Journal of Epidemiology and Public Health
e-ISSN: 2549-0273 Publisher: Masters Program in Public Health, Sebelas Maret University Jl. Ir Sutami 36A, Surakarta 57126, Central Java, Indonesia Editor in Chief: Vitri Widyaningsih, dr., M.S., Ph.D Universitas Sebelas Maret, Solo, Indonesia Aim and Scope The Journal of Epidemiology and Public Health (JEPH) is an open-access, peer-reviewed international journal dedicated to advancing knowledge and research in the fields of epidemiology and public health. Established on June 2, 2015, JEPH publishes high-quality original research articles, systematic reviews, and meta-analyses on a quarterly basis. Our mission is to contribute to the global improvement of population health by disseminating rigorous scientific evidence that informs public health policy, practice, and education. The journal seeks to highlight innovative research that addresses contemporary health challenges, with a particular emphasis on health disparities, disease prevention, health promotion, and health systems strengthening. JEPH welcomes contributions from researchers around the world and is particularly committed to amplifying the voices of scholars from low- and middle-income countries (LMICs). We encourage submissions that tackle regionally relevant health issues, apply robust epidemiological methods, and propose evidence-based solutions to pressing public health problems. Key areas of interest include, but are not limited to: Epidemiological studies of communicable and non-communicable diseases Social determinants of health and health inequalities Health systems research and policy evaluation Public health interventions and health promotion Environmental and occupational health Global health and health equity Biostatistics and methodological advances in epidemiological research Pandemic preparedness and response JEPH is officially accredited by the Ministry of Research, Technology, and Higher Education, Government of Indonesia, under decree No. 10/C/C3/DT.05.00/2025. The journal holds SINTA 2 status, valid from July 16, 2022, to July 16, 2027. Through the publication of high-impact, policy-relevant research, JEPH aims to foster the exchange of knowledge across disciplines and regions and to support the development of evidence-based solutions to the world’s most pressing public health challenges.
Health Belief Model Predictors of Tertiary Preventive Behavior and HbA1c Levels among Patients with Type 2 Diabetes Mellitus
Background: Type 2 diabetes mellitus (T2DM) remains a major public health challenge worldwide. This study applied the Health Belief Model (HBM) to examine its association with tertiary preventive behavior and HbA1c levels among patients with T2DM. The study aimed to analyze the effects of HBM constructs on tertiary preventive behavior and their impact on HbA1c levels in patients with T2DM. Subjects and Method: A quantitative study with a cross-sectional design was conducted among 210 patients with T2DM receiving outpatient care at UNS Hospital. Data were collected between September and October 2025. The independent variables included perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and cues to action. The dependent variables were tertiary preventive behavior and HbA1c levels. Data were analyzed using univariate analysis, bivariate analysis with simple logistic regression, and multivariate analysis using path analysis in STATA 13. Results: Self-efficacy (b = 0.190; 95% CI = 0.029 to 0.350; p = 0.020), perceived benefits (b = 0.162; 95% CI = 0.021 to 0.301; p = 0.023), and cues to action (b = 0.294; 95% CI = 0.122 to 0.465; p = 0.001) had direct and significant effects on tertiary preventive behavior. Tertiary preventive behavior (b = −0.183; 95% CI = −0.307 to −0.085; p = 0.004), age (b = 0.134; 95% CI = 0.005 to 0.263; p = 0.041), duration of diabetes (b = 0.164; 95% CI = 0.035 to 0.295; p = 0.014), and family history of diabetes (b = 0.228; 95% CI = 0.104 to 0.351; p < 0.001) had direct and significant effects on HbA1c levels. Sex had direct but non-significant effects on both tertiary preventive behavior and HbA1c levels. Perceived susceptibility and perceived severity exerted indirect but significant effects on tertiary preventive behavior through perceived benefits. Conclusion: Self-efficacy, perceived benefits, cues to action, and sex directly influenced tertiary preventive behavior, whereas perceived susceptibility and perceived severity exerted indirect effects through perceived benefits. Furthermore, tertiary preventive behavior, duration of diabetes, age, family history of diabetes, and sex directly affected HbA1c levels.
