Journal of Epidemiology and Public Health
e-ISSN: 2549-0273 Publisher: Masters Program in Public Health, Sebelas Maret University Jl. Ir Sutami 36A, Surakarta 57126, Central Java, Indonesia Editor in Chief: Vitri Widyaningsih, dr., M.S., Ph.D Universitas Sebelas Maret, Solo, Indonesia Aim and Scope The Journal of Epidemiology and Public Health (JEPH) is an open-access, peer-reviewed international journal dedicated to advancing knowledge and research in the fields of epidemiology and public health. Established on June 2, 2015, JEPH publishes high-quality original research articles, systematic reviews, and meta-analyses on a quarterly basis. Our mission is to contribute to the global improvement of population health by disseminating rigorous scientific evidence that informs public health policy, practice, and education. The journal seeks to highlight innovative research that addresses contemporary health challenges, with a particular emphasis on health disparities, disease prevention, health promotion, and health systems strengthening. JEPH welcomes contributions from researchers around the world and is particularly committed to amplifying the voices of scholars from low- and middle-income countries (LMICs). We encourage submissions that tackle regionally relevant health issues, apply robust epidemiological methods, and propose evidence-based solutions to pressing public health problems. Key areas of interest include, but are not limited to: Epidemiological studies of communicable and non-communicable diseases Social determinants of health and health inequalities Health systems research and policy evaluation Public health interventions and health promotion Environmental and occupational health Global health and health equity Biostatistics and methodological advances in epidemiological research Pandemic preparedness and response JEPH is officially accredited by the Ministry of Research, Technology, and Higher Education, Government of Indonesia, under decree No. 10/C/C3/DT.05.00/2025. The journal holds SINTA 2 status, valid from July 16, 2022, to July 16, 2027. Through the publication of high-impact, policy-relevant research, JEPH aims to foster the exchange of knowledge across disciplines and regions and to support the development of evidence-based solutions to the world’s most pressing public health challenges.
Implementation of Theory of Planned Behavior on Behavior Change and Outcomes in Type 2 Diabetes Mellitus Patients in Surakarta, Central Java, Indonesia
Background: The Theory of Planned Behavior (TPB) can serve as a conceptual framework for improving healthy behaviors among patients with type 2 diabetes mellitus (T2DM). The application of TPB is essential for predicting both behavioral patterns and health outcomes in individuals with T2DM. This study aimed to assess the implementation of TPB on behavioral change and outcomes in T2DM patients Subjects and Method: This cross-sectional study was conducted in Surakarta, Indonesia. There was 200 type 2 DM patients selected by purposive sampling. The dependent variables were HbA1c and behavior. The independent variables were behavioral belief, outcome evaluation, normative belief, motivation, control belief, control power, attitude, subjective norm, perceived behavioral control, and intention. Data were collected using a set of questionnaires and analyzed using path analysis. Results: HbA1c ≥6.5% was directly reduced by strong behavior, but it was statistically non signi­ficant (b= -0.22; 95%CI= -0.15 to 1.08; p= 0.745). Behavior was directly and significantly increased by strong intention (b= 1.66; 95% CI= 1.03 to 2.30; p<0.001) and high perceived behavior control (b= 0.87; 95% CI= 0.23 to 1.50; p= 0.007). Conclusion: The Theory of Planned Behavior can be used to predict healthy behavior among patients with type 2 DM.
Copyright (c) 2026 Journal of Epidemiology and Public Health
Analysis of Risk Factors Associated with Rabies Cases in South Timor Tengah Regency, East Nusa Tenggara, Indonesia
Background: Rabies is a zoonotic infectious disease that can be directly transmitted to humans and is fatal, leading to death in South Timor Tengah Regency. Rabies has been officially declared an outbreak in this region. This study aimed to analyze the effects of selected risk factors on rabies cases in South Timor Tengah Regency, East Nusa Tenggara Province, Indonesia. Subjects and Method: This study used primary data and employed an analytic observational design with a case–control approach. A total of 200 participants were included, consisting of 100 rabies cases and 100 controls, drawn from a population of 4,749 cases and controls using random sampling across 32 subdistricts in South Timor Tengah Regency. The dependent variable was rabies case status. The independent variables included community knowledge, history of contact with dogs, vaccination status of pet dogs, age, sex, stray dog bites, and stray dog population density. Data were collected using a questionnaire that had been tested for validity and reliability. Path analysis was conducted using STATA version 13. Results: The study found significant associations between rabies cases and community knowledge (OR= 0.06; 95% CI= 0.03–0.16; p < 0.001), stray dog population density (OR= 2.72; 95% CI= 1.30–5.70; p= 0.008), stray dog bites (OR = 4.59; 95% CI= 1.97–10.69; p < 0.001), age (OR= 0.97; 95% CI= 0.95–0.99; p= 0.008), and sex (OR= 0.33; 95% CI= 0.16–0.71; p = 0.005). In contrast, history of contact with dogs (OR= 1.30; 95% CI= 0.62–2.71; p= 0.487), vaccination of pet dogs (OR= 0.89; 95% CI= 0.37–2.13; p = 0.796), and educational level (OR = 1.31; 95% CI= 0.54–3.15; p= 0.553) were not statistically significant. Conclusion: High stray dog population density and stray dog bites increase the risk of rabies, while higher community knowledge, female sex, and age ≥35 years serve as protective factors against rabies in the population of South Timor Tengah Regency.
