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"Economic growth and the demographic transition in Indonesia affect the epidemiological transition. Communicable diseases began to decline, while noncommunicable diseases (NCDs) increased. NCDs is the largest disease burden in the world since a long period of illness, also causes a lot of death and disability. In 2005 an estimated 80% of deaths in developing countries due to NCDs. NCDs handling capacity program not get priority, so NCDs described as "The next Health Tsunami". NCDs action plan for East Asia and Pacific region is the research and development of health interventions to address cases of cerebrovascular and stroke. Stroke is the number one killer in Indonesia, Riskesdas 2007 showed 15.4% of total deaths in population due to stroke.Operational research has conducted to determine the burden of DALYs lost stroke in Indonesia and its economic burden in the year 2007 as well as 2020 predictions, with the counterfactual exposure to main risk factors. Calculation of DALYs lost due to stroke using the Global Disease Burden methode. A total of 5,449 cases of stroke from Riskesdas 2007 were analyzed with nine modifiable related risk factors . To reduce the incidence of stroke in the population was calculated PAF of combination risk factors that combined the most effective feasible and plausible. The economic burden is calculated based on the direct medical costs, transportation costs for medical treatment and opportunity costs.Estimates of DALYs lost due to the stroke of Indonesia population in 2007 with 2,337,718 loss of productive years lost and the estimated economic burden was Rp.3 trillion (equivalent to 20% of the budget of Ministry of Health 2007). There are three proven risk factors influence the incidence of stroke (p < 0,05); hypertension (OR 24.8), diabetes(OR 7.2) and lack of physical activity (OR 6.1). Combination of all three have a maximum value of PAR 0.792. In 2020 the incidence of stroke is predicted to increase 71.5% (169.012 cases) followed by an increase in the burden of DALYs stroke 32.5%, estimated economic burden was Rp.3 trilion. The counterfactual calculations of three risk factors within feasible limits is predicted decrease 19.071 incidence of stroke in 2020 and the costs can be saved Rp.1,485trillion. Efforts plausible counterfactual is predicted decrease 9.536 cases and the cost savings Rp.688billion ( budget in 2020 inflation calculated 4.2%).Needed improvement NCD prevention program planning in a proactive way to raise the target early detection cases of hypertension and diabetes become 75% which handled with health personnel and 50% which controllable. Strengthens the NCD network in order to integrated of health risk issues that can be democratically expressed, and enter to the political process to influence decision-makers in government. Improving quality of medical records, health survailance and vital registration , thus providing accurate information to make an evidence-based materials for advocacy to the decisionmakers in central and regional.

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Pertumbuhan ekonomi dan transisi demografi di Indonesia berdampak terhadap transisi epidemiologi. Penyakit menular mulai menurun, sementara penyakit tidak menular (PTM) terjadi peningkatan. PTM merupakan beban penyakit terbesar di dunia karena periode sakitnya lama, menyebabkan banyak kematian dan disabilitas. Tahun 2005 diperkirakan 80% kematian di negara sedang berkembang disebabkan PTM. Upaya pengendalian PTM belum mendapat prioritas, sehingga PTM dinyatakan sebagai "The next Health Tsunami". Rencana aksi PTM regional Asia Timur dan Pasifik adalah penelitian dan pengembangan intervensi kesehatan untuk mengatasi kasus serebrovaskular dan stroke. Stroke merupakan pembunuh nomor satu di Indonesia, berdasarkan Riskesdas 2007 sebesar 15,4% dari total kematian disebabkan stroke.Riset operasional dilakukan untuk mengetahui beban DALYs stroke di Indonesia dan beban ekonominya di tahun 2007 