Gema Lingkungan Kesehatan (GeLinKes) (e-ISSN: 2407-8948) is a peer-reviewed, open-access scientific journal dedicated to advancing knowledge in health sciences and medicine, with a particular emphasis on environmental health. The journal is published by Politeknik Kesehatan Kemenkes Surabaya and serves as an academic platform for disseminating evidence-based research, applied studies, and policy-relevant findings that contribute to environmental sustainability and population health improvement. Starting in 2025, the journal adopts a quarterly publication schedule, issuing four editions annually to accommodate the growing number of high-quality submissions.
Effectiveness of Virtual Reality-Based Health Promotion and Safety Training in Schools
Health and safety within the school environment are essential to ensuring a secure and sustainable learning process. Data from the Ministry of Health (2022) indicate that only 45% of secondary schools have an established emergency preparedness programme. A preliminary assessment at SMK Atisa Dipamkara also revealed substantial gaps: 73% of students had never participated in a fire simulation, and existing training remained conventional without interactive media. Nutritional issues were similarly prominent, as 60% of students frequently skipped breakfast, potentially impairing concentration and physical endurance. This study examined the effectiveness of a virtual reality (VR)-based training model integrating fire emergency simulation and balanced nutrition education. The study was conducted at SMK Atisa Dipamkara, Tangerang, from May to July 2025. A quasi-experimental design was employed involving 100 respondents assigned to VR and conventional training groups. Data were collected through knowledge tests, skills assessments, and Likert-scale satisfaction questionnaires. The findings demonstrate significant improvements in knowledge and skills among participants receiving VR training (p < 0.001), with outcomes superior to the conventional group. High satisfaction scores (M = 4.36; SD = 0.53) reflected strong perceptions of realism, interactivity, engagement, and active participation. VR-based training effectively addresses critical gaps in school preparedness and represents a strategic approach for strengthening comprehensive safety and health promotion programmes in educational settings.
Copyright (c) 2026 Gema Lingkungan Kesehatan https://creativecommons.org/licenses/by-sa/4.0
Estimated Health Risk of Cadmium and Chromium in Elderly Blood Cockle Consumers, Lantebug
This study assessed the non-carcinogenic health risks of Cadmium (Cd) and Chromium (Cr) exposure through blood cockle (Anadara granosa) consumption among elderly residents in Lantebung, Makassar Strait. Blood cockle samples were collected from six purposively selected points, and Cd and Cr concentrations were analyzed. Health risks were estimated using intake calculations and the Risk Quotient (RQ). Cd and Cr concentrations were generally below national and international food safety limits. However, some elderly individuals, particularly frequent consumers, exceeded the non-carcinogenic risk threshold (RQ > 1). The highest risks were associated with specific sampling points, reflecting localized contamination. Risk factors included high consumption rates, long exposure duration, and lower body weight. These findings suggest that compliance with contaminant limits alone may not ensure safety for vulnerable populations. Regular environmental monitoring, risk communication for high-risk groups, and strengthened pollution control measures are recommended. Public health interventions, including periodic health screening and guidance on safe seafood consumption, are needed to reduce long-term health impacts.
Preliminary Study of Life Cycle Assessment on Food Surplus Redistribution Compared to Food Waste Management in Surabaya
Food waste accounts for approximately 40% of total waste generation in Indonesia and contributes significantly to national greenhouse gas (GHG) emissions. While most food waste is still disposed of in landfills, food surplus redistribution through food banks has emerged as a potential mitigation strategy. This study evaluates the environmental performance of food surplus redistribution compared to conventional food waste management options using a life cycle assessment (LCA) approach. The analysis was conducted at Garda Pangan, Surabaya, with a functional unit of 1 ton of food surplus and assessed three scenarios: (1) landfill disposal, (2) composting and anaerobic digestion, and (3) food surplus redistribution. The assessment applied the CML IA Baseline method and focused on Global Warming Potential (GWP), using SimaPro 9.0 and the Ecoinvent 3 database. The results show that landfill disposal has the highest GWP at 1,920 kg CO₂-eq per ton of food waste, driven primarily by methane emissions from anaerobic decomposition. Composting and anaerobic digestion result in lower impacts, at 1,503 and 1,730 kg CO₂-eq per ton, respectively. In contrast, food surplus redistribution shows a markedly lower GWP of 1.24 kg CO₂-eq per ton of food surplus, as emissions are dominated by transportation activities within a simplified gate-to-gate system boundary. This preliminary analysis relied on secondary inventory data and excluded potential avoided food production impacts; therefore, the estimated GWP for redistribution may underestimate or overestimate actual emissions. These findings highlight the importance of prioritizing food waste prevention and the benefits of food surplus redistribution within integrated waste management strategies to reduce GHG emissions while delivering social co-benefits.
Mosquito Larvae Identification in Water Storage and Assesment of Worker’s Knowledege, Attitudes, and Practices
Vector-borne diseases remain a major public health concern in tropical regions, with dengue fever continuing to be the predominant vector-borne disease in urban Indonesia. Public tourist areas with high human activity may provide favorable breeding sites, making sanitation workers’ roles crucial. This study aimed to identify mosquito breeding characteristics and larval presence in water-holding containers (WHCs) and to describe the knowledge, attitudes, and practices (KAP) of sanitation workers in a historic public open space in an urban setting. A descriptive cross-sectional study using a mixed-methods approach was conducted, combining quantitative entomological surveys with qualitative in-depth interviews. All accessible WHCs at the study site were inspected for larvae, which were collected and morphologically identified, and Aedes larval indices (ABJ/Angka Bebas Jentik, HI, CI) were calculated. Sanitation workers were selected purposively as qualitative informants, and KAP data were analyzed thematically. Seven WHCs were identified, of which two outdoor natural pools (28.57%) were positive for larvae, yielding 13 larvae, all identified as Culex spp., with no Aedes spp. detected. Consequently, Aedes-specific indices showed an ABJ of 100%, HI of 0%, and CI of 0%, indicating a low risk of dengue transmission according to WHO criteria (HI <4% and CI <3%). Sanitation workers demonstrated generally good knowledge, positive attitudes, and routine preventive practices, although understanding of the full 3M Plus concept varied. In conclusion, despite the presence of non-Aedes larvae in outdoor natural containers, the absence of Aedes breeding sites suggests effective dengue vector control supported by routine sanitation practices in the study area.
