Gema Lingkungan Kesehatan (GeLinKes) [e-ISSN: 2407-8948 | DOI: 10.36568] is a peer-reviewed, open-access scientific journal that publishes cutting-edge research and critical reviews in the interdisciplinary fields of health sciences and medicine, with a specialised focus on environmental health. The journal is published by the Department of Environmental Health, Poltekkes Kemenkes Surabaya, and serves as a dynamic forum for the exchange of knowledge and innovations addressing contemporary public health challenges and environmental health issues in both local and global contexts. Founded with the vision of promoting scientific excellence and evidence-based practice, GeLinKes publishes high-quality manuscripts that contribute to improving human health outcomes through advancements in environmental science, medical research, and community-based health interventions. The journal welcomes submissions from researchers, academicians, clinicians, and public health practitioners from various health-related disciplines. GEMA Lingkungan Kesehatan has been accredited by Direktur Jenderal Pendidikan Tinggi, Riset, dan Teknologi starting in 2023 with an Accreditation Letter Number: 72/E/KPT/2024 and indexed by Sinta 2th.
Correlation Between TNF-α Levels and APRI Score with Ejection in Hepatic Cirrhosis
Cirrhotic cardiomyopathy is a condition of heart dysfunction characterized by impaired myocardial contractility, left ventricular hypertrophy, diastolic dysfunction, chronotropic dysfunction, and electrophysiological disturbances of the heart. One of the complications in patients with hepatic cirrhosis is influenced by several factors, particularly TNF-α levels and the APRI score. This study aimed to analyze the effect of TNF-α and APRI score on ejection fraction in Child-Pugh C hepatic cirrhosis. Methods: This study employed an analytical observational design with a cross-sectional approach. The sample consisted of 40 inpatients with Child-Pugh C hepatic cirrhosis at the dr. Moewardi Surakarta Regional General Hospital. Samples were selected using consecutive sampling. Data analysis was performed using Spearman’s correlation test and linear regression. Results: The correlation between TNF-α levels and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.559, p<0.001 (moderate correlation). The correlation between APRI score and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.445, p<0.001 (moderate correlation). There is a significant correlation between TNF-α levels and APRI score with ejection fraction in Child-Pugh C hepatic cirrhosis. The implication is that clinicians may incorporate TNF-α levels and the APRI score into clinical algorithms to monitor cirrhotic patients who are at high risk of developing cardiovascular complications.
Copyright (c) 2026 Gema Lingkungan Kesehatan https://creativecommons.org/licenses/by-sa/4.0
Design and Performance Evaluation of a Digital Chlorinator for Domestic Wastewater Disinfection in Healthcare Facilities
Domestic wastewater from healthcare facilities such as hospitals, community health centres, and polyclinics contains organic loads, toxic chemical compounds, and pathogenic microorganisms that have the potential to cause environmental pollution and pose a risk to public health if not treated adequately. Various conventional treatment methods, including UV, ozonation, aeration, and biofiltration, have been used to reduce pollutants, but cost limitations, high energy requirements, and technical reliability make chlorination the preferred option because it is relatively inexpensive, easy to implement, and produces disinfectant residues that provide continued protection. However, uncontrolled use of chlorine can lead to excessive residues, disinfection by-products (DBPs), and operational inefficiencies. To address these challenges, this study aims to design and evaluate the performance of a digital chlorinator equipped with an automatic control system with dual energy source flexibility (AC/DC and solar panels). This study used a one group pre-test and post-test design with domestic wastewater samples from hospitals, health centres, and polyclinics in Magetan Regency. The water quality parameters analysed included pH, BOD, COD, ammonia, chlorine demand, residual chlorine, and total coliforms. Initial measurements showed BOD of 105–145 mg/L, COD of 198–260 mg/L, ammonia of 13–18 mg/L, and total coliform of 8.5 × 10⁵ to 1.2 × 10⁶ MPN/100 mL, far above the national quality standards. After treatment using a digital chlorinator with an optimum dose of 200 ppm, BOD decreased by 77–82%, COD by 72–78%, ammonia by 75–80%, and total coliforms by more than 99%, while the pH remained stable in the range of 7.1–7.3 and the chlorine residue was maintained at 0.2–0.5 mg/L according to the recommended standard. A comparison of energy sources showed that the effectiveness of solar cells was almost equivalent to that of AC/DC, with a small difference in the reduction of BOD and COD that was not statistically significant. The results of this study conclude that digital chlorinators are effective, adaptive, and have the potential to be an innovative solution in improving the quality of domestic waste treatment in health facilities, especially in areas with limited access to electricity, and can support the achievement of sustainable environmental health goals.
Copyright (c) 2025 Gema Lingkungan Kesehatan https://creativecommons.org/licenses/by-sa/4.0
Maternal Age at Marriage and Risk of Childhood Stunting: Evidence from a Case-Control Study in North Sumatra, Indonesia
Stunting remains a major public health issue in Indonesia, particularly in urban areas such as Medan. While socioeconomic and nutritional factors are well recognized, the influence of maternal age at marriage on child growth is less explored. This study examined the association between maternal age at marriage and childhood stunting in Medan, Indonesia. Methods. An analytical observational study with a case–control design was conducted from January to March 2025 across several community health centres in Medan. A total of 124 mother–child pairs (62 stunted and 62 non-stunted children) were selected using cluster random sampling. Data were collected through structured interviews and health-record reviews. Stunting was defined as height-for-age Z-score < -2 SD based on WHO standards. Logistic regression was used to assess the relationship between maternal age at marriage (<25 years vs ≥25 years) and stunting, adjusting for maternal education, maternal health during pregnancy, socioeconomic status, and birth weight. Children of mothers who married before age 25 had significantly higher odds of being stunted compared with those whose mothers married later (adjusted OR = 2.85; 95% CI: 1.71-4.76; p < 0.001). Low maternal education (adjusted OR = 2.12; p = 0.021) and low birth weight (adjusted OR = 2.43; p = 0.030) were also independent predictors of stunting. Conclusion. Maternal marriage before 25 years is a strong determinant of childhood stunting in urban Medan. Delaying maternal marriage, enhancing women’s education, and strengthening maternal health programs could substantially reduce stunting prevalence. This study contributes new evidence to Indonesia’s national efforts to prevent stunting through life-course and policy-oriented interventions.
