PublicHealth of Indonesia

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Public Health of Indonesia

Volume 5 Issue 3 (2019)

Public Health of Indonesia is an open access journal emphasizing on original research findings that are

relevant for developing country perspectives including Indonesia. The journal considers publication of

articles as original article, review article, short communication / brief reports, Education forum, letters

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discipline of public health, specially relevant to national priorities, including ethical and social issues.

Articles aligned with national health issues and policy implications are preferred.

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e-ISSN2477-1570|p-ISSN2528-1542Public Health of Indonesia is indexed by DOAJ, Google Scholar, Garuda, Sinta, ISJD

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Public Health of Indonesia

Volume 5 Issue 3 (2019)

© Public Health of Indonesia – YCAB Publisher- IAKMI SULTRA 2019

YCAB Publisher Kompleks Kendari Permai Blok P 2 No 1 Kelurahan Padaleu, Kecamatan Kambu, Kota Kendari Indonesia Email: [email protected] Volume 5 Issue 3 (2019) Library of Congress Catagloging-in-Publication Data Public Health of Indonesia Volume 5 Issue 3 (2019)

P-ISSN 2528-181x | E-ISSN 2477-1570 Copyright © 2019, by the Author(s), Public Health of Indonesia – YCAB Publisher – IAKMI SULTRA. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited

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Editorial Team Editor-in-Chief Ramadhan Tosepu, SKM, M.Kes, PhD, (Scopus ID: 57193652279) Faculty of Public Health, University of Halu Oleo, Indonesia, Indonesia Editorial Advisory Panels Prof. Dr. drg. A. Arsunan Arsin, M.Kes, (Scopus ID: 57192980201) University of Hasanuddin, Indonesia Prof. Dr. Nur Nasry Noor, MPH, (Scopus ID: 7003593825) Faculty of Public Health, University of Hasanuddin, Indonesia Prof. Kyungho Choi, (Scopus ID: 35217582900) Seoul National University, School of Public Health, Seoul, South Korea Assoc. Prof. Kraichat Tantrakarnapa, Ph.D, (Scopus ID: 35220859500) Mahidol University, Department of Social and Environmental Medicine, Nakon Pathom, Thailand Editorial Board Members Prof. Masayuki Sakakibara, Ph.D, (Scopus ID: 7102236258) Ehime University, Graduate School of Science and Engineering, Matsuyama, Japan Prof. Benjamin S.C. Uzochukwu, (Scopus ID: 6603092294) University of Nigeria, Institute of Public Health, Nsukka, Nigeria Prof. Asnawi Abdullah, Bsc.PH, MHSM, MSc. HPPF, DLSHTM, PhD, (Scopus ID: 24478702900) Faculty of Public Health, University of Muhammadiyah Aceh, Indonesia Prof. Madya Dr. Rosediani Muhamad, M.D, MMED, PhD, (Scopus ID: 55061638100) Family Medicine Department, School of Medical Sciences Health Campus, Universiti Sains Malaysia, Malaysia Prof. Sukri Palluturi, SKM.,M.Kes.,M.Sc.PH.,Ph.D, (Scopus ID: 57189250331) Hasanuddin University, Faculty of Public Health, Makassar, Indonesia Komal Raj Rijal, Ph.D, (Scopus ID: 26424359300) Tribhuvan University, Central Department of Microbiology, Kathmandu, Nepal Dr. Azlin Muhammad, (Scopus ID: 8625546000) Department of Medical Parasitology and Entomology The National University of Malaysia Faculty of Medicine, Malaysia Riyanti Djalante, BSc, MSc, Ph.D, (Scopus ID: 54986191100) United Nation University, Institute for Environment and Human Security, Bonn, Germany Dr. Budi Haryanto, SKM.,M.Sc, (Scopus ID: 41861500300) Universitas Indonesia, Department of Environmental Health, Depok, Indonesia Sojib Bin Zaman, MBBS, DPH, MDS, MSc.IH, (Scopus ID: 57193070058) International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh | Khon Kaen University, Faculty of Public Health, Khon Kaen, Thailand Dr.PH. Tasnim SKM.,MPH, (Scopus ID: 57196117665) STIKES Mandala Waluya Kendari, Indonesia

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T A B L E O F C O N T E N T S

ARTICLES

EFFECT OF HEALTH EDUCATION OF SAFETY RIDING USING AUDIOVISUAL MEDIA ON KNOWLEDGE, ATTITUDES AND SUBJECTIVE NORMS OF JUNIOR HIGH SCHOOL STUDENTS IN SAMARINDA INDONESIA Wahnadita Rahman, Dina Lusiana Setyowati, Riza Hayati Ifroh

PDF 54-61

SMOKING AMONG ADOLESCENT MALES AT PULAU WEH, INDONESIA Knut Ragnvald Skulberg, Samarullah Hamid, Arild Vaktskjold

PDF 62-70

BEYOND INDONESIA FOREST WILDFIRES 2019 Joko Gunawan

PDF 71-72

KNOWLEDGE ABOUT PREGNANCY DANGER SIGNS AMONG MOTHERS ATTENDING ANTENATAL CARE IN JUGAL HOSPITAL, HARARI REGIONAL STATE, ETHIOPIA, 2019 Arif Hussen

PDF 73-79

RELATIONSHIP OF SAFE RIDING KNOWLEDGE, PERCEPTION ABOUT DANGER, AND SAFE RIDING BEHAVIOR AMONG SENIOR HIGH SCHOOL STUDENTS IN SAMARINDA INDONESIA Dina Lusiana Setyowati, Ade Rahmat Firdaus, Nur Rohmah Rohmah

PDF 80-84

Public Health of Indonesia, Volume 5, Issue 3, July - September 2019 54

Public Health of Indonesia Rahman, W., et al. Public Health of Indonesia. 2019 September;5(3): 54-61 http://stikbar.org/ycabpublisher/index.php/PHI/index

ISSN: 2477-1570

Original Research

EFFECT OF HEALTH EDUCATION OF SAFETY RIDING USING AUDIOVISUAL MEDIA ON KNOWLEDGE, ATTITUDES AND

SUBJECTIVE NORMS OF JUNIOR HIGH SCHOOL STUDENTS IN SAMARINDA INDONESIA

Wahnadita Rahman*, Dina Lusiana Setyowati, Riza Hayati Ifroh

Faculty of Public Health, Mulawarman University

Received: 25 May 2019 | Revised: 10 June 2019 | Accepted: 10 June 2019 Correspondence: Wahnadita Rahman Faculty of Public Health, Mulawarman University South Sempaja, Samarinda Utara, Samarinda City, East Kalimantan 75242, Indonesia Telp. 0541.7031343 Fax. 0541.202699 Email: [email protected]

Copyright: © the author(s), YCAB publisher and Public Health of Indonesia. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Traffic accidents are the main cause of death for adolescents aged 16-19 years. Teenagers in junior high school age are very vulnerable to traffic accidents. The importance of giving safety riding health education to junior high school students is to prepare them in the active phase of riding in an effort to prevent traffic accidents. Objective: To determine the effect of health education about safety riding using audiovisual on the knowledge, attitudes and subjective norms of VII grade students of the Junior High School of 32 Samarinda, Indonesia. Methods: This research employed a quasi-experimental with a non-equivalent pretest-posttest design, with a sample of 40 students in each intervention and control group selected using purposive sampling technique. Data were analyzed using Mann-Whitney test and Independent t-test. Results: There were significant differences in knowledge, attitudes, and subjective norms between the intervention and control groups (p-value = 0.000). Conclusion: The use of audiovisual is effective to provide health education about safety riding on the level of knowledge, attitudes, and subjective norms among junior high school students. Keywords: audiovisual, safety riding, adolescent, health education BACKGROUND More than 1.25 million people died from traffic accidents every year. Traffic accidents often occur at the age of 15-29 years, and are a major cause of teenage deaths. The death toll from traffic accidents is 90% in developing countries, even though developing countries only have about 54% of vehicles in the world. As many as 50% of victims who died on the road are vulnerable road users, namely motorbike riders, cyclists, or pedestrians. If

there is no ongoing effort to deal with the problem, it can be predicted that traffic accidents will be the seventh cause of death by 2030 (World Health Organization, 2018). Non-natural accidents occur in Indonesia, namely transportation accidents by 26% (Ministry of Health of the Republic of Indonesia, 2015). Samarinda city is the third largest number of traffic accident cases and


ranked first in the number of fatalities in traffic accidents in East Kalimantan Province in 2015, recorded 196 victims including 54 fatalities and 77 seriously injured (East Kalimantan Statistic Center, 2016). The victims of traffic accidents in 2016 were recorded as many as 118 people including 38 fatalities, 29 victims of serious injuries, and 41 minor injuries from the cases of motorbike traffic accidents among those aged 10-15 years as many as 10 people and ages 16-30 30 years old (East Kalimantan Communication and Information Agency, 2017). The age group of adolescents 16-20 years old is the second highest age group that experiences motorbike accidents which reached 18.4% (Anas & Manullang, 2017). The main factors that cause motorized accidents include underage, low knowledge, attitude of motorists who do not have a driving license and do not use helmets, and low driving experience (Tumwesigye et al., 2016; Woratanarat et al., 2013). Another research to mention states that behavior when driving is unsafe which includes the behavior of breaking traffic lights in yellow, calling, texting, and smoking while driving, and driving more than 2 people is a factor in traffic accidents on students (Setyowati et al., 2019). It is still found that many underage riders in urban or rural areas. The factor that causes underage adolescents living in rural areas to be more courageous to ride a motorbike is that in rural areas polices are not optimal in giving sanctions, parents facilitate and support children riding motorbikes, ignorance of the surrounding community towards underage teenagers who ride motorbikes, and environmental conditions that make children ride a motorbike (Nurlia et al., 2017). The application of audiovisual in a learning process has a positive influence on student learning outcomes (Nasrullah et al.). The significant effect in improving student learning outcomes is by applying learning through audiovisual media (Aprilia, 2015). A previous research revealed an increase in the knowledge of adolescents after receiving health education