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Multilevel Analysis of District- and City-Level Contextual Factors Influencing Hypertension Risk Among Adults: An Analysis of Indonesian Health Survey Year 2023
Background: Hypertension remains a major public health challenge in Indonesia, with prevalence continuing to rise across different population groups. The burden of hypertension varies across settings, including urban and rural areas, socioeconomic levels, and regional contexts. This study aimed to examine how district- and city-level contextual factors influence the risk of hypertension among adults in Indonesia. Subjects and Method: A cross-sectional study included a sample of 48,878 adults who participated in the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia). The data were analyzed using multilevel multiple linear regression. Results: Multilevel analysis showed that the risk of hypertension increased among individuals aged ≥60 years (b= 4.12; 95% CI= 3.76 to 4.48; p < 0.001), compared with those aged <20 years. Senior high school or higher education (b= –0.40; 95% CI= –0.48 to –0.31; p <0.001) was associated with a lower risk of hypertension compared with individuals with no formal education. Higher BMI was associated with an increased risk of hypertension among individuals with BMI 18.5–25 kg/m² (b= 0.19; 95% CI= 0.09 to 0.30; p < 0.001) and BMI ≥25 kg/m² (b= 0.92; 95% CI= 0.82 to 1.03; p < 0.001). Female sex (b= 0.21; p < 0.001), urban residence (b= 0.06; p= 0.021), and high Gini Ratio (b = 0.17; p < 0.001) increased the risk of hypertension, whereas high physical activity and higher provincial minimum wage reduced the risk. The ICC of 0.37% indicated low variation across districts/cities. Conclusion: Hypertension risk among Indonesian adults is mainly driven by individual factors, while income inequality is the only contextual factor with a significant effect. These results emphasize the need for interventions targeting both personal health behaviors and socioeconomic disparities.
Determinants of Tuberculosis Incidence Among Children Under Five in Karanganyar, Central Java, Indonesia
Background: Tuberculosis (TB) remains a major infectious disease and a leading cause of mortality worldwide, with 10.8 million cases and 1.25 million deaths reported in 2023. Indonesia is classified as a high-burden TB country, with 78,566 cases reported among children under five years of age. Young children are particularly vulnerable due to their immature immune systems. In Karanganyar Regency, Central Java, Indonesia, 137 cases of TB among under-five children were recorded in 2023. This study aimed to analyze the risk factors associated with TB incidence among children under five in Karanganyar Regency. Subjects and Method: This study employed an analytic observational design using a case-control approach. A total of 200 children under five were randomly selected, comprising 50 TB cases and 150 non-TB controls. Data were analyzed using simple logistic regression and path analysis to examine direct and indirect relationships among variables. Results: The incidence of TB among children under five increased with a history of contact with TB patients (b = 0.18; 95% CI = 0.10–0.26; p < 0.001) and living in homes with high humidity (b = 0.09; 95% CI = 0.01–0.17; p = 0.019). Conversely, TB incidence decreased with good lighting (b = -0.11; 95% CI = -0.19 to -0.03; p = 0.005), presence of bedroom windows (b = -0.41; 95% CI = -0.51 to -0.31; p < 0.001), living room windows (b = -0.31; 95% CI = -0.41 to -0.22; p < 0.001), and residence in highland areas (b = -0.13; 95% CI = -0.21 to -0.06; p < 0.001). Nutritional status was negatively affected by TB (b = -0.30; 95% CI = -0.43 to -0.15; p < 0.001) and positively influenced by family income (b = 0.17; 95% CI = 0.03–0.31; p = 0.016), with income exerting both direct and indirect effects through TB. The path analysis model demonstrated good fit (Chi-square p = 0.068; RMSEA = 0.052; CFI = 0.981; TLI = 0.960). Conclusion: The risk of TB among children under five increases with exposure to adult TB cases and living in humid housing conditions. Conversely, TB incidence decreases in children residing in well-lit homes with bedroom and living room windows and in highland areas. Nutritional status is influenced by both TB and family income, with income affecting TB directly and indirectly.
Pathways to Depression: A Multidimensional Composite Analysis of Socioeconomic Inequalities in a Population-Based Study
Background: Socioeconomic factors are recognized as key contributors to the risk of depression among adults and older populations. However, socioeconomic status (SES) is often measured using single indicators, which may not capture its multidimensional nature. Moreover, the mechanisms through which socioeconomic conditions influence depression remain insufficiently explored. This study aimed to examine the pathways linking socioeconomic inequalities to depression using a multidimensional composite measure of SES. Subjects and Method: A cross-sectional analysis was conducted using data from the 2023 Indonesian Health Survey, a nationally representative population-based survey. SES was constructed using principal component analysis (PCA) based on wealth index, education level, employment status, participation in government social protection programs, and provincial-level income inequality (Gini index). Path analysis was performed to assess direct and indirect relationships between SES, physical activity, comorbidity, and depression. All analyses were conducted using STATA 17. Results: Higher SES was associated with a lower risk of depression. Significant pathways were observed from SES to depression both directly (β= -0.06; 95% CI= -0.07 to -0.06; p <0.001) and indirectly through comorbidity (β= -0.03; 95% CI= -0.03 to 0.02; p <0.001). Conclusion: Socioeconomic inequalities play a critical role in shaping depression risk through multiple pathways.
