Gema Lingkungan Kesehatan (The Public Health and Health Sciences Journal) is a peer-reviewed, open-access scientific journal published by Politeknik Kesehatan Kemenkes Surabaya. The journal focuses on research and scientific developments in public health, health sciences, and environmental health, with the aim of contributing meaningful evidence to health practice, policy, and population health improvement. The journal provides a platform for researchers, academics, health professionals, and policymakers to share original research, review articles, systematic reviews, and other evidence-based scientific contributions. Topics covered include environmental health, epidemiology, community health, occupational health and safety, health promotion, disease prevention, nutrition, public health policy, and related areas of health sciences. Gema Lingkungan Kesehatan is committed to publishing scientifically sound and relevant research through a rigorous peer-review process and adherence to research integrity, publication ethics, and good scholarly publishing practices. The journal welcomes quality contributions from researchers in Indonesia and around the world that address current and emerging challenges in public health and health sciences. Since 2025, Gema Lingkungan Kesehatan has adopted a quarterly publication schedule, with four issues published annually. This schedule provides opportunities for the continuous dissemination of current research and scientific knowledge in public health and health sciences. Published by: Politeknik Kesehatan Kemenkes Surabaya E-ISSN: 2407-8948 Publication Frequency: Quarterly—4 issues per year.
An Intervension Using Gabus Fish Flakes to Improve Body Weight, Height and Nutrient Intake in Undernourished Toddlers
Undernutrition remains a nutritional problem among children under five years of age, particularly in populations with inadequate dietary intake. Snakehead fish (Channa striata) floss is a locally available animal-source food that may provide additional energy and nutrients to support the nutritional status of undernourished toddlers. Objective: This study aimed to determine the effect of snakehead fish floss supplementation on body weight, height, and nutrient intake among undernourished toddlers aged 24–59 months. A quasi-experimental study with a pretest–posttest control group design was conducted among 20 undernourished toddlers selected by purposive sampling. Participants were divided into an intervention group (n=10) and a control group (n=10). The intervention group received 30 g of snakehead fish floss daily for 30 consecutive days, while the control group received no fish-floss supplementation. Body weight and height were measured before and after the intervention, and dietary intake was assessed using a 24-hour dietary recall. Within-group changes were analyzed using the Wilcoxon Signed-Rank test, while differences in changes between groups were analyzed using the Mann–Whitney U test. Within the intervention group, significant increases were observed in body weight from 9.44 ± 1.24 to 9.68 ± 1.11 kg (p=0.007), height from 84.77 ± 6.74 to 84.88 ± 6.66 cm (p=0.016), energy intake by 168.20 kcal (p=0.005), protein by 4.92 g (p=0.009), carbohydrate by 20.84 g (p=0.005), and calcium by 59.00 mg (p=0.009). However, comparison of changes between groups showed significantly greater increases in body weight (U=11.0, p=0.002), height (U=25.5, p=0.042), and energy intake (U=7.0, p=0.001) in the intervention group. Differences between groups were not statistically significant for protein (p=0.082), fat (p=0.307), carbohydrate (p=0.174), or calcium (p=0.112). Daily supplementation with 30 g of snakehead fish floss for 30 days was associated with greater improvements in body weight, height, and energy intake among undernourished toddlers compared with the control group. However, the intervention did not demonstrate statistically significant between-group differences in protein, fat, carbohydrate, or calcium intake. Given the small sample size and short intervention period, these findings should be considered preliminary evidence of the potential benefit of snakehead fish floss as a locally sourced supplementary food.
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Corrigendum: Analysis of Eco-Enzyme Potential to Reduce BOD, COD, Oil and Grease Concentrations in Raw Water for Treated Water in Karawang: A Laboratory Experiment
This corrigendum is issued to correct several editorial and typographical errors in the article entitled "Analysis of Eco-Enzyme Potential to Reduce BOD, COD, Oil and Grease Concentrations in Raw Water for Treated Water in Karawang: A Laboratory Experiment", published in Gema Lingkungan Kesehatan, Volume 23, Issue 1, 2025 (DOI: https://doi.org/10.36568/gelinkes.v23i1.148). The corrections include: (1) capitalization and typographical revisions, (2) correction of the technical term "treated", (3) correction of the composition value for Variation D in Table 2 from 2,750.00 : 150.00 to 2,750.00 : 250.00 (Raw Water : Eco-Enzyme), and (4) replacement of several figure and graph labels from Indonesian to English. The correction to Table 2 reflects the actual experimental composition used throughout the study and resulted from a transcription error during the final manuscript preparation. These corrections do not affect the research methodology, experimental procedures, data analysis, results, discussion, scientific interpretation, or conclusions of the published article. This corrigendum is published to ensure the accuracy, clarity, and integrity of the scientific record.
Performance Evaluation of Plastic Drum Septic Tanks Equipped with Recycled Nylon Net Biofilters for Domestic Wastewater Treatment in Riverbank Communities
Water pollution caused by the direct discharge of domestic wastewater from toilets into watercourses remains a serious environmental health issue, particularly in riverside settlements with limited access to adequate sanitation facilities. This study aims to evaluate the performance of septic tanks made from plastic drums fitted with biofilters made from used nylon netting in improving the quality of domestic wastewater based on the parameters of Biochemical Oxygen Demand (BOD) and Total Suspended Solids (TSS). The study employed a quasi-experimental design with a post-test only control group design, conducted in the villages of Ambawang Kuala and Kuala Mandor B, Kubu Raya Regency. A total of eight plastic drum septic tanks were used, comprising four treatment units fitted with biofilters made from used nylon netting and four control units without biofilters. Wastewater samples were collected from the septic tank outlets and analysed for BOD and TSS using standard laboratory methods. A total of 64 samples were analysed; the data were then processed descriptively and tested using an independent t-test after meeting the assumptions of normality and homogeneity. The results of the study showed that the mean BOD concentration in the treatment group (5.74 mg/L) was lower than that in the control group (7.79 mg/L), whilst the mean TSS concentration in the treatment group was 3.45 mg/L and in the control group 3.17 mg/L. However, there were no statistically significant differences for either the BOD (p=0.227) or TSS (p=0.883) parameters. These results indicate that the use of biofilters made from used nylon netting tends to enhance the reduction in BOD levels, but has not yet yielded a significant improvement in wastewater quality under the conditions of this study. Therefore, this technology has the potential to be developed as an alternative for a simple, low-cost and environmentally friendly sanitation system; however, it still requires design refinements, longer operational periods and testing on a larger scale to ensure its effectiveness.