The Influence of Social Trust, Income Inequality, and Employment Status on the Risk of Depression
Background: Depressive disorders are among the most common and complex mental health problems worldwide, including in Indonesia. The determinants of depression are closely linked to social and economic factors. This study aimed to estimate the effects of social trust, income inequality, and employment status on the risk of depression. Subjects and Method: An observational study with a cross-sectional design utilized the fifth wave of the Indonesia Family Life Survey (IFLS5). The dataset includes more than 29,716 individuals across 13 provinces. The sample was selected using a purposive sampling method. Results: The risk of depression increased significantly among individuals who were unmarried (b = 0.97; 95% CI: 0.84 to 1.07; p < 0.001), female (b = 0.16; 95% CI: 0.06 to 0.26; p = 0.002), unemployed (b = 0.25; 95% CI: 0.14 to 0.35; p < 0.001), and living in provinces with higher income inequality (b = 0.32; 95% CI: 0.21 to 0.42; p < 0.001). Conversely, the risk of depression decreased significantly with higher social trust (b = -0.18; 95% CI: -0.29 to -0.08; p < 0.001), good sleep quality (b = -0.20; 95% CI: -0.21 to -0.19; p < 0.001), older age (b= -0.81; 95% CI: -0.99 to -0.63; p < 0.001), and higher education level (≥senior high school) (b= -0.36; 95% CI: -0.46 to -0.25; p < 0.001). Conclusion: The risk of depression increases with unmarried, female, unemployed, and living in provinces with higher income inequality. The risk of depression decreases with higher social trust, good sleep quality, older age, and education ≥senior high school.
The Influence of Gender, Body Mass Index, Work Fatigue and Noise Exposure on Blood Pressure among Manufacturing Industry Workers
Background: Noise in the work environment can exceed a set threshold and have an impact on workers' health, including increased blood pressure. In addition to noise, other factors such as work fatigue, body mass index, and gender also contribute to the risk of hypertension. Preliminary studies show that exposure to high noise and manual work activities is at risk of causing fatigue, so it requires further analysis of the influence of these factors on the blood pressure of industrial workers. Subjects and Method: The study design was a cross-sectional study. The study was conducted in Karanganyar Regency, Central Java in February-April 2025. Sampling in this study was conducted using the Fixed Exposure Sampling method, involving 200 worker samples from a herbal medicine factory and a fireworks factory in Karanganyar Regency, Central Java. The method used to collect data in this study was analytical observations with a cross-sectional approach. The analysis used in this study was path analysis. The dependent variable was blood pressure. The independent variables were noise exposure, fatigue, body mass index, and gender. Results: Blood pressure increased with high fatigue (b= 0.15; 95% CI <0.01 to 0.29; p= 0.038), noise exposure (b= 0.15; 95% CI= 0.02 to 0.28; p= 0.020). Blood pressure in female workers was lower than in men (b= -0.14; 95% CI= -0.28 to -0.01; p= 0.034). Blood pressure was indirectly affected by body mass index. Conclusion: This study shows that noise exposure and work fatigue have a direct effect on increasing blood pressure; women have lower blood pressure than men, while body mass index has an indirect effect on increasing the blood pressure of workers.