Association Between Screen Time Duration and Attention- Deficit/Hyperactivity Disorder Symptoms Among Children Aged 4–6 Years
Background: The rapid increase in screen time among children has raised urgent public health concerns due to its potential link with Attention- Deficit/ Hyperactivity Disorder (ADHD)-related symptoms. Emerging evidence suggests that excessive and early exposure to digital media may contribute to inattention, impulsivity, and behavioral dysregulation. This study aimed to examine the association between the duration of gadget use and ADHD symptoms in children aged 4–6 years. Subjects and Method: A cross-sectional study was conducted at four early childhood education institutions in Kartasura, Central Java, Indonesia. A total of 87 children aged 4–6 years were included. Screen time duration was assessed using a 7-day parent-reported observation sheet. ADHD symptoms were measured using the ADHD Rating Scale-5 (ADHDRS-5). The association between screen time duration and ADHD symptoms was analyzed using Pearson’s correlation test. Results: There was a statistically significant positive correlation between screen time duration and ADHD symptoms (r = 0.35; p = 0.001). Conclusion: Longer screen time duration is associated with higher levels of ADHD symptoms among children aged 4–6 years.
attention deficit hyperactivity disorder
Implementation of Theory of Planned Behavior on Behavior Change and Outcomes in Type 2 Diabetes Mellitus Patients in Surakarta, Central Java, Indonesia
Background: The Theory of Planned Behavior (TPB) can serve as a conceptual framework for improving healthy behaviors among patients with type 2 diabetes mellitus (T2DM). The application of TPB is essential for predicting both behavioral patterns and health outcomes in individuals with T2DM. This study aimed to assess the implementation of TPB on behavioral change and outcomes in T2DM patients Subjects and Method: This cross-sectional study was conducted in Surakarta, Indonesia. There was 200 type 2 DM patients selected by purposive sampling. The dependent variables were HbA1c and behavior. The independent variables were behavioral belief, outcome evaluation, normative belief, motivation, control belief, control power, attitude, subjective norm, perceived behavioral control, and intention. Data were collected using a set of questionnaires and analyzed using path analysis. Results: HbA1c ≥6.5% was directly reduced by strong behavior, but it was statistically non signi­ficant (b= -0.22; 95%CI= -0.15 to 1.08; p= 0.745). Behavior was directly and significantly increased by strong intention (b= 1.66; 95% CI= 1.03 to 2.30; p<0.001) and high perceived behavior control (b= 0.87; 95% CI= 0.23 to 1.50; p= 0.007). Conclusion: The Theory of Planned Behavior can be used to predict healthy behavior among patients with type 2 DM.
Analysis of Risk Factors Associated with Rabies Cases in South Timor Tengah Regency, East Nusa Tenggara, Indonesia
Background: Rabies is a zoonotic infectious disease that can be directly transmitted to humans and is fatal, leading to death in South Timor Tengah Regency. Rabies has been officially declared an outbreak in this region. This study aimed to analyze the effects of selected risk factors on rabies cases in South Timor Tengah Regency, East Nusa Tenggara Province, Indonesia. Subjects and Method: This study used primary data and employed an analytic observational design with a case–control approach. A total of 200 participants were included, consisting of 100 rabies cases and 100 controls, drawn from a population of 4,749 cases and controls using random sampling across 32 subdistricts in South Timor Tengah Regency. The dependent variable was rabies case status. The independent variables included community knowledge, history of contact with dogs, vaccination status of pet dogs, age, sex, stray dog bites, and stray dog population density. Data were collected using a questionnaire that had been tested for validity and reliability. Path analysis was conducted using STATA version 13. Results: The study found significant associations between rabies cases and community knowledge (OR= 0.06; 95% CI= 0.03–0.16; p < 0.001), stray dog population density (OR= 2.72; 95% CI= 1.30–5.70; p= 0.008), stray dog bites (OR = 4.59; 95% CI= 1.97–10.69; p < 0.001), age (OR= 0.97; 95% CI= 0.95–0.99; p= 0.008), and sex (OR= 0.33; 95% CI= 0.16–0.71; p = 0.005). In contrast, history of contact with dogs (OR= 1.30; 95% CI= 0.62–2.71; p= 0.487), vaccination of pet dogs (OR= 0.89; 95% CI= 0.37–2.13; p = 0.796), and educational level (OR = 1.31; 95% CI= 0.54–3.15; p= 0.553) were not statistically significant. Conclusion: High stray dog population density and stray dog bites increase the risk of rabies, while higher community knowledge, female sex, and age ≥35 years serve as protective factors against rabies in the population of South Timor Tengah Regency.
