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Background: The second stage of labor is a critical phase associated with risks of maternal and neonatal complications if it lasts too long. Nonpharmacological interventions such as the gymball method have the potential to accelerate labor progress by optimizing the position and mobilization of the mother in labor, but contextual evidence in primary health care facilities in Indonesia is still limited. Objective: This study aims to analyze the effect of the gymball method on accelerating the second stage of labor in laboring mothers at the Mananggu Community Health Center. Methods: This study used a quasi-experimental design with a posttest-only control group approach. The sample consisted of 30 laboring women divided into an intervention group (gymball) and a control group (standard care). The dependent variable was the duration of the second stage of labor. Data were collected using observation sheets and partographs, then analyzed using an independent t-test. Results: The average duration of the second stage of labor in the gymball group was significantly shorter than that in the control group (p < 0.05). Conclusion: The gymball method was proven to be effective in accelerating the second stage of labor. This intervention is safe, low-cost, and feasible to be implemented as part of midwifery care at community health centers to improve the quality of normal delivery services.

Background: Exclusive breastfeeding is essential for infant growth, immunity, and overall health. However, many breastfeeding mothers experience difficulties in maintaining exclusive breastfeeding due to improper breastfeeding techniques, low maternal knowledge, and lack of guidance from health workers. Proper application of breastfeeding techniques, including correct latch-on, positioning, and frequency, can improve breastfeeding consistency and prevent early weaning (Sari, 2020; Putri, 2021). Objective: This study aimed to determine the effect of the application of breastfeeding techniques on the consistency of exclusive breastfeeding in breastfeeding mothers at the Dambalo Community Health Center. Methods: A quantitative, pre-experimental study with a one-group pretest-posttest design was conducted. Thirty breastfeeding mothers were selected using purposive sampling based on inclusion criteria, including mothers of infants aged 0–6 months who were willing to participate and had no medical conditions preventing breastfeeding. Results: All 30 participants (100%) applied the recommended breastfeeding techniques after the intervention. Following the intervention, 27 mothers (90%) consistently practiced exclusive breastfeeding, while three mothers (10%) showed partial improvement. Statistical analysis using the Wilcoxon signed-rank test revealed a significant difference in exclusive breastfeeding consistency before and after the intervention (p = 0.000), indicating that the application of proper breastfeeding techniques significantly improved breastfeeding practices. Conclusion: The application of breastfeeding techniques has a significant positive effect on the consistency of exclusive breastfeeding among mothers at the Dambalo Community Health Center. Structured guidance and practical support from health workers, particularly midwives, are essential to improve maternal skills, reinforce proper practices, and ensure the health and growth of infants.

E-Puskesmas is a solution to problems caused by manual systems. It was created to streamline the method of reporting data to the Health Office and digitize the process of providing health services to the community at the Puskesmas. In addition, the online reporting system facilitates the dissemination of information effectively and efficiently. This study aims to determine the impact of using E-Puskesmas in improving the effectiveness of health services at the Pancur Community Health Center in Tanjungpinang City. The research method used is descriptive research with a qualitative approach conducted through observation, interviews, and documentation. The results of the study indicate that the implementation of E-Puskesmas has brought significant improvements in managing patient data, appointment scheduling, and reporting processes to the Health Office. Health workers find the system beneficial for storing accurate data, reducing paperwork, and enabling faster coordination with other health facilities. However, the use of the system is still hampered by unstable or slow internet or Wi-Fi networks, which often delay data input and retrieval during busy operational hours. This issue not only reduces efficiency but also causes frustration among staff who rely on the system for daily activities. The conclusion of this study highlights that the use of E-Puskesmas is effective in supporting digital health services but remains suboptimal due to technical challenges. Improving internet connectivity is critical to ensuring seamless operation and maximizing the benefits of the system. The study recommends that the local government and relevant stakeholders enhance the quality of network infrastructure and provide regular technical support and training for Puskesmas staff. By addressing these challenges, the Pancur Community Health Center can improve the stability of its operations and ensure that the E-Puskesmas application delivers optimal results in supporting high-quality, efficient, and technology-driven health services for the community.

