INTRODUCTIONThe presence and density of tobacco retailers is associated with the perception of high availability of cigarettes and ease of purchase. Indonesia is the second largest cigarette market in the world with an increasing smoking rate among young people aged 10–18 years. Our study aims to assess density of cigarette outlets in neighbourhoods and around schools, and to evaluate correlation between retailer proximity to schools and retailer selling practices.METHODSWe conducted a geographical mapping and then an audit survey of 1000 randomly selected cigarette retailers in Denpasar, Bali, Indonesia. We measured neighbourhood retailer density, and retailer proximity to schools. We linked the coordinate data to the audit data to assess the association between retailer distance from schools with likelihood of selling tobacco to young people and selling single cigarette sticks.RESULTSWe mapped 4114 cigarette retailers in Denpasar, the most common type was a kiosk, 3199 (77.8%), followed by mini market/convenience stores, 606 (14.7%). Retailer density was 32.2/km2 and 4.6/1000 population. We found that 37 (9.7 %) of the 379 schools in Denpasar have at least one cigarette retailer within a 25 m radius and 367 (96.8%) within a 250 m radius. Of the 485 audited retailers within a 250 m radius of a school, 281 (57.9%) admitted selling cigarettes to young people and 325 (67.0%) sold cigarettes as single sticks. Cigarette retailers were less likely to sell cigarettes to young people based on distance from schools, but this was only significant at the furthest distance of more than 500 m from schools.CONCLUSIONSIn an unregulated retailer setting such as Indonesia, cigarette retailers are ubiquitous and selling to young people is commonplace. The Indonesian government should enforce the prohibition on selling to young people and should regulate cigarette retailers to reduce youth access to cigarettes.

ObjectiveTo assess tobacco promotion intensity, retailer behaviours and tobacco company efforts to link retailer marketing to online channels.MethodsWe completed an audit of tobacco advertisements and promotions at 1000 randomly selected cigarette retailers in Denpasar, Bali, Indonesia that included an observation checklist, digital photos and structured interviews with retailers. We then calculated the tobacco promotion index for each retailer and made comparisons based on store types. Next, we conducted a photo analysis from 100 randomly selected retailers to explore links to online channels and other promotional cues to engage young people.ResultsMini-markets have both the highest total number of promotions and the highest indoor promotion index with a mean score of 5.1 and 3.7, respectively. Kiosks have the highest outdoor promotion index with a mean score of 1.6. Most of the retailers (98.9%) displayed cigarettes, more than half of kiosk retailers (54.8%) and mini-market retailers (56.3%) admitted selling cigarettes to young people, and 74% of kiosk retailers sell single stick cigarettes. We found links to online marketing, including two hashtags and a company website. Promotional materials also included youth-focused content such as English taglines, new products and small packs.ConclusionTobacco companies in Indonesia have strategically differentiated their advertisements based on retailer type and have bridged conventional retailer marketing to online channels. Reforming Indonesian tobacco laws to include bans on single sticks and small pack sales, point-of-sale advertising, including displays, and enforcement of laws on sales to minors is urgently required.

No abstract

No abstract

Diabetes mellitus (DM) increases the risk of developing pulmonary tuberculosis (TB) disease. Therefore, pulmonary TB screening among DM patients is essential. This study aimed to identify factors associated with participation of DM type II patients in pulmonary TB screening using chest X-ray. This was a cross-sectional analytic study and was part of TB-DM screening study in Denpasar, Bali, Indonesia. The sample consisted of 365 DM type II patients selected by quota sampling among DM type II patients joining the screening program from January until March 2016 in 11 public health centres in Denpasar. Data were collected via structured interviews. The contributing factors were determined by modified Poisson regression test for cross-sectional data. From the findings, less than half (45.48%) of DM type II patients participated in chest X-ray examination for TB. Factors associated with participation in pulmonary TB screening were having a higher educational level [APR = 1.34, 95% CI (1.07–1.67)], having family member who developed pulmonary TB disease [APR = 1.47, 95% CI (1.12–1.93)], the travel time to referral hospital for screening being ≤ 15 minutes [APR = 1.6, 95% CI (1.26–2.03)], having health insurance [APR = 2.69, 95% CI (1.10–6.56)], and receiving good support from health provider [APR = 1.35, 95% CI (1.06–1.70)]. Therefore, training for health provider on providing counselling, involvement of family members in screening process, and improving the health insurance coverage and referral system are worth considering.