Stunting maternal age at marriage, maternal education, birth weight, Indonesia
The Effectiveness of Beetroot and Date Juice as Phytopharmaceuticals in Treating Anaemia in Pregnant Women
Anaemia during pregnancy is a health problem that has serious implications for the condition of both mother and foetus. Treatment efforts should not only rely on iron supplementation, but can also involve natural approaches that are more acceptable and safer, such as administering beetroot juice and dates. This study aims to determine the effectiveness of a combination of beetroot juice and dates in increasing haemoglobin levels in pregnant women with mild anaemia. The study design used a quasi-experimental pretest–posttest control group design involving 32 pregnant women in their third trimester who were divided evenly into a control group and a treatment group. The control group only received iron tablets, while the treatment group received iron tablets along with beetroot and date juice intervention administered daily for 14 consecutive days, with a composition of 100 grams of beetroot and 50 grams of dates in each serving. The results showed that the combination of beetroot juice and dates was able to increase haemoglobin levels in pregnant women with mild anaemia compared to iron supplementation alone. This intervention proved to be safe, well-tolerated, and has the potential to be developed as a complementary phytopharmaceutical to support efforts to prevent and treat anaemia in pregnancy.
The Effect of TNF-α and FIB-4 Score on Diastolic Dysfunction in Child Pugh C Liver Cirrhosis
Liver cirrhosis is a major global health concern, often complicated by cardiac dysfunction such as diastolic heart failure. Tumor necrosis factor-alpha (TNF-α) and FIB-4 score are widely used biomarkers in cirrhotic patients, but their predictive value for cardiac complications remains unclear. To determine the effect of TNF-α and FIB-4 scores on the severity of diastolic dysfunction in patients with Child-Pugh C liver cirrhosis. This analytical cross-sectional study included 40 Child-Pugh C cirrhotic patients. Serum TNF-α levels were measured using ELISA. Diastolic function was evaluated using echocardiography. Ordinal logistic regression was used to analyze the association between TNF-α, FIB-4, and diastolic dysfunction grades. The majority of participants had moderate (65.0%) or severe (35.0%) chronic inflammation based on TNF-α levels, with a median TNF-α of 45.52 pg/mL. Significant liver fibrosis (FIB-4 >3.25) was observed in 82.5% of participants. Grade I diastolic dysfunction was the most prevalent (52.5%). TNF-α levels were significantly associated with the degree of diastolic dysfunction (p=0.042), whereas FIB-4 scores showed no significant correlation (p=0.533). Elevated TNF-α is strongly associated with worsening diastolic dysfunction in Child-Pugh C cirrhosis, suggesting its role in systemic inflammation and myocardial injury. In contrast, the FIB-4 index may not reflect cardiac involvement in advanced cirrhosis. TNF-α may serve as a potential biomarker for cardiovascular risk stratification in cirrhotic patients, supporting early intervention and integrated care approaches.
Impact of Air Temprature and Humidity on Sick Building Syndrome among Bank Employees
Sick Building Syndrome (SBS) is a condition in which inhabitants develop health problems or discomfort as a result of extended exposure to indoor surroundings. The purpose of this study was to investigate the association between air temperature and humidity in air-conditioned rooms and the prevalence of SBS, specifically mental weariness (burnout) instances, among employees of Bank Syariah Indonesia (BSI) in Banjarbaru City, Indonesia. The study followed a quantitative design with an analytical cross-sectional survey approach. Data were gathered using questionnaires and devices that measured air temperature and humidity. Univariate analysis defined the variable features, whereas bivariate analysis looked at the correlations between air temperature and humidity (independent variables) and the prevalence of SBS mental fatigue cases (dependent variable). The survey included 30 bank employees, with an average age of 32.4 years. The average air temperature was 25.8°C, with a relative humidity of 84.2%, which was outside of the permissible limit. The prevalence of SBS was 43.3%, with common symptoms including nose discomfort, eye irritation, headache, and fatigue. The prevalence of mental weariness was 36.7%. Pearson correlation analyses found significant positive relationships between air temperature and SBS prevalence (r = 0.48, p < 0.01), relative humidity and SBS prevalence (r = 0.39, p < 0.05), air temperature and mental fatigue (r = 0.41, p < 0.05), and relative humidity and mental fatigue. The findings emphasize the need of maintaining adequate indoor environmental conditions to reduce SBS risk and increase employee well-being in air-conditioned workplaces.