Literature Review : A Review of Solid Medical Waste Management in Hospitals
Background: Hospitals generate hazardous medical waste that threatens both environmental sanitation and human health. Common challenges include a lack of awareness, insufficient training, inadequate disposal infrastructure, and limited resources. Proper management is essential to minimize ecological impacts and prevent hospital-acquired infections (HAIs) at every stage—collection, segregation, transport, and storage. This study systematically evaluates global hospital waste management practices. Subjects and Method: This study is a systematic review literature review conducted on selected databases (PubMed, Science Direct, Google Schoolar) with a publication year between 2020 and 2025. Literature uses Indonesian and English. The literature included was literature with qualitative and quantitative method. The quality assessment of the literature was carried out using the JBI Critical Appraisal. Results: The research results from nine (9) articles related to solid medical waste management in Indonesia show that the process of sorting, transportation, temporary storage and final disposal in the management of medical waste from several hospitals has met the requirements in accordance with applicable regulations. Conclusion: While segregation and temporary storage show high compliance, final disposal remains a critical challenge due to incinerator licensing issues and third-party dependency. Addressing this requires practical staff training, routine audits, and a transition to alternative technologies like autoclaving. Strengthening contract governance and cost-benefit analysis between internal investment and outsourcing is essential for sustainable waste management in Indonesia.
Factors Associated with Post-Sternotomy Wound Infection: A Meta-Analysis
Background: Sternal wound infection is a serious complication following cardiac surgery, contributing to increased morbidity, mortality, and length of hospital stay. Obesity, diabetes mellitus, smoking habits, and re-operation are suspected to contribute to the incidence of post-sternotomy wound infections. This study aimed to estimate the magnitude of the influence of obesity, diabetes, smoking, and re-operation as risk factors for post-sternotomy wound infections. Subject and Method: This study is a systematic review and meta-analysis. Articles were obtained from databases including PubMed, Google Scholar and ScienceDirect, limited to publications from 2015 to 2025. The keywords and MeSH terms used were: “sternotomy, AND sternal wound infection OR deep sternal wound infection OR surgical site infection, AND “obesity OR body mass index, AND diabetes mellitus OR hyperglycemia AND smoking OR tobacco use AND re-operation AND cardiac surgery”. Article selection was based on eligibility criteria defined using the PICO model: P = patients post-sternotomy; I = obesity, diabetes, smoking, re-operation; C = non-obese, non-diabetic, non-smokers, no re-operation; O = post-sternotomy wound infection. Only full-text articles with a cross-sectional study design were included. Data were analyzed using RevMan version 5.3. Results: A total of 16 articles were included in this meta-analysis, originating from Finland, Denmark, Australia, Saudi Arabia, Colombia, Italy, France, China, Pakistan, Brazil, and United States. The meta-analysis showed that the risk of post-sternotomy wound infection was significantly increased in patients with obesity (aOR = 1.50; 95% CI: 1.31–1.72; p < 0.001), diabetes (aOR = 2.02; 95% CI: 1.26–3.25; p = 0.004), smoking (aOR = 2.44; 95% CI: 1.36–2.27; p = 0.05), obstructive sleep apnea (aOR = 1.76; 95% CI: 1.36–2.27; p < 0.001), and re-operation (aOR = 2.90; 95% CI: 1.49–5.64; p = 0.002). All findings were statistically significant. Conclusion: Risk of sternal wound infection post-sternotomy significantly increases with obesity, diabetes, smoking, and re-operation.
Patient Safety and Hospital-Based Health Promotion in Preventing Infections and Their Impact on Childhood Stunting: A Systematic Review
Background: Child stunting is influenced by nutrition, recurrent infections, and the quality of health services. Patient safety and hospital-based health promotion play key roles in preventing infections that increase stunting risk. This study aimed to analyze the role of patient safety and hospital-based health promotion in infection prevention and its impact on childhood stunting. Subjects and Method: A systematic review was conducted following the PRISMA guidelines and the PICO framework. The Joanna Briggs Institute (JBI) Checklist was used for quality assessment. Articles were collected from Scopus, ScienceDirect, ProQuest, SpringerLink, Google Scholar, Nature, JSTOR, and Emerald Insight, covering publications from 2020 to 2025. The keywords used were: “patient safety” AND “hospital-based health promotion” AND “infection prevention” AND “childhood stunting”, and “hospital governance” AND “infection control” AND “child growth”. Boolean operators and Medical Subject Headings (MeSH) were applied to each database. Results: This systematic review consisted of 10 articles that met the inclusion criteria. The studies, published between 2020 and 2025, originated from Indonesia, Ethiopia, Southeast Asia, and other developing regions. The findings showed that patient safety programs and infection control effectively reduced neonatal and childhood infections. Health promotion interventions, such as caregiver education and cadre training, improved hygiene and preventive behavior. Integration of hospital governance and policy strengthened infection prevention and service quality. Across the reviewed evidence, exposure to infection during the first 1,000 days of life was consistently linked to an increased risk of stunting (OR=1.85; 95% CI=1.42–2.37; p=0.001). Conclusion: Patient safety and hospital-based health promotion are crucial for preventing infections and reducing stunting. Strengthening hospital governance through integrated infection prevention strategies is essential to accelerate stunting reduction.
