Majalah Kesehatan Indonesia

Dietary Exposure to Harmful Chemicals and Health Outcomes in Children: A Systematic Review

Delto Loisandro Tanesab, SKM., MPH, Ayu Windy Malisa Menno, S.Pd., M.Pd — Fri, 02 Oct 2026 00:00:00 +0700

Children may be exposed to hazardous chemicals through contaminated foods or chemicals introduced during food production, processing, storage, and packaging. However, evidence on dietary chemical exposure and child health remains fragmented. This systematic review synthesized evidence on food-related chemical exposure and health outcomes in children. PubMed and Scopus were searched for primary studies published between 2016 and 2026. Eligible studies included children or adolescents younger than 18 years, assessed dietary or food-related chemical exposure, and reported health outcomes or biological responses. Studies were excluded if they lacked relevant outcomes, focused on non-dietary exposure, included adults only, or investigated microbial contaminants. Of 838 records identified, 23 studies met the eligibility criteria. These examined endocrine-disrupting chemicals and plasticizers, mycotoxins, metals and metalloids, fluoride, melamine, processing-related contaminants, natural plant toxins, and chemical mixtures. Seventeen studies reported direct health outcomes, and six reported intermediate biological responses. Associations involved growth, neurodevelopment, cognitive and pubertal development, cardiometabolic risk, dental outcomes, renal and oxidative stress biomarkers, immune and microbiome responses, respiratory and allergic outcomes, and clinical toxicity. The strength and consistency of associations varied across chemical-outcome relationships. Overall, substantial heterogeneity, methodological limitations, and limited evidence for several chemical-outcome pairs constrain causal interpretation.

Simple Clinical and Behavioral Markers for Early Identification of Development Risk in Preschool Children in Primary Healthcare Settings

Fri, 02 Oct 2026 00:00:00 +0700

Background: The preschool period is a critical window for child growth and development, yet in Indonesia early detection of developmental disturbance in primary care remains suboptimal and tends to focus narrowly on physical growth parameters, while behavioral dimensions of development receive comparatively little attention. Purpose: This study aimed to examine simple clinical and behavioral indicators as combined markers for the early identification of developmental risk among preschool children in a primary healthcare setting. Method: An analytical observational study with a cross-sectional design was conducted among 110 preschool children aged 3–5 years, recruited through purposive sampling from the catchment area of a primary health care facility. Developmental risk was assessed using the Pre-Screening Developmental Questionnaire (KPSP). Clinical indicators (weight-for-age, height-for-age, mid-upper arm circumference) and behavioral indicators (dietary pattern, physical activity, parental stimulation, and social interaction) were measured and analyzed using chi-square tests and multiple logistic regression. Result: Of the 110 children studied, 42 (38.2%) were classified as at risk of developmental disturbance. Bivariate analysis showed that all three clinical indicators and dietary pattern were significantly associated with developmental risk (p<0.001), whereas physical activity, parental stimulation, and social interaction were not (p>0.05). Multivariate analysis confirmed four independent predictors: height-for-age (AOR=4.15), weight-for-age (AOR=3.98), dietary pattern (AOR=3.94), and mid-upper arm circumference (AOR=3.90), together explaining 25% of the variance in developmental risk (Nagelkerke R²=0.25). Conclusion: Simple anthropometric measurement combined with a basic dietary-pattern assessment can meaningfully identify preschool children at higher risk of developmental disturbance, supporting the integration of nutritional and developmental screening into a single, low-cost framework for routine use in Posyandu and Puskesmas.

Abstrak: Latar Belakang Masa prasekolah merupakan periode kritis bagi pertumbuhan dan perkembangan anak. Namun, di Indonesia, deteksi dini gangguan perkembangan di pelayanan kesehatan primer masih belum optimal dan cenderung berfokus pada parameter pertumbuhan fisik, sementara dimensi perilaku dalam perkembangan anak relatif kurang mendapatkan perhatian. Tujuan Penelitian ini bertujuan untuk menganalisis indikator klinis dan perilaku sederhana sebagai penanda gabungan untuk mengidentifikasi secara dini risiko gangguan perkembangan pada anak usia prasekolah di pelayanan kesehatan primer. Metode: Penelitian observasional analitik dengan desain cross-sectional dilakukan pada 110 anak usia prasekolah berusia 3–5 tahun yang direkrut menggunakan teknik purposive sampling dari wilayah kerja suatu fasilitas pelayanan kesehatan primer. Risiko gangguan perkembangan dinilai menggunakan Kuesioner Pra-Skrining Perkembangan (KPSP). Indikator klinis yang meliputi berat badan menurut umur, tinggi badan menurut umur, dan lingkar lengan atas, serta indikator perilaku yang meliputi pola makan, aktivitas fisik, stimulasi orang tua, dan interaksi sosial diukur dan dianalisis menggunakan uji chi-square dan regresi logistik berganda. Hasil: Dari 110 anak yang diteliti, sebanyak 42 anak (38,2%) diklasifikasikan berisiko mengalami gangguan perkembangan. Analisis bivariat menunjukkan bahwa ketiga indikator klinis dan pola makan memiliki hubungan yang signifikan dengan risiko gangguan perkembangan (p<0,001), sedangkan aktivitas fisik, stimulasi orang tua, dan interaksi sosial tidak menunjukkan hubungan yang signifikan (p>0,05). Analisis multivariat mengonfirmasi empat prediktor independen, yaitu tinggi badan menurut umur (AOR=4,15), berat badan menurut umur (AOR=3,98), pola makan (AOR=3,94), dan lingkar lengan atas (AOR=3,90). Keempat variabel tersebut secara bersama-sama menjelaskan 25% variasi risiko gangguan perkembangan (Nagelkerke R²=0,25). Kesimpulan: Pengukuran antropometri sederhana yang dikombinasikan dengan penilaian dasar pola makan dapat secara bermakna mengidentifikasi anak usia prasekolah yang memiliki risiko lebih tinggi mengalami gangguan perkembangan. Temuan ini mendukung integrasi skrining status gizi dan perkembangan ke dalam satu kerangka yang sederhana dan berbiaya rendah untuk digunakan secara rutin di Posyandu dan Puskesmas.