Background: Since 2013, City of Denpasar government has adopted a smoke-free law. Implementation of the law faces several obstacles, partly due to the high social acceptability of smoking in the city, where cigarette and smoking has been deeply engrained within social life and become part of hospitality. This study aims to assess the smoke-free law compliance and to explore the social norms that may affect the compliance. Design and Methods: The study was a mix of cross-sectional compliance survey and qualitative exploration conducted in Denpasar in 2019. Survey included 538 samples, which were selected using stratified random sampling and a walking protocol. The qualitative data was collected through in-depth interviews and Focus Group Discussion (FGD) in four sub-districts of Denpasar.Results: Of the 538 venues, 32.9% complied with the seven compliance indicators. The university has the highest compliance (83.3%), while public places including worship places have a low compliance. The three most common violations were the absence of no-smoking signage (58.6%), provision of ashtray (17.5%), and smell of tobacco smoke (15.8%). The poor compliance was related to the lack of awareness of the regulation, and the fact that smoking is highly acceptable and part of the culture. The informants highlighted the essential role of public figures and potency of local policy as social disapproval of smoking.Conclusions: Compliance to the smoke-free law in Denpasar remains low, continuous education, socialization and improved supervision are crucial. Meanwhile, social and cultural acceptance of smoking is considered as an essential factor that hampers the implementation of the smoke free law.

ABSTRAKLama rawat inap merupakan faktor utama yang mempengaruhi beban biaya pasien stroke rawat inap. Penelitian ini bertujuan untuk mengidentifikasi faktor penentu lama pasien rawat inap di RSUD Klungkung tahun 2016. Penelitian ini menggunakan desain kohort retrospektif. Metode total sampling yang digunakan dalam pemilihan sampel dan 149 pasien stroke yang dipilih dirawat di RSUD Klungkung pada 2016. Data sekunder dikumpulkan dengan meninjau rekam medis dari file sampel. Analisis dilakukan dengan menggunakan analisis survival dengan metode Kaplan-Meier dan Cox Regression. Hasil menunjukkan bahwa rata-rata lama rawat inap di antara pasien stroke adalah 9 hari. Rata-rata lama rawat inap di antara pasien stroke dengan diabetes mellitus, komplikasi medis selama rawat inap dan stroke hemoragik adalah 7 (CI 95%: 6 - 8) hari, 11 (CI 95%: 7 - -) hari dan 15 (CI 95%: 14 - 17) hari. Diabetes mellitus, komplikasi medis dan jenis stroke adalah faktor yang mempengaruhi lama rawat inap di antara pasien stroke dengan HR = 1,82 (CI 95%: 1,09 - 3,06), HR = 2,73 (CI 95%: 1,36 - 5,46) dan HR = 3,52 (CI 95%: 1.89 - 6.57). Berdasarkan jenis stroke, diabetes mellitus berpengaruh signifikan terhadap lama rawat inap di antara pasien stroke iskemik dan hemoragik dengan HR = 1,74 (CI 95%: 1,01 - 2,99) dan HR = 2,26 (CI 95%: 5,78 - 8,87). Sementara itu, komplikasi medis memiliki efek signifikan di antara pasien stroke iskemik hanya dengan HR = 2,65 (CI 95%: 1,24 - 5,68). Penentu utama yang mempengaruhi lama rawat inap di antara pasien stroke di RSUD Klungkung adalah diabetes mellitus, komplikasi medis dan jenis stroke. Dianjurkan untuk mengontrol faktor-faktor risiko melalui integrasi dengan program Prolanis dan meningkatkan manajemen terutama pada pasien stroke hemoragik untuk mempersingkat lamanya tinggal dan penurunan angka kematian.Kata Kunci : Kecenderungan, Lama Rawat Inap, Stroke, RSUD Klungkung

Some sub-districts in Bali province have stunting prevalence more that national average which might be associated with the environmental health condition in those areas. This study aimed to examine the association between environmental health factors with stunting prevalence among children age 2-5 years. Case-control study was conducted at Karangasem district with 101 case and 101 control. Cases were obtained from the list of stunted children from the result of PSG 2017 in 4 sub-districts. The controls were children at the same age and sex which were randomly selected from the available list of children in the health center. Bivariate and multivariate (logistic regression) were used for analysis. The study shows that cases and controls were comparable for age, sex, health access, nutrition sensitive intervention, infection history, water access, solid waste management. Cases and controls differed for variables: education level of parents, toilet access and ownerships, disposal of child's feces, hand washing practice dan facilities, and distance to livestock shelter. Logistic regression showed that only father's education (AOR=2.429; 95%CI: 1.304-4.525) associated with stunting among children age 2-5 years. The optimum prediction model was obtained with variables of father's education, disposal of child's feces and distance to animal shelter. In conclusion, only father's education was found associated with stunting and only weak associations were found between environmental health factors and stunting.