through video (Imran, 2017). However, there are limitations to previous research regarding health education through the media, especially on audiovisual media about safe driving on the level of knowledge, attitudes and motivation in junior high schools on the outskirts of the city. The Junior High School of 32 (or called SMPN 32) is one of the junior high schools on the outskirts of Samarinda with 336 students. As many as 26% of students ride motorbikes to schools with unsafe driving, which has a higher risk of traffic accidents. It is important to provide health education about safe driving to prepare students for the active phase of driving. The purpose of this study was to determine the effectiveness of the use of audiovisual media in the form of animated films about safe driving on the level of knowledge, attitudes and subjective norms of students at SMPN 32 Samarinda. METHODS Study design This was a quasi experimental study with non-equivalent pretests and posttest designs. Setting and sample The study was conducted on Monday, March 25, 2019 at SMPN 32 Samarinda, East Kalimantan Province, Indonesia. The population in the study was 98 students of class VII with a sample of 40 people for each group (intervention and control group) selected using a purposive sampling technique. The inclusion criteria were the students who were willing to take part in research activities, and students who were recommended by the school principal in the curriculum to take part in the activity. Instrument The instrument in this study was a questionnaire containing questions to measure knowledge variables and statements to measure attitudinal variables and subjective norms. The knowledge variable uses multiple answer choices with the value of correct answer is 1 and the wrong answer is 0, with the highest score of 15 and the lowest score of 0. Attitude variables


and subjective norms use the Likert scale 1-5. The highest value for attitude is 80 and the lowest is 16. The highest value for the subjective norm variable is 45 and the lowest is 9. The instruments have been tested to obtain the validity and reliability among students at SMPN 23 Samarinda on Friday March 22, 2019. The validity results showed that, of 45 items questions, only 35 items had Pearson correlation > 0.3494 and 10 question items had Pearson correlation <0.3494. The reliability results showed Cronbach's alpha of 0.838. Intervention The audiovisual media for health education of safety riding was produced by the researchers with a duration of 8 minutes 4 seconds. The procedure carried out in the intervention group study included explaining the research activities, filling out informed consent, doing pretest, having audiovisual media, doing posttest, audiovisual media assessment, and discussing. There was no intervention for the control group. The educational materials related to safety riding were obtained from the Law of the Republic of Indonesia No. 22 of 2009 on Road Traffic and Transportation (The House of Representatives of the Republic of Indonesia, 2009), and the driving health materials were obtained from the Directorate General of Public Health, Ministry of Health of the Republic of

Indonesia in 2017 on healthy driving tips (Directorate General of Public Health, 2017). Data analysis Univariate data analysis was conducted to describe the characteristics of the sample including the identity of the sample (gender, age, class, driver’s license ownership), driving history (motorbike riding experience, traffic accident experience, police ticketing experience), and safe driving information sources. Bivariate data analysis used Mann-Whitney test for knowledge and attitude variables. Independent t-test was used for data analysis of subjective norm variables. Data were analyzed with a 95% probability level (α = 0.05). Ethical considerations This research was reviewed and approved by the Health Research Ethics Commission, Faculty of Medicine, Mulawarman University, Samarinda Number: 18 / KEKP-FK / III / 2019. An explanation of the confidentiality of the data and the identity of the subject of the study was carried out, and informed consents were given to the subject of the study prior to data collection. The control group was not given health education through audiovisual media, but for ethical considerations, after having posttest, the control group was given health education.

Table 1 Characteristic of the Respondents

No Characteristic Intervention Group Control Group n = 40 % n = 40 %

1 Characteristics of respondents Sex

Male Female

15 25

37.5 62.5

16 24

40 60

Age 12 years old 13 years old 14 years old 15 years old 16 years old

18 18 1 2 1

45 45 2.5 5

2.5

12 22 4 2 0

50 35 10 5 0

Class VII A VII B VII C VII D

21 0 0 19

52.5

0 0

47.5

0 19 21 0

0

47.5 52.5

0 Ownership of a driver’s license

0 0 0 0


No Characteristic Intervention Group Control Group n = 40 % n = 40 %

2 Riding history First age of riding

9 years old 10 years old 11 years old 12 years old 13 years old 14 years old

4 12 8 9 1 2

10 30 20

22.5 2.5 5

3 9 16 11 1 0

7.5 22.5 40

27.5 2.5 0

Riding a motorbike to school Yes No

17 23

42.5 57.5

17 23

42.5 57.5

Reasons of riding a motorbike to school Nobody drives Distant distance from home Get to school quickly

4 3 10

10 7.5 25

1 2 14

2.5 5 35

History of traffic accident 17 42.5 10 25 Being ticketed by police 1 2.5 1 2.5 3 Resources of safety riding

Parent Teacher Friends Society Police Health workers Newspaper Magazine Textbook Leaflet/Brochure Poster Television Film Internet Social Media Short message (SMS)

34 33 12 24 17 12 19 15 26 18 15 29 18 30 33 10

85 82.5 30 60

42.5 30

47.5 37.5 65 45

37.5 72.5 45 75

82.5 25

29 25 15 19 18 8 8 10 19 6 10 26 15 22 21 5

72.5 62.5 37.5 47.5 45 20 20 25

47.5 15 25 65

37.5 55

52.5 12.5

Table 2 shows that the average knowledge in the intervention group was 55.93 and in the control group was 25.08, with the Mann-Whitney value of 183 (p-value 0.000). Average attitude ratings in the intervention group was

51.73 and in the control group was 29.28, with the Mann-Whitney value of 351 (p-value 0.000). And Table 3 shows that the average difference between the intervention and control groups was 8.9 with p-value 0.000.

Table 2 Statistical Results of the Knowledge and Attitude of the Respondents

Group n Mean Rank Mann-Whitney p-value

Knowledge Intervention 40 55.93 183 0.000 control 40 25.08

Attitude Intervention 40 51.73 351 0.000 control 40 29.28

Table 3 Statistical Results of the Subjective Norm of the Respondents

Group n Mean Mean Difference p-value

Intervention 40 7.61 8.9 0.000 Control 40 -1.27


Figure 1 Distribution of Evaluation of Audiovisual Aid

Figure 1 shows that there were 6 criteria that were considered good by more than 80% of students including health education material (100%), clarity of material content / message (92.5 %%), information presented (92.5%), animated images (90 %) language usage (87.5%), and image accuracy (85%). DISCUSSIONS Findings showed that the intervention group and the control group had different levels of knowledge. The level of knowledge, attitudes and subjective norms in the intervention group was better than the level of those in the control group. This finding was in line with previous studies (Aeni et al., 2015; Imran, 2017; Meidiana et al., 2018; Nandipinta, 2013; Nurmilah, 2017; Siregar, 2018; Yanti & Dewi, 2015), revealed that there is a significant difference in the average knowledge of the intervention and control group after given health education using video or audiovisual media. The average knowledge of the intervention group (55.93) was higher than the average of knowledge of the control group (25.08). This result is supported by a previous study mentioned that a person can remember from what is heard and seen simultaneously

through video, which could obtain a power level of recall of as much as 50% (Yee, 1995). Findings also showed that there was a significant difference in the attitude of students between intervention and control group, which the attitude of students in the intervention group (51.73) were better than the attitude of those in the control group (29.28). This was similar with previous studies revealed that the students who received health education has increased attitude than those who did not receive health education (Hardinawanti et al., 2018; Madinah et al., 2017; Peyman & Jangi, 2015). In addition, the results of this study also showed that there was a significant difference in the subjective norms between both groups. The average difference shows the value of subjective norms of the intervention group (7.61) was higher than it in the control group (-1.27). This result confirms previous studies that there was an effect of health education through audiovisual media on the subjective norms (Ebrahimipour et al., 2016; Eslamimehr et al., 2017; Jalambadani et al., 2018; Safitri & Arif Widodo, 2018; Tafti, 2018). The results of this study also showed that the largest presentations of the sources of

92.5 87.572.5

9065

5 12.525

7.530

2.5 2.5 2.5 2.5 5

Message Language Writing Animation Narrator

Good Enough Less

72.5 77.5 85 92.5 100

25 20 15 7.52.5 2.5 0 2.5

Backsound Brightness Accuracy Information EducationalMaterial


information received by students about safe driving were originated from parents and teachers. However, the knowledge that has been obtained does not guarantee the students would apply safe driving behavior. The students who did not have a driving license and allowed to ride a motorbike were caused by the tendency of permissive attitudes of parents by allowing something that is not supposed to be through the provision of motorcycle facilities (Rozali, 2017). In addition, the environmental factors at home and school are also considered a source of formation of intention in riding a motorcycle. Children under the age of 17 who ride a motorbike psychologically did not have emotional stability because they were still entering the development phase, so that parents and teachers act as directors in giving examples of actions that should be followed by the children (Rozali, 2017). The results of this study add the new knowledge that the audiovisual media could communicate messages quickly and effectively in the provision of health education. A study stated that someone will be remember as much as 20% of what is heard, amounting to 30% of what is seen, and able to remember from what is seen and heard by 70% (Kholid, 2018). The learning process through audiovisual media provides high success in improving learning processes and outcomes, in terms of knowledge, attitude, and subjective norms (Asmara, 2015; Nasrullah et al.). In this study, we also evaluated the audiovisual media used as intervention. The audiovisual media were assessed by students objectively based on the opinions of each student. Clarity of material content and messages was assessed as good (92.5%), sufficient (5%) and less (2.5%). The message of the material presented on the video was considered good because there were pictures and sounds to explain the contents. The safety riding material aspects were also considered good (100%). Learning media channel information was clear and easily understood by the students. A previous study stated that the learning media in the form of

videos must provide visual, audio, and interesting information so that the students are interested in learning and not getting bored during the learning process (Kusuma et al., 2015). However, the audiovisual media can increase interest, desire, motivation, and stimulate students to learn (Kholid, 2018). Additionally, the narrator's voice was judged to be good with a percentage below 70%, which because of unclear voice of the speakers. Further study needs to pay attention to this variable. CONCLUSION There are differences in the average of knowledge, attitudes, and subjective norms of students between the intervention group and the control group with p-value of 0.000. The levels of knowledge, attitudes, and subjective norms in the intervention group were higher than those in the control group. The audiovisual media used in the delivery of health education is very effective in increasing students' knowledge, attitudes, and subjective norms about safety riding at junior high school students. Declaration of Conflicting Interest There is no conflict of interest. Acknowledgment The researcher was very grateful to all respondents who had contributed to this study, as well as to all teachers and the Principals of SMPN 32 Samarinda. REFERENCES Aeni, Q., Beniarti, F., & Warsito, B. E. (2015). Pengaruh

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Cite this article as: Rahman, W., Setyowati, D. L., Ifroh, R. H. (2019). Effect of health education of safety riding using audiovisual media on knowledge, attitudes and subjective norms of junior high school students in Samarinda Indonesia. Public Health of Indonesia, 5(3): 54-61.