The Influence of Social Trust, Income Inequality, and Employment Status on the Risk of Depression
Background: Depressive disorders are among the most common and complex mental health problems worldwide, including in Indonesia. The determinants of depression are closely linked to social and economic factors. This study aimed to estimate the effects of social trust, income inequality, and employment status on the risk of depression. Subjects and Method: An observational study with a cross-sectional design utilized the fifth wave of the Indonesia Family Life Survey (IFLS5). The dataset includes more than 29,716 individuals across 13 provinces. The sample was selected using a purposive sampling method. Results: The risk of depression increased significantly among individuals who were unmarried (b = 0.97; 95% CI: 0.84 to 1.07; p < 0.001), female (b = 0.16; 95% CI: 0.06 to 0.26; p = 0.002), unemployed (b = 0.25; 95% CI: 0.14 to 0.35; p < 0.001), and living in provinces with higher income inequality (b = 0.32; 95% CI: 0.21 to 0.42; p < 0.001). Conversely, the risk of depression decreased significantly with higher social trust (b = -0.18; 95% CI: -0.29 to -0.08; p < 0.001), good sleep quality (b = -0.20; 95% CI: -0.21 to -0.19; p < 0.001), older age (b= -0.81; 95% CI: -0.99 to -0.63; p < 0.001), and higher education level (≥senior high school) (b= -0.36; 95% CI: -0.46 to -0.25; p < 0.001). Conclusion: The risk of depression increases with unmarried, female, unemployed, and living in provinces with higher income inequality. The risk of depression decreases with higher social trust, good sleep quality, older age, and education ≥senior high school.
The Influence of Gender, Body Mass Index, Work Fatigue and Noise Exposure on Blood Pressure among Manufacturing Industry Workers
Background: Noise in the work environment can exceed a set threshold and have an impact on workers' health, including increased blood pressure. In addition to noise, other factors such as work fatigue, body mass index, and gender also contribute to the risk of hypertension. Preliminary studies show that exposure to high noise and manual work activities is at risk of causing fatigue, so it requires further analysis of the influence of these factors on the blood pressure of industrial workers. Subjects and Method: The study design was a cross-sectional study. The study was conducted in Karanganyar Regency, Central Java in February-April 2025. Sampling in this study was conducted using the Fixed Exposure Sampling method, involving 200 worker samples from a herbal medicine factory and a fireworks factory in Karanganyar Regency, Central Java. The method used to collect data in this study was analytical observations with a cross-sectional approach. The analysis used in this study was path analysis. The dependent variable was blood pressure. The independent variables were noise exposure, fatigue, body mass index, and gender. Results: Blood pressure increased with high fatigue (b= 0.15; 95% CI <0.01 to 0.29; p= 0.038), noise exposure (b= 0.15; 95% CI= 0.02 to 0.28; p= 0.020). Blood pressure in female workers was lower than in men (b= -0.14; 95% CI= -0.28 to -0.01; p= 0.034). Blood pressure was indirectly affected by body mass index. Conclusion: This study shows that noise exposure and work fatigue have a direct effect on increasing blood pressure; women have lower blood pressure than men, while body mass index has an indirect effect on increasing the blood pressure of workers.
Maternal Death Review Through the Maternal Perinatal Death Notification Surveillance System: An Aggregate Analysis at Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
Background: Maternal mortality remains a major concern in Indonesia, particularly in referral hospitals that manage high-risk pregnancies. This study aimed to examine maternal deaths and assess contributory factors at Universitas Airlangga Hospital in 2024 using the maternal perinatal death notification (MPDN) system. Subjects and Method: A retrospective-descriptive study was conducted, including all maternal deaths recorded from January to December 2024. Quantitative data were analyzed descriptively, and factors contributing to maternal mortality were classified using the Three Delays Model. A mixed method with multidisciplinary hospital staff provided qualitative insights into clinical and institutional gaps. Results: A total of 11 maternal deaths occurred during the study period, resulting in an MMR of 557 per 100,000 live births. Most deaths occurred in women over 35 years (81.8%) and during the third trimester (81.8%). Non-obstetric complications were the leading cause (40%), followed by pregnancy-related infections (20%) and hypertensive disorders (10%). First, delay factors, particularly socio-cultural barriers, were present in 36.4% of cases, while third, delay factors, including delayed diagnosis and treatment, were identified in 45.5%. FGDs highlighted gaps in emergency preparedness, blood availability, and interprofessional communication. Conclusion: These findings highlight the combined role of clinical complexity and systemic delays, emphasizing the need to strengthen referral readiness, rapid multidisciplinary response, and decision-making to reduce preventable maternal deaths.