Respiratory and Neurological Health Effects of Chromium and PM Exposure among Troso Woven Fabric Workers: A Cross Sectional Study in Jepara
The Troso weaving industry in Jepara, Indonesia, is a traditional craft sector that relies on synthetic dyes and manual production, thereby exposing workers to chromium (Cr) and particulate matter (PM2.5 and PM10) with potential respiratory and neurological risks. This study aimed to analyze their association with respiratory and neurological disorders among workers. A cross-sectional design was applied involving 101 weaving workers from four production sites. Environmental sampling measured Cr concentrations in wastewater and PM2.5/PM10 in the ambient air, while worker characteristics and health complaints were assessed using the ECSC-87 and Q18 questionnaire. Data were analyzed using chi-square tests and odds ratios. Cr concentrations in wastewater ranged from <0.010 to 0.104 mg/L, remaining below the effluent quality standard of 1.0 mg/L but confirming the continuous use of chromium-based dyes discharged without treatment. Average PM2.5 and PM10 levels were 108.75 µg/m³ and 117.75 µg/m³, both exceeding national air quality standards (55 and 75 µg/m³). Bivariate analysis showed that respiratory disorders were significantly associated with exposure duration ≥40 hours/week (OR=7.333; p=0.0001) and working period >5 years (OR=20.935; p=0.0001), whereas dye type, dyeing frequency, and PPE use were not significant. Neurological disorders were significantly associated with exposure duration (p=0.001), working period (p=0.001), type of dye (p=0.0001), frequency of dyeing (p=0.018), and PPE use (p=0.0001). Environmental monitoring confirmed elevated PM levels and chromium-based dye use, while statistical analysis showed that prolonged exposure and long working periods associated with respiratory disorders, and neurological disorders were linked to multiple occupational factors.
Evaluation of Hospital Sustainability Initiatives in South-east Asia
The increasing growth of hospitals in South-east Asia has not been in line with awareness and commitment to sustainability in healthcare facilities. Hospitals play an important role in maintaining public health and contributing to environmental sustainability. However, due to the region's vulnerability to the impacts of climate change, hospitals in South-east Asia have not yet fully transformed into green healthy hospital. This study compares the sustainability of each hospital in South-east Asia that is a member of the Global Green Healthy Hospital (GGHH) based on ten sustainability agendas. This study employs secondary data analysis sourced from the official GGHH website and utilises descriptive quantitative design techniques that include frequency and percentage calculations. The highest percentage of sustainability agenda implementation in the South-east Asia region is waste (72.3%), energy (63.49%), and leadership (52.48%). The lowest percentages are transportation (16.77%), pharmacy (24.92%), and chemicals (31.20%). Hospitals in South-east Asia show a low level of awareness about the implementation of green and healthy hospital practices. Only two countries, the Philippines and Indonesia, have healthcare facilities capable of implementing ten sustainability agendas.
Mothers’ Knowledge and Skills as Key Factors in Preventing Stunting in Toddlers: A Case Study in Malingping, Banten
Stunting in children under five years of age remains a serious public health problem in Indonesia because it affects physical growth, cognitive development, and long-term productivity. This study aims to analyse mothers' knowledge and skills in preventing stunting and the relationship between sociodemographic characteristics and these two aspects in the working area of the Malingping Community Health Centre, Banten. The study used a descriptive-analytical survey design with a cross-sectional approach involving 80 mothers of toddlers selected through purposive sampling. Data were collected using a structured questionnaire and analysed univariately and bivariately using the Chi-square test. The results showed that most mothers did not know the definition of stunting (81.3%), its causes (86.3%), signs (83.8%), or how to prevent it (88.8%). Mothers' skills in prevention were also low, with 78.8% unable to prepare a balanced complementary feeding menu, 73.7% lacking hygiene when preparing food, and 81.2% rarely monitoring their children's growth. Bivariate analysis showed no significant relationship between education and knowledge (p = 0.721), but there was a significant relationship between education and skills (p = 0.039). This study concludes that although mothers' knowledge about stunting is still low, practical skills are more influenced by education level. These findings emphasise the importance of educational interventions that not only increase knowledge but also build mothers' practical skills through community-based approaches and support from health cadres.
Association Between Community-Based Total Sanitation (CLTS) Pillars and Diarrhea Incidence in Wetland Communities of South Indralaya
Diarrhea remains a major global health problem and a leading cause of mortality among children under five, often exacerbated by inadequate sanitation and limited access to clean water. Community-Led Total Sanitation (CLTS) represents a national strategy for preventing environment-based diseases, including diarrhea. However, researchers have not comprehensively studied the effectiveness of each CLTS pillar within specific geographical contexts, such as wetland areas. This study aims to identify the relationship between sanitation factors of Community-Led Total Sanitation (CLTS) pillars and diarrhea incidence in the South Indralaya wetland community. This quantitative research employed a cross-sectional design and selected 100 respondents using a purposive sampling technique. Data were collected through questionnaires and analyzed using chi-square test for bivariate analysis and logistic regression for multivariate analysis. Our results indicated a diarrhea prevalence of 45% among total respondents. Multivariate analysis revealed that two CLTS pillars significantly associated with diarrhea incidence. Pillar 1, concerning latrine availability, showed that households without latrines had a 3.4 times higher risk of experiencing diarrhea (OR = 3.400; 95% CI: 1.037–11.155). Pillar 4, regarding unsafe waste management, also served as a strong predictor, increasing diarrhea likelihood up to 3.296 times (P-value = 0.008; Exp(B) = 3.296; 95% CI: 1.359–7.996). We found that latrine type (P = 0.053) acted as a confounder, which influenced the risk estimation of the main variables in the model. This study concludes that CLTS pillars 1 and 4, related to feces and solid waste management, are key determinants of diarrhea incidence in South Indralaya. Interventions focusing on improving access to and quality of latrines, as well as safe waste management practices, are crucial for reducing diarrhea incidence in the region.