The Effectiveness of Rice Straw and Cogongrass Straw Soaked Water Attractants on the Number of Aedes spp. Mosquitoes
Aedes spp. mosquitoes are the main vectors of Dengue Hemorrhagic Fever (DHF), which remains a public health problem in Indonesia. Chemical insecticide-based mosquito control has the potential to cause environmental pollution and vector resistance, so safer and more environmentally friendly control alternatives are needed. This study aimed to analyze the effectiveness of rice straw and cogongrass straw-soaked water attractants in attracting Aedes spp. mosquitoes. Method this study used a pure experimental design with a post-test only control group design. The study was conducted at Muhammadiyah Ahmad Dahlan University, Palembang. Traps were placed purposively with a total of 27 observation units consisting of three treatment groups, namely control (water without attractant), rice straw-soaked water attractant, and cogongrass straw-soaked water attractant, each with nine replications. Traps were set for 5–7 days. Data were analyzed using the Shapiro–Wilk normality test, homogeneity test, One Way ANOVA, and the Least Significant Difference (LSD) test with a significance level of 0.05. The results showed the total number of mosquitoes trapped in the control group was 16, in the rice straw attractant group was 31, and in the cogongrass straw attractant group was 32. The average number of mosquitoes in the control group was 2.00 ± 0.67, in the rice straw group was 3.00 ± 1.13, and in the cogongrass straw group was 4.00 ± 1.13. The results of the One- Way ANOVAanalysis showed a significant difference between the treatment groups (p = 0.01). Further LSD tests showed that both attractant groups were significantly different from the control, but there was no significant difference between the rice straw and cogongrass straw attractants. These findings indicate soaked water from rice straw and cogongrass straw was effective in increasing the number of trapped mosquitoes compared to the controlas a natural attractant to catch Aedes spp. mosquitoes and has the potential to be an alternative vector control that is cheap, easy to apply, and environmentally friendly.
Predictive Value of Neutrophil-to-Limphocyte Ratio for Detecting Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus Patients
Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by insulin resistance, leading to increased blood glucose levels (hyperglycemia). Insulin resistance is a key factor in the development of nonalcoholic fatty liver disease (NAFLD), a condition defined by excessive hepatic fat accumulation that is not caused by alcohol consumption. NAFLD can progress from simple steatosis to hepatic inflammation and fibrosis. The neutrophil-to-lymphocyte ratio (NLR) is a simple biomarker for systemic inflammation. Elevated NLR values may indicate increased inflammation, such as that observed in NAFLD. This study aimed to determine differences in NLR values in T2DM patients with NAFLD and without NAFLD. This cross-sectional study used secondary data from the medical records of 88 T2DM patients from 2022 to 2024, divided into groups without NAFLD (n=45) and with NAFLD (n=43) based on ultrasonographic liver findings. The Welch t-test was applied to compare NLR values, and receiver operating characteristic (ROC) analysis was used to identify the optimal cut-off value for NLR. The NAFLD group had significantly higher NLR values (mean difference = 3.80; 95% CI: 2.75–5.24; p<0.001), with an AUC of 0.962 (95% CI: 0.915–1.000; p<0.001) and an optimal cut-off value of ≥3.1964 (sensitivity 90.7%; specificity 100%). In conclusion, NLR is significantly elevated in T2DM patients with NAFLD and demonstrates strong discriminatory ability, indicating its potential use as a simple inflammatory biomarker in T2DM managements.
Correlation Between TNF-α Levels and APRI Score with Ejection in Hepatic Cirrhosis
Cirrhotic cardiomyopathy is a condition of heart dysfunction characterized by impaired myocardial contractility, left ventricular hypertrophy, diastolic dysfunction, chronotropic dysfunction, and electrophysiological disturbances of the heart. One of the complications in patients with hepatic cirrhosis is influenced by several factors, particularly TNF-α levels and the APRI score. This study aimed to analyze the effect of TNF-α and APRI score on ejection fraction in Child-Pugh C hepatic cirrhosis. Methods: This study employed an analytical observational design with a cross-sectional approach. The sample consisted of 40 inpatients with Child-Pugh C hepatic cirrhosis at the dr. Moewardi Surakarta Regional General Hospital. Samples were selected using consecutive sampling. Data analysis was performed using Spearman’s correlation test and linear regression. Results: The correlation between TNF-α levels and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.559, p<0.001 (moderate correlation). The correlation between APRI score and ejection fraction in Child-Pugh C hepatic cirrhosis is r = -0.445, p<0.001 (moderate correlation). There is a significant correlation between TNF-α levels and APRI score with ejection fraction in Child-Pugh C hepatic cirrhosis. The implication is that clinicians may incorporate TNF-α levels and the APRI score into clinical algorithms to monitor cirrhotic patients who are at high risk of developing cardiovascular complications.
