Background and purpose: Anemia in women is a public health concern that is prevalent in developing countries. Women of reproductive age (WRA) frequently suffer from anemia, which can contribute to morbidity and mortality of mothers and their infants. The purpose of this study was to determine the prevalence and factors associated with anemia among women of reproductive age (WRA) in Indonesia.

Methods: This study uses secondary data from the 2018 Indonesia Basic Health Research or Riset Kesehatan Dasar (Riskesdas) which was conducted in 34 provinces in Indonesia. The number of samples analyzed was 3,677 women aged 15-49 years who had data from interviews, measurements of height, weight, results of malaria tests, and hemoglobin levels. Data analysis was performed using multivariate logistic regression to determine the relationship between anemia and individual characteristics, nutritional and health status as well as environmental conditions and health service accessibility.

Results: The prevalence of anemia among WRA in Indonesia was 25.3% (95%CI: 23.9-26.7). Factors which found to be associated with the prevalence of anemia in WRA were age <20 years (AOR=3.44; 95%CI: 2.22-5.35; p<0.001), underweight (AOR=1.48; 95%CI: 1.08-2.05; p=0.017), obesity (AOR=0.68; 95%CI: 0.56-0.81; p<0.001) and the use of hormonal contraception (AOR=0.53; 95%CI: 0.44-0.64; p<0.001).

Conclusion: Based on the prevalence, anemia among WRA in Indonesia is categorized as a moderate public health concern and the most common risk factor for anemia was WRA aged <20 years and underweight. To reduce the incidence of anemia in WRA, interventions should be targeted at WRA aged <20 years and underweight.

Background and purpose: Mother-to-child transmission of HIV has been one of the problems in HIV prevention. In Indonesia, private practice midwives (PPM) play an important role in maternal and child health services. The roles of PPM in HIV vertical transmission prevention through PMTCT have not yet clearly understood. This research aims to analyse the roles of PPM in Bali Province in the PMTCT program as well as the PPM’s characteristics, knowledge, and attitudes about the program.

Methods: This study was a descriptive cross-sectional survey, conducted from March to May 2020. The study population was PPM in Bali Province. The samples obtained were 404 out of a total of 1,736 PPM (23% response rate). The variables studied included socio-demographic characteristics, services and resources characteristics, knowledge, attitudes, and the role of PPM in four PMTCT prongs. Data was collected via self-filled online questionnaires distributed through Indonesian Midwives Associations branches in every district/city in Bali Province. Data were analysed descriptively and differences in roles in PMTCT were analysed using the chi-square test.

Results: Of the 404 PPM, 66.1% served childbirth (deliveries), 25.4% had served HIV-positive women, and 18.3% had served HIV-positive pregnant women. As many as 95.5% of PPM played a good role in prong 1, and 99.0% of PPM, who had served HIV positive patients, played a good role in prong 2, 3 and 4. Statistically significant determinants for good implementation of prong 1 of PMTCT by the PPM were indicated by ownership or access to PMTCT information media (p=0.026), experience of serving HIV positive women (p<0.00), and having served higher number of PMTCT patients (p=0.019).

Conclusion: The PPM in Bali Province has played a good role in PMTCT, with a significant difference for good PMTCT implementation in prong 1 determined by the availability of information media, a history of serving HIV-positive women, and the number of PMTCT patients who have been served.

Background and purpose: The caesarean section (CS) trend continues to increase throughout the world, including Indonesia. Indonesia is one of the countries where the proportion of CS exceeds the WHO recommendation. CS on medical indications can save the mother and baby, but if the CS is performed without any medical indication it will affect the welfare and health of both. This study was conducted to determine the factors associated with CS deliveries in women of childbearing age (WCA) in Indonesia.

Methods: This study is a secondary data analysis using the 2017 Indonesia Demographic and Health Survey (IDHS) data. The data analyzed in this study were CS deliveries in the last 5 years and predictors variables which were collected via interviews. The number of samples in this analysis were 14,533 respondents from the total sample size of the 2017 IDHS as many as 50,730 female respondents aged 15-49 years. Data analysis was performed using multivariate logistic regression with backward method.

Results: The proportion of CS among women aged 15-49 years in Indonesia was 17.7% (95%CI: 17.4-18%). The risk factors for CS were age >35 years with AOR=2.35 (95%CI: 1.61-3.44), primiparity with AOR=2.03 (95%CI: 1.54-2.68), multiparity with AOR=1.53 (95%CI: 1.18-1.99), low infant weight with AOR=1.71 (95%CI: 1.45-2.03), maternal high education level with AOR=2.15 (95%CI: 1.79-2.59), husband's middle education level with AOR=1.41 (95%CI: 1.23-1.62), urban areas of residence with AOR=1.28 (95%CI: 1.15-1.41), high family wealth index with AOR=1.87 (95%CI: 1.64-2.13), has a health insurance with AOR=1.54 (95%CI: 1.41–1.70), delivered the baby at a private health facility with AOR=1.18 (95%CI: 1.07-1.31), number of ANC visits ≥4 times with AOR=1.87 (95%CI: 1.42-2.32), and have been exposed to information media with AOR=2.01 (95%CI: 1.02-3.97).