SEM-EDS Characterization of Metal-Bearing Particles in Kali Kabur River Sediments, Mimika, Central Papua, Indonesia: A Preeliminary Mineralogical Assessment
The Grasberg porphyry copper-gold mining district in Central Papua, Indonesia, has historically discharged tailings into the Ajkwa river system, raising concerns about downstream heavy-metal contamination in tributaries such as Kali Kabur, Mimika Regency. Because bulk geochemical techniques (e.g., XRD, XRF, ICP-MS) characterize average sediment composition but cannot resolve which specific mineral grains host which metals, this preliminary study applied Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy (SEM-EDS) spot analysis to two grab sediment samples from Kali Kabur (TS1, Lab No. 3647.25; TS2, Lab No. 3648.25), examined at the accredited tekMIRA laboratory (Certificate of Analysis No. 1044/LFM/10/2025) following internal method PU-3002FM. Backscattered electron imaging guided selection of eight metal-bearing particles (four per sample) for quantitative elemental analysis in weight percent. Results identified a Cu-Fe-S particle consistent with a chalcopyrite-like phase (TS1, Spectrum 1: Cu 44.78 wt%, Fe 22.58 wt%, S 32.64 wt%), a near-stoichiometric pyrite grain (TS1, Spectrum 2: S 47.19 wt%, Fe 52.81 wt%), iron oxide particles in both samples, quartz/silicate particles in both samples, and, in TS2, a Ti-Fe-Al-Si-O particle consistent with altered ilmenite/titanomagnetite intergrown with aluminosilicates, together with an Mn-bearing aluminosilicate phase. These assemblages are mineralogically consistent with the known porphyry Cu-Au mineralization and associated alteration facies of the Grasberg district. However, because no upstream or background reference samples, bulk metal concentrations, or independent mineralogical confirmation (e.g., XRD) were obtained, the data cannot, by themselves, distinguish natural geogenic inputs from mining-derived material, nor support quantitative statements about bioavailability or ecological/human health risk. The findings are reported as a preliminary, particle-level screening that complements but does not substitute for bulk geochemical and mineralogical characterization. We recommend that future work expand sample coverage with georeferenced, depth-controlled sampling and paired background sites, integrate SEM-EDS with XRD or automated mineralogy (e.g., QEMSCAN/MLA) and bulk ICP-MS/AAS analysis, and apply sequential extraction to evaluate bioavailable metal fractions before firm conclusions about environmental health risk in the Kali Kabur system can be drawn.
Human Health Risk Assessment Based on Lead (Pb) Exposure from Drinking Water and Aquatic Food in Pontianak, Indonesia
Lead (Pb) exposure through drinking water and aquatic food remains a serious public health issue, particularly in tropical urban areas. This study aims to identify the main sources of Pb exposure in the community of Pontianak City through analysis of rainwater, refill water, tilapia, shrimp, shellfish, and fish-based processed foods. The study was conducted using a cross-sectional observational design, involving 37 rainwater samples, 23 refill water samples, and 60 food samples. Analysis using the AAS method showed that the average Pb level in rainwater reached 0.093 mg/L (0.040–0.160 mg/L) with 100% of samples exceeding the WHO threshold (0.01 mg/L), while in refilled water the average was 0.012 mg/L (0.009–0.020 mg/L) and 39.1% exceeded the standard. In food, shellfish had the highest Pb content at 0.42 mg/kg (0.20–0.68 mg/kg) with 42.9% exceeding the Codex standard (0.3 mg/kg), followed by shrimp at 0.35 mg/kg (36.7%), tilapia at 0.22 mg/kg (13.6%), and fish nuggets 0.05 mg/kg (0%). Daily intake estimates show that rainwater consumption contributes 0.186 mg/day, much higher than refill water (0.024 mg/day). The combination of rainwater and shellfish resulted in a total Pb intake of 0.228 mg/day (81.6% from water, 18.4% from food), while the combination of refilled water and shellfish was only 0.066 mg/day. The highest Estimated Weekly Intake (EWI) value reached 26.6 µg/kg bw/week, approaching the international reference threshold. The results of the study confirm that collected rainwater is the dominant route of exposure, while shellfish and shrimp are significant additional sources. These findings underscore the urgency of mitigation through improvements in rainwater harvesting quality, enhanced monitoring of refill depots, and control of consumption of certain aquatic foods.
Unsafe Riding Behavior Among Adolescent Electric Bicycle Users in Semarang City
The use of electric bicycles among adolescents has increased along with their growing popularity as an alternative mode of transportation. However, this trend raises concerns regarding riding safety. This study aimed to describe the riding behavior of adolescent electric bicycle users and to analyze the association between unsafe riding behavior with traffic incident history. Unsafe riding behavior was assessed based on speeding, helmet use, mobile phone use while riding, adult supervision, and riding in motor vehicle lanes. A quantitative descriptive-analytic study with a cross-sectional design was conducted in Semarang City. A total of 35 adolescent electric bicycle users were recruited using accidental sampling. Data were collected through a questionnaire and analyzed using univariate analysis and fisher’s exact test. The results showed that more than half of respondents rode at speeds exceeding 25 km/h (54.3%), the majority did not use helmets (80.0%), frequently rode in motor vehicle lanes (74.2%), and were not consistently accompanied by adults. The mean riding speed was 30.03 km/h, with a maximum speed of 45 km/h. Regarding safety outcomes, 22.9% of respondents reported having experienced an accident, while 17.1% reported near-miss incidents. Unsafe riding practices were common among adolescent electric bicycle users in Semarang City. These findings suggest the importance of strengthening safety education and improving compliance with existing regulations governing electric bicycle use.