Literature Review : A Review of Solid Medical Waste Management in Hospitals
Background: Hospitals generate hazardous medical waste that threatens both environmental sanitation and human health. Common challenges include a lack of awareness, insufficient training, inadequate disposal infrastructure, and limited resources. Proper management is essential to minimize ecological impacts and prevent hospital-acquired infections (HAIs) at every stage—collection, segregation, transport, and storage. This study systematically evaluates global hospital waste management practices. Subjects and Method: This study is a systematic review literature review conducted on selected databases (PubMed, Science Direct, Google Schoolar) with a publication year between 2020 and 2025. Literature uses Indonesian and English. The literature included was literature with qualitative and quantitative method. The quality assessment of the literature was carried out using the JBI Critical Appraisal. Results: The research results from nine (9) articles related to solid medical waste management in Indonesia show that the process of sorting, transportation, temporary storage and final disposal in the management of medical waste from several hospitals has met the requirements in accordance with applicable regulations. Conclusion: While segregation and temporary storage show high compliance, final disposal remains a critical challenge due to incinerator licensing issues and third-party dependency. Addressing this requires practical staff training, routine audits, and a transition to alternative technologies like autoclaving. Strengthening contract governance and cost-benefit analysis between internal investment and outsourcing is essential for sustainable waste management in Indonesia.
Factors Associated with Post-Sternotomy Wound Infection: A Meta-Analysis
Background: Sternal wound infection is a serious complication following cardiac surgery, contributing to increased morbidity, mortality, and length of hospital stay. Obesity, diabetes mellitus, smoking habits, and re-operation are suspected to contribute to the incidence of post-sternotomy wound infections. This study aimed to estimate the magnitude of the influence of obesity, diabetes, smoking, and re-operation as risk factors for post-sternotomy wound infections. Subject and Method: This study is a systematic review and meta-analysis. Articles were obtained from databases including PubMed, Google Scholar and ScienceDirect, limited to publications from 2015 to 2025. The keywords and MeSH terms used were: “sternotomy, AND sternal wound infection OR deep sternal wound infection OR surgical site infection, AND “obesity OR body mass index, AND diabetes mellitus OR hyperglycemia AND smoking OR tobacco use AND re-operation AND cardiac surgery”. Article selection was based on eligibility criteria defined using the PICO model: P = patients post-sternotomy; I = obesity, diabetes, smoking, re-operation; C = non-obese, non-diabetic, non-smokers, no re-operation; O = post-sternotomy wound infection. Only full-text articles with a cross-sectional study design were included. Data were analyzed using RevMan version 5.3. Results: A total of 16 articles were included in this meta-analysis, originating from Finland, Denmark, Australia, Saudi Arabia, Colombia, Italy, France, China, Pakistan, Brazil, and United States. The meta-analysis showed that the risk of post-sternotomy wound infection was significantly increased in patients with obesity (aOR = 1.50; 95% CI: 1.31–1.72; p < 0.001), diabetes (aOR = 2.02; 95% CI: 1.26–3.25; p = 0.004), smoking (aOR = 2.44; 95% CI: 1.36–2.27; p = 0.05), obstructive sleep apnea (aOR = 1.76; 95% CI: 1.36–2.27; p < 0.001), and re-operation (aOR = 2.90; 95% CI: 1.49–5.64; p = 0.002). All findings were statistically significant. Conclusion: Risk of sternal wound infection post-sternotomy significantly increases with obesity, diabetes, smoking, and re-operation.