Biodigesters for Wastewater Treatment and Biogas Generation in Poultry Slaughterhouses
This study evaluates the integration of a biodigester reactor into the wastewater treatment system at a poultry slaughterhouse to improve effluent quality and produce biogas as an alternative energy source. Wastewater samples were collected before and after biodigester treatment, and the parameters analyzed included Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD), Total Suspended Solids (TSS), oil and grease, and pH stability. Biogas production was also monitored daily. The results showed significant reductions in COD (from 350 mg/L to 148 mg/L), BOD (from 225 mg/L to 82.4 mg/L), and TSS (from 180 mg/L to 32 mg/L), with average decreases of 57.83%, 63.38%, and 82.1%, respectively. Oil and grease levels decreased by 89.5%, although this reduction did not reach statistical significance (p=0,197). The pH values remained stable within the range of 6.0 to 9.0, supporting optimal microbial activity. Biogas production averaged 7.48 m³/hour in the morning and 6.70 m³/hour in the afternoon, demonstrating the biodigester’s capacity to generate renewable energy. The findings confirm that integrating a biodigester enhances organic pollutant removal efficiency, reduces reliance on fossil fuels, and minimizes wastewater pollution, offering both economic and environmental benefits. However, further optimization is needed to effectively reduce oil and grease concentrations. This study highlights the potential of biodigester technology as a sustainable solution for managing poultry slaughterhouse wastewater, contributing to environmental protection and energy recovery
The Role of PPAR in Liver Cirrhosis: An Update Review
Liver cirrhosis is the final stage of various chronic liver diseases characterized by fibrosis and nodule formation in the liver. The pathophysiology of liver cirrhosis involves a complex process, in which the role of peroxisome proliferator-activated receptors (PPAR) is very important. PPARα, which is mainly expressed in the liver, plays an important role in the regulation of hepatic lipid metabolism. In cirrhosis, PPARα expression is decreased, resulting in impaired fatty acid oxidation and increased lipogenesis. This contributes to the accumulation of fat in the liver, which is one of the characteristics of NAFLD that can progress to cirrhosis. PPARγ, although better known for its role in adipose tissue, also has important functions in the liver. In cirrhosis, PPARγ plays a role in inhibiting the activation and proliferation of HSCs, and modulating macrophage polarization. PPARγ activation can reduce liver inflammation and fibrosis, and increase insulin sensitivity. Recent studies have shown that PPARγ agonists can improve steatosis, reduce inflammation, and significantly improve the response to hepatitis viruses. PPARδ, which is widely expressed in various tissues including the liver, plays a role in lipid metabolism and liver inflammation. Moreover PPARs role in viral hepatitis induced liver chirrosis is still remain controversial. Although research on PPARδ in the context of liver cirrhosis is still limited, several studies have shown its potential anti-fibrotic effects. Thus, a deeper understanding of the role of PPARs in the pathophysiology of liver cirrhosis opens up new opportunities for the development of more effective therapies to treat this chronic liver disease.
A Analysis of Land Use on Water Quality in Merjosari Village, Lowokwaru Subdistrict, Malang City
Malang City faces several environmental challenges, including inadequate sanitation and water management, which have not been fully addressed across all aspects of life. This is not in line with the Sustainable Development Goals, which aim to ensure the availability and sustainable management of clean water and sanitation for all people. Malang City is also experiencing increasingly massive land use changes, from green open land to housing, which can impact clean water quality. This study aims to assess the quality of clean water from the non-Local Water Supply Utility in Merjosari Village, Lowokwaru Subdistrict, Malang City, which is undergoing land-use transformation. A quantitative observational approach was employed using the National Sanitation Foundation's Water Quality Index (NSF-WQI) method, which evaluates water quality based on physical, chemical, and biological parameters. The results showed that the water quality index in Merjosari Village, Lowokwaru District, Malang City, analyzed using the NSP-WQI method, has a value of 77.53 and falls within the good criteria. However, several parameter values exceed the clean water standard. The average value of the DO parameter, at 5.85 mg/,L is less than the quality standard of 6 mg/L. The average value of the BOD parameter, at 8.12 mg/,L exceeds the quality standard of 2 mg/L. The pH parameter at several sample points exceeds the quality standard of above 8.5, and the Nitrate Parameter at several sample points exceeds the quality standard of 20 mg/L. In conclusion, the land cover change in the Merjosari area, Lowokwaru District, Malang City, does not significantly affect the quality of clean water. However, the values of several water parameters exceed the clean water standard, which has the potential to impact public health negatively.
National Sanitation Foundation's-Water Quality Index
The Relationship of Water and Sanitation with the Incidence of Stunting: A Bibliometric Analysis
This research analyzes trends in studies regarding the relationship between water, sanitation, and stunting in children under five through bibliometric analysis. Water, sanitation, and hygiene (WASH) interventions are recognized as critical factors in addressing childhood stunting, yet the research landscape remains fragmented across disciplines. A total of 130 publications from the Scopus database covering 2010-2024 were analyzed using VOSViewer software. Co-occurrence analysis, co-authorship analysis, and citation analysis were performed to identify research patterns, collaboration networks, and knowledge clusters. The results reveal that medical sciences dominate the field (34.6%), followed by nursing (15.4%) and environmental sciences (13.8%), with research articles comprising 77.2% of publications. The United States leads in publication output with 35 documents, while Johns Hopkins Bloomberg School of Public Health emerges as the most prolific institution with 8 publications. Publication trends show significant growth from 2010 to 2020, peaking at 23 publications in 2020. International collaboration analysis demonstrates strong cooperation networks, particularly between the United States and the United Kingdom. Keyword co-occurrence analysis identified three distinct clusters: Cluster 1 focusing on growth disorders and child development, Cluster 2 emphasizing stunting epidemiology and risk factors, and Cluster 3 addressing WASH interventions and pathogen exposure. The research landscape reveals disciplinary fragmentation that may explain contradictory findings and limited intervention effectiveness. Enhanced interdisciplinary collaboration and integration of clinical, epidemiological, and intervention perspectives are essential for developing comprehensive stunting prevention strategies, particularly in low- and middle-income countries.