The Role of Mothers in the High Prevelance of Early Childhood Dental Caries: A Atudy Among Toddlers in the Peatland Areas of West Kalimantan
Peatland environments often rely on groundwater with low mineral content, which may increase children’s vulnerability to dental caries. This study examined whether family factors parental education, occupation, economic status, and parenting practices are associated with dental caries among young children. This descriptive cross-sectional study used a mixed-methods approach. The study was conducted at PAUD Dzafira, East Pontianak, West Kalimantan, and included 45 parent–child pairs selected through total sampling. Data on parental characteristics, parenting practices, and children’s caries status were collected. Quantitative data were analyzed using Spearman’s correlation, and qualitative data were analyzed using NVivo. The mean dental caries score was 3.91 ± 3.21, ranging from 0 to 14 decayed teeth. Significant correlations were observed between children’s caries and maternal education (r = −0.452; p = 0.002), family economic status (r = −0.300; p = 0.045), and maternal occupation (r = −0.535; p < 0.001). Caries-free children were generally characterized by early habit formation, active parental supervision, and consistent motivation. In contrast, inconsistent routines, inappropriate toothbrushing times, and limited parental ability to teach toothbrushing behaviors were more common among children with caries. Higher maternal education, stable employment, and better economic conditions are associated with lower dental caries among children. Strengthening oral health education, especially for mothers as primary caregivers, and improving access to affordable dental care are essential to reduce caries risk in peatland communities.
Health Risk Assessment of Lead (Pb) and Copper (Cu) Contamination in Sediments of Palu Bay, Indonesia
Heavy metals are persistent environmental pollutants that tend to accumulate in coastal sediments and may pose long-term ecological and human health risks. This study evaluated the concentrations of lead (Pb) and copper (Cu) in surface sediments of Palu Bay, Central Sulawesi, Indonesia, and assessed potential non-carcinogenic and carcinogenic health risks through dermal exposure. Sediment samples were collected from ten stations representing residential areas, ports, river estuaries, and relatively open zones. Concentrations of Pb and Cu were analyzed using Atomic Absorption Spectrophotometry (AAS) after acid digestion. Sediment contamination was evaluated using the contamination factor (CF) and geoaccumulation index (Igeo), while human health risk assessment (HRA) followed U.S. EPA guidelines. Mean concentrations of Pb and Cu were 6.61 ± 3.64 mg/kg and 20.70 ± 8.83 mg/kg, respectively, and were below international sediment quality guidelines (CCME and ANZECC). CF values (<1) and negative Igeo values indicated low contamination levels. The hazard quotient (HQ) and hazard index (HI) for dermal exposure were below the threshold of concern (HI < 1), suggesting no significant non-carcinogenic risk. Carcinogenic risk (CR) for Pb was within the acceptable range (10⁻⁶–10⁻⁴). Overall, surface sediments in Palu Bay show low levels of Pb and Cu contamination and currently pose minimal health risk through dermal contact. The results provide baseline data to support future monitoring and coastal management strategies.
Flood Preparedness in Urban Areas: An Analysis of the Role of Households in Disaster Risk Mitigation
Flooding is one of the most frequent disasters in urban areas of Indonesia, including Makassar City, which experiences major floods almost every year. Households are a critical unit of analysis because they are directly affected and serve as the first line of response during flood events. This study aimed to assess household flood preparedness using the Community Preparedness Index (CPI), which consists of four components: Knowledge and Attitudes toward Preparedness (KAP), Emergency Planning (EP), Warning System (WS), and Resource Mobilization Capacity (RMC). A quantitative cross-sectional design was used with purposive sampling of 100 households in Manggala District, Makassar City. Data were collected using a standardized 17 item flood preparedness questionnaire. The results showed that 53% of respondents had low preparedness, indicated by CPI scores below 60%. Distance of the house from rivers or water channels was the most significant factor associated with flood preparedness (p = 0.006). 76% respondents lived within 500 meters of a river or water source and generally demonstrated higher preparedness than those living farther away, likely due to higher risk awareness. Household preparedness is influenced by both internal and external factors. Strengthening disaster education, early warning systems, evacuation planning, and resource mobilization especially for high risk households is essential. These findings support the development of evidence based, community level flood mitigation policies.
Community-Based Sanitation Risk Model to Reduce Childhood Diarrhea in Flood-Prone Urban Settlements
Childhood diarrhea remains a major public health concern in flood-prone urban settlements, where inadequate sanitation and environmental contamination are common. This study aimed to develop and validate a community-based sanitation risk model to identify key environmental and behavioral factors associated with childhood diarrhea. An analytical cross-sectional design was conducted among 240 households with children under five years of age. Data were collected through structured interviews, household sanitation observations, and environmental assessments, covering variables such as water source, latrine condition, waste disposal, drainage, handwashing practices, and flood exposure. Bivariate analysis was used to assess associations between sanitation variables and diarrhea, followed by multivariable logistic regression to determine independent predictors and construct the risk model. The results showed that The two-week prevalence of childhood diarrhea was 27.5%. Multivariable analysis identified contaminated water sources (AOR = 3.42; 95% CI: 1.95–5.99), clogged or non-functional drainage (AOR = 3.85; 95% CI: 2.12–6.97), improper solid waste disposal (AOR = 2.67; 95% CI: 1.56–4.61), unimproved latrines (AOR = 2.11; 95% CI: 1.25–3.58), and inadequate handwashing behavior (AOR = 2.48; 95% CI: 1.40–4.38) as significant predictors of diarrhea. The model demonstrated good discrimination in identifying high-risk households. In conclusion, the The developed community-based sanitation risk model provides a simple, evidence-based tool for identifying households at high risk of childhood diarrhea in flood-prone urban settlements. This model can support targeted sanitation interventions and strengthen community-level disease prevention programs.