Unveiling the Drivers of Anemia: A Multifactorial Analysis
Background: Anemia remains a major public health concern, particularly in developing countries, due to its multifactorial causes and negative impact on individual productivity and quality of life. Identifying the determinants of anemia is essential for improving prevention strategies and targeted interventions. This study aimed to analyze factors associated with anemia among adult outpatients. Subjects and Method: The cross-sectional analytic study was conducted at Primary Health Care Ronowijayan, Ponorogo, Indonesia. The study population consisted of adult outpatients aged ≥18 years who visited the health center during the study period. A total of 100 participants were selected using an incidental sampling technique. The dependent variable was anemia, defined as hemoglobin level <12 g/dL in women and <13 g/dL in men, measured using a standardized spectrophotometric method. The independent variables included age, gender, body mass index (BMI), and economic status. BMI was calculated based on measured weight and height, while economic status was classified according to the regional minimum wage. Data were analyzed using Chi-square tests for bivariate analysis and multiple logistic regression for multivariate analysis, with a significance level of α = 0.05. Results: Most participants were aged <40 years (59.0%), female (54.0%), underweight (59.0%), and of low economic status (82.0%). Bivariate analysis showed that only economic status was significantly associated with anemia (OR = 4.87; p = 0.004). Multivariate analysis confirmed that economic status (OR = 6.77; 95% CI = 1.98–23.10; p= 0.002) and BMI (OR = 1.45; 95% CI = 0.78–2.68; p = 0.035) were significantly associated with anemia, while age (OR = 0.87; 95% CI = 0.27 to 1.24; p = 0.792) and gender (OR = 2.65; 95% CI = 0.07 to 0.33; p = 0.064). Conclusion: Low economic status was significantly associated with an increased risk of anemia among adult outpatients, while body mass index also showed a significant association. Age and gender were not significantly related to anemia. These findings highlight the importance of addressing socioeconomic disparities and nutritional status in anemia prevention and management at the primary health care level.
Patient Safety and Hospital-Based Health Promotion in Preventing Infections and Their Impact on Childhood Stunting: A Systematic Review
Background: Child stunting is influenced by nutrition, recurrent infections, and the quality of health services. Patient safety and hospital-based health promotion play key roles in preventing infections that increase stunting risk. This study aimed to analyze the role of patient safety and hospital-based health promotion in infection prevention and its impact on childhood stunting. Subjects and Method: A systematic review was conducted following the PRISMA guidelines and the PICO framework. The Joanna Briggs Institute (JBI) Checklist was used for quality assessment. Articles were collected from Scopus, ScienceDirect, ProQuest, SpringerLink, Google Scholar, Nature, JSTOR, and Emerald Insight, covering publications from 2020 to 2025. The keywords used were: “patient safety” AND “hospital-based health promotion” AND “infection prevention” AND “childhood stunting”, and “hospital governance” AND “infection control” AND “child growth”. Boolean operators and Medical Subject Headings (MeSH) were applied to each database. Results: This systematic review consisted of 10 articles that met the inclusion criteria. The studies, published between 2020 and 2025, originated from Indonesia, Ethiopia, Southeast Asia, and other developing regions. The findings showed that patient safety programs and infection control effectively reduced neonatal and childhood infections. Health promotion interventions, such as caregiver education and cadre training, improved hygiene and preventive behavior. Integration of hospital governance and policy strengthened infection prevention and service quality. Across the reviewed evidence, exposure to infection during the first 1,000 days of life was consistently linked to an increased risk of stunting (OR=1.85; 95% CI=1.42–2.37; p=0.001). Conclusion: Patient safety and hospital-based health promotion are crucial for preventing infections and reducing stunting. Strengthening hospital governance through integrated infection prevention strategies is essential to accelerate stunting reduction.
Effect of Postpartum Exercise and Oxytocin Massage on Uterine Involution among Postpartum Mothers
Background: Uterine involution is an essential physiological process following childbirth that restores the uterus to its pre-pregnancy size and function. When this process is delayed or incomplete, it can lead to postpartum complications such as hemorrhage. Postpartum exercise and oxytocin massage are non-pharmacological interventions widely believed to accelerate uterine recovery and reduce the risk of complications. Subjects and Method: This quantitative pre-experimental study with a pre-test and post-test without control design was conducted at Klinik Pratama Matahari, Tanjung Morawa, Deli Serdang, North Sumatra, Indonesia, from February to July 2025. Twenty postpartum mothers were selected using purposive sampling and divided into two groups: 10 received postpartum exercise and 10 received oxytocin massage. Uterine involution was assessed by fundal height observation before and after intervention. Data were analyzed using t-tests with a significance level of p < 0.05. Results: Most respondents were aged 26–30 years (50.0%), had a senior high school education (50.0%), and were unemployed (75.0%). Before the interventions, all participants (100%) had abnormal uterine involution. After the interventions, 70% of mothers in the postpartum-exercise group and 50% in the oxytocin-massage group achieved normal uterine involution. Statistical analysis indicated significant improvements in both groups, with a stronger effect in the postpartum-exercise group (mean difference= 0.70; p= 0.001) than in the oxytocin-massage group (mean difference = 0.50; p = 0.025). Conclusion: Both postpartum exercise and oxytocin massage effectively enhanced uterine involution among postpartum mothers, with postpartum exercise demonstrating greater effective­ness. These findings support the integration of structured postpartum exercise programs into routine maternal care to promote uterine recovery and prevent postpartum complications.