Effect of Turmeric Ethanol Extract (Curcuma Longa Linn.) on Tumor Necrosis Factor alpha (TNFα) and the extent of wound lesions (Experimental Study on Wistar Rats Exposed to UVB Rays)
Continuous exposure to ultraviolet B (UVB) radiation can induce photoaging and accelerate premature skin aging. Turmeric (Curcuma longa) is a medicinal plant that contains curcumin, an active compound known for its anti-inflammatory properties and its role in accelerating wound healing. This study aimed to evaluate the effect of turmeric ethanol extract on TNF-α levels and wound lesion areas in Wistar rats exposed to UVB radiation. A post-test-only control group design was employed, involving 24 Wistar rats divided into four groups: a healthy control group (K1), a negative control group (K2), and two treatment groups receiving oral turmeric ethanol extract at doses of 100 mg/kg BW (K3) and 200 mg/kg BW (K4) for 14 days, with concurrent UVB exposure. TNF-α levels were assessed using one-way ANOVA followed by Tukey's post hoc test, while wound lesion areas were analyzed using the Kruskal–Wallis test followed by the Mann–Whitney U test. The results showed that the highest TNF-α levels were observed in the healthy control group (129.14 ng/L), although no statistically significant differences were found between groups (p = 0.538). In contrast, a significant difference was observed in wound lesion areas (p < 0.001), with the largest lesions occurring in the negative control group. In conclusion, oral administration of turmeric ethanol extract did not significantly affect TNF-α levels but was effective in reducing the area of wound lesions caused by UVB exposure.
Effect of Turmeric Ethanol Extract (Curcuma Longa Linn) on IL-6, IL-10 Levels and Skin Moisture
Ultraviolet B (UVB) radiation is known to induce skin damage, including erythema, roughness, sagging, wrinkles, and reduced skin moisture, contributing to premature aging. Turmeric (Curcuma longa Linn.) contains curcumin, an active compound with potent anti-inflammatory properties. This study investigated the effect of turmeric ethanol extract on IL-6 and IL-10 levels, as well as skin moisture, in UVB-exposed rats. A total of 24 Wistar rats were randomly divided into four groups: healthy controls (K1), UVB-exposed without treatment (K2), UVB-exposed treated with turmeric ethanol extract at 100 mg/kg BW (K3), and 200 mg/kg BW (K4). The extract was administered orally for 14 days. IL-6 and IL-10 levels were measured using ELISA, and skin moisture was assessed macroscopically. Statistical analysis was performed using one-way ANOVA. Rats in groups K2, K3, and K4 exhibited very dry skin, redness, visible wrinkles, and peeling following UVB exposure. IL-6 levels were significantly lower in treated groups, with the lowest levels observed in K4 (1.85 ± 0.24 ng/L), compared to K1 (4.36 ± 0.75 ng/L) and K2 (4.46 ± 0.74 ng/L) (p = 0.000). IL-10 levels increased in the treated groups, notably in K3 (376.48 ± 78.24 pg/mL) and K4 (351.06 ± 78.24 pg/mL), compared to K1 (285.34 ± 45.54 pg/mL) and K2 (306.89 ± 45.54 pg/mL) (p = 0.001). These findings suggest that oral administration of turmeric ethanol extract modulates inflammatory responses by reducing IL-6 and enhancing IL-10 in UVB-exposed skin, although significant dryness persists.
Holistic Approach: Emotional Touch Intervention (Kissing and Hugging) and Macronutrient Nutrition in Stunting Prevention in Early Childhood)
Stunting can lead to complications such as decreased intelligence and impaired growth, which may further deteriorate development into adulthood. This study aimed to examine the effectiveness of maternal kissing, hugging, and macronutrient intake in the prevention of stunting. A randomized clinical trial was conducted involving 170 mothers with toddlers aged 6 to 60 months who were at risk of stunting in 2024. Participants were randomly assigned to intervention and control groups. In both groups, parenting behaviors involving maternal hugging and kissing were measured using a structured questionnaire, while macronutrient intake, particularly protein-rich intake, was assessed using microtoise and length boards. The results showed a significant improvement in the intervention group compared to the control group (p < 0.001). The incidence of stunting was significantly lower in the intervention group than in the control group (p < 0.001). Additionally, the effectiveness of the Emotional Touch Intervention (Kissing and Hugging) and Macronutrient Nutrition (a local playful interaction technique) was statistically significant with a p-value of 0.000 (< 0.05). These findings indicate that maternal kissing, hugging, and adequate macronutrient intake are beneficial strategies in stunting prevention among toddlers. This study contributes to health innovations by promoting a combined approach of affectionate parenting and nutritional support to enhance toddler health and well-being.