Anemia during pregnancy is a significant health issue that contributes to the incidence of low-birth-weight (LBW) babies. At the Bere-Bere Community Health Center, the prevalence of LBW is 15%, higher than the national average, and the prevalence of anemia in pregnant women is 30%. This study aimed to analyze the relationship between hemoglobin (Hb) levels in pregnant women and the incidence of LBW at the center. A cross-sectional design was used with 30 pregnant women selected via purposive sampling. Hb levels were categorized into anemia (Hb <11 g/dL) and normal (Hb ≥11 g/dL), while birth weight was categorized into LBW (<2500 grams) and normal (≥2500 grams). Data analysis was performed using univariate and bivariate analysis with the Chi-Square test. Results showed that 43.3% of pregnant women experienced anemia and 33.3% of babies had LBW. Of the 13 anemic mothers, 61.5% gave birth to LBW babies, while only 11.8% of mothers with normal Hb levels had LBW babies. The Chi-Square test revealed a significant relationship (p = 0.004, p < 0.05) between maternal Hb levels and LBW incidence. In conclusion, maternal anemia is significantly associated with LBW, highlighting the need for interventions such as iron supplementation, nutrition education, and regular check-ups to prevent anemia and reduce LBW rates.

Danger signs of pregnancy are signs or symptoms indicating that the mother or fetus is in danger. Knowledge of danger signs of pregnancy is a factor that influences the high Hamilton Anxiety Rating Scale (HARS) score of mothers in labor. This study aims to determine the relationship between mother's knowledge about pregnancy danger signs and HARS scale scores for mothers in childbirth in the Lamasi Health Center Work Area. This is a quantitative study using an observational cross-sectional approach. The population and sample were 32 people using total sampling technique. Data collection used questionnaires and observation sheets. Analysis used chi-square test. The results showed that there was a relationship between the mother's knowledge of pregnancy danger signs and HARS scale scores of mothers in labor in the Lamasi Health Center Work Area with a p value = 0.021 < α value = 0.05. It is hoped that health institutions can increase the knowledge of health workers and the community regarding pregnancy danger signs and the HARS score of mothers in labor.

Toddlers are the age group that most often suffers from nutritional problems, both undernutrition and severe malnutrition. Nutritional needs for children need to be considered early in their lives. Malnutrition can have unavoidable bad consequences, namely the worst manifestation can cause death. It is recorded that hundreds of millions of children in the world suffer from deficiencies, meaning that this problem occurs in a very large population. Objective: To determine the factors related to the nutritional status of children at the Moanemani Health Center, Dogiyai Regency. Method:This type of research is quantitative with a Cross Sectional Study approach, the research sample was 75 children with a total sampling technique. The data were analyzed using the SPSS (Statistical Program For Social Science) version 16.0 application using the chi square test. Results: The relationship between maternal employment and p-value (0.02) <0.05, family income valuep-value(0.39) >0.05, maternal education p-value (0.21) >0.05, and maternal knowledge p-value (0.00) <0.05 on toddler nutritional status. Conclusion: Family income and pThere is no significant relationship between maternal education and child nutritional status,workMothers and mothers' knowledge have a significant relationship with the nutritional status of children at the Moanemani Health Center, Dogiyai Regency.. Suggestion: It is expected that mothers at the Moanemani Health Center can update their knowledge about nutritional status so that the nutritional status of children is also optimal.

Reproductive health is an important aspect in improving the quality of life of the community, but the level of knowledge about reproductive health is still relatively low due to cultural factors, social norms, and limitations of the educational methods used. This study aims to analyze the effectiveness of the peer educator method in increasing the level of reproductive health knowledge of the community in the Akelamo Community Health Center, Tidore. This study used a pre-experimental design with a one-group pretest-posttest approach. The study sample consisted of 24 respondents selected using a total sampling technique. The intervention was carried out through reproductive health education using the peer educator method in small groups. Measurements of knowledge levels were carried out before and after the intervention using a standardized questionnaire. Data analysis used the Wilcoxon test with a significance level of p < 0.05 . The results showed an increase in the average knowledge score from 56.3 before the intervention to 78.5 after the intervention. Statistical tests showed a significant difference between the levels of knowledge before and after the intervention (p = 0.001). These results indicate that the peer educator method is effective in increasing public reproductive health knowledge .

The use of formula milk for infants is still common in the early stages of life and has the potential to hinder successful breastfeeding, even though the benefits of breast milk have been widely proven. Education and lactation counseling are considered important strategies to support breastfeeding practices and reduce the unnecessary use of formula milk. However, empirical evidence on the effectiveness of lactation counseling in reducing the intensity of formula milk use is still limited, especially in the context of primary health care in Indonesia. This study aims to analyze the effectiveness of lactation counseling in reducing the intensity of formula feeding in infants. This study uses a quantitative approach with a one-group pretest–posttest pre-experimental design. The sample consisted of 20 mothers who had infants and met the inclusion criteria in the Popayato Community Health Center working area, selected using total sampling technique. The intervention took the form of structured lactation counseling provided by health workers. The intensity of formula feeding was measured before and after the intervention using a structured questionnaire. Data analysis was performed descriptively and bivariately using the Wilcoxon Signed Rank Test. The results showed a decrease in the intensity of formula feeding after lactation counseling. The Wilcoxon test showed a significant difference between the intensity of formula feeding before and after education (p = 0.000). Lactation counseling was proven to be effective in reducing the intensity of formula feeding in infants. This educational intervention has the potential to be an important promotional strategy in maternal and child health services to support more optimal breastfeeding practices..

