Agus Setiawan

Improving Access to Child Health Care in Indonesia Through Community Case Management.

Objectives In order to reduce infant mortality in Indonesia, community case management (CCM) was introduced. CCM is a community-based service delivery model to improve children’s wellness and longevity, involving the delivery of lifesaving, curative interventions to address common childhood illnesses, particularly where there are limited facility-based services. This paper reports the findings of a qualitative study that investigated the implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the perspective of mothers who received care. Methods Seven mothers and health workers were observed during a consultation and these mothers were interviewed in their home weeks after delivery. Field notes and the interview transcriptions were analysed thematically. Findings Mothers reported that their access to care had improved, along with an increase in their knowledge of infant danger signs and when to seek care. Family compliance with care plans was also found to have improved. Mothers expressed satisfaction with the care provided under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in each village, preferably someone from that village. However two mothers did not wish their children to receive health interventions as they did not believe these to be culturally appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of care in terms of increasing access to health care and the uptake of lifesaving interventions for sick children. However there is a need to modify the program to demonstrate cultural sensitivity and meet cultural needs of the target population. While CCM is a potentially effective model of care, further integrative strategies are required to embed this model into maternal and child health service delivery.

PERILAKU SEKS TAK-AMAN PEKERJA BERPINDAH DI PANTAI UTARA JAWA DAN SUMATRA UTARA TAHUN 2007

Background: Although ANC coverage tends to be high, the pregnant women will not always giving birth by health provider. Jati Sampurna subdistrict, where most of the pregnant women prefer deliver their baby in Bekasi city and about 14.30% giving birth by traditional birth attendant. Objective: Analyze the maternal cohort data to prove correlation between compliance of ANC with selection of birth attendant in those area, which consisted of obedience of ANC, age, parity, birth spacing, pregnancy history, with selection of birth attendant. Methode: The retrospective cohort design study was used. After deciding several criteria: inclusion and exclusion criteria, and by simple random sampling, we achieved 372 subjects which consisted of 186 subjects in exposed group, and 186 subjects in unexposed group. Data analyzed by univariate, bivariate and multivariate. Result: The study showed that two out of five variables were statistically significant correlation, those are compliance of ANC [RR=2,41(95% CI 1,45-4,01)] and pregnancy history [RR=0,22 (95% CI 0,10-0,47)] or on the other result that [RR=4,55 (95% CI 2,13 -10,00)]. Conclusion: Promotion to pregnant women about the importance obedience of ANC and the selection of safe childbirth helper were in need of improvement. The measurement of history of pregnancy should be carried out consistently in ANC package as well. Keywords: Antenatal Care (ANC), birth attendant