Case Study: Physiotherapy Program in Down Syndrome Patients with Neuro Development Treatment Intervention at Dustira Hospital
Down Syndrome is a genetic disorder in which there is an extra chromosome on chromosome 21. This extra chromosome results in excessive amounts of certain proteins, which can interfere with the body's normal growth and cause changes in brain development. This case study report aims to determine the effect of physiotherapy intervention with Neuro Developmental Treatment (NDT) on improving motor skills in Down Syndrome children. This case study report was carried out in the children's growth and development clinic at the hospital Dustira Cimahi on January 15, 2024 to February 1, 2024. The intervention used is Neuro Development Treatment through a stimulation and facilitation approach. The results of the Early Growth and Development Detection examination from T1 to T6 showed increased developmental achievements in aspects of fine motor skills, observation and speech. The evaluation results of the Gross Motor Functional Measurement examination showed a total score at T1: 11% and T6: 18%, there was an increase in gross motor skills of 7%. Conclusion: Intervention using Neuro Development Treatment is a therapy that has been proven to be effective in improving the motor skills of Down Syndrome children
The Relationship Between Cigarette Smoke Exposure and Environmental Sanitation with The Incidence of Acute Respiratory Tract Infections in Toddlers
Acute Respiratory Infections (ARI) constitute infectious pathologies affecting superior or inferior respiratory pathways, capable of producing diverse clinical manifestations ranging from mild infectious processes to severe pathological conditions. Statistical records from the Malang City Health Department documented 56,000 ARI cases over 12 months in 2022, escalating to 43,000 cases within 6 months in 2023, demonstrating significant epidemiological increases. Documentation from TPMB Endang revealed that among 110 toddlers experiencing ARI, 37 originated from Gading Village, with the remaining cases from surrounding communities. Environmental assessment observations identified suboptimal residential hygiene conditions, sugar factory proximity, and prevalent family smoking behaviours. This investigation aimed to establish the relationship between cigarette smoke exposure and environmental sanitation with acute respiratory infection incidence among toddlers in Gading Village, Bululawang District. The research methodology employed quantitative approaches utilising analytical observational design with a cross-sectional framework. The study population encompassed all toddlers residing in Gading Village, totalling 55 individuals, with a sample of 35 toddlers selected according to predetermined inclusion criteria. Multiple linear regression analysis was implemented for data examination. Data analysis results demonstrate significant associations between cigarette smoke exposure and environmental sanitation with acute respiratory tract infection occurrence. This relationship is evidenced through regression variance analysis, specifically the Fh value of 145.846 > Ftable. Additionally, statistical significance is confirmed by the values of 3.178 (cigarette smoke exposure) > t table 1.690 and 2.567 (environmental sanitation) > t table 1.690. The study concludes that definitive relationships exist between cigarette smoke exposure and environmental sanitation with acute respiratory tract infection incidence among toddlers in Gading Village.
Pulmonary Function Impairment Associated with PM2.5, CO, and CO₂ Exposure in Home-Based Chips Industry Workers in Indonesia: A Cross-Sectional Study
Wood remains a traditional fuel source for many rural communities, particularly for cooking purposes. The incomplete combustion of wood, combined with prolonged heating of cooking oil at high temperatures, can release harmful carbon compounds and carcinogenic particles, posing significant risks to respiratory health. The World Health Organization (WHO) reported in 2024 that approximately 3.2 million premature deaths annually are attributable to exposure to such pollutants. This study seeks to evaluate pulmonary function impairments among workers employed in chip home industries that predominantly utilize wood as a primary energy source. The research was conducted across two chip-producing home industries located in Senduro Subdistrict, Lumajang Regency. A total of 44 respondents participated through total sampling, where all workers underwent pulmonary function examinations. The average workplace temperature, particularly near cooking pans and wood-burning stoves, was recorded at 34,7 °C. Concentrations of PM2.5 reached 694,8 µg/m³, while CO and CO2 levels were measured at 6 ppm and 4,460 ppm, respectively. Based on the threshold limits established by the Indonesian Ministry of Health—25 µg/m³ for PM2.5, 25 ppm for CO, and 5,000 ppm for CO₂ (Regulation No. 70 of 2016), only PM 2.5 concentrations significantly exceeded the permissible exposure levels. Although most workers reported few respiratory complaints due to perceived adaptation, field assessments revealed that 79% experienced pulmonary function impairment, either restrictive or obstructive types. Statistical analysis revealed a significant association between pulmonary impairment and age (p=0.001) as well as duration of employment (p=0.001). It is therefore recommended that home industry owners improve workplace environments, particularly by optimizing chimney systems and stove combustion processes, to safeguard workers' respiratory health over the long term.
Pesticide Spraying Practices and Hypertension Risk among farmers in Bumen Village, Indonesia
This study investigated the association between pesticide spraying practices and hypertension in horticultural farmers in Bumen Village, Sumowono District, Indonesia. A cross-sectional study was conducted among 132 male farmers selected through purposive sampling. Data were collected through structured interviews, blood pressure measurements, and field observations. Logistic regression revealed that mixing ≥2 pesticide types (OR=4.828; p=0.028), spraying ≥4 times per week (OR=4.552; p=0.010), and incomplete PPE use (OR=3.551; p=0.015) were significantly associated with hypertension. These findings underscore the need for stricter pesticide regulation, improved PPE use, and regular health monitoring to reduce health risks among farmers.