Exploring Training Needs to Improve Tuberculosis Notification in the Private Healthcare Sector: A Qualitative Study

Fri, 02 Oct 2026 00:00:00 +0700

Tuberculosis (TB) under-notification remains a challenge in pluralistic healthcare systems, where cases managed in private healthcare settings may not be captured in national surveillance systems. This study explored the training needs of physicians working in private healthcare settings to improve TB notification practices. A qualitative exploratory study was conducted among 10 physicians working in private clinics and independent practices in Batam, Indonesia. Participants were purposively selected based on experience managing TB cases. Semi-structured interviews were conducted between May and July 2026, audio-recorded, transcribed verbatim, and analyzed using thematic analysis. TB notification practices were shaped by interactions between provider competence, clinical workflow constraints, and the reporting environment. Although participants were aware of notification requirements, competing clinical responsibilities, limited workflow integration, and perceived reporting-system complexity constrained routine notification. Participants identified needs for practical competencies, including step-by-step guidance and hands-on practice, together with flexible educational delivery and continued implementation support. They also emphasized that system- and organizational-level barriers could not be addressed through training alone. Improving TB notification may therefore require practical, context-sensitive training integrated with ongoing support and enabling workflow and reporting conditions.

Abstrak: Tuberkulosis (TB) yang tidak dilaporkan masih menjadi tantangan dalam sistem pelayanan kesehatan pluralistik, di mana kasus yang ditangani di fasilitas kesehatan swasta mungkin tidak tercatat dalam sistem surveilans nasional. Penelitian ini bertujuan mengeksplorasi kebutuhan pelatihan dokter di fasilitas kesehatan swasta untuk meningkatkan praktik notifikasi TB. Penelitian kualitatif eksploratif dilakukan terhadap 10 dokter yang bekerja di klinik swasta dan praktik mandiri di Batam, Indonesia. Peserta dipilih secara purposif berdasarkan pengalaman menangani kasus TB. Wawancara semi-terstruktur dilakukan antara Mei dan Juli 2026, direkam, ditranskripsikan secara verbatim, dan dianalisis menggunakan analisis tematik. Praktik notifikasi TB dipengaruhi oleh interaksi antara kompetensi penyedia layanan, kendala alur kerja klinis, dan lingkungan pelaporan. Meskipun peserta memahami persyaratan notifikasi, tanggung jawab klinis, keterbatasan integrasi notifikasi dalam alur kerja, dan kompleksitas sistem pelaporan yang dirasakan menjadi hambatan dalam pelaksanaan notifikasi rutin. Peserta mengidentifikasi kebutuhan akan kompetensi praktis, termasuk panduan langkah demi langkah dan praktik langsung, serta metode pelatihan fleksibel dan dukungan implementasi berkelanjutan. Peserta juga menekankan bahwa hambatan sistem dan organisasi tidak dapat diatasi melalui pelatihan saja. Peningkatan notifikasi TB memerlukan pelatihan praktis dan sesuai konteks yang terintegrasi dengan dukungan berkelanjutan serta kondisi alur kerja dan sistem pelaporan yang mendukung.