System Dynamics Modelling of Population Growth and Waste Management Landfill Capacity Sustainability in Palangka Raya
This study analyzes the growing challenges of municipal solid waste management in Palangka Raya, driven by rapid population growth and limited landfill capacity. The research aims to develop an integrated dynamic system model combining population dynamics and waste management performance to project future conditions and evaluate policy interventions. Using a system dynamics approach, the study models population growth, household waste generation, landfill accumulation, and waste reduction strategies. Primary data were collected through field measurements of existing waste volumes and landfill capacities, while secondary data were obtained from official statistics and relevant reports. Model validation demonstrates high accuracy in projecting population growth, a key driver of increasing waste generation. Simulation results indicate that, under the current conditions, the Bukit Tunggal landfill will reach overload in 2018, revealing an unsustainable system. Moderate interventions produce minimal improvement, while an optimistic scenario delays landfill overload only until 2026. The findings demonstrate that achieving long-term landfill sustainability requires an extreme waste reduction strategy of at least 85% through significant enhancement of recycling, composting, and waste diversion efforts. The study concludes that incremental policies are inadequate to address the worsening waste crisis. Instead, a transformative shift toward high-performance waste processing and decisive policy intervention is essential to maintain landfill functionality and support sustainable urban development. The integrated model developed in this research provides a valuable tool for policymakers to design effective and long-term waste management strategies.
Development of a Raw Water Quality Detection System Prior for Municipal Drinking Water Treatment and Sustainable Environmental Management
Variations in raw water quality can reduce the effectiveness of municipal drinking water treatment processes, making early-stage monitoring prior to treatment essential for sustainable environmental management. This study aims to develop and validate a raw water quality detection system based on an ESP32 microcontroller for real-time measurement of pH, temperature, and turbidity. The research employed an engineering Research and Development (R&D) approach, including system design, sensor calibration, laboratory testing, and field validation. The study was conducted from January to March 2025 in Indramayu Regency, Indonesia, with field testing carried out on river water, seawater, rainwater, and groundwater sources. Measurement accuracy was evaluated by comparing sensor readings with laboratory reference instruments, and accuracy values were calculated based on percentage error and correlation analysis. The results show that the system achieved accuracy levels between 96% and 98%, with correlation coefficients (R²) greater than 0.9, indicating strong agreement with reference measurements. River water exhibited the highest turbidity value (86.4 NTU), while rainwater showed the lowest pH value (6.3), reflecting distinct environmental characteristics of each water source. Overall, the developed system demonstrated stable performance under real environmental conditions and can function as a low-cost and reliable early detection tool for raw water quality prior to treatment, with potential to support sustainable water resource management.
Design and Performance Evaluation of a Digital Chlorinator for Domestic Wastewater Disinfection in Healthcare Facilities
Domestic wastewater from healthcare facilities such as hospitals, community health centres, and polyclinics contains organic loads, toxic chemical compounds, and pathogenic microorganisms that have the potential to cause environmental pollution and pose a risk to public health if not treated adequately. Various conventional treatment methods, including UV, ozonation, aeration, and biofiltration, have been used to reduce pollutants, but cost limitations, high energy requirements, and technical reliability make chlorination the preferred option because it is relatively inexpensive, easy to implement, and produces disinfectant residues that provide continued protection. However, uncontrolled use of chlorine can lead to excessive residues, disinfection by-products (DBPs), and operational inefficiencies. To address these challenges, this study aims to design and evaluate the performance of a digital chlorinator equipped with an automatic control system with dual energy source flexibility (AC/DC and solar panels). This study used a one group pre-test and post-test design with domestic wastewater samples from hospitals, health centres, and polyclinics in Magetan Regency. The water quality parameters analysed included pH, BOD, COD, ammonia, chlorine demand, residual chlorine, and total coliforms. Initial measurements showed BOD of 105–145 mg/L, COD of 198–260 mg/L, ammonia of 13–18 mg/L, and total coliform of 8.5 × 10⁵ to 1.2 × 10⁶ MPN/100 mL, far above the national quality standards. After treatment using a digital chlorinator with an optimum dose of 200 ppm, BOD decreased by 77–82%, COD by 72–78%, ammonia by 75–80%, and total coliforms by more than 99%, while the pH remained stable in the range of 7.1–7.3 and the chlorine residue was maintained at 0.2–0.5 mg/L according to the recommended standard. A comparison of energy sources showed that the effectiveness of solar cells was almost equivalent to that of AC/DC, with a small difference in the reduction of BOD and COD that was not statistically significant. The results of this study conclude that digital chlorinators are effective, adaptive, and have the potential to be an innovative solution in improving the quality of domestic waste treatment in health facilities, especially in areas with limited access to electricity, and can support the achievement of sustainable environmental health goals.
Copyright (c) 2025 Gema Lingkungan Kesehatan https://creativecommons.org/licenses/by-sa/4.0
Maternal Age at Marriage and Risk of Childhood Stunting: Evidence from a Case-Control Study in North Sumatra, Indonesia
Stunting remains a major public health issue in Indonesia, particularly in urban areas such as Medan. While socioeconomic and nutritional factors are well recognized, the influence of maternal age at marriage on child growth is less explored. This study examined the association between maternal age at marriage and childhood stunting in Medan, Indonesia. Methods. An analytical observational study with a case–control design was conducted from January to March 2025 across several community health centres in Medan. A total of 124 mother–child pairs (62 stunted and 62 non-stunted children) were selected using cluster random sampling. Data were collected through structured interviews and health-record reviews. Stunting was defined as height-for-age Z-score < -2 SD based on WHO standards. Logistic regression was used to assess the relationship between maternal age at marriage (<25 years vs ≥25 years) and stunting, adjusting for maternal education, maternal health during pregnancy, socioeconomic status, and birth weight. Children of mothers who married before age 25 had significantly higher odds of being stunted compared with those whose mothers married later (adjusted OR = 2.85; 95% CI: 1.71-4.76; p < 0.001). Low maternal education (adjusted OR = 2.12; p = 0.021) and low birth weight (adjusted OR = 2.43; p = 0.030) were also independent predictors of stunting. Conclusion. Maternal marriage before 25 years is a strong determinant of childhood stunting in urban Medan. Delaying maternal marriage, enhancing women’s education, and strengthening maternal health programs could substantially reduce stunting prevalence. This study contributes new evidence to Indonesia’s national efforts to prevent stunting through life-course and policy-oriented interventions.