Public Health of Indonesia Skulberg, K.R., et al. Public Health of Indonesia. 2019 September;5(3): 62-70 http://stikbar.org/ycabpublisher/index.php/PHI/index

ISSN: 2477-1570

Original Research

SMOKING AMONG ADOLESCENT MALES AT PULAU WEH, INDONESIA

Knut Ragnvald Skulberg1*, Samarullah Hamid1,2,3, Arild Vaktskjold1,4

1Department of Public Health and Sport Sciences, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway

2Municipal Health Authority of Sabang, Jalan By Pass Cot Ba’U, Sabang, Province of Aceh, Indonesia 3Akademi Keperawatan Ibnu Sina Kota Sabang, Jalan By Pass Cot Ba’U, Sabang, Province of Aceh, Indonesia

4Forskningsavdelinga, Innland Hospital Trust, Sanderud, Norway Received: 20 August 2019 | Accepted: 14 September 2019 Correspondence: Knut Ragnvald Skulberg Inland Norway University of Applied Sciences Postboks 400 2418 Elverum Norway Email: [email protected] Phone: +47 90143164

Copyright: © the author(s), YCAB publisher and Public Health of Indonesia. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Use of tobacco may cause severe diseases like cardiovascular diseases and lung cancer. Smoking is a major threat to public health in many low- and middle-income countries. Objective: The aim of this study is to assess the prevalence of smoking among boys in the age group 13-15 years at Pulau Weh in Indonesia, and identify factors associated with smoking. Methods: A cross-sectional study was conducted of 291 male students, aged 13-15 years, in three participating secondary schools. A modified version of the Global Youth Tobacco Survey questionnaire was used to collect data. The association between active smoking within the previous 30 days, and social and demographic factors was analysed by multiple logistic regressions. Results: 40.2% of the male students were habitual smokers at the time of the study. The adjusted odds of current smoking increased with increasing age (odds ratio [OR] = 5.1, 95% CI: 2.2–12.3); having a father with a university or university college education (OR = 2.7, 95% CI: 1.0–7.1); having friends who smoke (OR = 5.2, 95% CI: 1.6–16.5), having sibling who smoke (OR = 2.7, 95% CI: 1.2–6.2); having a father who smokes (OR = 2.1, 95% CI: 1.1–3.9) and attending a rural school (OR = 7.4, 95% CI: 2.8–19.6). Conclusions: Cigarette smoking was found to be prevalent among 13 to 15-year-old male students in Pulau Weh, Indonesia, significantly higher in students attending a rural school compared to those attending an urban school. Indonesia should take steps to redress the smoking epidemic among adolescents by various means, e.g., minimizing access to tobacco products, stricter enforcement of tobacco control laws and changing attitudes to smoking. Keywords: Indonesia, smoking, adolescents

BACKGROUND There are approximately one billion smokers worldwide and nearly 80% of these live in low- and middle-income countries (WHO, 2017). According to the WHO global report (WHO,

2018), smoking prevalence among world’s population aged ≥ 15 years declined from 24.3% to 20.2% in the period 2005 to 2015, although the number of smokers increased.


Studies since the 1950s have revealed that smoking tobacco may cause severe diseases and (Bjartveit & Tverdal, 2005; Doll & Hill, 1954, 1956, 2004; Hjerman, Helgeland, Lund‐Larsen, & Leren, 1976; Scanlon et al., 2000) major diseases associated with tobacco use are ischemic heart diseases, stroke, lung cancers and chronic obstructive pulmonary disease. Several studies have found associations between second-hand smoke and respiratory and cardiovascular diseases among adults (Oberg, Jaakkola, Woodward, Peruga, & Pruss-Ustun, 2011). Parental smoking may induce the risk of lower respiratory infection and asthma in childhood (Oberg et al., 2011). Several scientific studies from Indonesia have explored different diseases related to smoking; including lung cancer (Kristina, Endarti, Sendjaya, & Pramestuty, 2016), cardiovascular diseases (Sumartono, Sirait, Holy, & Thabrany, 2011), child malnutrition (Semba et al., 2007), as well as the risk of child mortality (Semba et al., 2008). Prevalence of smoking varies between countries and over time. The WHO has developed a questionnaire to monitor tobacco use among adolescents, referred to as the GYTS (Yach et al., 2002). Valid and reliable data about tobacco use are essential to make a comparison between countries, reveal trends in tobacco use, identify risk groups and evaluate programmes aimed at preventing smoking. A review study by Allen et al. (2017) has shown clear evidence that the prevalence of smoking is affected by socioeconomic position. According to Indonesia Basic Health Research (Riskesdas, 2013), 29.3% of the population were daily smokers in 2013 (aged 10 years or

older). In 2016 the current smoking age-standardised prevalence for both genders was 33.9%, the proportion was 65.2% among men and 2.2% among women2 (aged 15 years or older). In 2014, the WHO used the GYTS to ascertain the prevalence of smoking among Indonesian schoolchildren aged 13-15 and found that 36.2% of boys and 4.3% of girls were active smokers (WHO, 2015). The aim of this study was to identify the prevalence of smoking among male pupils at secondary schools at Pulau Weh, Indonesia, and explore the association between active smoking, and demographic and social factors. METHODS Setting and Study Design This study was conducted at Pulau Weh, in the Aceh province of Indonesia. The island had 32,739 inhabitants in 2014. All boys in Pulau Weh between 13 and 15 years of age attend secondary school, either ordinary public schools or Quranic schools. The number of male students attending the 12 secondary schools totalled 2143. This cross-sectional study was carried out among male pupils between the ages of 13 and 15 years in January 2017. Sample/Participants

The 12 secondary schools were classified into three categories: “Public urban school”, “Quranic school” and “Public rural school”. The largest school in each category was invited to participate and all three gave their consent. 390 male students at the three selected schools were invited to participate and 291 volunteered (Table 1). Female students were not included in this study.

Table 1 Total Number of Participants Distributed Among the Three Schools

School Total number Number participating in the study Participation (%)

Quranic school 150 91 60.7 Public urban school 192 158 82.2 Public rural school 48 42 87.5 Total 390 291 74.6


Instrument A modified version of the GYTS questionnaire (Gaffar, Alsanosy, & Mahfouz, 2013; Zhao, Palipudi, Ramanandraibe, & Asma, 2016) was used for data collection. This questionnaire has also been used in previous Indonesian studies (Aditama et al., 2008). The original questionnaire was modified to refer only to cigarette use and a question was added about the type of school attended. The modified questionnaire includes age, religion, type of school, address, paternal and maternal education level, and the student’s weekly disposable income. The questionnaire also addresses former and current smoking habits, frequency of smoking in the last 30 days, age of initiation, smoking among friends and family, influence by the mass media, smoking behaviour, and attitudes towards smoking. Data Analysis For the purposes of this study, an active smoker is defined as someone who has smoked at least one cigarette daily, non-daily or occasionally in the past 30 days. Data were managed and analysed using IBM SPSS Statistics 24 (SPSS, Chicago, IL, USA). Unadjusted odds ratios (OR) with 95% confidence intervals (95% CI) were calculated to measure the strength of the association between each of the categorical variables and

an “active smoker”, the binary outcome variable. The variables were also analysed by multiple logistic regression, using conditional backward stepwise elimination, to estimate the adjusted association for the statistically relevant factors. Ethical Consideration The Norwegian Centre for Research Data considered the ethical aspects of this research study. No approval was required because neither direct nor indirect identifying personal data were registered. The Head of the Education Agency in the Pulau Weh Municipality and the principals of all three schools, granted authorization in December 2016. Informed consent to participate in the study was obtained from parents of the participants and participants were allowed to withdraw at any point during the study. RESULTS Most participants were 13 or 14 years old. 95.5% were Muslim and most had parents who had attended higher education. Table 2 gives background information about the study sample.

Table 2 Characteristics of the Study Group

Variable Value Number Percent (%) Age (N=291) 13 years old 130 44.7

14 years old 113 38.8 15 years old 48 16.5

Religion (N=291) Muslim 278 95.5 Another religion 13 4.5

Place of living (N=290) Town 226 77.9 Rural 64 22.1

How much money can you freely spend in a week? (N=291)

Less than 10.000 IDR 132 45.4 10.000 to 20.000 IDR 82 28.2 More than 20.000 IDR 77 26.5

Education of the father (N=291) No education, primary school or secondary school

54 18.6

High School 143 49.1 University college/University 79 27.1

Education of the mother (N=291) No education, primary school or secondary school

64 21.9

High School 133 45.7 University college/University 81 27.8


40.2% were active smokers and 14.5% had smoked earlier. Table 3 shows the smoking habits of the active smokers. 87.9% of the

active smokers smoked elsewhere rather than at home or in school. 73.5% of smokers bought their cigarettes in local kiosks.

