Implementation of mobile-health technology is associated with five-year survival among individuals in rural areas of Indonesia.

There is an urgent need to focus on implementing cost-effective health interventions and policies to reduce the burden of cardiovascular disease in Indonesia. This study aims to evaluate whether a mobile technology-supported primary health care intervention, compared with usual care, would reduce the risk of all-cause mortality among people in rural Indonesia. Data were collected from 11,098 participants in four intervention villages and 10,981 participants in four control villages in Malang district, Indonesia. The baseline data were collected in 2016. All the participants were followed for five years, and the mortality data were recorded. Cox proportional hazard model was used to examine the association between the intervention and the risk of all-cause mortality, adjusted for the covariates, including age, gender, educational attainment, employment and marital status, obesity and the presence of diabetes mellitus. During the five-year follow-up, 275 participants died in intervention villages, compared with 362 in control villages. Participants residing in intervention villages were at 18% (95%CI = 4 to 30) lower risk of all-cause mortality. Higher education attainment and being married are associated with lower risks of all-cause mortality among respondents who lived in the control villages, but not among those living in the intervention villages. A mobile technology-supported primary health care intervention had the potential to improve the five-year survival among people living in villages in an upper-middle income country.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review.

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

Vision and Hearing Difficulties and Life Expectancy Without ADL/IADL Limitations: Evidence From the English Longitudinal Study of Ageing and the Health and Retirement Study.

BACKGROUND: Hearing and vision difficulties are some of the most common deficits experienced by older adults. Having either visual or hearing difficulties increases the risk of comorbidity, disability, and poor quality of life. So far, however, few studies have examined the association between vision and hearing difficulties on life expectancy without activities of daily living (ADL) or instrumental ADL (IADL) limitations (LEWL). METHODS: Data came from the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States from 2002 to 2013. The outcome was defined as reporting 2+ limitations with ADL/IADL. Life expectancy was estimated by discrete-time multistate life table models for hearing and vision difficulties separately as well as for combined vision and hearing difficulties by sex and age. RESULTS: Thirteen percent of men in England and the United States had ADL/IADL limitations, whereas, for women, it was 16% and 19% in England and the United States. At all ages, either vision or hearing difficulty was associated with shorter LEWL compared to no difficulties. Dual sensory difficulty (vision and hearing) reduced LEWL by up to 12 years in both countries. At the ages of 50 and 60 in England, hearing difficulty was associated with fewer years lived without ADL/IADL limitations than vision difficulty. In contrast, in the United States, vision difficulty led to fewer years lived without ADL/IADL limitations than hearing difficulty. CONCLUSIONS: The implementation of strategies to reduce the prevalence and incidence of vision and hearing difficulties has the potential to increase the number of years spent without ADL/IADL limitations.

Facilitators and barriers to the adoption of mHealth apps for COVID-19 contact tracing: a systematic review of the literature.

Background: Despite the enormous potential of mobile health (mHealth) apps for COVID-19 contact tracing, the adoption rate in most countries remains low. Thus, the objective of the current study is to identify facilitators and barriers of mHealth apps adoption for COVID-19 contact tracing based on existing studies. Methods: We conducted a systematic review of mHealth studies before December 2021 that evaluate facilitators and barriers associated with the adoption of mHealth apps for COVID-19 contact tracing. We assessed the risk of bias for all included studies using the Cochrane tool. We based our narrative synthesis on the facilitators-barriers to the adoption of mHealth framework comprising seven key factors. Results: A total of 27 articles were reviewed from 16 countries representing high income countries (France, German, Italy, United Kingdom, United States, Australia, Singapore, Belgium, Republic Ireland, Netherland, Poland, and Japan), middle-income countries (Fiji), and low-middle income countries (India). We identified the main facilitators of mHealth adoption: perceived risks to COVID-19, trust, perceived benefit, social norm, and technology readiness. The main barriers of mHealth adoption were data privacy/security concerns. Among sociodemographic factors, females, lower education, lower-income, and older individual are barriers to adoption in low-middle income countries, while most of those factors were not significantly associated with adoption in a high-income country. Conclusion: The findings imply that resolving data privacy/security issues while developing trust, perceived benefits, social norms, and technology preparedness could be effective strategies for increasing adoption intentions and app use among the general public. In low-middle-income countries, addressing digital divide is critical to the app's adoption.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249500, identifier RD42021249500 (PROSPERO).

Subjective socioeconomic status and self-rated health in the English Longitudinal Study of Aging: A fixed-effects analysis.

