Service availability and readiness of malaria surveillance information systems implementation at primary health centers in Indonesia.

One of the most important indicators in malaria eradication is the malaria surveillance information system (SISMAL) for recording and reporting medical cases. This paper aims to describe the availability and readiness of SISMALs at primary health centers (PHCs) in Indonesia. A cross-sectional survey was implemented in seven provinces for this study. The data was analyzed using bivariate, multivariate, and linear regression. The availability of the information system was measured by assessing the presence of the electronic malaria surveillance information system (E-SISMAL) at the studied PHCs. The readiness was measured by averaging each component of the assessment. From 400 PHC samples, only 58.5% had available SISMALs, and their level of readiness was only 50.2%. Three components had very low levels of readiness: (1) the availability of personnel (40.9%), (2) SISMAL integration and storage (50.2%), and (3) the availability of data sources and indicators (56.8%). Remote and border (DTPK) areas had a 4% better readiness score than non-DTPK areas. Endemic areas were 1.4% better than elimination areas, while regions with low financial capacity were 3.78% better than regions with high financial capacity, with moderate capacity (2.91%). The availability rate of the SISMAL at PHCs is only 58.5%. Many PHCs still do not have SISMALs. The readiness of the SISMAL at these PHCs is significantly related to DTPK/remote area, high endemicity status, and low financial capacity. This study found that the implementation of SISMAL is more accessible to malaria surveillance for the remote area and regions with low financial capacity. Therefore, this effort will well-fit to address barrier to malaria surveillance in developing countries.

Smoking Behavior and Cigarette Expenditure in a Household: Evidence for Smoke-Free Houses Initiation in Indonesia.

Background: The household is considered as a private area that is untouched tobacco control policies in developing countries, especially in Indonesia, which has not ratified the Framework Convention on Tobacco Control (FCTC) treaty. Objectives: This study aims to identify smoking behavior and expenditure on cigarettes in the household, which are part of the initiation of a policy including a smoke-free home, so it assumes that the home is a public domain in Tegal Regency, Central Java Province, Indonesia. Methods: This research is an observational study with a quantitative descriptive design. A total of 225 subjects in the seven regions designated as smoke-free areas were all selected as samples in this study and were willing to be the subject of research. Results: The results found that 76.1% of smokers smoked with their nuclear family (wife/children/husband) present. Smoking behavior with the nuclear family inside the home (39.13%) and outside the home (36.96%) was more common than not smoking with the nuclear family. Expenditure for cigarettes per month was one-third of household revenue (IDR 607,521.74) based on the regency minimum wage (UMR) set by the local government. Conclusions: The study concludes that smokers who smoke with family still lack knowledge on smoking's impact on health and household economics. The smoke-free regulation that is initiated should include households as a parameter.

Hygiene and Health Coaching for Community Readiness to Perform the Hajj during an Ongoing COVID-19 Pandemic.

In March 2020, WHO declared Coronavirus Disease 2019 (COVID-19) as a global pandemic, which had a major impact on all mass gatherings (MG), including the Hajj. This has an impact for the government, as the party organizing the pilgrimage can make more mature preparations for a more optimal implementation of the pilgrimage. This study aimed to evaluate hygiene and health coaching for community readiness to perform the Hajj during an ongoing COVID-19 pandemic in Indonesia. We used a mixed qualitative and quantitative method, in which the quantitative component used an analytic cross-sectional design with a questionnaire given to 2425 pilgrims, while the qualitative component was carried out through Focus Group Discussion. During the pandemic, all hygiene and health coaching, including guidance, was carried out in three types of distance learning, called "online", "offline (face-to-face)", and "combination". This study shows that face-to-face health coaching is low (50.5%), while online coaching is high (70.0%). The total fraction of pilgrims who participated in blended coaching sessions was 55.1%, and the highest frequency of coaching was under four times (38.7%). However, in its implementation, there is still no integration between programs. There is quite a lot of health information given to pilgrims, but the material still varies between regions. Information on guidelines for preventing and transmitting COVID-19 for officers and pilgrims has not been fully socialized. There exists an urgent need to establish messages that are clear, meaningful, empathetic, consistent, and in context in order to achieve health improvement of pilgrims.

