need to be given more attention. The figure of psychiatrist in the society need to changed as well."