Table 3 Smoking Habits Among Active Smokers in Secondary Schools at Pulau Weh

Variable Value Number of active smokers

Percent (%) of active smokers

Where do you smoke? (N=116) At the school 1 0.9 At home 6 5.2 Other places 102 87.9 More than one answer 7 6.0

With whom do you smoke? (N=113) Together with the family 2 1.8 Together with close friends 68 60.2 Together with other persons 28 24.8 More than one answer (friends and other)

15 13.3

How do you become money to buy smoke? (N=114)

From family 19 16.7 Working myself 14 12.3 From my bank account 0 0.0 From friends 35 30.7 I smoke, but I did not buy cigarettes

24 21.1

Other 7 6.1 More than one answer 13.2

Where do you buy your cigarettes? (N=102)

In the shop 6 5.9 In the kiosk 75 73.5 Other 21 20.6

96.1% reported that they knew smoking could be dangerous to their health, and 59.9% answered that they had received information on smoking and health risks during the previous 12 months at school. 80.5% had seen information about health on cigarette packets and 35.8% reported that these health warnings deterred them from taking up smoking or made them consider quitting. 73.2% of all participants had close relatives who smoked and 85.5% of all participants had close friends who smoked.

The proportion of smokers increased with age in the group studied. 69.0% of participants attending the rural public school were active smokers, whereas 34.8% and 36.3% of those in the two urban schools were active smokers. As can be seen in Table 4, 56.3% of participants living in rural areas smoked, compared with 35.8% of participants living in the town. 45.1% of participants had friends who smoked.

Table 4 Unadjusted and adjusted risk of active smoking by individual background variables and social influence factors using logistic regression analysis. (Odds ratios with 95% confidence

intervals.)

Variable Value (number responding)

Number and % of active smokers

Unadjusted OR and 95% CI

Adjusted OR and 95% CI

Age 12-13 (N=130) 39 (30%) 1 1 14 (N=113) 46 (40.7%) 1.6 (0.9-2.7) 1.3 (0.7-2.4) 15-16 (N=48) 32 (66.7%) 4.7 (2.3-9.5) * 5.1 (2.2-12.3) *


Table 4 Unadjusted and adjusted risk of active smoking by individual background variables and social influence factors using logistic regression analysis. (Odds ratios with 95% confidence

intervals.) Cont.

Variable Value (number responding)

Number and % of active smokers

Unadjusted OR and 95% CI

Adjusted OR and 95% CI

Religion Muslim (N=278) 115 (41.4%) 1 - Another religion (N=13) 3 (15.4%) 0.3 (0.1-1.2) -

Type of school Public school in the town (N=158)

55 (34.8%) 1 1

Quranic school (N=91) 33 (36.3%) 1.1 (0.6-1.8) 1.2 (0.6-2.4) Public school in a rural area (N=42)

29 (69%) 4.2 (2.0-8.7) * 7.4 (2.8-19.6) *

Place of living Town (N=226) 81 (35.8%) 1 - Rural (N=64) 36 (56.3%) 2.3 (1.3-4.0) * -

Education of the father

No education, primary school or secondary school (N=54)

32 (51.9%) 1 1

High School (N=143) 54 (37.8%) 0.6 (0.3-1.1) 1.6 (0.7-3.6) University college/University (N=81)

28 (40.5%) 0.6 (0.3-1.2) 2.7 (1.0-7.1) *

How much money can you freely spend in a week?

Less than 10.000 IDR (N=132)

62 (47.0) 1 -

10.000 to 20.000 IDR (N=82)

27 (32.9%) 0.6 (0.3-1.0) * -

More than 20.000 IDR (N=77)

28 (36.4%) 0.6 (0.4-1.2) -

Influence by close related persons who smoke

Friends do not smoke (N=40)

5 (12.5%) 1 1

Friends smoke (N=235) 106 (45.1%) 5.3 (2.0-14.1) * 5.2 (1.6-16.5) * Father do not smoke (N=106)

30 (28.3%) 1 1

Father smoke (N=175) 87 (47.0%) 2.2 (1.3-3.8) * 2.1 (1.1-3.9) * Sibling do not smoke (N=254)

95 (37.4%) 1 1

Sibling smoke (N=37) 22 (59.5%) 2.5 (1.1-5.4) * 2.7 (1.2-6.2) * Grandfather do not smoke (N=260)

105 (40.4%) 1 1

Grandfather smoke (N=31) 22 (71.0%) 0.8 (0.3-1.8) - Influence by advertising in mass media

Have not seen any advertising (N=58)

21 (36.2%) 1 -

Have seen tobacco advertising (N=215)

81 (37.7%) 1.1 (0.6-2.0) -

Influence by advertising in stores or kiosks

Have not seen any tobacco advertising (N=158)

48 (30.4%) 1 -

Have seen tobacco advertising (N=131)

58 (44.3%) 1.6 (1.0-2.6) * -

Constant 0.2 Note: R2= 0.20 (Cox & Snell) 0.28 (Negelkerke). Model χ2 =60.2, p ‹ 0.000 Note: * = p<0.05 and 1 = reference category Table 4 also shows the adjusted risk of active smoking by background and social factors. Factors associated with an increased risk of active smoking are expressed as OR (95% CI): “the pupil’s age” 5.1 (2.2-12.3); “belonging to the rural public school” 7.4 (2.8-19.6); “high

education of the father” 2.7 (1.0-7.1); “having friends who smoke” 5.2 (1.6-16.5); “having a father who smokes” 2.1 (1.1-3.9) and “having sibling who smoke” 2.7 (1.2-6.2).


DISCUSSION Statement of principal findings Forty percent of male students between 13 and 15 years old in Sabang, Indonesia, were current smokers. Most smoked with friends and were able to purchase single cigarettes in local kiosks. Factors found to be positively associated with a smoking habit are age, attending a rural public school, a highly educated father, and a father, sibling or friends who also smoke. Disposable income or advertisements in the mass media or at the kiosk/store have not been found to be associated with smoking. Strengths and weaknesses of the study, discussing important differences in results in relation to other studies The Global Youth Tobacco Survey (GYTS) has been developed to collect information about tobacco use among youths in many countries (Yach et al., 2002). The survey uses a standardized questionnaire and results may be compared within a country as well as between countries. The GYTS study in Indonesia, completed in 2014, found that 33.9% (95% CI 26.1-42.7) of boys smoked in the age group 13-15. The corresponding finding in the study presented here is 40.2%, which is within the 95% CI of the GYTS study. Comparison of data from this study with neighbouring countries, indicates a lower prevalence of active smokers among young male adolescents aged 13-15 years, in places such as Vietnam (15.4%) (Giang et al., 2016) and Malaysia (27.9%) (Lim et al., 2017). Comparison of the prevalence of current smoking among 13 to 15-year-old boys in 61 countries, using GYTS, reveals a figure of 20.7% in Thailand, 20.5% in the Philippines and 6.3% in Vietnam (Arrazola et al., 2017). In a cross-sectional study of 15 to 17-year-old students in Java, Indonesia, 29.6 % were current smokers (Bigwanto, Mongkolcharti, Peltzer, & Laosee, 2017). Of the male students, 55.6% were current smokers. However, the mean age

of the study population was 16.4 years, as compared to 13.7 years in the study being presented here. When examining the incidence of smoking among youths, distribution of ages in the study group is of great importance in determining the prevalence of smokers. Analysis has shown that increased age is positively associated with smoking. This result is in accordance with results from the Indonesian GYTS (WHO, 2015). 66.7% of the 15-year-old boys were active smokers. However, most of the 13 to 15-year-old boys were not yet heavy smokers. These findings highlight the pressing need to prevent youngsters from taking up smoking, with an emphasis on effective tobacco cessation interventions focusing on males between 13 and 15 years old. In earlier studies, religion has been found to deter individuals from smoking (Lim et al., 2017). In the study presented here, 95.5% of the population were Muslims, but the prevalence of smoking remained high. A more detailed analysis of the association between religion and active smoking has not been feasible due to the small number of non-Muslim participants. This study has found that the odds of being an active smoker are 7.4 times higher among students at the public rural school, as compared to the public school in town. Rural residency may be a risk factor for tobacco use among adolescents (Bigwanto et al., 2017; Lutfiyya et al., 2008). In a study of the Jazan region in Saudi Arabia, no difference in smoking prevalence was found between urban and rural living, but a lower prevalence of smoking, compared to other regions in Saudi Arabia, was explained by large rural areas having increased control from the family (Gaffar et al., 2013). Most participants in this study had relatives or close friends who also smoked, potentially exposing them to second-hand smoke. These results are in accordance with findings of the Indonesian GYTS report (WHO, 2015), which revealed that 57.3% were exposed to smoke in their homes while 60.1% were exposed to second-hand smoke in enclosed public places. In a review article by Oberg et al. (2011), 40%


of children were found to have been exposed to second-hand smoke worldwide. Pulau Weh is an island with a defined population and the study was conducted over a short period. Furthermore, the study used a validated questionnaire. With a response rate of 74.6 %, the results are believed to provide reliable information on smoking prevalence among young boys in Pulau Weh. The higher prevalence in the rural school suggests that future assessments perhaps should include more than one rural school in the sampling, and underscores the importance of proportional sampling between rural and urban areas to obtain a good prevalence estimate. The cross-section design has a weaker scientific design than the RTC design. However, it may be a useful tool for recording the prevalence of smoking in the population and may focus on the impact of smoking on public health. This may also prompt interventions, aimed at smoking prevention or smoking cessation, at a societal level. Indeed, a school-based education programme focusing on smoking prevention has been implemented in the Aceh province of Indonesia. Meaning of the study: possible explanations and implications for policymakers This cross-sectional study may have implications for policymakers’ work on reducing the incidence of smoking among male adolescents. In the GYTS 2014 report (WHO, 2015), the Minister for Health in the Republic of Indonesia stated the need for proactive and sustained tobacco control efforts. Interventions guarding against the use of tobacco could be implemented by various legislative means. Given that most smokers in this study bought single cigarettes from kiosks, a ban on selling single cigarettes may effectively contribute to a reduction in the prevalence of smoking among male adolescents. Moreover, stricter controls and sanctions for kiosks that violate cigarette sales regulations will also reduce the availability of cigarettes for this age group