Effectiveness of Banana Peel Ash, Zeolite and Clam Shells in Reducing Waterturbidity and Iron (Fe) Contentration
One method to reduce iron content and water turbidity is to use banana peel coagulants and zeolite and clam shell filtration. The biochemical components in banana peels are believed to be effective in reducing turbidity and heavy metals, while zeolites and clam shells function to reduce iron levels in water. This study aims to determine the effectiveness of kepok banana peel ash coagulant (Musa acuminate balbisiana C.) and zeolite and clam shell filtration in reducing turbidity and iron (Fe) content in river water in Punggur Kecil Village, Sungai Kakap District, Kubu Raya Regency. The research method used was a quasi-experiment with a one-group pretest-posttest design, taking river water samples in Punggur Kecil Village, as many as 27 samples from 9 repetitions. Data were analyzed descriptively with the paired sample t-test statistical test. The results of the analysis showed that river water treatment using banana peel ash coagulant and clam shell filtration and zeolite decreased the average iron (Fe) content from 2.21 mg/l to 0.25 mg/l, with an effectiveness of 88.18%, but there was no significant change. While the average decrease in turbidity levels was from 57.67 NTU to 17.6 NTU, with an effectiveness of 65.56%, the results were also not significant. The results of the paired t-test showed a significant difference before and after treatment in iron content with a value of 0.000 (p < 0.05) and turbidity content with a value of 0.003 (p < 0.05). The conclusion of this study shows a significant difference in iron (Fe) and turbidity levels, but this treatment method has not been effective in reducing the level of turbidity of river water. The conclusion of this study shows a significant difference in iron (Fe) and turbidity levels, but this treatment method has not been effective in reducing the level of turbidity of river water.
Effect of Crystalloid Preloading on Blood Pressure Stability in Cesarean Section Under Spinal Anesthesia: A Study at Regional General Hospital of Sekarwangi
Spinal anesthesia is a form of regional anesthesia administered by injecting a local anesthetic into the subarachnoid space and is commonly employed in cesarean section (C-section) procedures. One of its major side effects is hypotension, which, if not properly managed, can compromise uteroplacental perfusion and potentially result in fetal hypoxia, acidosis, and neonatal complications. Preoperative intravenous fluid administration is a preventive strategy aimed at stabilizing blood pressure by increasing central blood volume. This study aimed to examine the effect of preoperative fluid administration on blood pressure stability in C-section patients undergoing spinal anesthesia at the Regional General Hospital at Sekarwangi. A quantitative analytic approach with a pre-test and post-test design was employed. The study population consisted of 62 C-section patients who received spinal anesthesia within the last three months. Data were analyzed using the Paired Samples t-test. The results showed a statistically significant difference in blood pressure before and after fluid administration (p = 0.000 < 0.05), indicating that preoperative fluid administration had a significant effect on blood pressure stability. Future studies are recommended to employ research designs that better control for external variables and address the limitations of the present study.
Hygiene and Sanitation of Refill Drinking Water Depots in Relation Escherichia coli: A Quantitative Study
Clean water is essential for various daily needs such as drinking, cooking, bathing, and washing. Ensuring proper hygiene and sanitation is critical to prevent waterborne diseases, particularly those caused by Escherichia coli. This descriptive observational study conducted from March to June 2024. The aim of this research is to worker hygiene practices and sanitation conditions at Refill Drinking Water Depots (RDWDs) as well as their relation to the presence of E. coli in the Timika Jaya Health Center area, Mimika Regency. All 20 certified RDWDs in the area were included in this study, involving workers and managers as respondents. Data were collected through sanitation inspections and water sampling for laboratory testing, and analyzed using SPSS to determine frequency distributions and percentages. The majority of respondents were male (87.1%), aged 25–30 years (38.7%), had completed senior high school (54.8%), and worked ≥8 hours per day (100%). In terms of hygiene compliance, only 3.2% of workers met the required standards, while 96.8% did not. All depots (100%) met sanitation standards related to location and equipment. However, 6 depots (30%) were found to be contaminated with E. coli. These findings indicate that inadequate personal hygiene among workers is a key risk factor for E. coli contamination, despite compliance with infrastructural sanitation standards. Regular monitoring, hygiene training, and enforcement of health regulations are strongly recommended to ensure the safe distribution of drinking water.
Respiratory Impact of PM10 and PM2.5 Exposure among Furniture Workers in Tegal
The furniture industry has a high potential for particulate matter (PM10 and PM2.5) exposure, which may lead to impaired lung function and occupational diseases. Dust from cutting, sanding, and finishing processes can be inhaled and accumulate in the respiratory tract, increasing the risk of respiratory dysfunction. This study aimed to determine the relationship between PM exposure and impaired lung function among furniture industry workers in Tegal Regency. This study was an analytical observational study with a cross-sectional approach involving 100 production workers. PM concentration was measured using the Haz Dust EPAM-5000, and lung function was assessed using spirometry. Bivariate analysis was conducted using the chi-square test, and multivariate analysis was performed using logistic regression. A total of 57% of respondents experienced impaired lung function. Bivariate analysis showed a significant relationship between PM 10 concentration (p=0.001; OR=4.725), PM 2.5 concentration (p=0.007; OR=3.580), inhalable dust concentration (p=0.034; OR=2.478), duration of employment (p=0.003; OR=3.929), and working hours (p=0.001; OR=4.143) with impaired lung function. A total of 57% of respondents experienced impaired lung function, consisting of mild restriction, moderate restriction, and mild obstruction. There was a significant association between PM 10 concentration (p = 0.001), PM 2.5 concentration (p = 0.007), and duration of employment (p = 0.003) with impaired lung function. Logistic regression analysis identified PM 10 concentration as the dominant factor associated with impaired lung function (p = 0.002; OR = 3.976; 95% CI: 1.641–9.637.