Participation and Policy Support for a Campus-Based Community Recycling Initiative in Yogyakarta, Indonesia
A campus-based community recycling initiative was implemented in a higher health vocational education in Yogyakarta, Indonesia, through a mandatory institutional policy to promote sustainable monthly campus waste management. This study aimed to assess participation, routine waste management behavior, and support for the continuation of the policy. A cross-sectional online survey was conducted among campus community members, including students, lecturers, and administrative staff. A total of 607 respondents completed the questionnaire and were included in the analysis. Univariate and multivariate logistic regression analyses with 95% confidence intervals (CIs) were used to identify factors associated with routine monthly waste management and support for policy continuation. Overall, 91.4% of respondents were registered as member of this initiative, 88.5% were aware of the mandatory policy, and 96.5% reported sorting waste before disposal. However, only 46.1% reported routine monthly waste management. In the adjusted model, routine monthly waste management was associated with perceived availability of digital services (AOR 3.20; 95% CI 2.15–4.77) and waste reduction with family or close friends (AOR 1.99; 95% CI 1.28–3.08). Respondents with compliance-only motivation had lower odds of routine participation than those with a compliant-internalized profile (AOR 0.40; 95% CI 0.21–0.76). Support for policy continuation was associated with routine monthly waste management (AOR 3.09), perceived availability of digital services (AOR 2.57), perceived environmental cleanliness (AOR 3.90), perceived program effectiveness (AOR 4.47), and higher overall perception scores (AOR 2.92). The mandatory campus-based recycling policy achieved high formal participation, but routine monthly participation remained limited. Sustained participation depends not only on institutional enforcement but also on internalized motivation, access to digital services, social support, and perceived program benefits.
Waste Characterization and Integrated Management Strategy for Small-Island Tourism in Derawan, Indonesia
This study aims to evaluate the waste generation and composition characteristics as a technical basis for designing an Integrated Solid Waste Management (ISWM) strategy on Derawan Island, a small island tourism destination. By applying a quantitative method referring to the SNI 19-3964-1995 standard, data were collected over eight consecutive days from three different sources: households (stratified random sampling), the commercial sector (purposive sampling), and marine debris (transect method). The analysis results showed that total daily waste generation reached 2,810.05 kg/day. The specific generation rate of 1.652 kg/capita/day was far above the national average, indicating a "double burden" phenomenon due to high tourism activity. In terms of composition, the waste stream was dominated by organic material (53.99%), followed by inorganic waste (40.18%) and hazardous waste (5.83%). These findings prove that the conventional "collect-transport-dispose" model is highly vulnerable and uneconomical given the 1.5-hour sea transport distance to the final disposal site on the mainland. Therefore, this characterization data supports a decentralized ISWM framework that prioritizes on-site bioconversion of the organic fraction (e.g., composting and utilization of Local Microorganisms/MOL), complemented by high-value recycling recovery. This baseline data-driven approach can theoretically reduce the final residue that must be transported by sea to only 18.15% of its initial mass, thereby overcoming acute logistical constraints while ensuring environmental sustainability for coral reef-based ecotourism.
Ethanolic Peel Extract Attenuates Isonazid-induced Hepatic Injury in Rats via Reduced NF-kB, and Caspase 3 Expression
Isoniazid can induce hepatotoxicity and liver fibrosis via oxidative stress, NF-κB, and caspase-3 pathways. Garcinia mangostana L. (mangosteen) peel extract, rich in xanthones, offers anti-inflammatory and anti-apoptotic properties that may mitigate drug-induced liver injury. To evaluate the effects of mangosteen peel ethanol extract on NF-κB p65, caspase-3 expression, and hepatic fibrosis in isoniazid-treated Wistar rats. In this experimental study, 28 male Wistar rats were divided into four groups: negative control (NC), positive control (PC; isoniazid 50 mg/kg), and two treatment groups receiving isoniazid plus mangosteen extract at 250 mg/kg (I1) and 500 mg/kg (I2) for 30 days. Liver tissues were analyzed using immunohistochemistry (NF-κB, caspase-3) and Masson’s trichrome staining (fibrosis). The 500 mg/kg dose significantly reduced NF-κB p65 and caspase-3 expression and mitigated hepatic fibrosis compared to the PC group (p < 0.05). The 250 mg/kg dose showed less pronounced effects. Garcinia mangostana L. peel extract, especially at 500 mg/kg, effectively attenuates isoniazid-induced liver injury by downregulating NF-κB and caspase-3 in isoniazid-induced Wistar rats. These findings suggest its potential as an adjunct in preventing isoniazid-induced hepatic injury in a preclinical setting. Additional translational and clinical investigations are needed to determine its efficacy and safety as a potential hepatoprotective agent in humans.
Hospital Disaster Resilience in Indonesia: An Evidence-Based Synthesis of Flood and Earthquake Preparedness
Indonesia is one of the most disaster-prone countries in the world due to exposure to earthquakes, floods, tsunamis, volcanic eruptions, and climate-related hazards. Hospitals play a critical role in maintaining healthcare delivery during disasters, yet their resilience capacity varies. This study synthesized evidence on hospital disaster resilience in Indonesia, focusing on preparedness for flood and earthquake hazards. An evidence-based descriptive synthesis was conducted using peer-reviewed studies, national reports, policy documents, and international guidance. Findings were analyzed across four resilience domains the Hospital Safety Index: structural and non-structural safety, emergency management systems, continuity of essential services, and governance and policy integration. The review found that improvements in hospital resilience were most evident in governance, disaster management planning, and policy integration, largely driven by accreditation requirements and national disaster risk reduction initiatives. However, structural resilience remains insufficient in many facilities, particularly regarding seismic preparedness and non-structural mitigation measures. Flood preparedness is more advanced than earthquake preparedness because hydrometeorological hazards occur more frequently. Persistent vulnerabilities were identified in continuity of essential services, including electricity, water supply, sanitation systems, and healthcare waste management. Although disaster preparedness plans are increasingly available, operational readiness through emergency exercises remains inconsistent. Overall, hospital disaster resilience in Indonesia remains uneven, characterized by stronger administrative preparedness than infrastructural and functional resilience. Strengthening disaster-safe hospitals requires integrated resilience frameworks, climate-resilient health infrastructure, sustained investment in emergency preparedness, enhanced workforce capacity, and stronger implementation of disaster risk reduction policies across the healthcare system to ensure service continuity during future emergencies and disasters.
