BKM Public Health and Community Medicine

Implementing tuberculosis preventive therapy: a qualitative study

Dina Apriana — 2025-08-14

Purpose: This study aims to analyze the implementation of tuberculosis preventive therapy (TPT) in Majalengka District using the Van Meter and Van Horn policy implementation model, focusing on inter-organizational communication, resources, implementer disposition, implementing agency characteristics, and economic-socio-political conditions.

Methods: This qualitative study employed a case study approach involving six selected community health centers with the highest and lowest TPT coverage. Data were collected through in-depth interviews with six tuberculosis (TB) program managers, five triangulation informants, direct observations, and document reviews. Data were analyzed thematically, involving data reduction, presentation, and inductive conclusion drawing.

Results: The study found that communication inconsistencies across national, provincial, and district levels led to information gaps at the community health center level. Implementation was hindered by limited human resources, diagnostic tools, and logistics, as well as the absence of clear internal regulations. However, proactive roles by TB program managers and cadres, supported by community-based outreach strategies, helped mitigate barriers. Social stigma, indirect costs, and low intersectoral coordination remained significant challenges.

Conclusion: TPT implementation faced barriers such as inconsistent communication, limited resources, and unclear regulations. Effective TPT implementation requires coordination by the Ministry of Health, improved diagnostics by health facilities, empowerment of health workers and cadres, and strong support from local governments.

Immune response in IGF-1 and growth parameters among infected children

Eva Ardianah — 2025-08-29

Purpose: Infections in children can affect weight gain and linear growth by influencing metabolism and nutrition. Chronic inflammation results in growth failure mediated by pro-inflammatory cytokines and poor nutritional intake, which affects the GH/IGF-1 axis. This study aimed to investigate the impact of the inflammatory response on children's anthropometry, particularly HAZ, and the role of IGF-1.

Methods: An observational study with a cross-sectional design was conducted from September 2021 to July 2022. The study involved children diagnosed with infections. The subjects had undergone a physical and laboratory investigation, which included a thorax photo, urine culture, Mantoux test, and complete blood test in a hospital setting. A complete medical history was obtained from the pediatrician.

Results: The prevalence of undernutrition was 37.33%; the prevalence of underweight/severely underweight, stunted/severely stunted, and wasted/severely wasted was 25.33%, 30.66%, and 14.67% respectively. Stunted/severely stunted was more prevalent in subjects under 2 years old, compared to subjects more than 2 years old (22/41 vs. 7/34, p=0.014). SEM analysis revealed that the inflammatory response affected IGF-1 levels (r=0.850, p=0.000), while IGF-1 affected body composition (r=0.245, p=0.025), and then affected HAZ (r=1.000, p=0.000). The effect of IGF-1 on HAZ appears to be indirect, acting through body composition. Parental height has a weak, albeit significant, effect on body composition (r=0.101, p=0.025) and HAZ (r=0.192, p=0.040). Univariate analysis revealed strong correlations between IL-6 and IL-10 and IGF-1 (r=0.870, p=0.000 and 0.876, p=0.000, respectively). In contrast, parental height showed a correlation with HAZ/LAZ (r=0.319, p=0.000). Maternal height was correlated positively with WAZ (r=0.320, p=0.044).

Conclusion: The prevalence of stunting among children under two years of age indicates that early childhood constitutes a critical period for intervention in growth and development. Inflammatory response has been demonstrated to influence IGF-1 levels in children. The role of IGF-1 on HAZ was mediated by body composition.

Promoting social transformation through basic social work training for the Nagari apparatus: a case study in West Sumatra

Hermaini Siswati — 2025-08-29

Purpose: This study aims to analyze why social support has not yet successfully transformed parenting behavior among caregivers of stunted toddlers in Nagari Tanjung, West Sumatra, and to identify internal and external barriers that prevent caregivers from accessing and utilizing the available support.

Methods: We used an exploratory qualitative approach with a case study design, involving 47 caregivers of stunted toddlers. The findings highlight parenting barriers and provide a compelling argument for promoting Basic Social Work Training (PDPS) among nagari officials, thereby enabling them to integrate various social components within their communities effectively. We collected data through in-depth interviews, participatory observation, and documentation, then thematically analyzed it based on internal and external factor categories. Data collection was conducted in Nagari Tanjung, West Sumatra, in 2024.

Results: The main barriers include low nutritional literacy, stigma, shame, minimal father involvement, and beliefs in myths such as palasik. Social support from family, community, health workers, and the government has not been effective due to a lack of integration, inadequate cultural contextualization, and insufficient attention to psychosocial aspects. Moreover, the role of community social workers (PSM) at the village level has not been fully optimized, further exacerbating the situation.

Conclusion: Community- and culture-based interventions are necessary, along with capacity-building for Nagari government officials through PDPS, to enable them to function similarly to social workers. The Ministry of Social Affairs should extend this training to the village or nagari level, not just at the provincial or district level. Strengthening the roles of nagari officials, village midwives, and community cadres (PKK, Posyandu, Family Planning, PPKBD, Human Development Cadres, PSM, and PKH facilitators) can help coordinate a sustainable and culturally contextual parenting support system.