Stunting maternal age at marriage, maternal education, birth weight, Indonesia
Factors Associated with Breast Milk Quality Related to Cigarette Smoke Exposure: A Cross Sectional Study in Balai Agung Health Center, Musi Banyuasin Regency
The quality of breast milk is an important factor in supporting infant growth and health, but it can be influenced by environmental and behavioural factors, including exposure to cigarette smoke. This study aims to analyse the relationship between exposure to cigarette smoke, exposure to household cigarette smoke, and breastfeeding patterns with breast milk quality in breastfeeding mothers in the working area of the Balai Agung Community Health Centre, Musi Banyuasin Regency. This study used an analytical observational design with a cross-sectional approach involving 60 breastfeeding mothers of infants aged 0–6 months who were selected purposively. Data were collected through structured interviews and breast milk quality tests in the laboratory, then analysed descriptively and bivariately using statistical tests with a significance level of 5%. The results showed that the majority of respondents were exposed to cigarette smoke (63.3%) and lived with smokers at home (70.0%). Mothers exposed to cigarette smoke had a nine times greater risk of producing poor-quality breast milk compared to mothers who were not exposed (OR = 9.00; p = 0.002). Exposure to cigarette smoke in the household was also significantly associated with breast milk quality (OR = 6.00; p = 0.015). In addition, non-exclusive breastfeeding patterns increased the risk of poor-quality breast milk by more than five times (OR = 5.44; p = 0.004). This study concluded that exposure to cigarette smoke and breastfeeding patterns are important determinants of breast milk quality, so efforts to protect breastfeeding mothers from cigarette smoke and strengthen exclusive breastfeeding practices need to be prioritised in primary health care services.
The Potential Use of Avocado Leavers (Persea americana) as an Antidiabetict Agent
Diabetes mellitus represents a chronic metabolic disorder that occurs when glycemic concentrations exceed normal levels. The use of natural ingredients such as avocado leaves (Persea americana) is an option due to the abundance of bioactive compounds that have antidiabetic potential. This article was written to present information and understanding related to the pharmacological activity of avocado leaves as an antidiabetic. It was compiled using a comparative review method based on data-driven literature searches. Based on the results of studies that have been conducted, it is known that avocado leaves have potential as an antidiabetic agent. In vivo studies show that avocado leaf extract can significantly lower blood sugar levels and regenerate the pancreas. In vitro studies reinforce the in vivo findings by showing high antioxidant activity (91.03%) and high α-amylase enzyme inhibition (88.95%), which is almost equivalent to acarbose. In addition, preliminary clinical studies show an improvement in glycemic levels in type 2 DM in humans that received avocado leaf decoction. Overall, avocado foliage extract shows great promising effects as an antidiabetic agent through various mechanisms, such as antioxidant activity, inhibition of glucose absorption enzymes, and regeneration of organs such as the pancreas and kidneys.
The Effectiveness of Beetroot and Date Juice as Phytopharmaceuticals in Treating Anaemia in Pregnant Women
Anaemia during pregnancy is a health problem that has serious implications for the condition of both mother and foetus. Treatment efforts should not only rely on iron supplementation, but can also involve natural approaches that are more acceptable and safer, such as administering beetroot juice and dates. This study aims to determine the effectiveness of a combination of beetroot juice and dates in increasing haemoglobin levels in pregnant women with mild anaemia. The study design used a quasi-experimental pretest–posttest control group design involving 32 pregnant women in their third trimester who were divided evenly into a control group and a treatment group. The control group only received iron tablets, while the treatment group received iron tablets along with beetroot and date juice intervention administered daily for 14 consecutive days, with a composition of 100 grams of beetroot and 50 grams of dates in each serving. The results showed that the combination of beetroot juice and dates was able to increase haemoglobin levels in pregnant women with mild anaemia compared to iron supplementation alone. This intervention proved to be safe, well-tolerated, and has the potential to be developed as a complementary phytopharmaceutical to support efforts to prevent and treat anaemia in pregnancy.
The Effectiveness of Moringa Leaf Powder Capsules (Moringa oleifera Lam.) in Reducing the Severity of Anaemia in Pregnant Women
Anaemia is an iron deficiency that causes anaemia in pregnant women, which can have a negative impact on foetal or infant growth and development during and after pregnancy. One way to increase haemoglobin levels in pregnant women with anaemia is to consume moringa leaf powder capsules (Moringa oleifera Lam.), which have haematopoietic activity and are beneficial in increasing platelet counts. The purpose of this study was to determine the effect of moringa leaf powder capsules (Moringa oleifera Lam.) on haemoglobin levels in pregnant women with mild to moderate anaemia with haemoglobin levels of 8–11 g/dL at the Reva Medika Clinic, Lebak Regency in 2025. The intervention was carried out for seven consecutive days with a dose of 2 moringa leaf capsules per day. Hemoglobin levels were measured using a digital hemoglobinometer EasyTouch® HB (Taiwan) in accordance with WHO standard procedures to ensure the accuracy of the test results. The sampling technique used was the Ishak and Michel method. The research respondents were pregnant women aged 20–35 years with a gestational age of 20–32 weeks who had mild to moderate anaemia with haemoglobin levels of 8–11 g/dL and no comorbidities. The study was conducted from January to March 2025. The results of the study after administering moringa leaf powder capsules for anaemia in pregnancy showed that the majority of pregnant women experienced mild anaemia (27 people or 84.4%) and severe anaemia (5 people or 15.6%). A significant difference was found between before and after the administration of moringa leaf powder capsules for anaemia in pregnancy. The Wilcoxon Sign Rank test showed a p-value of 0.000 0.05. It can be concluded that the administration of moringa leaf powder capsules had an effect on anaemia in pregnancy at the Reva Medika Clinic, Lebak District, in 2025.