Determinants of COVID-19 Knowledge, Perception and Attitudes in Indonesia: A Cross-Sectional Survey.

Many countries, including Indonesia, were gravely affected by the COVID-19 pandemic. While younger people were rarely severely affected by an infection, they still served as important spreaders of the disease. Therefore, the knowledge, perception and attitudes regarding COVID-19 of a mostly younger population was assessed in this study using a quantitative survey and semi-structured questionnaire. Out of 15 questions on COVID-19, males answered fewer questions (-1.26) correctly. Persons reporting more diseases in the last year (+0.49 per disease) that lived in a central area of Indonesia, and that had a better socio-economic status defined through household condition scores, had better knowledge of the symptoms, causes of and measures against COVID-19. Better knowledge independently predicted more responsible attitudes and stated behavior. Knowledge and understanding should be enhanced through information campaigns targeted specifically towards men, persons with poor socio-economic backgrounds and those living in the periphery of the state.

A Comparative Analysis of Hazardous Medical Waste Management Compliance Before (2019) and During (2020) the COVID-19 Pandemic in Indonesia.

Background: As a producer of hazardous waste, hospitals have the responsibility to manage the waste they produce. Hospital non-compliance in managing hazardous waste can have a negative impact on the environment and public health, especially during the COVID-19 pandemic, when the amount of hazardous waste produced by healthcare facilities is increasing. To protect the environment and public health from the negative impact of hazardous medical waste, this study was conducted to determine the level of compliance of hazardous waste management in hospitals in Indonesia before and during the COVID-19 pandemic, from 2019 to 2020. Study design: Cross-sectional. Methods: This study was conducted at 343 hospitals in Indonesia using secondary data obtained from Sikelim (Medical Waste Management Information System), which is owned and operated by the Ministry of Health. The data have been analyzed using chi-square tests and logistic regressions of the determinant model. Results: There was an increase in the level of compliance of hazardous waste management in hospitals from 82% to 86% during the pandemic. Furthermore, the availability of environmental documents and environmental health units were determinant factors of hazardous waste management compliance by hospitals before the pandemic in 2019. The only factor in 2020 was the availability of environmental health units. Conclusions: Despite the good level of compliance, additional efforts are needed to increase the activities of the treatment of hazardous medical waste by hospitals, as before the pandemic (i.e., in a normal situation) only 8% of hospitals was able to independently manage hazardous medical waste using authorized incinerators, a percentage that was reduced to 6% during the pandemic.

The effects of climate factors, population density, and vector density on the incidence of dengue hemorrhagic fever in South Jakarta Administrative City 2016-2020: an ecological study.

BACKGROUND AND AIM: Dengue hemorrhagic fever (DHF) is an infectious disease caused by the dengue virus (DENV) and is transmitted through the bite of the Aedes aegypti and Aedes albopictus mosquitoes. This study aims to analyze the relationship between the incidence of DHF which can be influenced by climatic factors in the same month (non-time lag), climatic factors with a lag of 1 month (time lag 1), climatic factors with a lag of 2 months (time lag 2), population density, and vector density. METHODS: The study design used is an ecological study. The data is sourced from the South Jakarta City Administration of Health, the South Jakarta City Administration of Central Statistics, and the Meteorology, Climatology and Geophysics Agency. Data were analyzed using correlation test. RESULTS: The results showed that the incidence of DHF was related to non-time lag rainfall, time lag 1, and time lag 2, air temperature time lag 2, air humidity non-time lag, time lag 1, and time lag 2, population density, and numbers of mosquito's larvae free index (ABJ). CONCLUSIONS: DHF is still a disease that needs to be watched out for in the South Jakarta Administrative City, requiring the government and the people of the South Jakarta Administration to continue to increase efforts to prevent and control DHF.

Health information system concept in health services in the national health insurance (JKN) era in Indonesia: An environment and one health approach.