Higher subjective socio-economic status (SES) goes along with better self-rated health: This finding is well-established in the literature, yet the majority of studies it is based on only rely on cross-sectional analyses and only account for few potential confounders of the association. Particularly wealth, which is increasingly thought of as an important dimension of accumulated advantage, is only rarely examined as a confounder. Using eight waves of panel data from the English Longitudinal Study of Aging (ELSA, 2002-19), we investigate the association between subjective SES and self-rated health. We use random effects models that account for theoretically important time-constant (such as education and social class) and time-varying confounders (such as income and wealth) as well as fixed-effects models, that in addition control for all time-constant confounders, whether observed or unobserved. The fully adjusted fixed-effects model reveals a statistically significant association between subjective SES and self-rated health. Yet, a one-point increase on the subjective SES ladder goes along with a two per cent of a standard deviation increase in self-rated health, only around a quarter of the size of the random-effects estimate. The role of wealth for the subjective SES-self-rated health association is negligible in the fixed-effects specifications. Smoking, drinking, and physical activity do not appear to mediate the association. A substantial part, though not all, of the observed association between subjective SES and self-rated health is due to unobserved confounding rather than a causal effect. Reducing health inequalities based on objective SES is likely more effective than based on subjective SES.

Health insurance and contraceptive use, Indonesian Family Planning Census 2021.

Objective: To assess the association between health insurance coverage and sociodemographic characteristics, and the use of modern contraception in Indonesia. Method: We used data from the 2021 Indonesian family planning census which included 38 408 597 couples. Contraception is covered by the national health insurance scheme: members are non-contributory (for poor families who do not make any monetary contribution) or contributory (for better-off families who pay for the insurance). We used regression analyses to examine the correlation between each type of health insurance (non-contributory, contributory, private or none) and contraceptive use and type of contraceptive used. Findings: The prevalence of the use of modern contraceptives in Indonesia was 57.0% (21 897 319/38 408 597). Compared with not having health insurance, having health insurance was associated with a greater likelihood of contraceptive use, odds ratio (OR): 1.14 (95% confidence intervals, CI: 1.13-1.14) and OR: 1.01 (95% CI: 1.01-1.01) for women with non-contributory and contributory health insurance, respectively. Having private health insurance was associated with lower use of modern contraceptives (OR: 0.94; 95% CI: 0.94-0.94). Intrauterine devices, lactational amenorrhoea and tubal ligation were the most common forms of contraceptive used by women. Conclusion: The prevalence of modern contraceptive use in Indonesia is lower than the 75% target of the 2030 sustainable development goals. As national health insurance positively correlated with modern contraceptive use, extending its coverage on remote Indonesian islands is recommended to increase the use of such contraceptive methods in those areas.

Association between an inflammatory biomarker score and future dementia diagnosis in the population-based UK Biobank cohort of 500,000 people.

This study was designed to investigate the relationship between a systematic inflammatory biomarker measure, concurrent and later cognitive performance, and future dementia risk. The literature has reported the potential involvement of inflammation in cognitive performance as well as Alzheimer's Disease, but not consistently. We used a population-based cohort of 500,000 people in the UK and assessed the association between a composite inflammatory biomarker and cognitive performance measures across five domains measured concurrently and 4-13 years later, taking advantage of the large sample size. We also assessed the same biomarker's association with dementia diagnosis 3-11 years later in the initially dementia-free sample. We report small but significant associations between elevated biomarker levels and worsened cognitive performance at baseline for four cognitive tasks (OR = 1.204, p<0.001 for Prospective memory, ß = -0.366, p<0.001 for Fluid intelligence, ß = 8.819, p<0.001 for Reaction time, and ß = -0.224, p<0.001 for Numeric memory), comparing the highest quartile of the biomarker to the lowest. We also found that for one measure (Pairs matching) higher biomarker levels were associated with fewer errors, i.e. better performance (ß = -0.096, p<0.001). We also report that the 4th quartiles of the baseline biomarker levels were significantly associated with cognitive task scores assessed years later on the p< = 0.002 level, except for the Pair matching test, for which none of the quartiles remained a significant predictor. Finally, the highest biomarker quartile was significantly associated with increased dementia risk compared to the lowest quartile (HR = 1.349, p<0.001). A case-only analysis to assess disease subtype heterogeneity suggested probable differences in the association with the highest biomarker quartile between vascular dementia and Alzheimer disease subtypes (OR = 1.483, p = 0.055). Our results indicate that systemic inflammation may play a small but significant part in dementia pathophysiology, especially in vascular dementia.

Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia?

Background: Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs). Aims: To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia. Method: A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake. Findings: The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473). Implications: Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.