Patient Characteristics Associated with Medication Adherence Among Patients with Type 2 Diabetes Mellitus in Primary Care: A Cross-Sectional Study

Fri, 02 Oct 2026 00:00:00 +0700

Medication adherence is essential for effective self-management in type 2 diabetes mellitus (T2DM), yet its association with routinely measured patient characteristics may vary across healthcare settings. This study examined sociodemographic and clinical characteristics associated with medication adherence among patients with T2DM receiving oral antidiabetic therapy in primary care. An analytical cross-sectional study was conducted among 84 patients at a primary care clinic in Cimahi, West Java, Indonesia, using accidental sampling. Medication adherence was assessed with the Indonesian version of the eight-item Morisky Medication Adherence Scale (MMAS-8) and categorized as low, moderate, or high. Bivariate associations were tested using chi-square analysis, followed by ordinal logistic regression. Participants had a mean age of 53.45 ± 11.75 years, and 69.0% were female. Low, moderate, and high adherence were reported by 29.8%, 39.3%, and 31.0% of participants, respectively. Adherence differed significantly across age groups (p=0.032) and diabetes-duration categories (p=0.018) in bivariate analyses. The proportional-odds assumption was satisfied (p=0.092), and the overall ordinal regression model was significant (likelihood-ratio χ²=12.13, df=5, p=0.033). However, no individual adjusted association reached statistical significance. Age ≥60 years (aOR=2.55; 95% CI: 0.90–7.27; p=0.079) and diabetes duration ≥5 years (aOR=2.41; 95% CI: 0.91–6.38; p=0.077) showed higher estimated odds of greater adherence. Routine patient characteristics alone may be insufficient to identify adherence difficulties, supporting individualized assessment of medication-taking barriers in primary care.

Abstrak: Kepatuhan minum obat merupakan komponen penting dalam pengelolaan mandiri yang efektif pada pasien diabetes melitus tipe 2 (DMT2), namun hubungannya dengan karakteristik pasien yang secara rutin diukur dapat bervariasi antarsetting pelayanan kesehatan. Penelitian ini bertujuan untuk menganalisis hubungan antara karakteristik sosiodemografis dan klinis dengan kepatuhan minum obat pada pasien DMT2 yang menerima terapi antidiabetik oral di pelayanan kesehatan primer. Penelitian analitik dengan desain potong lintang dilakukan terhadap 84 pasien di sebuah fasilitas pelayanan primer di Cimahi, Jawa Barat, Indonesia, dengan menggunakan teknik accidental sampling. Kepatuhan minum obat diukur menggunakan Morisky Medication Adherence Scale delapan item (MMAS-8) versi Indonesia dan dikategorikan menjadi tingkat kepatuhan rendah, sedang, dan tinggi. Hubungan bivariat dianalisis menggunakan uji chi-square, kemudian dilanjutkan dengan regresi logistik ordinal. Rerata usia peserta adalah 53,45 ± 11,75 tahun dan 69,0% berjenis kelamin perempuan. Kepatuhan rendah, sedang, dan tinggi masing-masing ditemukan pada 29,8%, 39,3%, dan 31,0% peserta. Pada analisis bivariat, tingkat kepatuhan berbeda secara signifikan menurut kelompok usia (p=0,032) dan kategori durasi diabetes (p=0,018). Asumsi proportional odds terpenuhi (p=0,092), dan model regresi ordinal secara keseluruhan signifikan secara statistik (likelihood-ratio χ²=12,13; df=5; p=0,033). Namun, tidak ada hubungan teradjustasi individual yang mencapai signifikansi statistik. Peserta berusia ≥60 tahun memiliki estimasi peluang yang lebih tinggi untuk berada pada kategori kepatuhan yang lebih tinggi (aOR=2,55; 95% CI: 0,90–7,27; p=0,079), demikian pula peserta dengan durasi diabetes ≥5 tahun (aOR=2,41; 95% CI: 0,91–6,38; p=0,077). Karakteristik pasien yang diukur secara rutin saja kemungkinan belum cukup untuk mengidentifikasi masalah kepatuhan, sehingga diperlukan penilaian individual terhadap hambatan dalam penggunaan obat di pelayanan kesehatan primer.

Patient-Centered Care Communication and Patient Outcomes in Cardiovascular Patients: Evidence from Structural Equation Modeling

Fri, 02 Oct 2026 00:00:00 +0700

This study examined the associations between patient-centered care (PCC)-based communication and patient understanding, engagement, satisfaction, and adherence among individuals with cardiovascular disease at Pakuhaji Hospital, Indonesia. A quantitative cross-sectional analytic design was employed. Data were collected from 100 cardiac patients using validated structured questionnaires and analyzed using Structural Equation Modeling (SEM) with AMOS, including confirmatory factor analysis and structural path analysis. The measurement model demonstrated satisfactory validity and reliability. Among PCC indicators, verbal communication and shared decision-making showed the strongest contributions, whereas interactive education showed the weakest contribution. Structural analysis indicated that PCC-based communication was not significantly associated with patient understanding (β = −0.155, p = 0.160). However, the model identified a significant sequential indirect pathway, in which understanding was positively associated with engagement, engagement was associated with satisfaction, and satisfaction was associated with adherence behavior. The overall model demonstrated acceptable goodness-of-fit indices, supporting its structural adequacy. These findings suggest that PCC-based communication is associated with patient outcomes through a sequence of interrelated constructs rather than through direct associations with adherence. Strengthening patient comprehension and engagement may be relevant for improving downstream behavioral outcomes in cardiovascular care.