Vol. 22 No. 2, Page 37-82

May 1, 2003

Pattern of mortality causing disease in urban and rural areas of Indonesia: Mortality study of Houeshold Health Survey (SKRT) 2001

By Sarimawar Djaja, Agus Suwandono, Soeharsono Soemantri

            The pattern of underlying cause of death and cause specific death rate are the indicators to evaluate the programs conducted to achieve Healthy Indonesia 2010. The mortality study in  Household Health Survey (HHS) 2001 was a national survey that  collected the cause of death in the population. The study design was cross-sectional. The sample size was 211,168 household, which selected with probability proportional to size (PPS) method from National Socio-Economic Survey (SUSENAS) Core 2001. From each household, data collector of SUSENAS 2001 identified all death cases in year 2000, and then the HHS interviewer (trained doctor) collected the diseases history from the family of the deceased with verbal autopsy technique. The death cause diagnosis is classified according to the 10th International Classification of Diseases (ICD). During 2000, the survey noted 3,322 death cases. The highest cause of death rate was circulatory disease, i.e. 222 per 100,000 populations, the second was infectious disease 174 per 100,000 populations, and the third was respiratory disease 85 per 100,000 populations. The circulatory death rate was the highest (male 236, female 207 per 100,000 population), infectious death rate was 186 in male and 160 in female per 100,000 populations.  Infectious and respiratory diseases death rate were higher in the rural area (204 and 102) than in the urban area (136 and 62). The cause of death in year 2000 in Indonesia had changed from infectious diseases to circulatory disease (heart and cerebrovascular). The pattern of cause of death in Indonesia had shown epidemiological transition in line with demographic transition. The government faces double burden of diseases, i.e. both infectious and non-infectious diseases that cause public health problems. The two-disease group require different prevention and treatment strategies.

Language : Indonesia

Relation between immediate breastfeeding and exclusive breastfeeding until four months

By Sandra Fikawati, Ahmad Syafiq

A cross-sectional study was done to investigate the relationship between immediate breastfeeding and exclusive breastfeeding for 4 months in 4 districts in West Java and 4 districts in East Java. Subjects were selected through 30-cluster method of WHO and a number of 1,377 mothers with infants under one year old were interviewed. Data was collected in March-April 2002. The study found that mothers who gave immediate breastfeeding was 21.16% and mother who exclusively breastfeed their infants until 4-5 months of age was 9.2%. Mothers who did not give immediate breastfeeding had 1.8 to 5.3 times higher risk to provide pre-lacteal food/beverages compared to mothers who gave immediate breastfeeding. Another finding was mothers who gave immediate breastfeeding had 2 to 8 times higher possibility to exclusively breastfeed their infants compared to mothers who did not give immediate breastfeeding. The study showed that the failure to exclusively breastfeed had already occurred at the first three days after birth, when pre-lacteal food/beverages were given to the infant. It was suspected that there were factors other than mother’s knowledge that contributed to the failure of exclusive breastfeeding practice.

Language : Indonesia

Surgical procedure in intracranial aneurism patients

By Eka J. Wahjoepramono, Jesaya Junus

       Definitive management of aneurysms in Indonesia is relatively young. It needs to be evaluated for recent treatment result. A descriptive retrospectively study about almost all patients underwent surgery of clipping immediately after angiogram showed the aneurysm. The data was collected from medical record since January 1996 – January 2003, consist of initial condition (International Cooperative Study grading/ICS), age, size and location of aneurysms by angiogram, and discharge outcome (glasgow outcome scale/GOS). From 74 cases of intracranial aneurysm, 73 cases underwent early surgery for clipping aneurysm. One case refused to receive surgery and died because of rebleeding. The best time to clip the aneurysm is still big discussion but overall early surgery give a better result compare to late surgery.  There were 73 cases with average age 41.4 years old (23-68) and 71.2% of patients under age 50. Most aneurysms in medium size (49.3%) with the most common location was posterior communicating artery (34.2%) followed by anterior communicating artery (30.1%). Most patients with ICS grade 1-3 showed excellent and good results (GOS 4-5) 49 (92.5%), compare to 7 (35%) with ICS grade 4-5. Overall mortality rate was 10 (13.6%), and 9 (90%) of the deaths came from the later group. Nine patients died from pneumonia and vasospasm, one patient died from intracranial infection. It was favorable results generally with the mortality rate of only 1.4% for the case with ICS grade 1-3 and 92.5% showed excellent and good outcomes.

Language : Indonesia

Healthy city development through healthy and civilized behavior towards Healthy Indonesia 2010

By Adi Hidayat*, Nugroho Abikusno**,

       The World Health Organization has stated that urban development is a primary threat to health in the 21st Century. Population living in cities has increased in proportion from 5% to 50% in the past two decades. Determinants needed for health are peace, shelter, education, social security, food, income, empowerment of women, a stable eco-system, social justice, and respect for human rights. Above all these determinants, poverty is a major threat to health. The health determinants are closely related to the health status of people in the cities. Healthy city provide an effective strategi to overcome the problems in urban areas. Community adopting healthy lifestyle behavior greatly supports healthy cities. Various initiatives are directed to create a healthy community. Health promotion is primarily directed to avoid unhealthy lifestyle behavior such as smoking, alcohol, substance abuse, promiscuity, all are avoidable by increasing mental, moral and spiritual health. Public urban health problem alleviation are directed to (i) increase family nutritional status specifically underfive year children, (ii) control of communicable disease of various vulnerable groups, (iii) decreasing maternal mortality rate through good, routine and accessible antenatal health care, and (iv) development of high quality essential health practice and services. It is necessary to diversify health insurance based on community cooperatives to fulfill the health service needs of urban groups or community.

Language : Indonesia

Forced therapy moral foundation in schizophrenic patients

By Rudy Hartanto

Coercive admission and treatment are common for mental disorders especially schizophrenia. They are usually considered as incompetent for signing the informed consent. At least there are three problems that should be considered : 1) Is the schizophrenic patient an autonomous moral agent? 2) Can coercive treatment for schizophrenic patient be considered as paternalistic action by the doctor? 3) What kind of coercive paternalistic intervention can be accepted as morally justified? A patient suffering from mental disorder does not necessarilly become incompetent. It depends on the type and severity of the disorder. The involuntary and unintentional conduct of the schizophrenic patient generally is considered as incompetence, but it fluctuates periodically. It is important to analyze and evaluate the competence of the patient before judging as incompetence. Moral basis for intervention of schizophrenic patients is based on harm and paternalism principles.

Language : Indonesia

Severe acute respiratory syndrome / SARS: a new very virulent epidemic

By Julius E Surjawidjaja

The emergence of a new human infectious disease caused by a virus has been reported in patients in Asia and North America. The disease was described as a rapidly progressive, sometimes fatal pneumonia that appeared to have arisen from Guangdong province in Southern China. The majority of patients were adults aged 25-70 years, but few suspected cases have been reported among children aged under 15 years. In the beginning of March 2003, the World Health Organization (WHO) issued a worldwide notice about the disease called the severe acute respiratory syndrome (SARS) was later found caused by coronavirus. At the time of WHO notice, there were known SARS cases in China, Hongkong, Vietnam, Singapore and Canada. Since then SARS has spread throughout the world and on May 3, 2003 there were 6,234 cases and 435 deaths in thirty countries.

Language : Indonesia