Background and purpose: The national family planning program prioritises the use of long-acting contraceptives which include intrauterine devices (IUD), tubectomy, vasectomy, and implant. However, the coverage of long-acting contraceptives in Indonesia remains low. This study aims to identify the determinants of long-acting contraceptives uptake among reproductive-age couples in Tanjung Karang Public Health Centre (PHC) Mataram City.

Methods: A cross-sectional study was conducted involving 169 reproductive age couples in Tanjung Karang PHC in 2016. Samples were selected from six sub-villages (dusun) in two villages using systematic random sampling. We selected 85 samples from coastal and 84 samples from non-coastal areas. Data on sociodemographic characteristics, perception, husband support, access to service, and information regarding long-acting contraceptives were collected through home interview. Analysis with logistic regression was applied to determine the factors influencing long-acting contraceptives uptake.

Results: The majority of respondents aged 20–35 years-old, and most of them have a lower level of education and knowledge regarding long-acting contraceptives. Among all current users, as many as 37.0% use long-acting contraceptive methods. The respondents refused to use long-acting contraceptives due to prohibited by the husband (92.8%) and desire to have more children (38.7%). Multivariate analysis using logistic regression showed that the uptake of long-acting contraceptives was significantly associated with area of residence (non-coastal) with an adjusted odds ratio (AOR)=2.89 (95%CI; 1.39-6.01), employment status with AOR=0.40 (95%CI; 0.18-0.90), income at minimum wages and above with AOR=2.47 (95%CI; 1.16-5.26), and husband support with AOR=2.19 (95%CI; 1.18-3.41).

Conclusions: The use of long-acting contraceptives are associated with husband support, living in non-coastal areas, and having a higher-income. Ongoing support from the husband, especially among those who live in coastal areas and from the lower socioeconomic background, is required to improve the coverage of long-acting contraceptives.

Background and purpose: The prevalence of severe and mild undernutrition among children aged under five years in North Lombok District is ranked second in West Nusa Tenggara Province after Bima City. The number of reported cases of early marriages in West Nusa Tenggara is higher than the national average. This study aims to examine the association between early marriages and undernutrition among children aged under three years in Gangga Subdistrict, North Lombok District.

Methods: A case-control study was conducted with a total of 49 cases (severe undernourished children) and 98 controls (normal-weight children). A systematic random sampling was used to select all cases and controls from the health post register based on the weight/age indicator in Gangga Public Health Centre. Variables of sex and residency were matched between cases and controls. Data were collected from October to November 2016 through interviews with the mother at their house. Logistic regression using a software STATA SE 12.1 was employed to identify the association between early marriages and nutritional status of the children.

Results: Cases and controls were comparable based on children’s gender, mother’s age, area of residency, employment status of mother, and family income. There were significant differences on children’s age and mother’s education. Multivariate analysis showed an association between the nutritional status and early marriages with adjusted odds ratio (AOR)=5.21 (95%CI: 1.36-19.95), the frequency of sickness over the last three months (AOR=1.93; 95%CI: 1.26-2.97) and low birth weight (AOR=14.12; 95%CI: 3.37-59.05).

Conclusions: Early marriages, frequency of sickness over the last three months, and low birth weight are associated with undernutrition among children aged under three years. Preventative measures to prevent early marriages, child infections and low birth weight need to be enhanced.

Abstract

Background and purpose: Breast cancer is the leading cause of death in females, followed by colorectal cancer. Early detection of breast cancer can be done through breast self-examination (BSE). BSE behaviour is influenced by an individual’s level of knowledge and perceptions of the procedure. This study examines the determinants of BSE behaviour in married women aged 15-49 in six villages in the working area of Puskesmas (public health centre) II in West Denpasar, Bali, Indonesia.

Methods: A cross-sectional survey was employed with 180 respondents selected by multistage random sampling. Data were collected using standardised questionnaire carried out from November-December 2016. Multiple poisson regression was used to identify the determinants of the BSE behaviours.

Results: The proportion of respondents who performed BSE in the three months prior to interview is 55.6%, and, of these, 50.0% reported performing BSE regularly. Multivariate analysis shows the significant determinants of BSE are: high-school and above (APR= 2.03; 95%CI:1.41 to 2.92); having a good knowledge of BSE (APR=1.41; 95%CI:1.09 to 1.82); perceived benefits  (APR=2, 24; 95%CI:1.53-3.29); perceived low barrier (APR=1.63; 95%CI:1.16-2.29); and high self-efficacy (APR=1.50;95%CI:1.16-1.95).

Conclusions: Level of education, good knowledge of BSE, perceived benefits, perceived low barriers, and high level of self-efficacy are the significant determinants of BSE practice. These findings suggest that education on BSE should be enhanced, particularly for women with lower levels of education.

