Bhisma Murti

How Much Does Village Environment Affect the Risk of Pneumonia in Children under Five? A Multilevel Evidence from Klaten, Central Java, Indonesia

Background: Pneumonia is the leading infectious disease killer of children worldwide. It kills 2,500 children each day. More children died of pneumonia than malaria, TB, measles, and AIDS combined. Imbalance between host, agent, and environment, can cause the incidence of pneumonia. This study aimed to estimate the contextual effect of village environment on the risk of pneumonia in children under five, after controlling for the effects of biological and social economic factors. n nSubjects and Method: This was a case control study conducted in Klaten District, Central Java, from October to November 2017. A total sample of 200 children under five was selected for this study by fixed disease sampling. The dependent variable was pneumonia. The independent variables were birth weight, exclusive breastfeeding, nutritional status, immunization status, maternal education, family income, quality of house, indoor smoke exposure, and cigarette smoke exposure. The data were collected by questionnaire and checklist. The data were analyzed by multilevel logistic regression analysis. n nResults: Birth weight ≥2,500 g (OR= 0.13; 95% CI= 0.02 to 0.77; p= 0.025), exclusive breastfeeding (OR= 0.15; 95% CI= 0.02 to 0.89; p= 0.037), good nutritional status (OR= 0.20; 95% CI= 0.04 to 0.91; p= 0.038), immunizational status (OR= 0.12; 95% CI= 0.02 to 0.67; p= 0.015), maternal educational status (OR=0.18; 95% CI= 0.03 to 0.83; p= 0.028), high family income (OR= 0.25; 95% CI= 0.07 to 0.87; p= 0.030), and good quality of house (OR=0.21; 95% CI= 0.05 to 0.91; p= 0.037) were associated with decreased risk of pneumonia. High indoor smoke exposure (OR= 8.29; 95% CI= 1.49 to 46.03; p= 0.016) and high cigarette smoke exposure (OR= 6.37; 95% CI= 1.27 to 32.01; p= 0.024) were associated with increased risk of pneumonia. ICC= 36.10% indicating sizeable of village as a contextual factor. LR Test p= 0.036 indicating the importance of multilevel model in this logistic regression analysis. n nConclusion: The multilevel logistic regression has provided evidence that the village environment has a sizeable contextual effect on the risk of pneumonia in children under five, after controlling for the effects of biological and social economic factors. n nKeywords: pneumonia, biological, social economic, environmental factor, children under five

Multilevel Analysis on the Biological, Social Economic, and Environmental Factors on the Risk of Pneumonia in Children Under Five in Klaten, Central Java

Background: Pneumonia is one of the leading causes of death in children under five in the world, particularly in the developing countries including Indonesia. Imbalance between host, agent, and environment, can cause the incidence of pneumonia. This study aimed to examine the biological, social economic, and environmental factors on the risk of pneumonia in children under five using multilevel analysis with village as a contextual factor. Subjects and Method: This was an analytic observational study with case control design. The study was conducted in Klaten District, Central Java, from October to November, 2017. A total sample of 200 children under five was selected for this study by fixed disease sampling. The dependent variable was pneumonia. The independent variables were birth weight, exclusive breastfeeding, nutritional status, immunization status, maternal education, family income, quality of house, indoor smoke exposure, and cigarette smoke exposure. The data were collected by questionnaire and checklist. The data were analyzed by multilevel logistic regression analysis. Results: Birth weight ≥2.500 g (OR=0.13; 95% CI= 0.02 to 0.77; p= 0.025), exclusive breastfeeding (OR= 0.15; 95% CI= 0.02 to 0.89; p= 0.037), good nutritional status (OR=0.20; 95% CI= 0.04 to 0.91; p= 0.038), immunizational status (OR= 0.12; 95% CI= 0.02 to 0.67; p= 0.015), maternal educational status (OR= 0.18; 95% CI= 0.03 to 0.83; p= 0.028), high family income (OR= 0.25; 95% CI= 0.07 to 0.87; p= 0.030), and good quality of house (OR= 0.21; 95% CI= 0.05 to 0.91; p= 0.037) were associated with decreased risk of pneumonia. High indoor smoke exposure (OR= 8.29; 95% CI= 1.49 to 46.03; p= 0.016) and high cigarette smoke exposure (OR=6.37; 95% CI= 1.27 to 32.01; p= 0.024) were associated with increased risk of pneumonia. ICC= 36.10% indicating sizeable of village as a contextual factor. LR Test p= 0.036 indicating the importance of multilevel model in this logistic regression analysis. Conclusion: Birth weight, exclusive breastfeeding, good nutritional status, immunizational status, maternal educational status, high family income, and good quality of house decrease risk of pneumonia. High indoor smoke exposure and high cigarette smoke exposure increase risk of pneumonia. Keyword: pneumonia, biological, social economic, environmental factor, children under five Correspondence:Âxa0 Nurul Ulya Luthfiyana, Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: ulya.luthfiyana@gmail.com. Journal of Epidemiology and Public Health (2018), 3(2): 128-142 https://doi.org/10.26911/jepublichealth.2018.03.02.03 Â

Path Analysis on the Biopsychosocial Determinants and Genital Hygiene on Cervical Cancer at Dr. Moewardi Hospital, Surakarta, Central Java

Background: Cervical cancer is the fourth most common cancer in women worldwide and the second most common cancer in women in developing countries after breast cancer. The prevalence of cervical cancer in Indonesia was 0.8‰ with an estimated 98.692 cases. This study aimed to determine the biopsychosocial and genital hygiene factors for cervical cancer.Subjects and Method: This was an analytic observational study with a case-control design, conducted at Dr. Moewardi Hospital, Surakarta, from December 2017 to February 2018. A total of 178 study subjects including 95 women with cervical cancer (case) and 83 women without cervical cancer (control) were selected by fixed disease sampling. The dependent variable was cervical cancer. The independent variables were the age at first sexual intercourse, a number of sexual partners, body mass index (BMI), stress, education, income, and genital hygiene. Cervical cancer data was collected by medical record. The other data were collected by questionnaire. The data were analyzed by path analysis model.Results: The risk of cervical cancer increased with the number of sexual partner >1 (b=1.91; 95% CI= 0.31 to 3.49; p=0.019), BMI ≥25 (b= 0.98; 95% CI= -0.06 to 2.04; p=0.067), and stress (b= 1.59; 95% CI= 0.39 to 2.80; p=0.009). The risk of cervical cancer decreased with higher education (b= -3.58; 95% CI= -4.77 to -2.39; p 1 (b= 1.36; 95% CI= 0.12 to 2.61; p=0.032).Conclusion: The risk of cervical cancer increases with the number of sexual partners, BMI, and stress, but decreases with higher education, higher income, age at first sexual intercourse, and genital hygiene.Keywords: cervical cancer, biopsychosocial determinants, genital hygiene, path analysisCorrespondence: Afriza Umami. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta, Indonesia. Email: afrizaumami20@gmail.com. Mobile : +6282254348041Journal of Epidemiology and Public Health (2018), 3(2): 277-291https://doi.org/10.26911/jepublichealth.2018.03.02.07