Type 2 Diabetes Mellitus is the Risk Factor for Multi-drug Resistance Tuberculosis: A Meta-Analysis
Background: Type 2 Diabetes Mellitus (T2DM) has a significant risk of developing active Tuber-culosis (TB) and complicates its treatment. There is no conclusive evidence on whether TB-T2DM comorbidities are associated with an increased risk of Multidrug Resistant Tuberculosis (MDR-TB). The study aims to analyze and estimate the relationship of T2DM to MDR-TB incidence and to estimate the size of the combined effect. Subjects and Method: This study was a meta-analysis with PICO, Population: patients actively undergoing MDR-TB treatment. Intervention: Patients with comorbid Type 2 Diabetes Mellitus. Comparison: Tuberculosis patients without comorbid Type 2 diabetes mellitus. Output: MDR-TB (Multidrug Resistant Tuberculosis). The articles used in this study were obtained from databases with keywords to search for articles were ("Diabetes Mellitus, Type 2" OR "diabetic" OR "diabetes") AND "tuberculosis" AND ("Tuberculosis, Multidrug-Resistant" OR "drug resistance" OR "multidrug-resistant" OR "multidrug resistant" OR "multidrug resistance" OR "drug-resistant" OR "drug resistant"). Articles were selected based on inclusion criteria, is published in the form of an English full-text article from January 2015 to January 2025, reporting the relationship between T2DM and MDR-TB among TB patients. The articles were selected using the PRISMA flow diagram and analyzed using the Review Manager 5.3 application. Results: This meta-analysis consisted of 9 articles originating from Europe, Asia, Africa and America. Results of the meta-analysis showed that the cohort study of type 2 diabetes mellitus had a 4.11 times greater risk of developing MDR-TB compared to people who did not have type 2 diabetes mellitus. In a control case study of type 2 diabetes mellitus, there was a 3.11 times greater risk of developing MDR-TB than people without type 2 diabetes mellitus, and both were statistically significant (aOR= 3.39; CI 95%= 2.05 to 8.24; p= 0.001). Conclusion: Type 2 diabetes mellitus is a risk factor for MDR TB.
Copyright (c) 2025 Journal of Epidemiology and Public Health
Effect of Noise Exposure on Occupational Stress and Hypertension among Workers: a Meta-Analysis
Background: The work environment greatly affects the health condition of the workers so that there are no work-related accidents or occupational diseases. Noisy physical environmental factors above the threshold value have a risk of causing occupational diseases such as psychological work stress and hypertension. This study aims to analyze the effect of noise exposure on occupational stress and hypertension among workers. Subjects and Method: This study is a systematic review and meta analysis with the following PICO. P: working society, I: exposure noise ≥85 dBA, C: not exposed to noise ≥85 dBA, O: Stress and Hypertension. This study used of articles published between 2009 and 2022 were comprehensively searched for using electronic databases like PubMed, ProQuest, Scopus, and Google Scholar. The keywords to search for articles were “noise exposure” OR “occupational noise” AND “occupational stress” OR “work stress” AND “hypertension”. The adjusted odds ratio was used to evaluate the effect size (aOR). To evaluate the bias risk, the Critical Appraisal Skill Program (CASP) was used. Articles were analyzed using the Review Manager 5.3 application. Results: This study includes 14 papers, using cross-sectional and case-control study designs, from Asia, including Indonesia, Malaysia, China, Jordan, and South Korea. Based on 5 studies cross-sectional on the effects of exposure to noise in the event of work stress, work stress increases 4.88 times compared to workers who are not exposed to noise (aOR=4.88; 95% CI= 1.77 to 13.47; p= 0.002). 9 subgroup studies with cross-sectional and case-control study designs on the effect of noise exposure showed an increase of 2.47 times the incidence of hypertension compared to workers who were not exposed to noise at work (aOR= 2.47; 95% CI= 1.75 to 3.48; p<0.001). Conclusion: Exposure to noise increases the risk of work-related stress and hypertension. Suggestions that can be made are to carry out engineering, periodic measurements, work time management, workforce education and use of PPE.