Indonesian tobacco companies use, among others, small retail outlets to advertise tobacco products (WHO, 2012). At Pulau Weh, tobacco product advertisements are visible in many places, especially the kiosks where adolescents buy their single cigarettes. The multivariate analysis in this study has not confirmed the influence of advertising on smoking status. However, other studies have found that a ban on tobacco advertising and promotion may reduce the exposure of adolescents to tobacco products (Long et al., 2016; WHO, 2017). Indonesia needs to make a concerted effort to halt the smoking epidemic among adolescents by measures which could include the banning of cigarette marketing aimed at adolescents. Unanswered questions and future research Future research into smoking among youths in Indonesia should quantify the varying impact of rural versus urban housing, religion, social inequality and cultural differences. Smoking among male youths in Indonesia is widespread and will lead to major health concerns for individuals and society in the future. Further research should include assessment of the efficacy of different adolescent anti-smoking interventions at a societal level. CONCLUSION At Pulau Weh in Indonesia, more than a third of boys in the 13-15 age group were found to smoke. Increasing age, and the influence of friends, sibling and father who smoke were found to constitute risk factors in habitual smoking. Furthermore, attending a rural school rather than an urban school, was a high-risk factor. These findings emphasize the need for urgent, effective action to reduce cigarette use among young males on both an individual and social level. Competing interests The authors declare that they have no competing interests. Acknowledgements The authors wish to thank all the schools involved in the study, especially the pupils who participated.


Funding Inland Norway University of Applied Sciences and Municipal Authority of Sabang, Province of Aceh, Indonesia covered travel expenses and accommodation for KRS in October 2017. The funder had no involvement in the study design, data collection, analysis, and interpretation, or writing of the manuscript. Authors' contributions KRS and SH were responsible for designing the study, analysing the data and writing the first drafts. SH was responsible for organizing and conducting data retrieval at Pulau Weh, Indonesia. AV had input into design of the study, the analysis plan and interpretation of the results. All three authors contributed to the writing of the final manuscript. REFERENCES Aditama, T. Y., Pradono, J., Rahman, K., Warren, C. W.,

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Cite this article as: Skulberg, K.R., Hamid, S., Vaktskjold, A. (2019). Smoking among adolescent males at Pulau Weh, Indonesia. Public Health of Indonesia, 5(3): 62-70.


Public Health of Indonesia Gunawan, J. Public Health of Indonesia. 2019 September;5(3): 71-72 http://stikbar.org/ycabpublisher/index.php/PHI/index

ISSN: 2477-1570

Letter to the Editors

BEYOND INDONESIA FOREST WILDFIRES 2019

Joko Gunawan*

Belitung Raya Foundation, Indonesia Accepted: 23 September 2019 Correspondence: Dr. Joko Gunawan Belitung Raya Foundation, Indonesia Manggar, Belitung Timur, Provinsi Bangka Belitung 33472 Email: [email protected]

Copyright: © the author(s), YCAB publisher and Public Health of Indonesia. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: forest, wildfires, Indonesia, global warming Dear Editors,

Again, Indonesia greatly contributes to the global warming today by bringing repeated forest wildfires to our lovely earth. Although there are many speculations related to this issue, both from a political perspective in regards to the movement of the capital city of Indonesia from Jakarta to East Kalimantan, and from a business perspective related to the palm oil industry, however, this indicates that the Government of Indonesia is still not able to anticipate nor to prevent the case of fire. As a consequence, the forest fires not only have destroyed the natural habitat of orangutans in Kalimantan, but also have threaten the life of people in the area with hazardous air quality index (with Particulate Matter 10 = 593.08) on 23 September 2019 (Prima, 2019). In addition, the haze has also reached Asean countries, especially Malaysia, Singapore, and Philippines, which may affect the international cooperation between Indonesia and those countries (Abbugao, 2019; Macasero, 2019). Sadly, more than 6,000 people suffered from an upper respiratory infection specifically in children at Central Kalimantan, followed by 1

people died at North Kalimantan on 21 September 2019, and 2 babies also died at Banyuasin on 16 September and at Riau on 18 September 2019 (Arif, 2019; Berita Satu, 2019). With the killer hazard of the haze, the risks of early deaths will be increased, ranged from 26,300 to 174,300 deaths (BBC News, 2019). Additionally, on 23 September 2019, the Meteorology climatology geophysical agency (2019) has also alarmed 12 provinces in Indonesia, which will potentially have additional forest fires and haze. Although the government has been trying to deal with this problem, and the communities in the affected area have also been praying for rain to reduce the haze. However, the impact may not be so fast as expected. This environmental problem certainly remains the biggest challenge for public health professionals in Indonesia today. This letter aims to invite all public health scholars in both Indonesia and around the world to do the best efforts to help the affected community and pray for Indonesia.


Declaration of Conflicting Interest There is no conflicting of interest. REFERENCES Abbugao, M. (2019). Forest fire haze clears

over Singapore ahead of F1. Retrieved from https://www.thejakartapost.com/news/2019/09/20/forest-fire-haze-clears-over-singapore-ahead-of-f1.html

Arif, A. (2019). Berlindung dari bahaya kabut asap [Protect from the haze]. Retrieved from https://bebas.kompas.id/baca/utama/2019/09/21/berlindung-dari-bahaya-kabut-asap/

BBC News. (2019). Indonesia haze may have led to 100,000 premature deaths, says report. Retrieved from https://www.bbc.com/news/world-asia-37404515

Berita Satu. (2019). Kabut asap di Kalimantan mulai meminta nyawa [Haze in Kalimantan starts asking for life]. Retrieved from http://beritasatu.com

Macasero, R. (2019). IN PHOTOS: Indonesia forest fire haze reaches the Philippines. Retrieved from

https://www.rappler.com/nation/240709-photos-indonesia-haze-reaches-philippines

Meteorology climatology geophysical agency. (2019). Peringatan dini BMKG besok Senin, 23 September 2019: Waspada wilayah kebakaran hutan dan kabut asap [Early warning of BMKG tomorrow Monday, 23 September 2019: Look out of forest fire and haze]. Retrieved from https://www.tribunnews.com/nasional/2019/09/22/peringatan-dini-bmkg-besok-senin-23-september-2019-waspada-wilayah-kebakaran-hutan-dan-kabut-asap?page=4.

Prima, E. (2019). Kondisi partikel udara Pekanbaru berbahaya, sekolah lumpuh [The condition of air particles of Pekanbaru particles is dangerous, the school is down]. Retrieved from https://tekno.tempo.co/read/1251124/kondisi-partikel-udara-pekanbaru-berbahaya-sekolah-lumpuh

Cite this article as: Gunawan, J. (2019). Beyond Indonesia Forest Wildfires 2019. Public Health of Indonesia. 5(3): 71-72.


Public Health of Indonesia Hussen, A. Public Health of Indonesia. 2019 September;5(3):73-79 http://stikbar.org/ycabpublisher/index.php/PHI/index

ISSN: 2477-1570

Original Research

KNOWLEDGE ABOUT PREGNANCY DANGER SIGNS AMONG MOTHERS ATTENDING ANTENATAL CARE IN JUGAL HOSPITAL,

HARARI REGIONAL STATE, ETHIOPIA, 2019

Arif Hussen*

Harar Health Science College, Department of Pediatrics Nursing, East Ethiopia Received: 10 September 2019 | Accepted: 20 September 2019 Correspondence: Arif Hussen, MSC Harar Health Science College, Department of Pediatrics Nursing, East Ethiopia Telephone 025-666-0255, p.o.box# 806, Harar, Ethiopia Email address: [email protected]

Copyright: © the author(s), YCAB publisher and Public Health of Indonesia. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Every pregnant woman faces the risk of sudden, unpredictable complication that could end in death or injury to mother or infant. Each year, approximately 287,000 women die from complications related to pregnancy and childbirth in developing countries. Maternal mortality ratio (MMR) in developing regions is 15 times (240/100,000 live births) higher than in developed regions (16/100,000live births) Objective: The aim of this study was to determine the knowledge about pregnancy danger signs among mothers attending antenatal care in Jugal Hospital, Harari Regional State, Ethiopia. Methods: Institution based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants from pregnant mothers attending antenatal care during the time of data collection. Data were collected using a structured questionnaire and it was entered in to EPI Data version 3.1 software program and exported to SPSS version 20 software for analysis. Results: A total of 316 pregnant women were included in the study with a response rate of 86%. The study indicated that 44.67% of the respondents had knowledge on danger signs of pregnancy, and there was a significant association with the knowledge on danger signs of pregnancy and the age of the respondent and educational status of the respondent (P <0.05). Conclusion: The study finding shows that poor awareness about danger signs of pregnancy among antenatal care attendants in Jugal hospital, Harari Regional State. There was a significant association between educational status, the age of the mother and knowledge about pregnancy danger signs among mothers attending antenatal care. Keywords: danger sign, knowledge, antenatal care, Ethiopia, pregnancy BACKGROUND Every pregnant woman faces the risk of sudden, unpredictable complication that could end in death or injury to mother or infant (Central Statistical Agency and ORC Marco, 2016). Danger signs are problems that face the mother during pregnancy, labor and the postpartum period. This includes bleeding from the vagina, no matter how slight, swelling of the face or hands or legs, severe headache, dimness or

blurring of vision, severe or continuous pain in the abdomen. In addition, it includes severe or continuous vomiting, chills or fever, pain or burning with urination, sudden escape of fluid from the vagina in the second half of pregnancy, if the baby (fetus) moves less than you are used to, or stops moving and pelvic or abdominal pain (Midhet & Becker, 2010).