Anthropometry is a direct technique for evaluatingnutritional status, especially protein and energy levels of the body. One of the efforts to develop competent and skilled cadres in anthropometric measurements is through training techniques. To determine the relationship between knowledge, role, motivation and length of service of Posyandu cadres towards the use of anthropometric tools at the Topo Health Center UPTD.Method:This type of research is observational analytic using Cross Sectional Study. The research sample amounted to 30 cadres from 3 active posyandu. Data analysis used the Statistical Program For Social Science (SPSS) version 16.0.Results:Chi Square Testshows that there is no relationship between cadre knowledge and the use of anthropometric tools based on the measurement of the foot scale and stadiometer (p-value> 0.05). There is a relationship between cadre knowledge and the use of anthropometric tools based on the measurement ofLiLa, infantometer, and head circumference (p-value <0.05). While the relationship between work period and the use of anthropometric tools and the relationship between motivation and the use of anthropometric tools is not related (p-value> 0.05). Conclusion: There is a significant relationship between cadre knowledge and the use of anthropometric tools (measurement ofLiLa, infantometer, and head circumference). There is no significant relationship between work period and the use of anthropometric tools, as well as motivation and the use of anthropometric tools. Suggestion: it is hoped that cadre training will be held frequently and will be improved and more active in using anthropometric tools.

This community service program was implemented to strengthen the digital literacy and competencies of health cadres in Simogirang Village, Prambon Sub-district, Sidoarjo Regency, particularly in the recording and management of Posyandu (integrated health service post) data. The initiative responded to ongoing issues stemming from manual documentation methods, which were prone to human error, inefficiency, and lack of integration with regional health information systems. To address these challenges, the program delivered an IT-based training module using a combination of direct instruction, demonstrations, and hands-on simulations. The training emphasized the use of accessible and cost-effective tools such as Google Forms and Google Sheets, designed in alignment with the principles of adult learning (andragogy) and Kurt Lewin’s change management model to facilitate behavioral adaptation and technology acceptance among the participants. A total of 25 health cadres participated in the program. Pre- and post-training evaluations demonstrated significant improvement in digital skills, with 80% of participants achieving a minimum of 85% accuracy in completing digital forms and managing records. In addition, a prototype digital system based on Google Workspace was successfully piloted in two Posyandu locations. This system enhanced the timeliness, accuracy, and integration of health data reporting to local health centers (Puskesmas), offering a scalable and sustainable solution for grassroots healthcare data management. Despite the positive outcomes, the program also identified key challenges, notably limited internet infrastructure and varying levels of prior digital exposure among cadres. These findings underscore the need for continuous mentoring, support from local government stakeholders, and potential investment in digital infrastructure. Overall, the initiative contributes to Indonesia’s broader goals of digital transformation in public health, particularly at the village level.

Low birth weight (LBW) is a major concern in Indonesia due to its impact on neonatal health and growth. One of the contributing factors is maternal anemia during pregnancy, which limits oxygen and nutrient supply to the fetus. This study aimed to determine the relationship between maternal anemia and the incidence of LBW in the working area of the Cimerak Health Center, Pangandaran Regency. This research used a retrospective case-control design involving 124 mothers, divided into 62 cases and 62 controls. The results of the chi-square test showed a significant relationship between maternal anemia and the incidence of LBW (p = 0.000). It is concluded that maternal anemia is associated with a higher risk of LBW, thus emphasizing the need for improved maternal care and anemia prevention strategies.

Stunting is a chronic nutritional problem that has long-term impacts on the quality of human resources and is closely related to maternal health during pregnancy. Antenatal care (ANC) serves as an important promotive and preventive strategy to reduce the risk of stunting; however, pregnant women’s active participation in utilizing ANC services remains a challenge, particularly at the primary health care level. This study aims to analyze the relationship between pregnant women’s knowledge about stunting and their active participation in ANC at the Saritani Community Health Center. This research employed a quantitative analytical design with a cross-sectional approach. The population consisted of all pregnant women who attended ANC services, with a sample of 60 respondents selected through purposive sampling. Data were collected using a structured questionnaire measuring knowledge of stunting and ANC attendance behavior. Data analysis was conducted using univariate and bivariate methods, with the Chi-square test applied to examine the relationship between variables. The results showed a significant association between knowledge of stunting and ANC participation (p < 0.05). Pregnant women with higher knowledge levels were more likely to attend ANC regularly. In conclusion, improving knowledge about stunting among pregnant women is a key strategy to enhance ANC utilization and support early prevention efforts.