Conclusion: The proportion of CS delivery in Indonesia remains relatively high. Education for mothers and families about the impact of unnecessary CS delivery needs to be increased so that mothers and families are able to make appropriate and rational decisions. Interventions should be focused on mothers and husbands who are more educated, have higher socioeconomic status, live in urban areas and have chosen delivery in private health facilities.

Background and purpose: Tuberculosis (TB) is a global health problem and one of the top ten causes of deaths in the world. TB case finding is an important component of TB control. In Indonesia, most case findings were done passively so that the referral coverage for TB sputum was lower than the target. This study aims to determine the effectiveness of training for TB patients as volunteers to increase the active referral of presumptive TB cases.

Methods: The pretest-posttest design intervention study was conducted in five public health centers (PHCs) which had the highest number of TB patients in Denpasar. The intervention was carried out for seven weeks (February-May 2020). A total of 35 TB patients, who were currently undergoing treatment at the PHCs, met the study criteria and willing to volunteer, were trained through meetings, discussions and demonstrations about the risk of TB transmission, contact investigations and how to collect sputum samples. Before and after the interventions, data on volunteers' knowledge, the number of presumptive TB and sputum referrals by volunteers were collected through interviews and daily records. A regular reminder was sent in the form of a WhatsApp message once a week. Bivariate data analysis was performed with chi-square and Wilcoxon Signed Rank Test.

Results: Volunteers' knowledge scores increased significantly after training, with a median score of 13.0 to 15.0 (p<0.001), and there was a significant difference in knowledge improvement among those who actively responded to regular reminders compared to those who were less active (p=0.002). A total of 31 presumptive TB cases were successfully referred during the study period (7 weeks). Volunteers managed to refer as many as 30 sputum preparations with good quality, but no positive sputum was found.

Conclusion: Recruitment and training of TB patients as volunteers can increase the knowledge and skills of volunteers to identify and refer presumptive TB cases and quality sputum samples. More TB patients should be trained as volunteers with a longer observation time to increase TB patient detection.

Background and purpose: Traditional health services has been integrated into health services at the public health center (PHC), however, its implementation remains suboptimal. Situational analysis is required to identify implementation factors of traditional health services. This study aims to explore key strengths, weaknesses, opportunities and threats of providing quality traditional health services at PHCs in Tabanan District.

Methods: A qualitative study using an explorative case study design was conducted across PHCs in Tabanan District between January and February 2020. We utilized a SWOT analysis framework to facilitate our study. Data were collected through semi-structured in-depth interviews with 14 informants. They were purposively selected to allow rich data being collected. Six informants were considered as key informants and eight informants were considered as supporting informants. Data were analyzed using thematic approach.

Results: The strengths of PHCs in Tabanan District to provide quality traditional health services include commitment and competency of health providers, trust towards traditional medicine from health staff and community members, promotional activities, the tariff scheme and an established partnership with traditional healers. The weaknesses include limited numbers of staff, high workload of existing health providers and lack of supporting facilities and financial assistance. The opportunities include support from the community, the potency of traditional medicines, availability of government regulations, an established collaboration between traditional and conventional health services and potential customers brought by tourism industries of Bali Province. The threats include unlicensed traditional healers, lack of support from local governments and irresponsible promotional conducts.

Conclusion: Our study reveals key strengths, weaknesses, opportunities and threats of providing quality traditional health services at the PHC level in Tabanan District. Findings from our SWOT analysis can be used to develop strategies for improving implementation of traditional health services at the PHC level.

Background and purpose: Labor complications are conditions during or after labor that can threaten life of the mother and the baby to be born. Some factors have been associated with labor complications, including inter-pregnancy interval and gestational age. This study was conducted to determine the relationship between inter-pregnancy interval and gestational age with labor complications at the Sele Be Solu Regional Public Hospital of Sorong City.

Methods: This study was an analytic observational study with a cross-sectional design. The samples of this study were pregnant women who gave birth at the Sele Be Solu Regional Public Hospital of Sorong City in 2016-2018 and met the inclusion criteria. We used secondary data from the medical records retrieved in July to August 2019. We retrieved mothers’ identities (age, education, employment status), inter-pregnancy interval, gestational age and labor complications. A number of 261 samples (121 with labor complications and 140 without labor complications) were selected using convenience sampling technique. Descriptive analysis and Chi-Square test with SPSS 25.0 were performed.

Results: Most of the mothers (85.8%) were in the non-high-risk age group, graduated from senior high school or above (82%), were not employed/housewives (68.6%), the majority (67.8%) of inter-pregnancy interval was in the non-high-risk group, more than half (52.5%) of gestational age was in the high-risk group and the most common type of complications (17.2%) was the premature rupture of membranes. There were significant relationship between age (p<0.001; OR=5.201; 95%CI: 2.275-11.889), inter-pregnancy interval (p<0.001; OR=2.955; 95%CI: 1.722-5.070) and gestational age (p<0.001; OR=4.606; 95%CI: 2.722-7.794) with labor complications. There were no relationship between education (p=0.166; OR=0.599; 95%CI: 0.312-1.151) and employment status (p=0.230; OR=1.428; 95%CI: 0.845-2.412) with labor complications.

Conclusions: There are significant relationship between inter-pregnancy interval and gestational age with labor complications. Health offices and health workers have an essential role in minimizing the risk of labor complications by providing early detection of possible labor complications and active counseling to the community especially women of childbearing age.