Promotional Media Needs in Capacity Building of Health Cadres in Rural Areas: A Qualitative Study in Lebak District
Health cadres play an important role in community health promotion, especially in rural areas. However, the process of empowering and training cadres has not always been effective in achieving the expected goals. This study aims to explore the knowledge, barriers, and needs of cadres related to child growth and development, so that health workers can design appropriate learning media and methods. This study used a qualitative phenomenological approach and was conducted in the Mandala Rangkasbitung Health Centre Working Area, Lebak Regency, Banten Province, in June-October 2024. The results showed that the cadres' knowledge about children's growth and development was quite good. However, they experienced difficulties in explaining the material to the community due to limited media. Cadres expressed the need for simple, pictorial health promotion media with written explanations to support their work. Therefore, traditional media such as leaflets or posters with a flip-sheet format are urgently needed to improve the effectiveness of health promotion by cadres.
The Influence of Balinese Dancing on Children’s Self Confidence in Denpasar, Bali
School-aged children tend to prefer physical and social activities. This period is the right time to develop oneself in areas such as physical, cognitive, language, social, emotional, spiritual, self-concept, discipline, and independence. Self-confidence is a personality trait that can be characterized by the ability to interact with friends and family. This research aims to determine the effect of Balinese dancing activities on the self-confidence of school-aged children at the Denpasar Dance Studio. This research uses a quasi-experimental design, particularly the pre-test-post-test control group design. Self-confidence measurements for school-age children were carried out twice a week for one month, while the control group was beginner musicians who had never performed. The sampling technique used in sample selection was purposive sampling with inclusion and exclusion criteria. The difference in pre-test and post-test results using the Wilcoxon signed rank test in the intervention group, with a p-value of 0.000, signifies that Balinese dancing activities influence self-confidence in school-aged children. Meanwhile, in the control group, the p-value was 0.993, meaning that beginner Balinese music activities did not affect the self-confidence of school-aged children. The Mann-Whitney test found a p-value of 0.005, indicating a difference in the self-confidence of school-aged children in the intervention and control groups. It is hoped that this research will provide input for parents to provide physical activity in the form of Balinese dancing to school-aged children to increase their self-confidence.
Association Between Climatic Factors and Malaria Incidence in Papua, Indonesia
Malaria remains a major public health concern in many countries, including Indonesia, particularly in endemic regions such as Papua. The province of Papua records the highest number of malaria cases, contributing approximately 92% of the national burden. Fluctuations in morbidity and mortality rates due to malaria in this region underscore the urgency of targeted control measures. Several environmental and climatic factors are believed to influence malaria transmission, yet comprehensive analyses in Papua remain limited. This study aimed to determine the relationship between climatic factors and the incidence of malaria in Papua.This type of research is descriptive observational with ecological study design. The data source was secondary data from the Indonesian Health Survey for malaria cases and the Meteorology Climatology and Geophysics Agency (BKMG) for climate factor data. Based on the results showed that Rainfall (p=0.187; r=-0.445), humidity (p=0.627, r=-0.176), temperature (p=0.091, r=0.802), wind speed (p=0.004, r=0.818), and duration of sunshine (p=0.038, r=0.661). Findings suggest that wind speed and solar irradiation are significant predictors of malaria incidence, thus environmental management strategies should consider consider thes variables.
The Effectiveness of Warm Compresses and Tepid Sponge Baths on Body Temprature in Toddlers Who Have a Fever on the First Day
Toddlers are susceptible to fever because their immune systems are immature. Non-pharmacological managements, such as warm compresses and tepid sponge baths, are commonly used to reduce fever. This study aimed to determine the effectiveness of warm compresses and tepid sponge baths in lowering body temperature in toddlers on the first day of fever. A quasi-experimental pretest-posttest non-equivalent control group design was used, involving 30 toddlers at TK II Udayana Denpasar Hospital. Respondents were selected through purposive sampling and divided into two groups: tepid sponge (n=15) and warm compress (n=15). Subjects belonging to the intervention group were administered tepid sponge baths, and subjects in the control group were applied warm compresses. Each group was given 20 minutes of treatment using lukewarm water with a temperature no higher than 43°C. Body temperature was measured using a calibrated digital thermometer before and after the intervention. The data were analyzed using paired t-tests for within-group differences and independent t-tests for between-group comparisons. Both interventions significantly reduced body temperature in toddlers with fever on the first day (p=0.001). The average temperature decrease in the tepid sponge group was 1.14°C (p value 0,001), slightly higher than the temperature drop in the warm compress group, which is 0.99°C (p value 0,001). Statistical analysis showed a significant difference in effectiveness between the two interventions (p value 0.001), with tepid sponge being more efficacious. Tepid sponge baths are more effective than warm compresses in reducing fever in toddlers on the first day. Nurses are encouraged to apply tepid sponge therapy as an alternative to pharmacological interventions to minimize the side effects of antipyretic drugs.
Occupational Safety and Health Model Affecting Worker Performance Using Structural Equation Modelling
Construction is one of the industries with a high risk of occupational accidents, which can negatively impact worker performance. The high rate of workplace accidents in this sector makes the implementation of an effective Occupational Safety and Health (OSH) system crucial. Occupational safety and occupational health can be key factors in improving worker performance. This study aimed to identify the most significant OSH factors affecting worker performance in the context of construction projects. The methodology used in this study was data collection through a questionnaire designed to evaluate various aspects of OSH and worker performance using a Likert scale. Data were collected from 50 respondents involved in five high-rise construction projects in Surabaya. The research findings indicate that occupational health factors have a more significant impact compared to occupational safety factors. The analysis shows that improving occupational health programs, such as regular health check-ups and providing adequate facilities, can directly improve worker performance. These findings underscore the importance of construction companies integrating occupational health aspects into their OSH programs, not only to protect workers but also to improve the performance of construction project workers. This study provides new insights into understanding the relationship between OSH and worker performance, while also offers practical recommendations for the construction industry to create a safer occupational environment and improve worker performance more effectively.