Each year, approximately 287,000 women die from complications related to pregnancy and childbirth in developing countries. Maternal mortality ratio (MMR) in developing regions is 15 times (240/100,000 live births) higher than in developed regions (16/100,000live births) (Requejo, Victora, & Bryce, 2014). Sub-Saharan Africa had the highest maternal mortality ratio at 500 maternal deaths per 100,000 live births. Most of the studies have been reported that Ethiopia is one of the six countries that contribute about 50% of the maternal deaths; the others are India, Nigeria, Pakistan, Afghanistan and the Democratic Republic of Congo (World Health Organization, 2015). Studies conducted in South West Ethiopia, Arbaminch and Benchmaji indicated that the level of awareness on pregnant women about obstetric danger signs during pregnancy was low (Dile, Taddesse, Gedefaw, & Asmama, 2015; D. Hailu & Berhe, 2014). Low awareness of danger signs and symptoms during pregnancy contribute to delays in seeking and receiving skilled care. For that matter, increased awareness is essential for reducing delays in seeking health care and in reaching a health facility. Despite these all problem, no articles found in the study area showing the severity of the problem that encourage the concerned bodies to take remedial action. The study therefore aims to fill this gap by assessing the current status of knowledge about pregnancy danger signs among mothers attending Antenatal Care (ANC) in Jugal hospital, Harai Regional State, Ethiopia, 2019. METHODS Study setting and study design The study was conducted at Jugal Hospital, Harar City, which is located 525 km to East of Addis Ababa. It has a total of 342 staff, which 208 of them are health care professionals and the rest are non-health professionals, administrative staff of the hospital found in

Harar towns. It is the first governmental hospital in Ethiopia established in 1902 GC, named as Misrak Arbegnoch Hospital, and the hospital changed its name to Jugal Hospital. Currently, the hospital is providing ANC with six midwives, two of them are BSc and the rest are diploma nurses. Institutional based quantitative cross-sectional study design was conducted. Data were collected from June 1th - 15th, 2019. Sample size determination and sampling procedure All pregnant women attending ANC were selected if met the inclusion criteria. Systematic random sampling was used. The inclusion criteria were all mothers who gave birth in the hospital and have willing to participate in the study. The following assumptions were made to determine the sample size: The formula to calculate the sample size was n= (zα/2)²p (1-p)/D², where n=number of the study subjects, Z= the standardized normal distribution curve value for the 95% confidence interval (1.96), P= the level of knowledge on obstetric danger signs during pregnancy, it was 31.9% in the study done in Balegoba (7) {Bogale, 2015 #162}(Bogale & Markos, 2015), d=the desired precision of the estimate (the margin of error between the sample and population, 5%) = (1.96)²x 0.319 (1-0.319) / (0.05)² =333+33 =366 = the total sample size after computing for 10 % non-response rate was 366. Data collection, quality and analysis Data were collected using a structured questionnaire. The data collectors were four BSc. midwives. The questionnaire was gathered and checked for completeness. For data processing and analysis, SPSS version 20 was used. Data were checked for completeness and consistency. Coded data were entered into computer programs after the required cleaning was done. Univariate, bivariate and multivariate analysis were carried out. Odds ratio (OR) with confidence intervals and P-values were calculated the output of the analysis were given, and odds ratio with their respective confidence intervals. P-value of 0.05 was taken as level of significance.


Ethical considerations Ethical clearance was obtained from Harar Health Science College research ethical committee before the staring of the field work. An official letter of co-operation was written to Jugal Hospital. Consent was obtained from administrative body of the hospital and the participants. Confidentiality of the data has been kept throughout the study.

RESULT Socio-Demographic Characteristics of Participants Among a total of 366 sampled participants, 316 mothers were participated making response rate of 86%. 38.61% of the participants aged 26-29 years. Majority of participants (94.94%) were married, and 60.13% of them were housewives. Majority had illiterate level of educational status (34.18%) (Table 1).

Table 1 Distribution of Socio-Demographic Characteristics of Respondents

Variable Frequency Percent (%) Age 15-19 10 3.16

21-25 85 26.90 26-29 122 38.61 30-34 55 17.41 35-39 34 10.76 ≥40 10 3.16

Marital status

Single 16 5.06 Married 300 94.94

Religion

Orthodox 75 23.73 Muslim 205 64.87 Protestant 36 11.39

Ethnicity

Oromo 196 62.03 Amhara 95 30.06 Tigre 5 1.58 Harari 15 4.74 Ethio- Somale 5 1.58

Occupation

House Wife 190 60.13 Employee of GO/NGO 101 31.96 Business 25 7.91

Educational Status Illiterate 108 34.18 Read and Write 69 21.84 Elementary 30 9.49 Secondary 49 15.51 College or University 60 18.99

Obstetric Characteristics of the Respondents From the total number of respondents, 133 (42.09%) had history of 2 pregnancies and 26 (8.23%) mothers were pregnant for more than four times. Regarding the first pregnancy age,

217 (31.33%) mothers got their first pregnancy at age greater than 20 years. Of the total number respondents, 75 (23.73%) had previous risk of pregnancy. In the case of ANC follow up, only 15 (4.7%) mothers had ≥ 4 visits (Table 2).

Table 2 Obstetric characteristics of the respondents Variables Frequency Percent Gravid

1 88 27.85 2 133 42.09 ≥3 95 30.06

Parity

None 88 27.85 1-4 202 63.92 ≥4 26 8.23

Age at 1st pregnancy <20 99 68.67 >20 217 31.33


Variables Frequency Percent Previous risk of pregnancy Yes 75 23.73

No 241 76.27 Number of ANC visit 1 146 46.20

2-3 155 49.05 ≥4 15 4.75

Source of Information Regarding Obstetric Danger Signs During Pregnancy There were 311 participants (98.42%) had heard obstetric danger signs during pregnancy. From those who heard obstetric danger signs majority, 251(80.7%) of the study participants answered the signs that indicated the pregnant or/and the pregnancy has illness. 175 participants (56.27%) had got danger signs information from health personnel followed by media, friends and relatives with 106(34.08%), 21(6.75%) and 9(2.89%) respectively.

Knowledge on Danger Signs During Pregnancy Of the 316 respondents, 311 (98.42%) reported that they had got information about obstetric danger sign during pregnancy. From those who had the information, 246 respondents (79.10%) identified severe vaginal bleeding at any time during pregnancy as danger sign, while the least was fever identified only by 56 participants (18.01%) (Table 3).

Table 3 Knowledge on Danger Signs During Pregnancy Among Participants

No Danger sign pregnancy Frequency Percent 1 Vaginal bleeding 246 79.10 2 Absent/ decreased fetal movements 189 60.77 3 Convulsion 179 57.56 4 Severe vomiting 178 57.33 5 swelling of the body 168 54.02 6 foul smelling vagina discharge 142 45.66 7 blurring of version 79 25.40 8 Severe abdominal pain 63 20.26 9 Severe frontal headache 57 18.33 10 Fever 56 18.01

The study participants who responded correctly considered having awareness about danger signs of pregnancy. Based on this, 138 respondents (44.67%) have knowledge, and 173 respondents (55.33) do not have knowledge about danger sign of pregnancy. Factor Affecting Knowledge of Danger Sign During Pregnancy In bivariate logistic regression analysis, age, marital status, occupation, educational status, age of the 1st pregnancy, and number of ANC visit were statistically significant associated with knowledge of danger sign during pregnancy. Variables which showed statistically significant associations with knowledge of danger sign during pregnancy in the bi-variate analysis were re-entered into multi-variate logistic regression, to control possible confounders.

After controlling the effect of other predictor variables, the multivariate logistic regression analysis showed statistically significant association between maternal age and knowledge of danger sign during pregnancy, as well as between educational status and knowledge of danger sign during pregnancy with P-value <0.05. In this study, the odds of having knowledge of danger sign during pregnancy was 7.21 times higher among literate group than illiterate group (AOR =7.21; 95% CI =1.17-27.90). Furthermore, in this study, the odds of having knowledge of danger sign during pregnancy was 1.43 times higher among age greater than or equal to 26 years of age group than age less than 26 years of age group (AOR=1.43; 95% CI=1.05-1.89).


DISCUSSION This research revealed that 79.10% of respondents knew vaginal bleeding, 60.77% reduced fetal movement, and 54.02% swollen hand and face as danger sign of pregnancy. This finding is higher than study done at rural Tanzania which revealed 45.9% vagina bleeding, 1.2% reduced fetal movement, and 10.7% swollen hand and face (Mushi, Mpembeni, & Jahn, 2007). This difference might be due to the difference study areas, study design or sample size, the major difference might be this study was institutional at urban, but study done at Tanzania were community based in rural area. This study finding showed that 44.67% of the participants had knowledge about danger signs of pregnancy, which is higher than studies done in Alexandria, Egypt 26% (Rashad & Essa, 2010), Jordan 15.2% (Okour, Alkhateeb, & Amarin, 2012), Uganda 20% (Mbalinda et al., 2014), South Africa 16% (Coleman, 2014), Tanzania 14.8% (Urassa, Pembe, & Mganga, 2012), Debra Birhan town 38.6% (Solomon, Amanta, Chirkose, & Badi, 2015), AletaWondo 30.4% (M. Hailu, Gebremariam, & Alemseged, 2010), Dar-es-salaam, Tanzania 31% (Mwilike, 2013), and Salem, Tamil Nadu 34% (Mahalingam & Venkateasan, 2014). In contrary, it was lower than study done in other part of Ethiopia, Tsegedi distric 58.8% (D. Hailu & Berhe, 2014), Debark town north west 47% (Mengesha & Taye, 2012), East Gojjam Zone 55.1% (Amenu, Mulaw, Seyoum, & Bayu, 2016), and Mekelle city Tigray 82.5% (Abiyot, Kassa, Buruh, & Kidanu, 2014). The differences might be due to the difference study area, sample size, study setting and might be due variation in socio-economic difference of study participates. In this study, the educational status of study participants affected the level of awareness, as educational status increase, the level of awareness also increases. This is similar with studies done in Indonesia (Sugiyarto, 2007), Uganda (Kabakyenga, Östergren, Turyakira, & Pettersson, 2011), Bench maji (Demissie, Dessie, & Michael, 2015), and Mekele (Abiyot