Factors Affecting the Severity of Non-Hemorrhagic Stroke
Background: Stroke severity is influenced by multiple factors, including sociodemographic characteristics, health access, and time of treatment. Timely recognition of stroke onset and early hospital arrival are critical to reduce neurological damage. However, evidence on these factors in local Indonesian settings remains limited. This study aimed to analyze factors affecting the severity of non-hemorrhagic stroke among patients at Darmayu Ponorogo Public Hospital. Subjects and Method: This cross-sectional study was conducted at Darmayu Ponorogo Public Hospital from July to September 2025. A total of 200 patients aged ≥18 years, diagnosed with non-hemorrhagic stroke, were selected using an accidental sampling method. The dependent variable was stroke severity, measured using the National Institutes of Health Stroke Scale (NIHSS). Independent variables included age, gender, education, occupation, income, health insurance, distance from home to hospital, and prehospital delay. Data were collected using structured questionnaires and medical records. Analysis was performed using simple logistic regression for bivariate analysis and multiple logistic regression for multivariate analysis. Results: Bivariate analysis showed that prehospital delay was most powerfully significant factor, where patients arriving within ≤4.5 hours had lower odds of severe stroke compared to those with delays >4.5 hours (OR = 0.20; p = 0.020). Multivariate analysis confirmed prehospital delay as an independent predictor (OR = 0.09; 95% CI = 0.01 to 0.62; p = 0.015). Conclusion: Prehospital delay is the most significant determinant of non-hemorrhagic stroke severity. Early hospital arrival (≤4.5 hours) substantially reduces the risk of severe stroke.
Type 2 Diabetes Mellitus is the Risk Factor for Multi-drug Resistance Tuberculosis: A Meta-Analysis
Background: Type 2 Diabetes Mellitus (T2DM) has a significant risk of developing active Tuber-culosis (TB) and complicates its treatment. There is no conclusive evidence on whether TB-T2DM comorbidities are associated with an increased risk of Multidrug Resistant Tuberculosis (MDR-TB). The study aims to analyze and estimate the relationship of T2DM to MDR-TB incidence and to estimate the size of the combined effect. Subjects and Method: This study was a meta-analysis with PICO, Population: patients actively undergoing MDR-TB treatment. Intervention: Patients with comorbid Type 2 Diabetes Mellitus. Comparison: Tuberculosis patients without comorbid Type 2 diabetes mellitus. Output: MDR-TB (Multidrug Resistant Tuberculosis). The articles used in this study were obtained from databases with keywords to search for articles were ("Diabetes Mellitus, Type 2" OR "diabetic" OR "diabetes") AND "tuberculosis" AND ("Tuberculosis, Multidrug-Resistant" OR "drug resistance" OR "multidrug-resistant" OR "multidrug resistant" OR "multidrug resistance" OR "drug-resistant" OR "drug resistant"). Articles were selected based on inclusion criteria, is published in the form of an English full-text article from January 2015 to January 2025, reporting the relationship between T2DM and MDR-TB among TB patients. The articles were selected using the PRISMA flow diagram and analyzed using the Review Manager 5.3 application. Results: This meta-analysis consisted of 9 articles originating from Europe, Asia, Africa and America. Results of the meta-analysis showed that the cohort study of type 2 diabetes mellitus had a 4.11 times greater risk of developing MDR-TB compared to people who did not have type 2 diabetes mellitus. In a control case study of type 2 diabetes mellitus, there was a 3.11 times greater risk of developing MDR-TB than people without type 2 diabetes mellitus, and both were statistically significant (aOR= 3.39; CI 95%= 2.05 to 8.24; p= 0.001). Conclusion: Type 2 diabetes mellitus is a risk factor for MDR TB.