serta prediksi tahun 2020, dengan analisis kontrafaktual pajanan faktor risiko utama. Perhitungan DALYs lost akibat stroke menggunakan metode Global Burden Disease. Sebanyak 5.449 kasus stroke dianalisis dengan sembilan faktor risiko yang dapat diubah. Untuk menurunkan insiden stroke di populasi dihitung PAF kombinasi gabungan faktor risiko secara feasible dan plausible. Beban ekonomi dihitung berdasarkan biaya medis langsung, biaya transpotasi selama berobat dan biaya oportunitas.Hasil Estimasi DALYs lost akibat stroke Indonesia tahun 2007 menunjukkan nilai kerugian 2.337.718 tahun produktif yang hilang dengan perkiraan beban ekonomi Rp.3 Triliun (setara 20% anggaran Kementerian Kesehatan 2007). Diketahui ada tiga faktor risiko yang mempengaruhi kejadian stroke (p < 0,05) yaitu hipertensi (OR 24,8), DM(7,2) dan kurang aktifitas fisik (OR 6,1). Gabungan ketiganya mempunyai nilai maksimal PAR 0,792. Hasil prediksi tahun 2020 insiden stroke meningkat 71,4% (169.012 kasus) diikuti peningkatan DALYs lost akibat stroke 32,5%, prediksi beban ekonomi Rp.3,7Triliun. Perhitungan kontrafaktual tiga faktor risiko batas feasible diprediksi menurunkan 19.071 insiden stroke tahun 2020, biaya yang dihemat Rp.1,5 Trilyun. Upaya kontrafaktual plausibel diprediksi menurunkan 9.536 kasus, biaya yang dihemat Rp.688 Milyar (biaya tahun 2020 memperhitungkan inflasi 4,2%).Diperlukan peningkatan perencanaan proram pencegahan PTM dengan cara proaktif untuk menaikan target deteksi dini kasus hipertensi dan DM menjadi 75% tertangani petugas dan 50% yang terkontrol. Membangun jejaring PTM agar isu risiko kesehatan PTM dapat terintegrasi secara demokratis, dan masuk dalam proses politik untuk mempengaruhi pengambil keputusan. Meningkatkan kualitas data rekam medik, survailans kesehatan, dan pencatatan penyebab kematian, yang dapat digunakan sebagai bahan advokasi."

"Latar Belakang: Stunting atau tumbuh pendek sudah dimulai dari kandungan ibu dengan indikasi BBLR dengan pertumbuhan dibawah kurva standar. Masa kritis pertumbuhan terjadi pada 1000 hari pertama kehidupan. Studi ini dilakukan untuk meneliti pengaruh pertumbuhan dini terhadap pertumbuhan pada usia pra-pubertas.Metode: Disain penelitian adalah retrospektif, menggunakan data panel Indonesian Family Life Survey tahun 1993, 1997, dan 2000. Studi populasi adalah rumah tangga, mencakup 13 dari 27 provinsi yang ada pada tahun 1993 dengan keterwakilan urban-rural dan nasional. Sampel adalah anak usia 0-2 tahun pada baseline, diukur kembali pada usia 4-6 tahun dan 7-9 tahun (pra-pubertas). Data analisis dilakukan dengan metode Regresi Logistik Ganda.Hasil: Pertumbuhan usia dini menentukan pertumbuhan usia pra-pubertas. Faktor- faktor yang berpengaruh pada pendek usia dini antara lain miskin (OR=1,78; 95%CI=1,06-2,99), tinggal di perdesaan (OR=2,92; 95%CI=1,74-4,90), sanitasi lingkungan yang buruk (OR=1,84; 95%CI=1,10-3,09). Stunting pada usia 4-6 tahun dipengaruhi oleh pendek pada usia dini (OR=3,73; 95%CI= 2,160-6,343).Pengaruh dan pola pertumbuhan pendek (P) dan normal (N) pada usia dini (02) dan usia 4-6 tahun (46) menunjukkan, 77,1% anak 02P_46P tumbuh tetap pendek pada usia pra- pubertas (OR=27,43; 95%CI=11,68-64,43). Sebanyak 59,5% anak 02N_46P mengalami growth faltering dan menjadi pendek (OR=14,00; 95%CI=5,95-32,95). Anak yang usia 02P_46N sebanyak 84,3% tumbuh tetap normal (OR=1,48; 95%CI=0,55-4,00; p=0,441) pada usia pra-pubertas. Perbaikan pertumbuhan setelah usia dini didukung oleh adanya perbaikan ekonomi secara umum.Faktor-faktor yang berpengaruh terhadap stunting pada usia pra-pubertas berbeda menurut disain yang digunakan dalam analisis. Analisis dengan disain cross-sectional menunjukkan, faktor yang berpengaruh terhadap stunting pada pra-pubertas adalah pendek pada usia dini, miskin, sanitasi lingkungan dan jenis kelamin; sedangkan analisis dengan disain longitudinal menunjukkan, stunting pada usia pra-pubertas secara signifikan dipengaruhi oleh pertumbuhan pada usia dini dan pola pertumbuhan antara usia dini dan pra-pubertas.