The Effect of TNF-α and FIB-4 Score on Diastolic Dysfunction in Child Pugh C Liver Cirrhosis
Liver cirrhosis is a major global health concern, often complicated by cardiac dysfunction such as diastolic heart failure. Tumor necrosis factor-alpha (TNF-α) and FIB-4 score are widely used biomarkers in cirrhotic patients, but their predictive value for cardiac complications remains unclear. To determine the effect of TNF-α and FIB-4 scores on the severity of diastolic dysfunction in patients with Child-Pugh C liver cirrhosis. This analytical cross-sectional study included 40 Child-Pugh C cirrhotic patients. Serum TNF-α levels were measured using ELISA. Diastolic function was evaluated using echocardiography. Ordinal logistic regression was used to analyze the association between TNF-α, FIB-4, and diastolic dysfunction grades. The majority of participants had moderate (65.0%) or severe (35.0%) chronic inflammation based on TNF-α levels, with a median TNF-α of 45.52 pg/mL. Significant liver fibrosis (FIB-4 >3.25) was observed in 82.5% of participants. Grade I diastolic dysfunction was the most prevalent (52.5%). TNF-α levels were significantly associated with the degree of diastolic dysfunction (p=0.042), whereas FIB-4 scores showed no significant correlation (p=0.533). Elevated TNF-α is strongly associated with worsening diastolic dysfunction in Child-Pugh C cirrhosis, suggesting its role in systemic inflammation and myocardial injury. In contrast, the FIB-4 index may not reflect cardiac involvement in advanced cirrhosis. TNF-α may serve as a potential biomarker for cardiovascular risk stratification in cirrhotic patients, supporting early intervention and integrated care approaches.
Climate-Sensitive Diseases and Community Vulnerability in Coastal Indonesia: A Systematic Review with Narrative Synthesis
Climate change is increasingly exacerbating health risks in tropical regions, particularly in archipelagic nations such as Indonesia. This study aims to systematically identify and synthesize scientific evidence on climate-sensitive diseases and community vulnerability in coastal Indonesia. A systematic review with narrative synthesis was conducted across four databases (PubMed, Scopus, ScienceDirect, and Google Scholar). The search was performed on 15 June 2025, covering studies published between 2013–2024. Of the 263 records identified, 20 studies met the eligibility criteria, consisting of 12 observational studies, 5 modelling studies, and 3 review or mixed-method papers. The findings indicate consistent associations between rising temperatures, shifting rainfall patterns, flooding, drought, and sea-level rise with increased incidence of dengue, malaria, diarrhea, filariasis, and climate-related mental health outcomes. These climate-sensitive risks are amplified by structural vulnerabilities, including inadequate sanitation, high population density, dependence on climate-sensitive livelihoods, and limited access to healthcare in coastal and remote areas. Most included studies originated from Indonesia and Southeast Asia, underscoring strong contextual relevance. The synthesis highlights that fragmented, sectoral approaches remain insufficient in addressing health impacts of climate change. Integrated strategies—such as climate-informed disease surveillance, community-based early warning systems, and strengthened cross-sectoral coordination—are urgently needed to enhance adaptive capacity. This review is limited by the absence of quantitative meta-analysis and the geographic focus on Indonesia. Future studies should employ longitudinal designs, higher-resolution spatial climate data, and interdisciplinary approaches to support more robust climate-health adaptation strategies.
The Role of Prenatal Environmental Risk Factors in Autism Spectrum Disorder Severity: Insight from Lead Exposure, Tobacco Smoke, and Low Birth Weight
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition influenced by interactions between genetic susceptibility and environmental exposures during critical developmental periods. However, evidence regarding how environmental factors relate to ASD severity remains limited. This study aimed to examine the associations between urinary lead (Pb) levels, prenatal cigarette smoke exposure, history of low birth weight (LBW), and ASD severity, providing insights into potential environmental influences on clinical outcomes. A cross-sectional study was conducted among 43 children diagnosed with ASD attending a special needs school (SLB C) in Banjarbaru, South Kalimantan, Indonesia. Urinary Pb concentrations were measured using UV-Visible spectrophotometry. Information on prenatal cigarette smoke exposure and birth history was obtained through structured parental interviews. ASD severity was assessed using the Childhood Autism Rating Scale, Second Edition (CARS-2), and classified as mild–moderate or severe. Higher urinary Pb levels, prenatal cigarette smoke exposure, and a history of LBW were significantly associated with ASD severity, highlighting potential environmental risk factors that may influence clinical presentation and management strategies. In conclusion, among children with ASD in this school-based population, environmental and perinatal factors were associated with differences in ASD severity. While these findings are promising, emphasizing the need for further research can foster a sense of hope and motivation among researchers, clinicians, and students. Due to the cross-sectional design, causal inferences cannot be drawn. Further studies using longitudinal designs and objective exposure measurements are warranted.
