Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months.

Background: Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia. Methods: Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression. Results: The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045). Conclusion: Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.

The Effort to Rationalize Antibiotic Use in Indonesian Hospitals: Practice and Its Implication.

An effective strategy for combatting AMR in Indonesia is to make the use of antibiotics in hospitals more rational with the help of an Antimicrobial Resistance Control Program (AMR-CP). This study aims to analyze the implementation of the AMR-CP in hospitals by conducting in-depth interviews with health professionals from ten hospitals and health officers of ten provincial health offices in ten different provinces and observation towards its documents. The sample location was selected by purposive sampling. Informants at the hospitals were hospital directors, chairmen of the AMR-CP team, chairmen of the medical committee, persons in charge of the microbiology laboratory, clinicians, nurses, clinical pharmacists, and those program managers at the provincial health offices who are responsible for administering antibiotics. Information is first collected and then a thematic analysis is applied along with triangulation to confirm the validity of information from multiple sources, including document observation results. The analysis is adapted to the framework of the system (i.e., input, process, and output). Results show that hospitals in Indonesia already have the resources to implement AMR-CP, including AMR-CP team and microbiology laboratories. Six hospitals examined also have clinicians trained in microbiology. Though hospital leadership and its commitment to implementing AMR-CP are favorable, there is room for improvement. AMR-CP teams organize routine activities for socialization and training, develop standard operating procedures (SOPs) for antibiotic use, antibiotic patterns surveillance, and bacterial mapping. Some obstacles to implementing AMR-CP policies are posed by the human resources, facilities, budget, antibiotics and reagent shortages, and clinician compliance with SOPs. The study concludes that there was an improvement in antibiotic sensitivity patterns, rational use of antibiotics, use of microbiological laboratories, and cost-efficiency. It recommends the government and healthcare providers continue to improve AMR-CP in hospitals and promote AMR-CP policy by making the regional health office of the hospital a representative of the regional government.

Antimicrobial Resistance Situation in Indonesia: A Challenge of Multisector and Global Coordination.

High levels of antimicrobial resistance (AMR) in Indonesia are caused by the use of inappropriate antimicrobials (AM) in healthcare services and the livestock and fisheries sector. The available data and information about overused antibiotics and the AMR threat in Indonesia are limited. The aim of the study is to describe the AMR situation in Indonesia based on perceptions of government officials, health professionals, and the community to determine actions needed to develop AMR-related strategy and policy. The study was done in eight provinces in Indonesia and included reviewing AMR-related policy, collecting antibiotic use reports in primary health care from health offices and hospitals, and conducting in-depth interviews and focus group discussions with informants from health and nonhealth sectors. The results of the study show that AM misuse happens not only in healthcare facilities but also in communities. Medical officers are unfamiliar with AMR-related policy, as are officers in the livestock and fisheries sectors. There is limited coordination between sectors regarding the AMR situation in Indonesia. The government has to take stronger measures to oversee better implementation of AMR policies.