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Background: Stunting or growing short has been started in the womb of mothers, indicated by having low birth weight and grew in deviation curve. Critical window of growth taken place at first 1000 days of life. This study was conducted to investigate the influence of early growth, towards the growth of pre-puberty's period.Method: The design of the study was retrospective, utilizing the Indonesian Family Life Survey panel data of 1993, 1997, and 2000. Study population was Indonesian households covering 13 out of 27 provinces in 1993 for the representativeness of urban-rural and national. Sampel was children age of 0-2 years old at the baseline, followed up at age of 4-6 years and 7-9 years (pre-puberty). The method of data analysis was Multivariate Logistic Regression.Results: Early child growth was appointed growth of pre-puberty. Factors related to stunted or short at early life was poverty (OR=1,78; 95% CI=1,06-2,99), urban settlement (OR=2,92; 95% CI=1,74-4,90), as well as poor hygiene and sanitation (OR=1,84; 95% CI=1,10-3,09). Short at age of 4-6 years is related to short at early age (OR=3,73; 95% CI= 2,160-6,343).Early growth and growth pattern of stunted (S) and normal (N) at early age or age of 0-2 years (02) and age of 4-6 years (46) showed, 77,1% of 02S_46S stayed stunted (OR=27,43; 95%CI=11,68-64,43). As much as 59,5% of 02N_46S experienced growth faltering becoming stunted (OR=14,00; 95%CI=5,95-32,95). Children who were 02S_46N account for 84,3% growed normal (OR=1,48; 95%CI=0,55-4,00; p=0,441) at pre-puberty. Growth improvememnt of these subjects seemed supported by the economic development in general.Factors related to pre-puberty growth differed between the methods of analysis. Cross- sectional analysis showed that factors related to pre-puberty growth were short in early age, poverty, health sanitation and sex; meanwhile longitudinal analysis of growth showed that pre-puberty growth significantly influenced by early growth and growth pattern in between the age period.Conclusion and novelty: the growth at early age and growth pattern in between age period appointed the pre-puberty growth. Novelty of this study is stunted or short at age 0-2 and continuously short at age 4-6 year was at risk of stayed short at pre-puberty (7-9 year). In addition, grew normal at early age, but short at age 4-6 year was also at risk of stunting at pre-puberty. However, short at age 0-2, but getting normal or catch up at age of 4-6 was protective or stayed normal at pre-puberty.Recommendation: Recommendation of this research is that a multi-center study need to be conducted at the pocket areas of NTT and Papua so that problems related specific solution can be done to prevent stunting. Efforts in stunting intervention should be focused at first 1000 days of life, and if necessary be followed up until age of five years. The implementation of standard operational procedure of mother's and baby's cohorts as well as KIA's book should be strengthened. In addition, law enforcement of those procedure should be complemented with structured trainings of the midwives as a capital of a valid data that can be used to study growth in relation to degenerative diseases in the future. Intergrated programs with other sectors should be conducted hands in hands to reduce stunting through community empowerment as well as households income's generation."