et al., 2014), showed that as educational status increases awareness also increased. The education is believed to be the most powerful influencing factor to increase women’s’ knowledge about danger signs of pregnancy. In this study, maternal age was one factor that has been indicated as predictors of awareness of danger signs of pregnancy. When maternal age increases level of awareness of danger sign of pregnancy became good. This finding is consistent with studies done in Tsegedi district (D. Hailu & Berhe, 2014), Debark town North West Ethiopia 66.8% (Mengesha & Taye, 2012), Egypt (Rashad & Essa, 2010), and Tanzania (Urassa et al., 2012), Dar-es-salaam, Tanzania (Mushi et al., 2007), Arba Minch Ethiopia (Workineh et al., 2014), and Mekelle city Tigray (Demissie et al., 2015), but inconsistent with study done in Southeast Nigeria (Ossai & Uzochukwu, 2015) that showed younger age groups were aware than elderly. This might be explained as increased awareness among older women may be related to their own experiences of pregnancy and delivery which is an important source of their information, especially those who had complications associated with their pregnancy. Limitation of the study Since it was confined to women visiting governmental health institution, the findings might not be generalized to the women who did not visit health institution. CONCLUSIONS The study finding shows that poor awareness about danger signs of pregnancy among ANC attendants in Jugal hospital, Harari Regional State was identified. There was a significant association between educational status, the age of the mother, and knowledge about pregnancy danger signs among mothers attending ANC in Harari regional state. Based on finding of this study, the following recommendations are forwarded. As women’s awareness about danger signs of pregnancy increased in line with the increase of educational status, it is suggested that women must empower to get


higher educational degree. The health education related to danger signs of pregnancy to minimize pregnancy related complications is also necessary. Declaration of Conflicting Interest There is no conflicting of interest. Acknowledgment I acknowledge all data collectors as well as all mothers who participate in the study. REFERENCES Abiyot, T., Kassa, M., Buruh, G., & Kidanu, K. (2014).

Awareness of obstetric danger signs and its associated factors among pregnant women in public health institutions, Mekelle City, Tigray, Ethiopia 2014. Journal of Pregnancy Child Health, 2(3), 1-6.

Amenu, G., Mulaw, Z., Seyoum, T., & Bayu, H. (2016). Knowledge about danger signs of obstetric complications and associated factors among postnatal mothers of Mechekel District Health Centers, East Gojjam Zone, Northwest Ethiopia, 2014. Scientifica, 2016.

Bogale, D., & Markos, D. (2015). Knowledge of obstetric danger signs among child bearing age women in Goba district, Ethiopia: a cross-sectional study. BMC Pregnancy and Childbirth, 15(1), 77.

Central Statistical Agency and ORC Marco. (2016). Ethiopian demographic and health survey, 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Marco.

Coleman, A. (2014). The use of ICT tools (mobile phones) to improve awareness of pregnancy danger signs among pregnant women in rural communities of South Africa. Journal of Communication, 5(2), 203-209.

Demissie, E., Dessie, F., & Michael, F. (2015). kahsay T, Tadele N (2015) Level of awareness on danger signs of pregnancy among pregnant women attending antenatal care in Mizan Aman General Hospital, Southwest, Ethiopia: Institution Based Cross-sectional Study. Journal of Women’s Health Care, 4(288), 2167-0420.1000288.

Dile, M., Taddesse, D., Gedefaw, M., & Asmama, T. (2015). Knowledge of obstetric danger signs and its associated factors in Debaytilatgin District, Ethiopia: a community based cross sectional study. Gynecology Obstetric (Sunnyvale), 5(9), 315.

Hailu, D., & Berhe, H. (2014). Knowledge about obstetric danger signs and associated factors among mothers in Tsegedie District, Tigray Region, Ethiopia 2013: community based cross-sectional study. Plos One, 9(2), e83459.

Hailu, M., Gebremariam, A., & Alemseged, F. (2010). Knowledge about obstetric danger signs among pregnant women in Aleta Wondo District,

Sidama Zone, Southern Ethiopia. Ethiopian Journal of Health Sciences, 20(1).

Kabakyenga, J. K., Östergren, P.-O., Turyakira, E., & Pettersson, K. O. (2011). Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reproductive Health, 8(1), 33.

Mahalingam, G., & Venkateasan, M. (2014). Mother's knowledge of warning signs of pregnancy, labour and puerperium. International Journal of Medical Science and Public Health, 3(6), 720-723.

Mbalinda, S. N., Nakimuli, A., Kakaire, O., Osinde, M. O., Kakande, N., & Kaye, D. K. (2014). Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications. Health Research Policy and Systems, 12(1), 60.

Mengesha, E., & Taye, H. (2012). The level of awareness on danger signs of pregnancy and associated factors among ANC attendant pregnant women in Debark Town, North West Ethiopia, 2012. Placenta, 1, 6.

Midhet, F., & Becker, S. (2010). Impact of community-based interventions on maternal and neonatal health indicators: Results from a community randomized trial in rural Balochistan, Pakistan. Reproductive Health, 7(1), 30.

Mushi, D. L., Mpembeni, R. M., & Jahn, A. (2007). Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania. BMC Pregnancy and Childbirth, 7(1), 5.

Mwilike, B. (2013). Knowledge of danger signs during pregnancy and subsequent health seeking actions among women in Kinondoni municipality, Tanzania. Makerere University,

Okour, A., Alkhateeb, M., & Amarin, Z. (2012). Awareness of danger signs and symptoms of pregnancy complication among women in Jordan. International Journal of Gynecology & Obstetrics, 118(1), 11-14.

Ossai, E., & Uzochukwu, B. (2015). Knowledge of danger signs of pregnancy among clients of maternal health service in urban and rural primary health centres of Southeast Nigeria. Journal of Community Medicine and Health Education, 5(337), 2161-0711.1000337.

Rashad, W. A., & Essa, R. M. (2010). Women’s awareness of danger signs of obstetrics complications. Journal of American Science, 6(10), 1299-1306.

Requejo, J., Victora, C., & Bryce, J. (2014). Data resource profile: countdown to 2015: maternal, newborn and child survival. International Journal of Epidemiology, 43(2), 586-596.

Solomon, A. A., Amanta, A., Chirkose, E., & Badi, M. B. (2015). Knowledge about danger signs of pregnancy and associated factors among pregnant women in Debra Birhan Town, Central Ethiopia. Science Journal of Public Health, 3(2), 269-273.


Sugiyarto, T. (2007). Knowledge and practice of maternal health care in Indonesia. Jurnal Kependudukan Indonesia, 2(2), 1-17.

Urassa, D. P., Pembe, A. B., & Mganga, F. (2012). Birth preparedness and complication readiness among women in Mpwapwa district, Tanzania. Tanzania Journal of Health Research, 14(1).

Workineh, Y., Hailu, D., Gultie, T., Degefu, N., Mihrete, M., Shimeles, M., . . . Alemu, M. (2014). Knowledge of obstetric danger signs and its associated factors in Arba Minch town,

Ethiopia. American Journal of Health Research, 2(5), 255-259.

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Cite this article as: Hussen, A. (2019). Knowledge about pregnancy danger signs among mothers attending antenatal care in Jugal Hospital, Harari Regional State, Ethiopia, 2019. Public Health of Indonesia, 5(3): 73-79.


Public Health of Indonesia Setyowati, D.L. et al. Public Health of Indonesia. 2019 September;5(3):80-84 http://stikbar.org/ycabpublisher/index.php/PHI/index

ISSN: 2477-1570

Original Research

RELATIONSHIP OF SAFE RIDING KNOWLEDGE, PERCEPTION ABOUT DANGER, AND SAFE RIDING BEHAVIOR AMONG SENIOR

HIGH SCHOOL STUDENTS IN SAMARINDA INDONESIA

Dina Lusiana Setyowati*, Ade Rahmat Firdaus, Nur Rohmah Rohmah

Mulawarman University

Received: 25 July 2019 | Revised: 2 September 2019 | Accepted: 14 September 2019

Correspondence: Dina Lusiana Setyowati, S.K.M., M.Kes Mulawarman University

Department of Occupational health and safety

JL. Sambaliung Kampus Gunung Kelua Samarinda, East Kalimantan, Indonesia

Email: [email protected]

Copyright: © the author(s), YCAB publisher and Public Health of Indonesia. This is an open-access article distributed under

the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use,

distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT Background: A traffic accident is a major factor of death of young people, especially in males, and those with physical

disabilities. Although there was a decrease of the number of traffic accidents in 2014 (1,094 accidents) compared to a previous

year (1,041 accidents), however it still remains high.

Objective: This study aimed to identify the relationship of safe riding knowledge, perception about danger, and safe riding

behavior in high school students in Samarinda City, Indonesia.

Methods: The study employed a survey with cross sectional approach in 315 students. Data were collected using

questionnaires to measure safe riding knowledge, perception about danger, and safe riding behavior. Data were analyzed using

Chi square with α .05.

Results: The results showed that there was a significant relationship of safe riding knowledge, perception of danger, and safe

riding behavior in high school students (p <.05).

Conclusion: This finding provides the insights to reduce traffic accidents in high school students increasing the knowledge

and perception of safe riding by highlighting the involvement of parents, teachers and related institutions.

Keywords: safe riding, behavior, perceptions of danger, knowledge

BACKGROUND World Health Organization (WHO) stated that

approximately 1.25 million people die each

year due to traffic accidents. Traffic accidents

were the leading cause of death among young

people aged 15-29 years. It is 90% of the deaths

occurred in low- and middle-income countries,

since these countries have about half of the

world's vehicles. Half of those who died in

traffic accidents were vulnerable road users

such as pedestrians, cyclists and motorcyclists.