Variation in Price of Cardiovascular and Diabetes Medicine in Indonesia, and Relationship with Quality: A Mixed Methods Study in East Java.

Lower-middle income Indonesia, the world's fourth most populous country, has struggled to contain costs in its mandatory, single-payer public health insurance system since the system's inception in 2014. Public procurement policies radically reduced prices of most medicines in public facilities and the wider market. However, professional associations and the press have questioned the quality of these low-cost, unbranded generic medicines. We collected 204 samples of four cardiovascular and one antidiabetic medicines from health facilities and retail outlets in East Java. We collected amlodipine, captopril, furosemide, simvastatin, and glibenclamide, sampling to reflect patients' likelihood of exposure to specific brands and outlets. We recorded sales prices and maximum retail prices and tested medicines for dissolution and percentage of labeled content using high-performance liquid chromatography. We conducted in-depth interviews with supply chain actors. All samples, including those provided free in public facilities, met quality specifications. Most manufacturers make both branded and unbranded medicines. Retail prices varied widely. The median ratio of price to the lowest price for an equivalent product was 5.1, and a few brands sold for over 100 times the minimum price. Prices also varied between outlets for identical products because retail pharmacies set prices to maximize profit. Because very-low-cost medicines were universally available and of good quality, we believe richer patients who chose to buy branded products effectively protected medicine quality for poorer patients in Indonesia because manufacturers cross-subsidize between branded and unbranded versions of the same medicine.

Education mediating the associations between early life factors and frailty: a cross-sectional study of the UK Biobank.

OBJECTIVES: Exposures in utero and during infancy may impact the development of diseases later in life. They may be linked with development of frailty, although the mechanism is unclear. This study aims to determine the associations between early life risk factors and development of frailty among middle-aged and older adults as well as potential pathways via education, for any observed association. DESIGN: A cross-sectional study. SETTINGS: This study used data from UK Biobank, a large population-based cohort. PARTICIPANTS: 502 489 individuals aged 37-73 years were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Early life factors in this study included being breast fed as a baby, maternal smoking, birth weight, the presence of perinatal diseases, birth month and birth place (in or outside the UK). We developed a frailty index comprising 49 deficits. We used generalised structural equation modelling to examine the associations between early life factors and development of frailty and whether any observed association was mediated via educational attainment. RESULTS: A history of breast feeding and normal birth weight were associated with a lower frailty index while maternal smoking, the occurrence of perinatal diseases and birth month with a longer day length were associated with a higher frailty index. Educational level mediated the relationship between these early life factors and frailty index. CONCLUSIONS: This study highlights that biological and social risk occurring at different stages of life are related to the variations in frailty index in later life and suggests opportunities for prevention across the life course.

Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017).

BACKGROUND: frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE: to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN: population-based cohort study. SETTING: communities in England. SUBJECTS: in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS: multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS: the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS: in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Development, validation and performance of laboratory frailty indices: A scoping review.

INTRODUCTION: Frailty is a syndrome characterised by decline in functional ability and increasing vulnerability to disease and associated with adverse outcomes. Several established methods exist for assessing frailty. This scoping review aims to characterise the development and validation of frailty indices based on laboratory test results (FI-Lab) and to assess their utility. METHODS: Studies were included in the review if they included data concerning the development and/or testing an FI-Lab using the deficit accumulation method. Studies were identified using PubMed/MEDLINE, Embase (Elsevier), OpenGrey and Google Scholar from 2010 to 2021. Two reviewers independently screened all abstracts, and those that met the inclusion criteria were reviewed in detail. Data extracted included details about the study characteristics, number, type and coding of laboratory variables included, validation, and outcomes. A narrative synthesis of the available evidence was adopted. RESULTS: The search yielded 915 articles, of which 29 studies were included. In general, 89% of studies were conducted after 2016 and 51% in a hospital-based setting. The number of variables included in FI-Labs ranged from 13 to 77, and 51% included some non-laboratory variables in their indices, with pulse and blood pressure being the most frequent. The validity of FI-Lab was demonstrated through change with age, correlation with established frailty indices and association with adverse health outcomes. The most frequent outcome studied was mortality (79% of the studies), with FI-Lab associated with increased mortality in all but one. Other outcomes studied included self-reported health, institutionalisation, and activities of daily living. The effect of combining the FI-Lab with a non-laboratory-based FI was assessed in 7 studies with a marginal increase in predictive ability. CONCLUSION: Frailty indices constructed based on the assessment of laboratory variables, appear to be a valid measure of frailty and robust to the choice of variables included.