Impact of Air Temprature and Humidity on Sick Building Syndrome among Bank Employees
Sick Building Syndrome (SBS) is a condition in which inhabitants develop health problems or discomfort as a result of extended exposure to indoor surroundings. The purpose of this study was to investigate the association between air temperature and humidity in air-conditioned rooms and the prevalence of SBS, specifically mental weariness (burnout) instances, among employees of Bank Syariah Indonesia (BSI) in Banjarbaru City, Indonesia. The study followed a quantitative design with an analytical cross-sectional survey approach. Data were gathered using questionnaires and devices that measured air temperature and humidity. Univariate analysis defined the variable features, whereas bivariate analysis looked at the correlations between air temperature and humidity (independent variables) and the prevalence of SBS mental fatigue cases (dependent variable). The survey included 30 bank employees, with an average age of 32.4 years. The average air temperature was 25.8°C, with a relative humidity of 84.2%, which was outside of the permissible limit. The prevalence of SBS was 43.3%, with common symptoms including nose discomfort, eye irritation, headache, and fatigue. The prevalence of mental weariness was 36.7%. Pearson correlation analyses found significant positive relationships between air temperature and SBS prevalence (r = 0.48, p < 0.01), relative humidity and SBS prevalence (r = 0.39, p < 0.05), air temperature and mental fatigue (r = 0.41, p < 0.05), and relative humidity and mental fatigue. The findings emphasize the need of maintaining adequate indoor environmental conditions to reduce SBS risk and increase employee well-being in air-conditioned workplaces.
Assessment of Water Quality in Rural Drinking Water Supply Systems in Yogyakarta
Access to safe drinking water in rural areas remains a global public health challenge, especially in Indonesia. This study evaluates the water quality of the Tirta Wening Rural Drinking Water Supply System in Kulon Progo Regency, Special Region of Yogyakarta, which operates two treatment facilities: SPAM 1 and SPAM 2. In order to assess each network’s compliance with national quality standards for drinking water, a total of twelve quality parameters were measured at six different water sampling points. These parameters include: (1) phys­ical properties—temperature, turbidity, color, odor, total dissolved solids/TDS; (2) chemical concentra­tions—pH, nitrite, nitrate, iron, manganese; (3) microbiological contaminations—E. coli, total coliform. The results show that the physical and chemical parameters have already aligned with their standards, except for TDS and manganese concentrations. There are two sampling points in SPAM 1 and five points in SPAM 2 that have a higher TDS than the permissible concentration of 300 mg/L. The manganese concentrations exceed the maximum standard of 0.1 mg/L at one sampling point in SPAM 1 and three points in SPAM 2. In terms of microbiological parameter, E. coli contamination was found at four sampling points in SPAM 1 and all points in SPAM 2, and total coliform exceeds 300 CFU/100 mL at almost all the sampling points. These findings highlight the need for improved treatment, routine monitoring, and household-level solutions to meet national drinking water quality standards.
A Comparative Analysis of Taksimari and Taksinada in Alleviating Pain Following IUD Insertion
The Intra Uterine Device (IUD) is the best contraceptive for most women but often causes problems, namely pain. Pain can cause physiologic changes such as increased blood pressure, increased heart rate, vasoconstriction (arterial) blood vessels, increased respiratory activity, loss of water, and extreme fatigue. This study aims to determine the comparison of the effectiveness of the use of Five Finger Relaxation Technique (Taksimari with Deep Breath Relaxation Technique (Taksinada) on post-installation pain of the IUD at UPTD Puskesmas Sidemen. The research design used in this study was posttest design with a control group, namely research conducted after treatment (posttest) with two groups of subjects, namely the control group and the treatment group. The sample in the study amounted to 30 respondents with the following criteria: women aged 18-45 years, new IUD acceptors, and IUD installation at Sidemen Community Health Center, 15 respondents were given Taksimari and 15 respondents were given Taksinada. The analysis test used was the Mann Whitney test. The results showed that there were 14 respondents (93.33%) experiencing moderate pain in the Taksimari group, while in the Taksinada group there were 15 respondents (100%) experiencing moderate pain. The results of the bivariate analysis test showed that there was no difference in the effectiveness of non-pharmacological therapy Taksimari with Taksinada with a value of p = 0.317. This study found that there was no difference in the effectiveness of non-pharmacological therapy Taksimari with Taksinada. This study can be used as a basis for consideration in carrying out independent midwifery interventions in pain management.
Association of Riverside Living with SIRS Incidence in Stroke Patient in South Kalimantan
South Kalimantan is a province that has 97 rivers, and many people who live on the riverside make the rivers a source of life. Currently, there is more and more river water pollution, which has an impact on the health status of people living on the riverside, especially inflammation. This study used an analytic-observational design. The study subjects were stroke patients who were treated at the stroke unit and nerve ward at Ulin Hospital, Banjarmasin, for the period October 2022-May 2023. There were 128 subjects who were divided into two groups based on whether they lived on the riverside (64 people) or not (64 people). Variable analysis used descriptive analysis, the chi-square test, and multivariate analysis using the logistic regression test. Based on the descriptive analysis, it was found that there were no variables that showed meaningful results. Bivariate analysis resulted in variables that had a significant relationship. In the multivariate analysis, it was found that living on the riverside and mortality rate were independent predictors, which together with the dependent predictor factor, i.e., the type of stroke, affected the incidence of SIRS in stroke patients. Living on the riverside and mortality can be used as predictors of SIRS in stroke patients. SIRS assessment in an appropriate manner in stroke patients who live on river banks should be a routine examination. Prevention and monitoring of risk factors can prevent stroke patients from experiencing SIRS conditions to avoid complications that can occur.