The Hepatoprotective Role of Ethanolic Mangosteen Peel Extract (Garcinia mangostana L.) on MDA, TNF-α, E-Selectin, and SGPT Levels in Isoniazid-Induced Liver Fibrosis Wistar Rats
Isoniazid is a first-line anti-tuberculosis drug known to cause drug-induced liver injury (DILI) through oxidative stress and inflammatory mechanisms that contribute to the development of liver fibrosis. Mangosteen peel (Garcinia mangostana L.) contains xanthone compounds with antioxidant and anti-inflammatory properties, making it a potential hepatoprotective agent. This study aimed to determine the role of ethanol extract of mangosteen peel on malondialdehyde (MDA) levels, tumor necrosis factor-α (TNF-α) expression, E-selectin expression, and SGPT levels in the liver of isoniazid-induced fibrosis Wistar rats. This experimental study used a post-test only control group design. Twenty-eight male Wistar rats were randomly divided into four groups: negative control group, positive control group (isoniazid 50 mg/kgBW/day), treatment group 1 (isoniazid + mangosteen peel ethanol extract 250 mg/kgBW/day), and treatment group 2 (isoniazid + mangosteen peel ethanol extract 500 mg/kgBW/day) for 30 days. MDA and SGPT levels were measured using spectrophotometry, while TNF-α and E-selectin expression were assessed using immunohistochemistry. Administration of mangosteen peel ethanol extract significantly reduced MDA and SGPT levels and decreased TNF-α and E-selectin expression compared to the positive control group. The most significant reduction was observed in the group receiving the extract dose of 500 mg/kgBW. Mangosteen peel ethanol extract reduces MDA, TNF-α, E-selectin, and SGPT levels in isoniazid-induced Wistar rats. These findings demonstrate its hepatoprotective potential in a preclinical setting, further translational and clinical studies are warranted to evaluate its efficacy and safety in humans as potential hepatoprotective agent.
Spatiotemporal Water Quality Assessment of Lake Mahalona via Google Earth Engine
Freshwater lake ecosystems are increasingly recognized as sensitive indicators of environmental health, where shifts in physicochemical water quality parameters reflect broader ecological pressures from anthropogenic activities and climate variability This study aims to map the spatial distribution, analyze temporal trends, and evaluate the water quality status of Lake Mahalona in Towuti Subdistrict, East Luwu Regency, South Sulawesi, based on pH, TSS, BOD, COD, and ammonia parameters. The analysis was conducted using the GEE platform with Sentinel 2 Level-2A imagery data for pH, TSS, BOD, and COD parameters, as well as GEOS-CF data for ammonia, covering the period from January to November 2025. The methods applied included creating an Area of Interest (AOI), using the JRC Global Surface Water Mapping Layers, v1.4, utilizing Harmonized Sentinel-2 MSI Level-2A (SR), atmospheric correction, cloud and water body masking, outlier removal using the inter-quantile range, deriving functional equations for water quality parameters, and exporting the data. Satellite-derived estimates yielded pH values ranging from 6.587 to 7.154; TSS from 17.55 to 19.821 mg/L; BOD from 3.215 to 7.266 mg/L; COD from 2.857 to 6.116 mg/L; and atmospheric ammonia pressure indicators at 0.001 mg/L. Time-series analysis revealed fluctuations in all parameters, with increases in TSS, BOD, and COD from August to October, while ammonia remained stable at very low concentrations. Based on Government Regulation No. 22 of 2021, the pH, TSS, COD, and ammonia parameters still meet Class II and III water quality standards; however, the BOD value has exceeded the 2 mg/L threshold, indicating organic pollution pressure from anthropogenic activities in the watershed. The GEE-based approach demonstrates considerable potential for efficient spatial and temporal monitoring of lake water quality, providing important baseline information for the sustainable management and conservation of Lake Mahalona.
Comparative Analysis of Aedes spp. Mosquito Oviposition Preferences for Various Natural Attractants in Ovitraps
Dengue fever remains a major public health problem in tropical countries, including Indonesia. Ovitraps are widely used as a simple and cost-effective tool for monitoring and controlling Aedes mosquito populations; however, their effectiveness depends on the type of attractant and trap material used. This study aims to evaluate various types of attractants for *Aedes* mosquito egg traps as part of surveillance efforts. The research method is a quasi-experimental study with a posttest-only control group design was conducted from August to October 2025 in Sokaraja Subdistrict, Banyumas Regency, Central Java, Indonesia. A total of 16 ovitraps consisting of different trap materials (glass, bamboo, coconut shell, and black plastic) and attractants (fermented palm sugar solution, fermented young coconut water, red chili infusion, and clean water as control) were deployed in 15 households. The attractants tested were fermented palm sugar solution (45%), fermented young coconut water (20%), and red chili infusion (15%), all prepared based on preliminary trials. Control treatments included egg traps filled with clean water and transparent glass egg traps to control for material-related effects. This study has received approval from the UNDIP ethics committee with NO. 280/EA/KEPK-FKM/2025. The results showed that egg counts were recorded from ovistrips after a five-day exposure period and analyzed using descriptive statistics and Mann–Whitney tests. Coconut shell ovitraps captured the highest mean number of eggs (67.58), followed by black plastic (26.07) and bamboo traps (20.83), while glass ovitraps showed the lowest mean (0.25). Among attractants, fermented young coconut water produced the highest mean egg count (70.05), followed by red chili infusion (24.38) and fermented palm sugar solution (14.35), whereas clean water showed the lowest value (5.95). Statistical analysis demonstrated significant differences among both ovitrap materials and attractant types (p < 0.05). These findings indicate that fermented young coconut water, combined with coconut shell traps, exerts a strong oviposition-attracting effect on Aedes spp. mosquitoes. This combination offers a potential, eco-friendly alternative method for optimizing community-based surveillance systems for dengue vectors.