Trajectories of self-reported hearing and their associations with cognition: evidence from the United Kingdom and United States of America.

OBJECTIVE: This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory. METHODS: Data were drawn from 5 waves (2008-2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors. RESULTS: Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (-1.260, P < 0.001). CONCLUSIONS: Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

Subjective social status and allostatic load among older people in England: A longitudinal analysis.

BACKGROUND: Subjective social status has a known association with health, whereby better health outcomes are observed for those with higher perceived status. In this research, we offer new evidence on the status-health relationship using a rigorous methodological approach that considers both observed and unobserved confounders. METHODS: We use 5 waves of data spanning 15 years from the English Longitudinal Study of Ageing and derive a measure of allostatic load with biomarkers as an objective measure of health. We apply 'within-between' panel regression models. RESULTS: Models reveal the expected association between subjective status and health when comparing participants (the 'between' estimate), but no association when examining temporal variation within participants (the 'within' estimate). When controlling for personality traits including optimism, and parental education, the 'between' association between subjective status and allostatic load is reduced but does not disappear. CONCLUSIONS: Person-level confounders play some role in explaining the observed link between subjective status and health. The exact nature of the link, including the role of psychological pathways and early-life confounders, remains a question for future research.

A prospective analysis examining frailty remission and the association with future falls risk in older adults in England.

BACKGROUND: Previous research has shown older adults experience dynamic changes in frailty status. This study aimed to determine the occurrence of sustained frailty remission and how remission is associated with falls risk. METHODS: Participants who contributed data to the analysis were in the English Longitudinal Study of Ageing from Waves 1 to 8 (2002-2017). Frailty was defined across waves using the frailty index and categorised into robust, pre-frail and frail. We classified participants who improved their frailty category from Wave 1 (2002) to Wave 2 (2004) and sustained/improved category again into Wave 3 (2006) and compared them with those who were either robust or frail across Waves 1-3. Cox proportional hazard modelling was used to determine the risk of incident falls reported at Waves 4-8, with results expressed as hazard ratios and 95% confidence intervals. RESULTS: Of 2,564 participants, 389 (15·2%) improved frailty category and sustained this during Waves 2-3, 1,489 (58·1%) remained robust and 686 (26·8%) remained frail during Waves 1-3. During the 10-year period (Waves 4-8), a total of 549 participants reported a fall. Compared with those who remained frail during Waves 1-3, those who with sustained frailty remission had a lower risk of future falls (HR 0·41; 95% CI = 0·36-0·45). CONCLUSIONS: Frailty remission is possible and can be sustained across 5 years. There is a lower risk of future falls in those who sustain frailty remission compared with those who remain frail.

A study of the quality of cardiovascular and diabetes medicines in Malang District, Indonesia, using exposure-based sampling.

BACKGROUND: The WHO has warned that substandard and falsified medicines threaten health, especially in low and middle-income countries (LMICs). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine quality recorded that 15.4% of cardiovascular and 6.8% of diabetes samples failed at least one quality test. Review authors warn that study quality was mixed. Because they did not record medicine volume, no study reflected the risk posed to patients. METHODS AND FINDINGS: We investigated the quality of five medicines for cardiovascular disease and diabetes in Malang district, East Java, Indonesia. Our sample frame, based on dispensing volumes by outlet and price category, included sampling from public and private providers and pharmacies and reflected the potential risk posed to patients. The content of active ingredient was determined by high-performance liquid chromatography and compared with the labelled content. Dissolution testing was also performed.We collected a total of 204 samples: amlodipine (88); captopril (22); furosemide (21); glibenclamide (21) and simvastatin (52), comprising 83 different brands/products. All were manufactured in Indonesia, and all samples met specifications for both assay and dissolution. None was suspected of being falsified. CONCLUSIONS: While we cannot conclude that the prevalence of poor-quality medicines in Malang district is zero, our sampling method, which reflects likely exposure to specific brands and outlets, suggests that the risk to patients is very low; certainly nothing like the rates found in recent reviews of surveys in LMICs. Our study demonstrates the feasibility of sampling medicines based on likely exposure to specific products and underlines the dangers of extrapolating results across countries.

Allostatic load and risk of hearing impairment.