If there is no action, traffic accidents are

expected to rise to the leading cause of 7 deaths

by 2030 (WHO, 2016).

According to data from the State Police of the

Republic of Indonesia in East Kalimantan in

2014 (Pemerintah Provinsi Kalimantan Timur,

2015), the number of motor vehicles were

2,233,278 pieces in total, with the largest

number in Samarinda (29.41%), and the single

motorcycles are 1,971,629 units. In 2014 the

number of traffic accidents decreased compared

to the previous year, from 1,094 to 1,041

(Pemerintah Provinsi Kalimantan Timur,

2015).


The number of accidents in East Kalimantan

Province in 2011 had been decreased, as

reported by Indonesian National Police, the

number of accidents reached 1,347 events,

while in 2010 it reached 1767 incidents. Of the

total number of victims, 2,115, 463 people were

died, 517 people were seriously injured, and

1,135 people suffered from minor injuries

(Directorate General of Land Transportation of

East Kalimantan Province, 2013). Throughout

the year 2013, it is recorded that 83 people died

in traffic accidents that occurred in the City of

Samarinda, East Kalimantan. Although the

incidence of accidents decreased from 2012,

but the number of deaths had increased. The

Traffic Unit Polresta Samarinda noted that there

were 83 people died in 2013, while there were

only 67 people died due to traffic accidents in

2012 (Jalil, 2013).

The traffic accident contributes as the major

factor of young people’s death, especially

males, and it also contributes to make the

victims have physical disabilities. High

mortality rates of young people due to traffic

accidents could be caused by their low

perception of hazard risk in traffic. Young

riders are more likely put themselves in

dangerous situations such as riding motorcycles

at high speeds, passing the red lights, and not

using helmet and gloves as safety tools.

However, this study was to determine factors

associated with safety riding in senior high

school students in Samarinda Indonesia.

METHODS Study Design

This study used a survey with a cross-sectional

design, with safe riding behavior as dependent

variable, and safe riding knowledge and

perception of danger as independent variables.

Setting and Sample The study was conducted on 22

nd-24 July 2017

at Senior High School No 2 (SMAN 2)

Samarinda, SMAN 3 Samarinda, SMAN 5



Samarinda, SMA Islam Samarinda, SMA

Kristen Sunodia Samarinda, East Kalimantan,

Indonesia. A total of samples from those

schools was 315 high school students selected

using a proportional random sampling.

Instrument

Data were obtained using questionnaires which

have been tested for validity and reliability (r>r

table .2787, and Cronbach alpha .918). The

questionnaires were developed based on safe

riding behavior theory and the Law of the

Republic of Indonesia No. 22 of 2009 on Road

Traffic and Transportation (Presiden Republik

Indonesia, 2009). A Likert scale was used,

which consisted of 140 valid items.

Data Analysis Data were not-normally distributed, which

therefore analyzed using Chi-square in a

computer program with 95% significance level.

Ethical Consideration

The study permission was obtained from the

Educational Office of Samarinda City and

schools. Prior to data collection, each

respondent was given an informed consent

about the objective and procedures of the study.

RESULTS Based on Table 1, it was found that 59.7% of

respondents were female, 1.9% respondents

claimed already had a driving license C. It was

30.8% of respondents said that they had traffic

accident in the past, and 39.4% of respondents

stated that the main reason for riding a

motorcycle was because no one can accompany

them to the schools. It was also 50.8% of

respondents behaved unsafely, 49.2% of

respondents had bad knowledge about safe

riding, and 42.2% of respondents had positive

perception related to dangers (see Table 1).


Table 1 Characteristics of Respondents

No Characteristic n % 1. Sex

Men 127 40.3

Women 188 59.7

2. Ownership of driving license C Yes 6 1.9

No 309 98.1

3. Have Experience on Traffic Accidents Yes 97 30.8

No 218 69.2

4. Main Reasons to Drive a Motorcycle Nothing to take 124 39.4

Distance home 37 11.7

Fast to the school 58 18.4

No public transports 31 9.8

Others 65 20.6

5. Safe Riding Behavior Unsafe 160 50.8

Safe 155 49.2

6. Knowledge on Safe Riding

Poor 155 49.2

Good 160 50.8

7. Perception About Danger

Negative Perception 182 57.8

Positive Perception 133 42.2

Total 315 100

Table 2 shows that 68.4% of respondents who

did not have good knowledge about safe riding

behaved unsafely. The results showed that there

was a significant relationship (p = .000)

between knowledge of safe riding and safe

riding behavior. 61.5% of respondents had

negative perceptions about the dangers of

unsafe behavior. There was a significant

relationship between perceptions of danger

with safe riding behavior (p = .000).

Table 2 Relationship of Safe Riding Knowledge, Perception of Danger, and Safe Riding Behavior

No Variable Safe Riding Behavior Total

p Unsafe Safe n % n % n %

1. Perceptions of Danger

.000** Negative

112 61.5 70 38.5 182 100

Positive 48 36.1 85 63.9 133 100

2 Safe riding Knowledge .000** Poor 106 68.4 49 31.6 155 100

Good 54 33.8 106 66.3 160 100

** Significant (α = .05)

DISCUSSIONS

The Relationship Between Knowledge About Safe Riding and Safe Riding Behavior In general, traffic accidents occurred due to

several factors, such as human negligence, road

conditions, vehicle eligibility, and unoptimal

traffic law enforcement. Based on Outlook

2013 Transportasi Indonesia (Andy, 2013),

there were four factors which caused accidents,

namely the condition of facilities and

infrastructures of transportation, human and

natural factors. Among those four factors,

human negligence was the main factor which

caused the highest number of traffic accidents.

Therefore, good traffic awareness is needed by

the society, especially for those who are in


productive age or teenagers (Badan Intelijen

Negara, 2013).

Teenagers usually think that they are mature

enough to ride motorcycles, but without

sufficient knowledge, it can make fatal

accidents. They still have lack of knowledge

about vehicles since it is still new for them.

Lack of knowledge and experience made

teenagers drive more carelessly in dangerous

situations, so the potentials of accidents to

happen is high (Rakhmani, 2013).

Factors which caused accidents were: 1) human

factors, i.e. non-compliance with traffic

regulations, 2) vehicle factors, 3) road factors,

and 4) environmental factors (Zayu, 2012). It is

mentioned that the incidence of motorcycle

accidents among motorcyclists in adolescents is

11%, and more than 50% of traffic accident

victims have hyperarousal, memory

disturbances, more emotional, also cognitive

and social disorders (Kazantzis et al., 2012).

The dominant factor caused traffic accidents is

unsafe action or unsafe behavior of the bikers.

Young groups under 25 were highly susceptible

to traffic accidents, with risk of severe injury

and even death. World Health Organization

(2010) divided the age of adolescence into two

groups: early adolescents (10-14 years) and late

adolescents (15-20 years), while in Indonesia

adolescence is in the age of 11-24 years and

unmarried (Infodatin, 2015).

The result showed that 50.8% of respondents

behaved unsafely. Safe riding was an attempt to

minimize danger levels and maximize safety in

driving in order to create safe condition. 49.2%

of respondents had poor knowledge about safe

riding in this study. The knowledge about safety

riding would affect the behavior of people in

driving. The results also showed that

knowledge was related to safe riding, as a

predisposing factor that someone acts because

they have enough knowledge in carrying out

these actions (Glanz, Rimer, & Viswanath,

2008). The better the knowledge they have, the

better the behavior they will act, but if the less

knowledge they have, the high possibility of

respondents would behave badly in riding. The

result of this research was also in line with

Notosiswoyo (2014) stated that knowledge was

related to motorcycle accidents and preventive

behavior (p = .018). But, the results of this study

was not in line with the research results of

Khakim (2016) which stated that knowledge

was not related to safe riding behavior (p =

.810).

The Relationship Between Perception of Dangers and Safe Riding Behavior Driving involves responding to real objects in

the spatial world. It requires domain specific

knowledge, motor skills, and high perceptual

and cognitive skills. Compared to more

experienced drivers, novice drivers have a

relatively high accident involvement (Kuiken &

Twisk, 2001). The frequency of finding the

danger to the rider will be directly proportional

to the amount of distance that has been taken

(Ridho, 2012).

The results had also showed that 57.8% of

respondents had negative perceptions related to

hazards, 25.1% of respondents stated that

before an accident they would not use standard

safety equipment such as helmets, 17.8% stated

that speeding up does not matter as long as it

would not crash anything, and only 13.7% of

respondents stated it is important to use

standard safety tools. Negative hazard-induced

perceptions were indicated through their

responses in suggesting that driving on the road

may speed up as long you would not have an

accident and still using standard safety tools,

would affect their behavior while riding on the

highway. Unsafe riding behavior would be

harmful to the riders and others. The results of

Tangkudung, Sampouw, and Tjahjono (2010)

on the perception of motorcycle riders showed

that positive perceptions need to be nurtured

continuously so that the perception becomes

stronger, and the behavior towards safety would

be getting better.

CONCLUSION This finding provides the insights to reduce

traffic accidents in high school students by

increasing knowledge and perception about


safe riding. It is suggested for the involvement

of parents, teachers and related institutions to

provide interventions, particularly related to

safe riding knowledge and perception of

danger.

Acknowledgments Thanks to the Directorate of Research and Community

Service, Directorate General of Research and Technology

Development, Ministry of Research, Technology and

Higher Education in accordance with the Research

Contract Number: 360 / UN17.41 / KL / 2017.

Declaration of Conflicting Interest The author does not have a conflict of interest that is

relevant to this paper to be disclosed.

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Cited this article as: Setyowati, D.L., Firdaus, A. R.,

Rohmah, N.R. (2019). Relationship of safe riding

knowledge, perception about danger, and safe riding

behavior among senior high school students in

Samarinda Indonesia. Public Health of Indonesia, 5(3):

80-84.

PublicHealth of Indonesia

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