Evaluating Waste Bank Effectiveness in Batam City: Linking Participation Gaps with Strategic Management
This study aims to evaluate the effectiveness of the Waste Bank as a community-based waste management instrument in Batam Kota District, focusing on the gap between knowledge and participation as well as the formulation of strengthening strategies through SWOT analysis. The study employs a mixed-methods approach with data collection via a questionnaire administered to 100 respondents, in-depth interviews, and field observations The quantitative component involved a structured questionnaire administered to active Waste Bank customers. The qualitative phase included interviews with Waste Bank managers, representatives of the Batam City Environmental Agency (DLH), and relevant stakeholders involved in Waste Bank management. The results indicate that while the community’s level of knowledge is relatively high (68%), actual participation in waste sorting remains low (35%). Operationally, waste management still faces limitations, particularly in the processing of organic waste most of which still ends up at the Final Processing Site (FPS)—as well as the dependence of Unit Waste Banks on the Main Waste Bank for the management of non-organic waste. The SWOT analysis results indicate that Waste Bank management falls into Quadrant I (SO strategy), suggesting development opportunities through institutional strengthening, enhanced processing capacity, and expanded cross-sectoral partnerships. This study confirms that the effectiveness of Waste Banks is determined not only by the level of community participation but also by institutional capacity and adaptive partnership networks in supporting a sustainable waste management system.
Hydraulic Coagulation–Ultrafiltration for Peat Water in South Kalimantan
Access to safe drinking water remains a critical public health challenge in South Kalimantan, where peat-influenced water sources exhibit high turbidity, elevated iron concentrations, and acidic pH. This experimental study designed, fabricated, and evaluated a Circular Pipe–Synthetic Ultrafiltration (CP-SKU) device a hydraulic coagulation reactor requiring no mechanical energy input — for treatment of peat-influenced dug well water. Five sequential treatment configurations were tested in triplicate using PAC Powder (100 mg/L) as coagulant. The CP-SKU configuration achieved the best performance: turbidity reduction from 19.8 to 0.47 NTU (97.63%), iron below detection limit (<0.1 mg/L), and pH 6.72 — all compliant with Indonesian Ministry of Health Regulation No. 2 of 2023. Extended trials on high-turbidity raw water (83.67 NTU) confirmed 98% turbidity removal and 99.55% MPN Coliform reduction. However, effluent pH (6.39) fell marginally below the 6.5 regulatory threshold, and residual coliform indicators did not meet zero-tolerance standards, necessitating upstream pH correction and downstream disinfection prior to consumption.
Administrative Innovation in the Implementation of the Healthy Indonesia Program with a Family Approach (PIS-PK)
This study aims to analyze the implementation of administrative innovations in the Healthy Indonesia Program with a Family Approach (PIS-PK) and its impact on program effectiveness and family participation. The research method used a qualitative approach with data collection through in-depth interviews, participant observation, and documentation of PIS-PK administration in four community health centers. Data analysis was conducted through data reduction, coding, comparisons between community health centers, and triangulation to ensure the validity of the findings. The results showed that administrative innovations included digitizing family data, standardizing health forms and indicators, digital data-based monitoring, family education and participation, and cross-stakeholder coordination. The implementation of these innovations increased the accuracy and efficiency of data collection, accelerated reporting, facilitated the identification of priority families, and encouraged active family involvement. The main challenges included limited human resources, infrastructure, and community adaptation to the digital system. However, strategies such as routine training, portable hotspots, and cadre mentoring were able to overcome these challenges. This study provides an important contribution to the development of standardized and integrated data-based family health service administration and environmental health management.
The Green Hospital: A Hybrid Systematic Literature Review and Bibliometric Analysis
In recent decades, Green Hospitals have been the subject of numerous studies, yet conceptual fragmentation and ambiguity persist. Thus, the purpose of this study is to address the fragmentation and conceptual ambiguity in green hospital literature by a hybrid approach that integrates a systematic literature review (SLR) and bibliometric analysis. Unlike prior studies, which are predominantly descriptive, this study provides a structured synthesis, identifies theoretical gaps, and develops an integrative framework. A total of 169 Scopus-indexed articles between 2011 and 2025 were systematically identified using an expanded Boolean search strategy ("Green Hospital" OR “sustainable hospital” OR “green healthcare” OR “eco-friendly hospital”) and analyzed following PRISMA guidelines. Bibliometric analysis was conducted using VOSviewer to map intellectual structure, collaboration networks, and thematic evolution. The study findings indicate that the existing study is heavily concentrated on environmental and infrastructure dimensions, while behavioral, governance, and policy aspects remain underexplored. The study also identifies geographic concentration and potential database bias in the global distribution of the study. Importantly, the study develops an integrated Green Hospital Sustainability Framework (IGHSF) based on an inductive thematic approach. This study contributes to the literature by improving methodological rigor in green hospital studies through a hybrid SLR-bibliometric approach, advancing theoretical understanding of sustainability integration in healthcare systems, and providing actionable insights for policymakers and healthcare managers in implementing sustainable hospital practices.