The incidence of out-of-hospital cardiac arrest increased (OHCA) significantly. The survival rates of OHCA would be decreased 7-10% every minutes. Therefore, the patients with OHCA must be performed cardiopulmonary resuscitation (CPR) immediately. However, CPR is commonly not performed due to lack of knowledge, skills and fair of being transmitted of diseases. Hands Only CPR (HOCPR) is designed for lay rescuer through two simple steps, firstly call the nearest health center, secondly performed compression to the middle of chest. This socialization aimed to improve knowledge and willingness of lay rescuer to perform HOCPR.  This socialization has been done in CFD Samota Sumbawa on 18th  June 2023. More than 100 flayers have been distributed followed by discussion regarding the importance of CPR. The result of the outreach showed that visitor of CFD Samota were very enthusiastic and they were able and willing to perform HOCPR. Therefore, health care centers, such as hospitals, university and organizations related to emergency sector need to actively provide outreach and demonstrations related to HOCPR.

Digital transformation in health services faces significant challenges, particularly the gap between rapid technological advancements and the readiness of institutional work culture. This study investigates the cultural lag experienced during the implementation of digital systems at the East Nunukan Health Center. Using an observational qualitative approach, it examines health workers' responses to digital applications such as e-Puskesmas and various Health Information Systems. The findings reveal substantial resistance to change, attributed to factors like limited digital literacy, inadequate infrastructure, and the persistence of traditional work patterns. Despite the introduction of digital systems, healthcare practices remain largely dependent on manual methods, highlighting the disconnect between technological progress and the socio-cultural preparedness of healthcare organizations. The study concludes that this cultural lag within healthcare institutions can significantly impede the effectiveness of digital transformation efforts. To address these issues, the research advocates for ongoing training, improvement of supporting facilities, and the adoption of strategies that align with local work culture. This research provides valuable insights into the socio-cultural dynamics affecting the digitization of public services, especially in border regions with limited technological access.

Malaria remains a significant public health issue both globally and in Indonesia, particularly affecting high-risk groups such as infants, young children, and pregnant women. The increasing incidence of malaria is closely linked to environmental and behavioral factors. This study aims to examine the relationship between community behavior and environmental conditions with malaria incidence at the Arso City Health Center, Keerom Regency. A quantitative, cross-sectional design was used, allowing analysis of variables at a single point in time. The sample was selected through simple random sampling based on inclusion and exclusion criteria. Findings revealed that there is no significant relationship between the habit of going outside the house and malaria incidence (p = 0.07). However, there is a significant relationship between the use of mosquito repellent and malaria incidence (p = 0.000). Similarly, using mosquito nets and gauze also showed a significant relationship with reduced malaria cases. Environmental aspects such as mosquito breeding sites and unsealed house walls were also found to be significantly associated with malaria occurrence. These results suggest that both behavioral factors—particularly protective measures—and environmental conditions contribute to malaria transmission in the community. Public health efforts should prioritize education on preventive behaviors and improvements in living environments to reduce malaria risk.

The 2023 Indonesian Health Survey stated that the proportion of exclusive breastfeeding in Sumatera Utara Province was quite low, namely 43.9%. The low coverage of exclusive breastfeeding is closely related to the lack of knowledge of postpartum mothers, which is a predisposing factor that encourages mothers to only give breast milk for 6 months to their babies. The purpose of this study was to determine the factors related to postpartum mothers' knowledge of exclusive breastfeeding in the Tuntungan Health Center work area, Pancur Batu Subdistrict. This study was an observational analytic study with a cross-sectional design. The sample in the study were postpartum mothers in the Tuntungan Health Center work area who met the inclusion and exclusion criteria, namely 50 people. The data collected were primary data obtained through questionnaires distributed to postpartum mothers. Bivariate analysis was carried out using the chi-square test to determine the relationship between the independent and dependent variables. Based on the study conducted, it is known that there is a relationship between age (p-value = 0.015), education (p-value = 0.026), and parity (p-value = 0.008) with postpartum mothers' knowledge of exclusive breastfeeding. There is no relationship between occupation (p-value = 0.224) and postpartum mothers' knowledge of exclusive breastfeeding. It is recommended that health workers in the Tuntungan Health Center work area, Pancur Batu Subdistrict, to improve the knowledge of postpartum mothers, especially for young mothers (<20 years) and primigravida mothers. It is also recommended that postpartum mothers improve their knowledge through various media, especially social media.