The Impact of Long-Term Particulate Matter with Diameter Micrometers ≤2.5 Exposure on Type 2 Diabetes Risk: A Meta-Analysis
Background: The rising global prevalence of type 2 diabetes (T2D) has prompted investigations into environmental risk factors beyond traditional lifestyle causes. Air pollution, particularly fine particulate matter (PM₂.₅) has emerged as a potential contributor to diabetes. This systematic review synthesizes evidence from large scale cohort studies to evaluate the association between long term air pollution exposure and T2D risk. Subjects and Method: We analyzed prospective cohort studies (2020–2025) assessing air pollution and incident T2D, sourced from PubMed, Web of Science and EMBASE using the search terms: ("air pollution" OR "PM2.5") AND ("type 2 diabetes" OR "T2D") AND ("cohort" OR "longitudinal"). We using PECO framework (Populatio= adults population; Exposure=High Exposure of PM2.5; Comparison=Low Exposure of PM2.5; Outcomes=T2D). The independent variable was Exposure of PM2.5 and dependent variable was T2D. Primary studies included were cohort manuscript published in english with year of publication between 2020 until 2025, reported adjusted hazard ratios (aHR), and the subjects was adults without diabetes at baseline. Studies were evaluated using the CASP Scale, and data were analyzed using RevMan 13. Results: This study includes 9 papers, using Cohort study designs, from China, United Kingdom, South Korea and United States. PM₂.₅ exposure consistently increased T2D risk with stronger effects at lower exposure levels (aHR = 1.24; 95% Cl = 1.07 to 1.42; p=0.004). Conclusion: Long-term PM₂.₅ exposure significantly increases T2D risk and progression
Design of a Streptococcus suis Meningitis Epidemiological Surveillance Application to Improve Zoonotic Disease Prevention and Control in Bali Province, Indonesia
Background: Streptococcus suis meningitis is an inflammation of the human central nervous system caused by the Streptococcus suis bacterium. The Health Department of Bali Province, Indonesia, repor­ted a total of 7 cases of Streptococcus suis meningitis in Bali Province from January to April 2023, with 2 fatalities. The government has conducted an epidemiological investigation. However, the re­cor­ding of epidemiological investigation data is still done manually, resulting in inaccurate and untimely data. This study aimed to develop a digital surveillance application for investigating Strep­tococcus suis meningitis based on Figma and Kobo Toolbox. Subjects and Method: This was a design-based study using the Design Science Research Method (DSRM), conducted across all nine districts and cities in Bali Province. The target users were public health surveillance officers. A total of 130 respondents participated in the user acceptance evaluation. The application prototype was developed using Figma, and data collection forms were designed via Kobo Toolbox. The study evaluated application acceptance using the Technology Acceptance Model (TAM), which includes the following dependent variables: timeliness, information completeness, information accuracy, accessibility, usefulness, and ease of use. Data were analyzed descriptively. Results: The results showed high user acceptance of the application, with mean percentages as follows: timeliness (85.8%), information completeness (86.8%), information accuracy (84.6%), accessibility (86.2%), usefulness (84.7%), and ease of use (81.9%). Conclusion: The digital application for epidemiological surveillance of Streptococcus suis me­ning­itis demonstrated good acceptance among users. Its implementation could improve the accuracy and efficiency of data collection, potentially enhancing the response time and decision-making in zoonotic disease control.
Effect of Early Mobilization on Intestinal Peristaltic Recovery As Prevention of Paralytic Ileus in Post Cesarean Section Patients
Background: The majority of cesarean section deliveries use spinal anesthesia which can have an effect on the deterioration of the gastrointestinal system so that intestinal peristalsis becomes slow. Slow intestinal peristaltic function leads to difficulty defecation and prolongs the day of treatment, in some cases can increase the risk of paralytic ileus. To prevent the risk of complications, intervention can be carried out in postoperative cesarean section patients with early mobilization. This study aims to determine the effect of early mobilization on intestinal peristaltic recovery in post- cesarean section patients. Subjects and Method: This was a quasy experiment conducted at Islamic Hospital in Demak, Central Java, from July to December 2024. A sample of 58 post-cesarean section mothers was selected using purposive sampling and divided into two groups. Assessment of intestinal peristaltic variables through auscultation examination with a stethoscope and early mobilization using observation sheet instruments. Intestinal peristaltic recovery between two groups were examined logistic regression. Results: There was a difference in intestinal peristaltic recovery in post- cesarean section patients between the intervention group and the control group (p=0.000) with the mean value of intestinal peristalsis in the intervention group of 25.45 (SD=6.07) and in the control group of 11.38 (SD=7.69). Patients who were given early mobilization had a 4.48 times faster chance of recovery of intestinal peristalsis. Conclusion: Early mobilization had a positive impact on the recovery of intestinal peristaltic (p<0.05). Health workers should not only provide education, but also assistance in the implement-tation of early mobilization, especially in the first 24 hours post- cesarean section. Keywords: early mobilization, intestinal peristaltics, post cesarean section.