Occupational Pesticide Exposure and Reduced eGFR in Farmers
Pesticides are frequently utilized in modern farming to sustain crop productivity. However, improper use may pose occupational health risks, including chronic renal toxicity. In Indonesia, evidence regarding long-term kidney effects among farmers remains limited. This study aimed to determine the prevalence of reduced estimated glomerular filtration rate (eGFR) and examine its association with pesticide exposure among horticultural farmers in Wanasari District, Brebes Regency. A cross-sectional analytical study was conducted among 367 farmers aged 18-63 years. Data on pesticide use, personal protective equipment (PPE), smoking habits, health complaints, and hypertension were collected through interviews. Serum creatinine levels were measured enzymatically and used to estimate eGFR. Multivariate logistic regression analysis was applied to identify factors associated with reduced renal function. Several variables showed a significant association with decreased renal function, namely smoking status (OR = 2.972; 95% CI: 1.299-6.001; p = 0.009), pesticide dosage (OR = 4.555; 95% CI: 2.415-8.291; p < 0.001), PPE use (OR = 0.383; 95% CI: 0.199-0.737; p = 0.004), health complaints (OR = 2.972; 95% CI: 1.567-5.636; p = 0.001), hypertension (OR = 2.367; 95% CI: 1.278-4.382; p = 0.006), working period (OR = 15.057; 95% CI: 3.510-64.591; p < 0.001). Working period was the dominant factor associated with decreased kidney function in farmers. This indicates the importance of chronic exposure duration in increasing the risk of pesticide-induced nephrotoxicity. Prevention efforts should focus on controlling exposure duration, improving adherence to PPE use, providing education on pesticide use, and regularly monitoring kidney function.
Viral Load, CD4 Count, NLR, SGPT, and eGFR Levels as Factors Associated with Quality of Life in HIV Patients
Human Immunodeficiency Virus (HIV) infection remains a major global health problem and may affect the quality of life of people living with HIV. Quality of life can be assessed using the World Health Organization Quality of Life-Human Immunodeficiency Virus BREF (WHOQOL-HIV BREF) questionnaire. This study aimed to analyze the association of viral load, CD4 count, neutrophil-to-lymphocyte ratio (NLR), serum glutamic pyruvic transaminase (SGPT), and estimated glomerular filtration rate (eGFR) with quality of life among HIV patients. This observational analytic study used a cross-sectional design and was conducted at the Voluntary Counseling and Testing Clinic of Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. A total of 100 HIV patients undergoing antiretroviral therapy were included based on predefined inclusion and exclusion criteria. The independent variables were viral load, CD4 count, NLR, SGPT, and eGFR, while the dependent variable was quality of life assessed using the WHOQOL-HIV BREF questionnaire. Clinical and laboratory data were obtained from medical records. Data were analyzed using univariate analysis, Spearman correlation test, and ordinal logistic regression with SPSS version 29.0. Higher viral load, lower CD4 count, and elevated NLR were significantly associated with poorer quality of life. In contrast, SGPT and eGFR were not significantly associated with quality of life. In the multivariate analysis, CD4 count showed the strongest association with quality-of-life category. These findings suggest that viral load, CD4 count, and NLR are associated with quality of life among HIV patients. The integration of virological, immunological, and inflammatory markers may complement clinical assessment of quality of life in people living with HIV, particularly in the Indonesian clinical setting. Further longitudinal studies are needed to clarify their predictive value.
Association of Environmental Sanitation and Personal Hygiene with Skin Health Complaints among Residents in Ibul Besar II
Skin health problems remain a common public concern, influenced by poor environmental sanitation and inadequate personal hygiene practices. Ibul Besar II Village is a suburban locale traversed by a tributary of the Ogan River. Data from the Pegayut Public Health Center in 2022 shows only 991 residents had access to proper sanitation. Moreover, of the 748 houses surveyed, only 284 were classified as healthy housing. In 2023, skin diseases ranked among the top ten most common illnesses at the Pegayut Public Health Center, with 115 cases reported. This study aimed to examine the association between environmental sanitation, personal hygiene, and skin complaints among residents of Ibul Besar II Village. Using a cross-sectional design with 142 respondents meeting the inclusion criteria, data were analyzed through univariate, bivariate (chi-square test), and multivariate (multiple logistic regression) methods. The bivariate results showed significant associations between skin complaints and factors such as bathing habits (p = 0.001; OR = 3.402; 95% CI: 1.670–6.931), hand and nail hygiene (p = 0.012; OR = 2.532; 95% CI: 1.276–5.027), clothing hygiene (p = 0.021; OR = 3.000; 95% CI: 1.240–7.255), bedding and bed linen hygiene (p = 0.011; OR = 2.548; 95% CI: 1.286–5.047), faeces disposal facilities (p = 0.011; OR = 2.919; 95% CI: 1.331–6.402), and wastewater disposal systems (p = 0.001; OR = 4.067; 95% CI: 1.804–9.167). Multivariate analysis showed that inadequate wastewater disposal systems had the strongest association with skin health complaints (p = 0.003; OR = 3.959; 95% CI: 1.605–9.758). To prevent skin health issues, priorities should include improving wastewater disposal facilities and promoting better hygiene of bedding and linen. Additionally, community members are encouraged to improve personal hygiene and maintain environmental sanitation to reduce the risk of skin disorders.
Association between Stunting Prevention Behaviors and Quality of Life among Adolescent Girls: A Cross-Sectional Study in Lebak District, Indonesia
Adolescent girls constitute a strategic group in the prevention of intergenerational stunting through the establishment of healthy lifestyle behaviours from an early age. However, evidence regarding the relationship between stunting prevention behaviours and quality of life remains limited. This study aims to analyse the relationship between stunting prevention behaviours and quality of life among adolescent girls in Lebak Regency, Indonesia. The study employed an observational analytical design using a cross-sectional approach involving 113 adolescent girls selected at random from a senior secondary school. Stunting prevention behaviours were measured using a health behaviour questionnaire, whilst quality of life was assessed based on the dimensions of satisfaction, productivity, independence and social participation. Analysis was performed using Kendall’s tau correlation test. The results showed a statistically significant positive association between stunting prevention behaviour and overall quality of life (r=0.349; p<0.001), as well as across all dimensions of quality of life (r=0.181–0.268; p<0.05), although the strength of the association ranged from weak to moderate. These findings suggest that adolescents with better stunting prevention behaviours tend to have a better quality of life. However, as a cross-sectional design was used in a single school, the study results cannot be used to draw conclusions about a cause-and-effect relationship. A longitudinal study that accounts for confounding factors is required to confirm these findings.
