Berita Kedokteran Masyarakat

Legal reform, pandemic, and adolescent marriage: a change-point analysis of marriage dispensation trends in Yogyakarta, 2010–2021

Dedik Sulistiawan — 2026-08-29

Purpose: This study examined temporal trends in adolescent marriage dispensation applications in the Special Region of Yogyakarta between 2010 and 2021 to better understand the impact of both structural and contextual shifts.

Methods: This quantitative study used a time-series design and data on marriage dispensation applications from January 2010 to March 2021. Data were obtained from the High Religious Court and the Religious Courts of each district/city across the Special Region of Yogyakarta, using court-issued dispensations as a proxy for adolescent marriage under definitions applicable before and after the 2019 legal amendment. To detect significant shifts over time, we modeled overall trends and applied change-point analysis (CPA) using multiple algorithms, including mean, variance, and mean-variance approaches.

Results: A statistically significant change point was identified in the second quarter of 2019. Prior to this period, marriage dispensation applications fluctuated within a stable range. After quarter 2 2019, applications increased sharply, peaking in quarter 3 2020 during the COVID-19 pandemic. The variance-based change-point analysis provided the best model fit (MBIC = 11.35), indicating heterogeneous community responses to the revised marriage law that were likely exacerbated by the COVID-19 pandemic.

Conclusion: The variance-based change point indicates that the legal reform was followed by heterogeneous community responses, which were likely exacerbated by the socioeconomic disruptions of the COVID-19 pandemic. These findings highlight the need to accompany legal reform with community preparedness and public health interventions to minimize unintended increases in marriage dispensation applications.

Epidemiological characteristics and risk factors of a Chikungunya outbreak in Bantul, Indonesia (April-May 2024): a matched case-control study

Nilna Saadatar Rohmah — 2026-08-29

Purpose: The study aims to confirm the outbreak and identify associated risk factors of Chikungunya-like illnesses in the working area of Puskesmas Imogiri I, Bantul.

Methods: A matched case-control design (1:1) using neighborhood control was conducted. Cases (n=86) were individuals with fever and arthralgia residing in Garjoyo and Karangtalun, and controls (n=86) were healthy individuals from the same area. Purposive sampling was conducted among 731 individuals identified as the population at risk within a 100-meter radius of confirmed cases. Data were collected using standardized questionnaires and Rapid Diagnostic Test (RDT) and analyzed using conditional logistic regression.

Results: Multivariate analysis identified low income (aOR 8.49; 95% CI: 2.76-26.13), travel history to endemic areas (aOR 7.29; 95% CI: 1.19-44.54), and male sex (aOR 2.67; 95% CI:1.19-5.97) as significant risk factors. Paradoxically, the absence of larvivorous fish (aOR 0.13; 95% CI: 0.06-0.32) and lack of mosquito-repellent plants (aOR 0.06; 95% CI: 0.01-0.57) were associated with lower odds of infection, indicating a profound temporal bias following post- outbreak interventions.

Conclusion: This localized outbreak was primarily driven by mobility-related viral importation and socioeconomic vulnerabilities. The findings underscore the limitations of reactive interventions and highlight the need for proactive, community-based larval control integrated with travel-aware surveillance to prevent future arboviral transmission.

Quality of life in patients with chronic kidney failure: self-efficacy as a determinant factor

Maria Magdalena Dwi Wahyuni — 2026-08-29

Purpose: Self-efficacy is a key determinant of self-care ability and quality of life in patients with chronic kidney disease (CKD) undergoing hemodialysis. This study aimed to analyze self-efficacy among hemodialysis patients at Prof. Dr. W. Z. Johannes Hospital in Kupang to improve their quality of life.

Methods: This was an observational, quantitative, cross-sectional study. We included 80 CKD patients undergoing routine hemodialysis using total sampling. Data were collected through interviews using structured questionnaires and medical records from January to September 2025. We analyzed the data using PLS-SEM in SmartPLS version 3.2.9 to examine relationships among variables.