Meta-Analysis: The Influence of Knowledge, Hormonal Contraceptive Use, and Sexually Transmitted Disease on Cancer Screening Uptake
Background: Cervical cancer is still the most common problem among women. Prevention of cer­vical cancer can be done prospectively through human papillomavirus (HPV) vaccination and screen­ing or early diagnosis. Screening is essential to reduce the incidence and death of cervical can­cer. This study aims to analyze and estimate the influence of knowledge, the use of hormonal con­­tra­ceptives, and the history of sexually transmitted diseases on cervical cancer screening. Subject and Method: This study is a meta analysis using the PRISMA flowchart and the PICO model. Population: women of childbearing age. Intervention: using hormonal contraceptives, having good cervical cancer knowledge, and having a history of sexually transmitted infections. Comparation: not using hormonal contraceptives, poor cervical cancer knowledge and no history of sex­ually transmitted infections. Outcome: cervical cancer screening. The process of searching for articles by searching through databases in Google scholar, Scopus, ProQuest, PubMed, Elsevier, and Science direct. The keywords used are "hormonal contraception" OR "pill" OR "injection" OR "implant" AND "Cervical cancer screening" OR "sexually transmitted infection" OR "HIV" OR "STD" OR "syphilis" OR "gonorrhea" AND "cancer knowledge" AND "cross sectional" AND "aOR". Art­icles are selected based on inclusion criteria, namely multivariate articles with a cross sectional design published in 2014-2024. Data analyzed using Revman 5.3. Results: A meta analysis was conducted on 15 primary studies from Ethiopia, Cambodia, and Ugan­da. The results showed that the use of cervical cancer screening increased with good know­ledge (aOR= 2.03; CI 95%= 1.70 to 2.43; p<0.001), use of hormonal contraceptives (aOR= 1.83 CI 95%= 1.70 to 1.96; p<0.001), and history of sexually transmitted diseases (aOR= 2.32; CI 95%= 1.81 to 2.97; p<0.001). Conclusion: Good knowledge, use of hormonal contraceptives, and history of infectious diseases incre­a­se the use of cervical cancer screening performance
The Relationship Between Macronutrient Intake and Stunting Among Children Aged 1–2 Years: Quantitative and Qualitative Approaches
Background: Stunting among children aged 1–2 years remains a critical public health concern in Indonesia, particularly during the vital 1,000-day window of child development. This study aimed to analyze the relationship between macronutrient intake and stunting using a mixed-methods approach. Subjects and Method: This was a sequential explanatory mixed-methods study conducted from February 2024 to May 2025 at Community Health Center Dadok Tunggul Hitam, Padang City. The quantitative component employed a case-control design involving 66 children aged 1–2 years, divided equally into stunted (cases) and non-stunted (controls) groups. Sampling was conducted purposively for cases and by simple matching for controls. The independent variables were intake of carbohydrates, proteins, and fats; the dependent variable was stunting, defined using WHO growth standards. Macronutrient intake was assessed via a 24-hour recall. Data were analyzed using Chi-square tests to determine associations, and Odds Ratios (OR) with 95% Confidence Intervals (CI) were reported. The qualitative phase included interviews with mothers, health workers, and community volunteers, analyzed thematically using NVivo 12. Results: Children with inadequate carbohydrate intake were significantly more likely to be stunted (OR=3.50; 95% CI=1.27 to 9.64; p=0.015). No statistically significant associations were found for protein intake (OR=2.60; 95% CI=0.91 to 7.44; p=0.074) or fat intake (OR=2.44; 95% CI=0.89 to 6.70; p=0.082). Qualitative findings revealed barriers such as loss of appetite during illness, preference for snacks, food aversions, and limited maternal knowledge and resources, all of which contributed to inadequate macronutrient intake. Conclusion: Inadequate carbohydrate intake was significantly associated with stunting in children aged 1–2 years. Contextual factors such as eating behavior and parental feeding practices further influenced nutritional outcomes. Interventions should address both dietary intake and behavioral barriers within families.