The health information system is a component of the healthcare system. The health information system in health services in Indonesia has experienced many problems in getting support for policy making, the implementation of the industrial revolution 4.0, and national health insurance (JKN). To answer the above problems, it is necessary to make a concept of health information systems in health services that based on environment and one health perspectives. This research was part of the thematic research of the 2019 JKN National Health Facilities Survey (Rifaskes) in Indonesia. The systems approach and cross-sectional research were carried out by collecting quantitative data. A structural equation model with Lisrel 88 software was used to model the health information system. The health information system produced a concept that included the following structured input components: governance, human resources, infrastructure, types of information system (IS) (program, JKN, management), and financing; process components: funding, technical guidance, and verification and validation; and output components: open access, standards and quality, utilization, bridging, and security. The concept for strengthening the health information system prioritizes improving the output components (standards, utilization, bridging, open access, and security) in the process components (funding, verification, technical guidance) while the input components (financing, human resources, governance, IS programs, infrastructure, IS JKN, IS management).

Associated Factors of Male Participation in Antenatal Care in Muaro Jambi District, Indonesia.

Objective: This study aims to evaluate the level of male participation and factors associated with male participation in antenatal care. Methods: A cross-sectional study was performed, involving a survey of 381 men, selected through multistage random sampling. The outcome variable male participation in antenatal care was constructed from eight dichotomized indicators, and measurement results were low (scored 1 and 2) and high (scored 3 and 4). Multiple logistic regression analysis was performed using SPSS 24.0 at a significance level of 0.05. Results: The percentage of male participation in antenatal care was low (41.2%). Associated factors included age (OR = 1.858, 95%CI = 1.066-3.240), number of children (OR = 2.909, 95%CI = 1.532-5.522), income (OR = 1.715, 95%CI = 1.060-2.775), and knowledge (OR = 3.706, 95%CI = 2.320-5.919). Knowledge was found to be the main factor for male participation in antenatal care in Muaro Jambi Regency. Conclusion: Male participation in antenatal care in Muaro Jambi District was low and was influenced by age, number of children, income, and knowledge. Health promotion programs are needed to empower men to participate in antenatal care by providing communication, education, and information.

Health Personnel Improvement in the Implementation of Shariah's Ethical Code of Conduct in Tangerang Hospital, Indonesia.

Background: The Shariah hospital aims to provide health services inclusive of the appropriate code of ethics of Sharia, which exceeds the standard of service expected of conservative hospitals. Hospital care depends on the performance of health professionals. The study aimed to assess the relationship between the implementation of the ethical code of Shariah hospitals and the performance of health personnel. Methods: The study is a quantitative analysis that collects cross-sectional data from 119 health personnel respondents in one Shariah hospital in Indonesia. Data analysis was performed using structural equation modeling (SEM). Results: The implementation of the ethical code of Shariah hospitals, whether explicit or implicit, has a significantly positive influence on the performance and well-being of health personnel, which is evident from the t value of 4.31 (more substantial than the t value of 1.960). This implementation should run consistently and with the commitment of all parties. Conclusion: Such insight, in turn, can be counted as an input to an approach to health services, particularly in increasing the performance rates in hospital. This study is the first to provide new insight into discussion about Shariah hospital's code of conduct by presenting its beneficiary to not only improve health personnels' performance but also provide the inclusive health service for all religions and cultures which is essential in further study.

Support of the Implementation of a Whistleblowing System for Smoke-Free Environments: A Mixed Methods Approach.

Enforcement of a smoke-free policy is of vital concern in support of the health of smokers and bystanders. Indonesia has issued a smoke-free law, but implementation and enforcement lie with the regional and municipal governments. In a survey of 225 respondents recruited via schools, knowledge about the health effects of smoking and the smoke-free regulation, as well as attitudes towards and commitment and support of the enforcement of the smoke-free regulation in the Kendari City through an electronic whistleblowing system was examined. Furthermore, the participants were asked about the smoking status and smoking behavior. About half of the respondents were students (teenagers), the other half-their parents. Male respondents were strongly overrepresented (85%). Only 18% of the respondents declared to be smokers, mostly adults and males. Both the smokers and the non-smokers supported the smoke-free law and its enforcement through a whistleblowing system. Representatives of the local government were interviewed and participated in focus group discussions. In general, they also exhibited strong support of an electronic enforcement tool. However, issues of efficiency, costs, and responsibility must still be resolved. Nevertheless, an electronic whistleblowing system has the potential to further the health and livelihoods in a community like the Kendari City.