Results: Self-efficacy had a significant direct effect on the quality of life (T-value = 11.077) and significantly influenced self-care agency and self-care demand. The generality and strength dimensions were the most dominant indicators forming self-efficacy. Social support indirectly improved quality of life by increasing self-efficacy. Most participants demonstrated low self-efficacy and poor quality of life across the physical, psychological, social, environmental, and spiritual domains.

Conclusion: Self-efficacy plays a central role in improving self-care capabilities and the quality of life among hemodialysis patients. Strengthening self-efficacy through social support and biopsychosocial interventions is essential for developing effective self-care models that enhance patients' quality of life.

Evaluation of the management of iron tablet supplementation program for adolescent girls in Indonesia: a scoping review

Noerfitri Noerfitri — 2026-08-29

Purpose: This study aimed to analyze the evaluation of the management of iron and folic acid supplementation programs for adolescent girls in Indonesia using the input–process–output–outcome (IPOO) framework.

Methods: This scoping review followed PRISMA-ScR guidance. Six information sources, including Google Scholar, PubMed, ScienceDirect, Semantic Scholar, Taylor & Francis Online, and Wiley Online Library, were searched for studies published up to 2025 using terms related to program management, iron supplementation, adolescent girls, and Indonesia. Eligibility criteria were structured using the JBI Population–Concept –Context (PCC) framework, with adolescent girls aged 10–19 years as the population, iron supplementation program management as the concept, and Indonesia as the context. Studies published in English or Indonesian were eligible, while reviews, editorials, and commentaries were excluded.

Results: Of 2,692 records identified, 28 reports were sought for retrieval, 24 underwent full-text assessment, and seven studies met the eligibility criteria, comprising six qualitative studies and one mixed-methods study. The IPOO synthesis identified limited human resources and program resources as key input constraints, while weak monitoring, irregular supervision, and untimely distribution represented major process barriers. These implementation challenges contributed to inadequate program coverage, poor adherence to iron supplementation, and limited knowledge among adolescent girls.

Conclusion: Iron supplementation programs showed inconsistent effectiveness due to persistent implementation barriers. Strengthening program management, resource capacity, super- vision, health education, monitoring and reporting systems, and cross- sectoral collaboration between health services and schools is essential to improve adherence and ensure that program outputs translate into sustain- ed behavioral and health outcomes.

Antimicrobial resistance among WHO priority carbapenem-resistant pathogens in Indonesia: a bibliometric analysis and scoping review

Anwar Rovik — 2026-08-29

Purpose: Carbapenem-resistant organisms (CROs) designated as "Critical Priority" on the 2024 Bacterial Priority Pathogens List (BPPL) pose a major public health risk in Indonesia. However, the country's research focus and the precise epidemiological burden of these pathogens remain poorly understood.

Methods: This study combined bibliometric analysis with a scoping review. Metadata were extracted from Scopus and PubMed (February 2026) using targeted Boolean queries. Bibliometric mapping was conducted in VOSviewer (v1.6.20), and the scoping review followed PRISMA-ScR guidelines and the PECO framework. The analysis focused on carbapenem-resistant Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), and Enterobacterales (CRE) in Indonesian clinical settings.

Results: Eleven studies were included from 31 identified records. Research output increased after 2019, with activity primarily centered in Jakarta and Surabaya, and a noticeable shift from phenotypic to molecular characterization after 2020. Key findings include a 50.5% resistance rate in CRAB and high rates of carbapenemase gene carriage in CRPA (69.7%) and K. pneumoniae (96.0%), with blaNDM identified as the predominant genotype. Clinically, CRAB infections were associated with significantly longer ICU stays and more than twice the hospitalization costs compared with susceptible cases.

Conclusion: Carbapenem resistance among WHO critical priority pathogens in Indonesia is significant and genetically diverse, imposing a serious clinical and economic burden. Current research is largely concentrated in Java. To address this crisis, expanded national surveillance, decentralized research capabilities, and stronger infection prevention and control (IPC) programs are needed nationwide.