Copyright (c) 2025 Journal of Epidemiology and Public Health
Effect of Noise Exposure on Occupational Stress and Hypertension among Workers: a Meta-Analysis
Background: The work environment greatly affects the health condition of the workers so that there are no work-related accidents or occupational diseases. Noisy physical environmental factors above the threshold value have a risk of causing occupational diseases such as psychological work stress and hypertension. This study aims to analyze the effect of noise exposure on occupational stress and hypertension among workers. Subjects and Method: This study is a systematic review and meta analysis with the following PICO. P: working society, I: exposure noise ≥85 dBA, C: not exposed to noise ≥85 dBA, O: Stress and Hypertension. This study used of articles published between 2009 and 2022 were comprehensively searched for using electronic databases like PubMed, ProQuest, Scopus, and Google Scholar. The keywords to search for articles were “noise exposure” OR “occupational noise” AND “occupational stress” OR “work stress” AND “hypertension”. The adjusted odds ratio was used to evaluate the effect size (aOR). To evaluate the bias risk, the Critical Appraisal Skill Program (CASP) was used. Articles were analyzed using the Review Manager 5.3 application. Results: This study includes 14 papers, using cross-sectional and case-control study designs, from Asia, including Indonesia, Malaysia, China, Jordan, and South Korea. Based on 5 studies cross-sectional on the effects of exposure to noise in the event of work stress, work stress increases 4.88 times compared to workers who are not exposed to noise (aOR=4.88; 95% CI= 1.77 to 13.47; p= 0.002). 9 subgroup studies with cross-sectional and case-control study designs on the effect of noise exposure showed an increase of 2.47 times the incidence of hypertension compared to workers who were not exposed to noise at work (aOR= 2.47; 95% CI= 1.75 to 3.48; p<0.001). Conclusion: Exposure to noise increases the risk of work-related stress and hypertension. Suggestions that can be made are to carry out engineering, periodic measurements, work time management, workforce education and use of PPE.
The Impact of Long-Term Particulate Matter with Diameter Micrometers ≤2.5 Exposure on Type 2 Diabetes Risk: A Meta-Analysis
Background: The rising global prevalence of type 2 diabetes (T2D) has prompted investigations into environmental risk factors beyond traditional lifestyle causes. Air pollution, particularly fine particulate matter (PM₂.₅) has emerged as a potential contributor to diabetes. This systematic review synthesizes evidence from large scale cohort studies to evaluate the association between long term air pollution exposure and T2D risk. Subjects and Method: We analyzed prospective cohort studies (2020–2025) assessing air pollution and incident T2D, sourced from PubMed, Web of Science and EMBASE using the search terms: ("air pollution" OR "PM2.5") AND ("type 2 diabetes" OR "T2D") AND ("cohort" OR "longitudinal"). We using PECO framework (Populatio= adults population; Exposure=High Exposure of PM2.5; Comparison=Low Exposure of PM2.5; Outcomes=T2D). The independent variable was Exposure of PM2.5 and dependent variable was T2D. Primary studies included were cohort manuscript published in english with year of publication between 2020 until 2025, reported adjusted hazard ratios (aHR), and the subjects was adults without diabetes at baseline. Studies were evaluated using the CASP Scale, and data were analyzed using RevMan 13. Results: This study includes 9 papers, using Cohort study designs, from China, United Kingdom, South Korea and United States. PM₂.₅ exposure consistently increased T2D risk with stronger effects at lower exposure levels (aHR = 1.24; 95% Cl = 1.07 to 1.42; p=0.004). Conclusion: Long-term PM₂.₅ exposure significantly increases T2D risk and progression
Effect of Psychoeducation on Postpartum Stress and Knowledge Related to Cyberbullying: An Experimental Study in Central Java
Background: Cyberbullying can trigger postpartum mother to experience anxiety and depression, which impacts their enthusiasm for caring for their babies. This study aimed to know the Impact of Psychoeducation on Postpartum Stress and Knowledge Related to Cyberbullying. Subjects and Method: This was a quasi-experimental study conducted in Surakarta, Central Java, Indonesia. A total of 86 postpartum mothers who experienced cyberbullying were included for study. The dependent variables were knowledge and postpartum stress. The independent variable was psychoeducation. Educational media video given to the respondent once a day for a week. Before and after the intervention, depression was measured using the Edinburgh Postnatal Depression Scale (EPDS). Data was analyzed using the Wilcoxon Test. Results: A total of 86 postpartum mothers had a high school education, were housewives, and married without prior depressive history. Knowledge of cyberbullying increased markedly, with the proportion of respondents in the "high knowledge" category rising from 15.56% to 84.44% (p = 0.02). Anxiety and depression levels showed substantial reduction. The number of mothers in the "normal" category increased from 24.44% to 82.22%, with no respondents remaining in the moderate or severe depression categories post-intervention. Conclusion: Innovative interventions play a positive role in increasing the knowledge level of postpartum mother about cyberbullying and decreasing their anxiety and depression due to cyberbullying.