Effect of Banana Consumption to Reducing Hyperemesis Gravidarum In Pregnant Women
Background: Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that can lead to dehydration, weight loss, and nutritional deficiencies, posing risks to both maternal and fetal health. Exploring the potential of banana consumption as a natural, accessible intervention may offer a simple dietary strategy to alleviate HG symptoms and improve maternal well-being. This study aimed to determine whether banana comsumption contributes to a decrease in the number of cases of nausea and vomiting experienced by pregnant women. Subjects and Method: This was a quasi experiment conducted at the Mitra Siaga Hospital, Tegal, Central Java, Indonesia, in April-May 2024. A number of 30 pregnant women with hyperemesis gravidarum was selected using purposive sampling. Hyperemesis gravidarum was measured using Pregnancy Unique Quantification of Emesis and Nausea (PUQE) questionnaire. Difference score of hyperemesis gravidarum before and after intervention was examined using t test. Results: The results of the Wilcoxon test before and after consuming bananas with Confidence Interval 95% showed p-value = 0.000, with a significance level of p-value 0.000 < 0.05, which indicates that banana consumption is effective in reducing complaints of nausea and vomiting in hyperemesis gravidarum mothers at Mitra Siaga Hospital, Tegal. The results of the linear regression test of the effect of banana consumption on hyperemesis gravidarum t value = 20.110 > t table and the significance level of p-value 0.000 < 0.05, which indicates that banana consumption has a positive and significant effect on reducing complaints of nausea and vomiting in mothers with hyperemesis gravidarum at Mitra Siaga Hospital, Tegal. Conclusion: Banana consumption can reduce vomiting in pregnant women.
Environmental Risk Factors and Hookworm Infection among Schoolchildren in Rural Areas of Indonesia
Background: The prevalence of hookworm infection is a serious public health concern globally. Java Island and Kalimantan Island have differential environmental risk factors of hookworm infection, espe­cial­ly in rural areas of Indonesia, which have high-risk environmental factors for the prevalence of hook­worm infection. This study aimed to investigate the infection rates and correlation between environmental risk factors and the prevalence of hookworm infection. Subjects and Method: This was a cross-sectional study conducted among 226 school children from rural East Java province, Central Java Province, and East Kalimantan Province, Indonesia. A simple random sampling method was applied to select participants from each school area. This study used two diagnostic methods: Kato Katz and Koga agar plate culture/KAP culture for diagnosing hookworm infections. Environmental variables examined included soil texture, organic carbon content, clay content, soil pH, rainfall volume, number of rainy days, humidity, temperature, elevation, vegetation type, and pet infection status. Pearson's chi-square analysis was used to study the correlation between environmental factors and hookworm infection. Results: Hookworm, Strongyloides sp, and Ascaris sp infections were found in this study; 137 (60.63%), 25 (11.1%), and 124 (9.84%), respectively. Environmental risk factors such as rainy season, quality of soil, and infection with hookworm in pets have a significant correlation (p<0.050) with hookworm infection among schoolchildren in a rural area in Indonesia. Conclusion: The prevalence of hookworm infection correlates with environmental factors, and the findings in this research could contribute to decreasing the prevalence of hookworm infection, espe­cially among schoolchildren in rural areas.
Maintaining Occupational Health: An Analysis of Fatigue and Safety Compliance in Construction Workers
Background: Safety compliance is a critical component in preventing workplace accidents and ensuring employee well-being. Various factors may influence workers’ adherence to safety protocols, including individual characteristics such as education level and fatigue. The purpose of this study was to examine the relationships between education level, work fatigue, and safety compliance. Subjects and Method: This cross-sectional study involved 137 respondents, categorized by fatigue status. The dependent variable was safety compliance. Independent variables included work fatigue and education level. Instruments included the Fatigue Assessment Scale (FAS) questionnaire for fatigue. Data analysis utilized the chi-square test for fatigue and education levels. Results: The proportion of workers who comply with safety procedures varies across education levels, but the differences are not statistically significant. In contrast, workers with higher levels of fatigue were significantly more compliant with safety practices than those with lower fatigue.. Conclusion: These findings highlight the complexity of behavioral responses to workplace demands and the need for targeted interventions.
