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Literature Review IMSTC 2017

The current situation and outlooks for hypertension as non communicable disease in
Indonesia

A. Muh. Yasser Mukti* ,Dzulfachri Kurniawan**, Elsa Shafira Prasetyati***

* First Year Medical Student, Muslim University Of Indonesia


(andimuh_yassermukti@dr.com)

** First Year Medical Student, Muslim University Of Indonesia


(fachri.spensix3@gmail.com)

*** First Year Medical Student, Muslim University Of Indonesia


(elsaprasetyati@gmail.com)
Abstract

Non-communicable diseases (NCDs) including cardiovascular disease, diabetes, asthma, and chronic
respiratory infections, and cancers are the leading cause of death worldwide. In this context, hypertension
is one of the major cause that can cause non-communicable disease, primarily cardiovascular disease
(Galambos, Louis and Sturchio, Jeffrey L. Noncommunicable Diseases in the Developing World:
Addressing Gaps in Global Policy and Research). Hypertension is an increase abnormal blood pressure,
both systolic blood pressure and diastolic blood pressure, in general someone said to suffer from
hypertension if systolic blood pressure / diastolic> 140/90 mmHg (Normally 120/80 mmHg). Health
Research (Riskesdas) in 2007 showed that the majority of cases of hypertension in the community have not
been diagnosed. This is evident from the results of measurements of blood pressure at age 18 years and
over prevalence of hypertension in Indonesia amounted to 31.7%, of which only 7.2% of the population
who already know have hypertension and only 0.4% of cases were taking medication hypertension.This
problem is caused by the lack of early detection of hypertension actively, access to services and treatment.
This brief review summarizes the present situation and problems of hypertension in department healthcare
of Indonesia. Epidemiological data if the disease were obtained from several sources. (Suyono,
Slamet.,2001)

Keywords : Non-communicable disease, Hypertension

Introduction the leading cause of death worldwide. In this


context, hypertension is one of the major cause
Non-communicable diseases (NCDs) including
that can cause non-communicable disease,
cardiovascular disease, diabetes, asthma, and
primarily cardiovascular disease. An estimated
chronic respiratory infections, and cancers are
36 million people die from such disease each
year, roughly two out of three deaths globally; available. This is evident from the results of
80% of these fatalities occur in low- and middle- measurements of blood pressure at age 18 years
income countries (LMICs). The statistics are and over prevalence of hypertension in Indonesia
stark, yet they hide the human toll of such disease amounted to 31.7%, of which only 7.2% of the
burdens. The global health community has population who already know have hypertension
become increasingly aware of NCDs as primary and only 0.4% of cases were taking medication
threats to individuals, communities, health hypertension (Ministry of Health Republic of
system infrastructures, and economic Indonesia,. 2012).
development. It is now acknowledged that NCDs
Situation and Problems Of Hypertension in
contribute greatly to rising healthcare costs and
Indonesia
the loss of economic productivity. (Galambos,
Louis and Sturchio, Jeffrey L.,2014) Based on the results of blood pressure
measurement, the prevalence of hypertension in
Hypertension is an increase abnormal
the population aged 18 years and over in 2007 in
blood pressure, both systolic blood pressure and
Indonesia is 31.7%. According to province, the
diastolic blood pressure, in general someone said
highest prevalence of hypertension in South
to suffer from hypertension if systolic blood
Kalimantan (39.6%) and lowest in West Papua
pressure / diastolic> 140/90 mmHg (Normally
(20.1%). Meanwhile, if compared with the year
120/80 mmHg). Hypertension in Indonesia will
2013 decreased by 5.9% (from 31.7% to 25.8%).
continue to increase in incidents and the
This decline can occur to various factors, such as
prevalence, associated with changes lifestyle,
tool tension gauges are different, people who
foods high in fatty, cholesterol, decreased
have started to realize the dangers hypertension.
physical activity, the rise events and other stress-
The highest prevalence in Bangka Belitung
another. (Prof. Tjandra Yoga.2015)
(30.9%), and Papua had the lowest (16.8)%. The
Hypertension remains a major challenge prevalence of hypertension in Indonesia obtained
in Indonesia. hypertension is a condition that is through questionnaire undiagnosed health
often found in health care primary healthcare. It workers by 9.4 percent, which was diagnosed
is a health problem with a prevalence high, at force health or currently taking medication at 9.5
25.8%, according to the data Riskesdas 2013. In percent (Riskesdas,.2013). So, there was a 0.1
addition, controlling hypertension has not been percent taking medication alone.
adequate though effective medicines many
Table 1: Classification JNC* VII, 2003

CLASIFICATION BLOOD PRESSURE SISTOL BLOOD PRESSURE DIASTOL


(mmHg) (mmHg)
NORMAL <120 <80
PREHYPERTENSION 120-139 80-89
STAGE 1 140-159 90-99
STAGE 2 160 or >160 100 or >1 00
JNC ~ Joint National Committee on the prevention, detection, evaluation and treatment of high
blood pressure, central in Amerika.
percentage exceeds the national average, with
highs in Bangka Belitung (30.9%) or in absolute
The next in the year 2013 by using
terms at 30.9% x 1.380.762 inhabitants = 426 655
individual analysis unit shows that nationally
inhabitants. In absolute terms the number of
25.8% of Indonesia's population suffering from
people with hypertension in five provinces with a
the disease hypertension. If the current of
prevalence of hypertension
Indonesia's population of 252.124.458
inhabitants there exists 65.04811 million souls The highest popularity Riskesdas 2013 were as
who suffer from hypertension. A condition that is follows:
quite surprising. There are 13 provinces that
Table 2 : 5 provinces with prevalence of high hypertension in absoulut kuantity (people)