This study investigates the influence of patient involvement and effective communication on the image of the Emergency Department (ED) at Dr. Dradjat Prawiranegara Regional Hospital in Serang, with service quality acting as a moderating variable. Utilizing a quantitative research method, data were collected through questionnaires distributed to 315 patients who received emergency care services between October 1 and November 1, 2024. The data were analyzed using multiple regression analysis and Moderated Regression Analysis (MRA). The findings show that patient involvement has a significant and positive impact on the image of the ED, while effective communication alone does not show a statistically significant effect. However, service quality positively moderates the relationship between effective communication and the ED’s image, enhancing its influence. In contrast, service quality does not moderate the relationship between patient involvement and ED image. These results highlight the importance of engaging patients in medical decisions and ensuring effective communication strategies supported by high service quality to enhance the institutional image of emergency healthcare services. The study suggests that hospital management should develop integrated service improvement policies focusing on staff communication training, patient-centered care practices, and continuous quality improvement. It also recommends further qualitative studies to explore deeper insights into patient experiences and to examine other hospital departments to broaden the understanding of healthcare service quality's role in shaping hospital image.

Acute Otitis Media (AOM) is a common middle ear infection in children, particularly in rural areas. This study aims to explore the clinical characteristics of AOM in children treated at rural health centers (puskesmas) and to examine the barriers to effective management. A descriptive qualitative method was employed through a literature review analyzing symptoms, stages, risk factors, and treatment approaches. The findings reveal that AOM in children often begins with an upper respiratory tract infection and presents with sudden ear pain, high fever, sleep disturbances, and ear discharge. Risk factors include young age, poor environmental conditions, and limited access to healthcare services. Management of AOM depends on its clinical stage and requires accurate diagnosis. However, in rural puskesmas, a lack of diagnostic tools and limited public awareness often leads to delayed treatment. Therefore, it is essential to provide health workers with basic ENT training, ensure the availability of diagnostic equipment, and educate parents to enable early detection and prevent complications that could affect a child’s development.

HB 0 immunization in Bandar Baru Health Center, Sibolangit District is still low at 39.0%. The low HB 0 immunization in infants is related to predisposing factors such as knowledge and attitudes, supporting factors, namely the place of delivery and reinforcing factors that support the family. This study aims to analyze predisposing, supporting and reinforcing factors related to the provision of HB 0 immunization in the Bandar Baru Health Center area, Sibolangit District. This type of research is a survey using an explanatory research approach. The population in this study were all mothers who had babies at the Bandar Baru Health Center, Sibolangit District, as many as 68 people and a sample of 68 people. Data were obtained by means of interview questionnaires and observations, analyzed using Multiple Logistic Regression statistical tests at = 5%. The results of the study showed that there were significant predisposing factors such as knowledge and attitudes, supporting factors were the place of delivery, reinforcing factors were family support for HB 0 immunization in the Bandar Baru Health Center area, Sibolangit District and the variable that most influenced HB 0 immunization in the Bandar Baru Health Center, Sibolangit District where the workforce was a variable with Exp B = 12,733. It is possible for health workers to provide socialization to mothers about HB 0 immunization to increase HB 0 immunization, the Deli Serdang Regency Health Office should further improve implementation and provide education to the community about the HB 0 program and the community at the Bandar Baru Health Center, Sibolangit District must carry out hepatitis B prevention.

Street-level bureaucracy refers to the role of frontline bureaucrats who directly engage with the public in the implementation of public policies, including stunting management. In Sidoarjo Regency, stunting remains a critical public health issue with long-term implications for human capital development, despite the government’s continuous efforts to reduce its prevalence. Actors such as posyandu cadres, health center personnel, and officials from the District Health Office serve as the front line in detecting stunting cases, delivering nutritional counseling, monitoring child growth, and connecting communities with essential health services. However, the effectiveness of these roles is often constrained by limited resources, excessive workloads, lack of adequate training, and insufficient incentives that do not reflect the complexity of their responsibilities. Furthermore, policy implementation is frequently hindered by weak inter-sectoral coordination, low community engagement, and the gap between administrative guidelines and the realities faced in the field. The discretionary power held by these street-level bureaucrats becomes both a strength and a challenge—allowing for flexible adaptation to local needs while raising concerns about accountability and service consistency. Addressing stunting effectively at the local level requires strategic capacity-building for implementers through continuous training, fair compensation, and strengthened collaboration among governmental actors and other stakeholders. These efforts must be integrated, holistic, and sustainable in order to truly tackle the root causes of stunting and generate meaningful improvements in public health outcomes.