Background: Prevention of hearing loss via addressing potentially modifiable risk factors may offer means of reducing the global burden of hearing loss. Prior studies reported associations between individual markers of inflammation and risk of hearing impairment. Allostatic load is an index of cumulative physiological stressors, including inflammation, to multiple biological systems. Our aims were to investigate associations between allostatic load and both audiometric and self-reported hearing impairment and examine whether associations are stronger over time due to prolonged high allostatic load. Methods: Data were taken from the English Longitudinal Study of Ageing (ELSA), a nationally representative study of people aged 50+ living in England over 3 time points between 2008 and 2014. Allostatic load score was comprised of thirteen different measures available at baseline and 4 years post-baseline (high-density lipoprotein/total cholesterol, triglyceride, fibrinogen, haemoglobin A1c, C-reactive protein, insulin-like growth factor 1 (IGF-1), systolic and diastolic blood pressure, mean arterial pressure, resting pulse rate, peak expiratory flow, BMI and waist circumference), measured using clinical cut-off points for normal biomarker parameters. Hearing acuity was measured with a simple handheld tone-producing device at follow-up 7 years post-baseline, while self-reported hearing impairment was measured at time point. Results: We included samples of 4373 and 4430 for the cross-sectional and longitudinal analysis, respectively. In the cross-sectional model high allostatic load was associated both self-reported (OR = 1.08, 95% CI 1.0,1.1; p < 0.01) and objective hearing loss (OR = 1.10, 95% CI 1.1,1.2; p < 0.001) adjusting for age and sex. Cross-sectional associations between allostatic load and hearing were not significant after further adjustment for covariates (qualification, physical activity and smoking).In longitudinal modelling, high allostatic load was associated with both audiometric (Z score OR = 1.11, 95% CI 1.1,1.2; p < 0.001) and self-reported hearing impairment (OR = 1.08, 95% CI 1.0,1.1; p < 0.001) adjusting for age and sex. Allostatic load was no longer associated with self-reported hearing loss but the association with audiometric hearing impairment (OR = 1.08, 95% CI 1.03,1.13; p < 0.001) remained following additional adjustment for baseline self-reported hearing, education, physical activity, and smoking. Conclusions: Prolonged high allostatic load was associated with risk of hearing impairment. Reducing allostatic load via healthy lifestyle changes including non-smoking, healthy diet and exercise may offer an opportunity to reduce the risk of hearing impairment in later life.

Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia.

Background: Community-based Healthcare Interventions (CBHIs) are regarded as a critical component of healthcare task-sharing in LMICs and have the potential to address LMICs' health system weaknesses to improve NCDs prevention care. This study aims to investigate the relationship between participation in CBHIs and NCDs early detection at medical facilities among Indonesians. Methods: Data come from the fifth Indonesian Family Life Survey (2014-2015), a total of 27,692 individuals (14,820 female and 12,872 male individuals age 15 and older). Multiple ordered logistics and logistics regression was used to assess the association between individual participation in CBHI and early detection of NCDs at medical facilities. Findings: Participation in CBHIs are associated with higher odds of having regular blood pressure test (adjusted odds ratio [OR], 3.09; 95% confidence interval [CI], 2.67-3.58), cholesterol test (adjusted OR, 1.88; 95% CI, 1.60-2.22), blood glucose test (adjusted OR, 1.88; 95% CI, 1.58-2.23), electrocardiogram (adjusted OR, 1.37; 95% CI, 1.06-1.76) and basic dental examination (adjusted OR, 1.32; 95% CI, 1.09-1.60) at medical facilities. The odds of having pap smears (adjusted OR, 2.20; 95% CI, 1.62-2.98) and breast self-examination (adjusted OR, 1.73; 95% CI, 1.37-2.19) among females who participated in CBHIs are substantially larger than those who did not participate in CBHIs. No significant association is shown for the basic vision examination (adjusted OR, 1.14; 95% CI, 0.95-1.37), while the association of participation in CBHIs on prostate cancer checkup (adjusted OR, 0.18; 95% CI, 0.04-0.76) was negative and significant. The results were controlled with a wide range of predisposing, enabling and need factors for NCDs early detection. Conclusion: and recommendation: CBHIs may benefit NCDs early detection for the general population in Indonesia. Policymakers and health practitioners need to design CBHIs programs that are attractive to the population, especially men and younger people.

Understanding community health worker employment preferences in Malang district, Indonesia, using a discrete choice experiment.

BACKGROUND: Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. METHODS: A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents' choices were analysed with a mixed multinomial logit model and latent class analyses. RESULTS: Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (ß=0.53, 95% CI=0.43 to 0.63), followed by recognition in the form of a performance feedback report (ß=0.13, 95% CI=0.07 to 0.20). A large monthly financial benefit (US$~20) was most unappealing to respondents (ß=-0.13, 95% CI=-0.23 to -0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours' worked per week and income. CONCLUSION: CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours.

Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia.

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs' knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response.