From Knowledge to Treatment Adherence: A Pre-Post Questionnaire-Based Study among Tuberculosis Patients in Primary Healthcrae Centers
Tuberculosis remains a major public health problem that requires serious attention, particularly with regard to treatment success, which is highly dependent on patient adherence. Low levels of treatment adherence are frequently associated with limited patient knowledge about the disease, the therapeutic process, and the potential risks of incomplete treatment. This study aims to analyze changes in patients’ knowledge levels following an educational intervention and to examine the influence of knowledge on treatment adherence in tuberculosis management within primary healthcare settings. This study employed a quantitative approach with a pre-experimental one-group pre–post design. Data were collected using structured questionnaires administered before and after the intervention, involving 30 tuberculosis patients (n = 30) from 17 primary healthcare centers in Baubau City. Data analysis was conducted using descriptive statistics, paired t-test, and multiple linear regression analysis. The results showed a significant improvement in patients’ knowledge and treatment adherence following the intervention, with the mean knowledge score increasing from 14.10 to 17.20 and statistically significant differences observed between pre- and post-intervention measurements (p < 0.05). Furthermore, regression analysis indicated that patient knowledge had a significant effect on treatment adherence (β = 0.354; p = 0.015), demonstrating that higher levels of knowledge contribute to better adherence behavior. These findings emphasize that enhancing patient knowledge is a key factor in the successful management of tuberculosis and should be supported through continuous, contextual, and behavior-oriented educational interventions aimed at achieving long-term behavioral change.
Development and Preliminary Clinical Validation of the Vitaltrack Early Warning Score Prototype for Integrated Inpatient Monitoring
Early detection of changes in patients' clinical conditions is very important to prevent critical events. The Early Warning Score (EWS) assessment still relies on conventional tools that require multiple devices and time, which reduces efficiency and accuracy. Objective: To develop and evaluate a portable vital sign measurement tool based on EWS (Vitaltrack EWS) to improve the speed and accuracy of assessments compared to conventional methods. Methods: The study used a Research and Development (R&D) design involving 39 inpatients in the neurology and surgery wards of RSUD Dr. Soedarso Pontianak. Five physiological parameters blood pressure, pulse rate, body temperature, respiratory rate, and oxygen saturation were measured using two methods: conventional tools and Vitaltrack EWS. A t test was used to assess the equivalence or differences in results between the two measurement methods. Results: EWS score p = 0.932, systolic blood pressure p = 0.907, body temperature p = 0.584, heart rate p = 0.487, respiratory rate p = 0.083, oxygen saturation p = 0.487, measurement time p = 0.000. Vitaltrack EWS is assessed to be accurate and efficient in monitoring patients' vital signs, comparable to the standard tools that have been used in hospitals. Conclusion: Vitaltrack EWS is capable of improving the efficiency and accuracy of vital sign measurements and supports the effective implementation of EWS in inpatient settings. Optimization of sensors and applications through further research provides a scientific basis for the feasibility of commercializing the tool.
Association Between Nutritional Status and Development of Preschool Children at An-Nizam Kindergarten, North Sumatra: A Cross-Sectional Study
Effectiveness of Virtual Reality-Based Health Promotion and Safety Training in Schools
Health and safety within the school environment are essential to ensuring a secure and sustainable learning process. Data from the Ministry of Health (2022) indicate that only 45% of secondary schools have an established emergency preparedness programme. A preliminary assessment at SMK Atisa Dipamkara also revealed substantial gaps: 73% of students had never participated in a fire simulation, and existing training remained conventional without interactive media. Nutritional issues were similarly prominent, as 60% of students frequently skipped breakfast, potentially impairing concentration and physical endurance. This study examined the effectiveness of a virtual reality (VR)-based training model integrating fire emergency simulation and balanced nutrition education. The study was conducted at SMK Atisa Dipamkara, Tangerang, from May to July 2025. A quasi-experimental design was employed involving 100 respondents assigned to VR and conventional training groups. Data were collected through knowledge tests, skills assessments, and Likert-scale satisfaction questionnaires. The findings demonstrate significant improvements in knowledge and skills among participants receiving VR training (p < 0.001), with outcomes superior to the conventional group. High satisfaction scores (M = 4.36; SD = 0.53) reflected strong perceptions of realism, interactivity, engagement, and active participation. VR-based training effectively addresses critical gaps in school preparedness and represents a strategic approach for strengthening comprehensive safety and health promotion programmes in educational settings.
Determinants of Pneumonia in Toddlers: Multivariate Analysis
Pneumonia remains a leading cause of morbidity and mortality among toddlers aged 12-59 months at Cikande Health Center Serang Regency, with 89 cases reported from January to March 2025. This unmatched case-control study included 118 toddlers (59 pneumonia cases and 59 healthy controls from nearby households, 1:1 ratio, purposive sampling). Pneumonia was defined as cough ≥2 days with rapid breathing or chest indrawing. Data on toddler gender, maternal education/knowledge, bedroom ventilation (≥10% floor area), humidity (40-60% RH), occupancy density (≤2 persons/room) and cigarette smoke exposure were analyzed via Chi-Square (bivariate) and multiple logistic regression (multivariate, stepwise elimination, interaction tests) using SPSS. Bivariate analysis showed significant associations (p < 0.05) for all factors. Multivariate modelling retained maternal education (pv=0.041, OR=2.606, 95% CI: 1.042-6.518), maternal knowledge (pv=0.003, OR=3.916, 95% CI: 1.580-9.708), bedroom ventilation (pv=0.026, OR=2.771, 95% CI: 1.126-6.818), bedroom humidity (pv=0.001, OR=5.360, 95% CI: 2.077-13.835) and occupancy density (pv=0.006, OR=3.676, 95% CI: 1.464-9.228). Bedroom humidity was the most dominant factor. No significant interactions found. Modifiable environmental factors (humidity, density) and maternal factors are key pneumonia determinants. Interventions should target home environmental improvements and maternal education.