Abstract

Background and purpose: The relationships between those responsible for clinical training, clinical instructors (CIs) and nurses, and the nursing students, have a great impact upon student learning during clinical placements. The present study investigates the pattern of working relationships among CIs, nurses, and student nurses, and analyses the extent to which they achieve ideal mentoring practices.

Methods: Qualitative study employing in-depth interviews with CIs (n=3), nurses (n=8), and nursing students (n=8) on a clinical placement was undertaken from June-July, 2017, at Badung District Hospital, Denpasar, Bali.  Content analysis was conducted to identify the key themes that emerged from these interviews and formed the basis of the findings. The results are presented narratively in order to highlight the patterns of the working relationships identified and perceived by CIs, nurses, and nursing students, with the aim of developing improved mentoring practices.

Results: Analysis of the in-depth interviews identified three main themes: (i) perceptions on the hospital’s mentoring practices, (ii) the role(s) and behaviour in the mentoring process, and (iii) the patterns of working relationships between those involved in the mentoring process. In general, participants defined mentoring in terms of the provision of guidance and instruction to students. Participant’s contrasting perceptions of their role(s) affected how they behaved in the mentoring process. Furthermore, participant’s perceptions of their own’s roles and their behaviour provides a detailed overview of the working relationships pattern of the nursing students, nurses and CIs. Specifically, working relationships between CIs and nurses tend to fit an employee-employer type pattern, whereas those between CIs/nurses and nursing students do not appear to reflect typical mentor-mentee relationships.

Conclusions: The pattern of working relationships identified between CIs/nurses and nursing students do not, in fact, reflect a typical mentor-mentee relationship. Furthermore, this paper highlights the impact that suboptimal mentoring may have on nursing students' achievement of medical competence, as well as on the quality of nursing care provided to patients in teaching hospitals.

Abstract

Background and purpose: Early marriage through merariq or eloping tradition is a common practice in West Nusa Tenggara particularly in Central Lombok. Early marriage leads to several negative consequences on the reproductive health of female adolescents. This study aims to explore early marriage practices and its impacts on the reproductive health of female adolescents in Central Lombok.

Methods: A qualitative study with a case study approach was conducted, and seven early married female adolescents purposively selected as the study participants. Interviews were also conducted with two family members of the female adolescents, one community leader, and a midwife who worked as an adolescent health coordinator at a public health centre. Data were analyzed using a thematic approach to map the reasons for early marriage and its impacts on the reproductive health of female adolescents.

Results: Our in-depth interviews revealed that several reasons associated to early marriage practices were: lacking in knowledge regarding the effects of early marriages, perceived benefits of early marriages including perception on maturity and logical thinking, and social sanctions from the society because it considered a disgrace when the eloped girl returned home. Several negative consequences of early marriages emerged from this study were complicated pregnancy/delivery, low birth weight, and undernourished children. Our informants concerned about the psychological effects of early marriages which include fear, regret, and depression. Eloped female adolescents lose their agency for decision making including the right for further education.

Conclusions: Early marriage practices bring negative health consequences to female adolescents. An active collaboration across health sector and community leaders is required to provide sufficient information regarding the harmful effects of early marriages. Also, a more effective communication strategy using a family-based approach is required to appropriately target female adolescents with health information associated with the impacts of early marriage.

Abstract

Background and purpose: Prevention of mother to child transmission (PMTCT) is a government program aimed at preventing mother-to-child transmission of HIV. A comprehensive PMTCT program involves the implementation of HIV testing up to antiretroviral (ARV) treatment for mothers with positive HIV test results. Coverage of comprehensive PMTCT remains low, with many HIV-positive pregnant women who discontinued ARV treatment. This study aims to explore the reasons of HIV-positive pregnant women to discontinue with the comprehensive PMTCT program.

Methods: A qualitative study was carried out in Badung District, Bali Province, with seven respondents: one HIV-positive pregnant woman who did not continue the ARV treatment, two HIV-positive women who gave birth the previous year and did not take ARV, three public health centre (PHC) providers, and one head of PHC. Respondents were selected using a purposive sampling technique. Data were collected through in-depth interviews and analyzed thematically. The results presented narratively to illustrate the reasons why HIV-positive pregnant women discontinued with the comprehensive PMTCT program.

Results: The emerging themes related to the reasons of HIV-positive pregnant women discontinued with the comprehensive PMTCT program included the lack of comprehensive PMTCT-related information, the lack of health provider assistance, and the high stigma towards people living with HIV (PLHIV). These barriers were affecting the willingness of HIV-positive pregnant women to continue with the program.

Conclusions: Lack of comprehensive PMTCT-related information, lack of assistance by health care providers, and high public stigma impacts upon HIV-positive pregnant women’s willingness to continue with comprehensive PMTCT program. There is a need for a minimum service standard in the implementation of comprehensive PMTCT services and comprehensive information on HIV infection in order to reduce the stigma towards PLHIV.