No. Provinsi Total society % Hypertension Absoulut Hypertension


1 Bangka Belitung 1.380.762 30,9 426.655 people
2 Kalimantan Selatan 3.913.908 30,8 1.205.483 people
3 Kalimantan Timur 4.115.741 29,6 1.218.259 people
4 Jawa Barat 46.300.543 29,4 13.612.359 people
5 Gorontalo 1.134.498 29,4 33,542 people
Table 3 : 5 provinces with prevalence of low hypertension in absoulut kuantity (people)

No. Provinsi Total society % Hypertension Absoulut Hypertension


1 Papua 3.486.432 16,8 585.720 people
2 Bali 4.225.384 19,9 840.851 people
3 DKI Jakarta 10.135.030 20,0 2.027.006 people
4 Papua Barat 877.437 20,5 179.874 people
5 Riau 6.358.636 20,9 1.328.954 people

Table 4 : Prevalence Hypertension by Gender in Indonesia

Based on the above table hypertension prevalence by gender in 2007 and in 2013 the prevalence of
women is higher than men. The complications of hypertensive disease is coronary heart disease (CHD)
kidney failed and Stroke.

Prevention of Hypertension in Indonesia

Hypertension is one of non- shifting describes a situation where a task


communicable diseases is quite high at the normally performed by a physician is transferred
moment. For that we need look back especially to a health professional with a different or lower
on medical personnel. In this context, there is a level of education and training, or to a person
need to develop an alternative workforce that is specifically trained to perform a limited task only,
structured around the community and consumer without having formal health education.
needs (Beaglehole, R and Yach, D,.2003). Task-
Task-shifting may be facilitated by prolonging their lives. One of their jobs is
medical technology, which standardizes the creating national policies and legislation. They
performance and interpretation of certain tasks, set the strategy and direction, creates and updates
therefore allowing them to be performed by non- the policy and legislative frameworks within
physicians or technical assistants instead of which services operate and ensures a robust
physicians. This has typically been done in close system of regulation is in place for the
collaboration with the medical profession. Task- professions and allied industries. Peoples care is
shifting can potentially result in cost and in the hands of the professionals who look after
physician time savings without compromising the them. This arrangement works well and the
quality of care or health outcomes for patients. A Departments role should rarely be visible to
study from Uganda reporting the potential impact healthcare professionals, patients and service
of task-shifting on the costs of antiretroviral users. However, that role is vital in securing high
therapy and physician supply found that the quality, efficient and fair services now and
estimated annual mean costs of follow-up per sustaining them in the future (Joshi R, Alim M,
patient were US$31.68 for physician follow-up, Kengne AP, Jan S, Maulik PK, Peiris D, et
US$24.58 for nurse follow-up and US$10.50 for al,.2014)
pharmacist follow-up. It is also potentially an
The Department is responsible for
efficient way of reorganizing the workforce by
sponsoring individual national bodies by
ensuring better specialization of tasks, allowing
supporting them and holding them to account for
physicians to focus on the jobs that cannot be
carrying out their responsibilities. They fund and
otherwise delegated. A study from Rwanda
assure the delivery and continuity of healthcare
showed that task-shifting from a physician-
services while considering the multiple
centered to a nurse-centered model for
stakeholder in account. This sponsorship is also
antiretroviral therapy reduced the demand on
used to fund researches and technologies to seek
physician time by 76% (Department of
improvements in the coming future. The
Health.2016).
Department of Health works together with
partner organizations with similar goals, and
As a mediator of these task-shifting, the
hand in hand try to achieve their purpose.
department of health have provided various
methods to alert the society regarding danger of In the last century, the Department of
non-communicable disease and how to prevent Health from across the globe and many other
them. The Department of Health (DH) is an scientists have put a lot of effort in researching
institution whose main goal is to provide help for the cure for various diseases, especially
others in need of medical assistance, hence infectious disease. There used to be countless
pandemic diseases throughout the globe, such as prevalence. Prevention of hypertension is very
influenza and hepatitis. For that reason, remained especially for department healthcare
researchers have developed vaccines to prevent workers. Prevention can be done by giving
further infection of these lethal diseases (Joshi R, information on the danger of the disease to
Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, herself. Task-shifting may be facilitated by
et al,.2014). However, although it is important to medical technology, which standardizes the
get vaccinated, the cause of disease doesnt only performance and interpretation of certain tasks,
on infectious ones. The neglect of non- therefore allowing them to be performed by non-
communicable disease has cause the society to physicians or technical assistants instead of
disregard its fatality and it is now becoming one physicians. This has typically been done in close
of the major causes of death. collaboration with the medical profession. Task-
shifting can potentially result in cost and
CONCLUSION
physician time savings without compromising the
Hypertension remains a major challenge quality of care or health outcomes for patients.
in Indonesia, it is a health problem with a high

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