Estimated Health Risk of Cadmium and Chromium in Elderly Blood Cockle Consumers, Lantebung
This study assessed the non-carcinogenic health risks of Cadmium (Cd) and Chromium (Cr) exposure through blood cockle (Anadara granosa) consumption among elderly residents in Lantebung, Makassar Strait. Blood cockle samples were collected from six purposively selected points, and Cd and Cr concentrations were analyzed. Health risks were estimated using intake calculations and the Risk Quotient (RQ). Cd and Cr concentrations were generally below national and international food safety limits. However, some elderly individuals, particularly frequent consumers, exceeded the non-carcinogenic risk threshold (RQ > 1). The highest risks were associated with specific sampling points, reflecting localized contamination. Risk factors included high consumption rates, long exposure duration, and lower body weight. These findings suggest that compliance with contaminant limits alone may not ensure safety for vulnerable populations. Regular environmental monitoring, risk communication for high-risk groups, and strengthened pollution control measures are recommended. Public health interventions, including periodic health screening and guidance on safe seafood consumption, are needed to reduce long-term health impacts.
Preliminary Study of Life Cycle Assessment on Food Surplus Redistribution Compared to Food Waste Management in Surabaya
Food waste accounts for approximately 40% of total waste generation in Indonesia and contributes significantly to national greenhouse gas (GHG) emissions. While most food waste is still disposed of in landfills, food surplus redistribution through food banks has emerged as a potential mitigation strategy. This study evaluates the environmental performance of food surplus redistribution compared to conventional food waste management options using a life cycle assessment (LCA) approach. The analysis was conducted at Garda Pangan, Surabaya, with a functional unit of 1 ton of food surplus and assessed three scenarios: (1) landfill disposal, (2) composting and anaerobic digestion, and (3) food surplus redistribution. The assessment applied the CML IA Baseline method and focused on Global Warming Potential (GWP), using SimaPro 9.0 and the Ecoinvent 3 database. The results show that landfill disposal has the highest GWP at 1,920 kg CO₂-eq per ton of food waste, driven primarily by methane emissions from anaerobic decomposition. Composting and anaerobic digestion result in lower impacts, at 1,503 and 1,730 kg CO₂-eq per ton, respectively. In contrast, food surplus redistribution shows a markedly lower GWP of 1.24 kg CO₂-eq per ton of food surplus, as emissions are dominated by transportation activities within a simplified gate-to-gate system boundary. This preliminary analysis relied on secondary inventory data and excluded potential avoided food production impacts; therefore, the estimated GWP for redistribution may underestimate or overestimate actual emissions. These findings highlight the importance of prioritizing food waste prevention and the benefits of food surplus redistribution within integrated waste management strategies to reduce GHG emissions while delivering social co-benefits.
Association Between Menopausal Status and Serum Uric Acid Levels Among Women in Southeast Pontianak
Serum uric acid levels are influenced by multiple factors, including hormonal status in women. Menopause, defined as the absence of menstruation for at least 12 consecutive months, is associated with decreased estrogen levels that may reduce renal uric acid excretion. However, local epidemiological data regarding uric acid profiles among menopausal women in Southeast Pontianak remain limited. This study aimed to analyze serum uric acid levels based on menopausal status among women in the working area of Puskesmas Kampung Bangka, Southeast Pontianak. A cross-sectional study was conducted using a purposive sampling technique. From a population of 230 women, 76 respondents met the inclusion criteria. Premenopausal women were defined as those with regular menstruation, while postmenopausal women were defined as those with amenorrhea ≥12 months based on interview data. Serum uric acid levels were measured using a spectrophotometric enzymatic colorimetric method and analyzed descriptively. The results showed that among 43 premenopausal women (56.6%), 97.7% had normal uric acid levels and 2.3% were below normal. Among 33 postmenopausal women, 75.8% had normal levels, 18.2% had elevated levels, and 6.0% were below normal. Elevated uric acid levels were more frequently observed in postmenopausal women compared to premenopausal women. In conclusion, although most respondents had normal serum uric acid levels, postmenopausal women showed a higher proportion of hyperuricemia, suggesting a potential influence of hormonal changes. This study provides important local evidence to support early metabolic risk screening among menopausal women in Southeast Pontianak.
uric acid, menopause, premenopause, serum levels, women
Red Ginger Extract Nanoemulgel: Antibacterial and Wound-Healing Efficacy Against Staphylococcus aureus in a Preclinical Mouse Model
Wound infections by Staphylococcus aureus (St. aureus), exacerbated by biofilm formation and antibiotic resistance, are a major challenge in wound management. This study aims to test the efficacy of Red Ginger Extract Nanoemulgel (RGE Nanoemulgel) as a new topical agent in controlling bacterial infections and accelerating the healing of experimentally induced infected incision wounds in a preclinical mouse model. The study comprised in vitro antibacterial and anti-biofilm activity assays comparing RGE Nanoemulsion against Gentamicin, followed by in vivo efficacy testing in an animal model comparing RGE Nanoemulgel, RGE, and Mupirocin in terms of bacterial abundance (log CFU/gram) and wound contraction percentage. Results indicated that RGE Nanoemulsion demonstrated promising in vitro antimicrobial activity; at a concentration of 25%, antibacterial inhibition reached 75.11% (exceeding Gentamicin at 51.18%), and anti-biofilm inhibition reached 90.79% at 50% concentration. In vivo, RGE Nanoemulgel suppressed bacterial abundance to 3.96 log CFU/gram, comparable to Mupirocin, and achieved a wound contraction rate of 93.50% on Day 12, exceeding Mupirocin (63.16%). These preclinical findings suggest that RGE Nanoemulgel may represent a promising non-antibiotic topical candidate, combining antibacterial, anti-biofilm, and wound-supportive properties. Further toxicity, stability, and clinical validation studies are warranted before therapeutic claims can be established.