Respiratory and Neurological Health Effects of Chromium and PM Exposure among Troso Woven Fabric Workers: A Cross Sectional Study in Jepara
The Troso weaving industry in Jepara, Indonesia, is a traditional craft sector that relies on synthetic dyes and manual production, thereby exposing workers to chromium (Cr) and particulate matter (PM2.5 and PM10) with potential respiratory and neurological risks. This study aimed to analyze their association with respiratory and neurological disorders among workers. A cross-sectional design was applied involving 101 weaving workers from four production sites. Environmental sampling measured Cr concentrations in wastewater and PM2.5/PM10 in the ambient air, while worker characteristics and health complaints were assessed using the ECSC-87 and Q18 questionnaire. Data were analyzed using chi-square tests and odds ratios. Cr concentrations in wastewater ranged from <0.010 to 0.104 mg/L, remaining below the effluent quality standard of 1.0 mg/L but confirming the continuous use of chromium-based dyes discharged without treatment. Average PM2.5 and PM10 levels were 108.75 µg/m³ and 117.75 µg/m³, both exceeding national air quality standards (55 and 75 µg/m³). Bivariate analysis showed that respiratory disorders were significantly associated with exposure duration ≥40 hours/week (OR=7.333; p=0.0001) and working period >5 years (OR=20.935; p=0.0001), whereas dye type, dyeing frequency, and PPE use were not significant. Neurological disorders were significantly associated with exposure duration (p=0.001), working period (p=0.001), type of dye (p=0.0001), frequency of dyeing (p=0.018), and PPE use (p=0.0001). Environmental monitoring confirmed elevated PM levels and chromium-based dye use, while statistical analysis showed that prolonged exposure and long working periods associated with respiratory disorders, and neurological disorders were linked to multiple occupational factors.
Evaluation of Hospital Sustainability Initiatives in South-east Asia
The increasing growth of hospitals in South-east Asia has not been in line with awareness and commitment to sustainability in healthcare facilities. Hospitals play an important role in maintaining public health and contributing to environmental sustainability. However, due to the region's vulnerability to the impacts of climate change, hospitals in South-east Asia have not yet fully transformed into green healthy hospital. This study compares the sustainability of each hospital in South-east Asia that is a member of the Global Green Healthy Hospital (GGHH) based on ten sustainability agendas. This study employs secondary data analysis sourced from the official GGHH website and utilises descriptive quantitative design techniques that include frequency and percentage calculations. The highest percentage of sustainability agenda implementation in the South-east Asia region is waste (72.3%), energy (63.49%), and leadership (52.48%). The lowest percentages are transportation (16.77%), pharmacy (24.92%), and chemicals (31.20%). Hospitals in South-east Asia show a low level of awareness about the implementation of green and healthy hospital practices. Only two countries, the Philippines and Indonesia, have healthcare facilities capable of implementing ten sustainability agendas.
Environmental and Pet-Associated Risk Factor for Hookworm Infection in Coastal East Kalimantan
Hookworm infection remains an important community health concern, particularly in the coastal areas of East Kalimantan, Indonesia, where environmental conditions facilitate transmission. Key risk factors in this region include the presence of domestic animals (cats and dogs), infection in these pets, and specific types of soil surrounding households. This study aimed to determine the prevalence of hookworm infection and its association with various environmental and behavioral risk factors. A cross-sectional survey was conducted in 2019 among 213 individuals from rural areas of Kutai Kartanegara Regency. Stool specimens were examined using Kato-Katz and Koga Agar Plate (KAP) culture technique. The prevalence of hookworm infection was 33.8% (72/213). Higher infection rates were significantly associated with older age (≥13 years), agricultural occupation, poor sanitation facilities, use of unsanitary water sources, and open defecation practices. Environmental factors, including wet soil, high soil organic carbon content, low elevation, high humidity, frequent rainfall, and proximity to rivers or plantation areas, were also significantly associated with hookworm infection (p < 0.05; ORs ranged approximately from 1.7 to 2.9). The presence of hookworm-infected domestic dogs was significantly associated with human infection (p < 0.001). These findings highlight that hookworm transmission in coastal East Kalimantan is influenced by an alliance of environmental, behavioral, and animal-related factors. Comprehensive control strategies focusing on sanitation improvement, environmental management, and control of zoonotic reservoirs are essential to reduce infection rates in endemic rural setting.
Mothers’ Knowledge and Skills as Key Factors in Preventing Stunting in Toddlers: A Case Study in Malingping, Banten
Stunting in children under five years of age remains a serious public health problem in Indonesia because it affects physical growth, cognitive development, and long-term productivity. This study aims to analyse mothers' knowledge and skills in preventing stunting and the relationship between sociodemographic characteristics and these two aspects in the working area of the Malingping Community Health Centre, Banten. The study used a descriptive-analytical survey design with a cross-sectional approach involving 80 mothers of toddlers selected through purposive sampling. Data were collected using a structured questionnaire and analysed univariately and bivariately using the Chi-square test. The results showed that most mothers did not know the definition of stunting (81.3%), its causes (86.3%), signs (83.8%), or how to prevent it (88.8%). Mothers' skills in prevention were also low, with 78.8% unable to prepare a balanced complementary feeding menu, 73.7% lacking hygiene when preparing food, and 81.2% rarely monitoring their children's growth. Bivariate analysis showed no significant relationship between education and knowledge (p = 0.721), but there was a significant relationship between education and skills (p = 0.039). This study concludes that although mothers' knowledge about stunting is still low, practical skills are more influenced by education level. These findings emphasise the importance of educational interventions that not only increase knowledge but also build mothers' practical skills through community-based approaches and support from health cadres.