Determinants of Dementia Among the Elderly in Jakarta, Indonesia
Background: The incidence of dementia rises sharply, and it is expected to grow worldwide in the decades ahead. This study aimed to investigate the determinants of dementia among the elderly in Jakarta, Indonesia. Subjects and Method: A cross-sectional design was employed in the Aisyah organization at Jakarta City, Indonesia. A total of 65 elderly people were selected using Stratified random sampling. The dependent variable was dementia. The independent variables were education, occupation, married status, and exercise routine. The dementia was assessed using the Mini-Mental State Examination (MMSE) questionnaire, which was translated into Bahasa. Results: The participants had an education level of high school or below (52.31%), were not married (53.85%), and were not working (55.38%). The majority reported frequent exercise (92.31%), and 44.62% were identified with dementia. Bivariate analysis showed that higher education (OR = 0.92; 95% CI= 0.26 to 3.22; p= 0.002) and being married (OR= 0.94; 95% CI= 0.34 to 2.61; p= 0.020) were significantly associated with lower dementia risk. Exercise routine showed a strong protective effect (OR = 0.17; 95% CI= 0.01 to 1.79; p= 0.043), while occupational status was not significantly associated (p= 0.074). In multivariate analysis, only exercise routine remained significantly associated with dementia (OR= 0.17; 95% CI= 0.01 to 1.78; p= 0.042), suggesting it as an independent protective factor after controlling for confounders. Conclusion: Regular physical activity was identified as a significant protective factor against dementia among the elderly. Promoting exercise may be an effective strategy for dementia prevention in this population.
Impact of Pesticide Exposure on Farmer Metabolism Systems : A Systematic Review
Background: Farmers are informal sector workers exposed to multiple health risks due to the unsafe use or storage of pesticides. Farmer are at high risk of pesticide poisoning, which can affect their metabolic disorders. This review aims to systematically examine the impact of pesticide exposure on health disorders in farmers’ metabolic systems. Subjects and Method: This was a systematic review using the PICO model. The keywords used for the search for the study were “Impact” and “Pesticide” AND “Exposure” AND “Farmers’” AND “Meta­bolism System” in various databases. The inclusion criteria in this study were studies discussing varia­bles, research articles, and articles published from 2021 onwards, while the exclusion criteria were articles that do not have access or are not full-text. Data were collected using the extraction form, which includes PICO, and assessed using the PRISMA diagram. Data analysis was done descriptively by comparing the research results. Results: The study found that pesticide exposure can affect the metabolic system, potentially damaging cells and causing oxidative stress by damaging lipids, proteins, and DNA, leading to genetic mutations and cell degeneration. The impact of exposure to glyphosate and arsenic pesticides causes liver and kidney function damage and decreased cardiovascular health. Exposure to paraquat, glyphosate, and oxyfluorophene causes Thyroid Cancer. Exposure to organophosphate and organo­chlorine pesticides causes Parkinson’s. Insecticides, herbicides, and fungicides cause sleep disorders. In addition, herbicide pesticides have a significant relationship with type 2 diabetes. Conclusion: Based on research findings, pesticide exposure impacts farmers’ metabolic systems, including the incidence of Chronic Kidney Disease, decline in cardiovascular health, Thyroid Cancer, Parkinson’s Disease, Sleep Disorders, and Type 2 Diabetes.
Global Research Trends on Preconception Care on the Infertility Prevention: A Bibliometric Study
Background: Infertility affects approximately one in six individuals globally and remains a growing reproductive health concern, often linked to modifiable risk factors present before conception. Preconception care (PCC) has gained recognition as a preventive strategy, however the implementation of PCC at scale remains challenged and yet its research landscape in relation to infertility remains under-mapped.This study aimed to analyze global research trends on preconception care in the context of infertility prevention using bibliometric methods. Subjects and Method: A bibliometric analysis was conducted using the Scopus database, with data retrieved on May 12, 2024. The search strategy included terms related to PCC and infertility, yielding 486 eligible publications after screening. Included documents were English-language publications in final form, relevant to preconception care and infertility, and classified as articles, reviews, conference papers, or book materials. Analysis was performed using Scopus tools, Biblioshiny (R), and VOSviewer to examine publication trends, key contributors, and thematic evolution. Results: A total of 486 publications from 1991 to 2025 were identified, with an annual growth rate of 6.43%. Most documents were original articles (67.7%) and reviews (28.4%), authored by 2,529 contributors across 307 publication sources. Several national strategies have formalized PCC into broader public health policy to reduce disparities in pregnancy outcomes and unmet fertility needs, but there remains a critical gap in the global PCC research agenda, such as the heterogeneity in intervention protocols. Conclusion: Research on preconception care in the context of infertility prevention has expanded steadily. However, Future research should prioritize longitudinal and interventional studies, foster global collaboration, and align with broader reproductive justice goals to strengthen the evidence base. Ultimately, enhancing the visibility and implementation of PCC in both clinical and public health domains will be pivotal in addressing modifiable infertility risks and promoting equitable reproductive outcomes worldwide.