Metal Contents of Lake Fish in Area Close to Disposal of Industrial Waste.

This research was conducted to analyze the content of Fe, Cu, Cd, Cr, and Pb in several species of fish taken from three lakes that are close to the disposal of industrial waste in Indonesia. The fish samples were taken from three lakes, namely, Muara Angke, Weda, and Morowali. The samples from Morowali were analyzed in April 2019, those from Weda from November to December 2019, and those from Muara Angke in June 2018. All the samples were then analyzed at the Chemistry Laboratory of the Department of Chemistry, Faculty of Mathematics and Natural Science, University of Indonesia, and the Integrated Laboratory of IPB. The main results showed that all types of fish from Morowali and Weda were no longer safe to consume because they contained Fe, Cu, Cd, and Cr exceeding the threshold of metal contamination. Meanwhile, all types of fish from Muara Angke, except for ayam-ayam, are still safe for consumption. The results of this study can be a source of information regarding metal content in fish and fish feed for safe consumption. Given the high consumption rate of fish and the hazards of heavy metals on humans' health, such research must be furthered.

Prevalence of Smoke-Free Zone Compliance among Schools in Indonesia: A Nationwide Representative Survey.

BACKGROUND: With the increasing prevalence of teenage or school-age smokers, schools have become the main focus of the Indonesian government in tobacco control, including through the smoke-free zone (SFZ) policy. This study aims to obtain information related to the implementation of SFZ policies in schools. METHODS: A nationally representative survey was employed in 900 elementary, junior high, and senior high schools that were located in 60 regions or 24 provinces of Indonesia. Each school's compliance with SFZ parameters was measured using a closed-ended questionnaire. The dataset was analyzed using frequency distribution, while the chi-square was performed to analyze the measurement effect of each parameter for SFZ compliance. RESULTS: Java Island is the region with the largest proportion of school units (10%) studied in this study, and the largest group of the schools are high schools (36.1%). In terms of SFZ compliance, 413 (45.9%) of schools had perfect compliance scores of 8, followed by 183 schools (20.3%) with a score of 7 and 107 (11.9%) with a score of 6. It was found that parameter 5, namely cigarette butts found in the school environment, had the largest proportion when a school did not apply SFZ. Cigarette butts were found in 261 (29.0%) schools. Cigarette butts found in schools contributed 7.8 times to not applying SFZ compared to schools where no cigarette cutters were found. CONCLUSION: Although the SFZ compliance rate in Indonesian schools is 66.2% at least on 7 of 8 existed parameters, this means most of schools still aren't fully complying with the regulations for SFZs. This recent evidence will help decisionmakers to enforce tobacco control, particularly among youth, which form the pillar of national development.
.

An Evaluation of Health Policy Implementation for Hajj Pilgrims in Indonesia.

BACKGROUND: For last decades, the mortality rate of hajj pilgrims from Indonesia was between 2.1 and 3.2 per 1000 hajj pilgrims. At the same time, morbidity affected 87% of the elderly (>65 years old), of which 83% faced high risk of health problems. This is a complex problem affecting hajj health care in Indonesia. The study was aimed to understand what extent of the hajj implementation on health care in Indonesia. METHODS: This review was conducted by abstracting of three studies in Indonesian hajj health care. Two of the studies were based on cross-sectional reviews, while one was a case-control study. The majority of the studies performed laboratory tests to evaluate the disease conditions among hajj pilgrims through secondary data. RESULTS: First study presented that hajj Posbindu (integrated post-coaching) was not functional in managing the health problems of the pilgrims. It shows that the stroke prevalence is 10.9 per 1000 people, Diabetes Mellitus (DM) 10.9% of the people, and coronary heart disease 1.5%. The second study expressed that, according to health isthitaah (policy implementation), there were 20% hajj pilgrims who delayed their trip because of health issues. Most of them had chronic kidney disease, dementia, or lung tuberculosis. The policy implementation of health isthitaah was not smooth; there was little collaboration between the Ministry of Health and Ministry of Religious Affairs, and the population was not sufficiently educated in the area, resulting in hajj pilgrims with poor knowledge, attitude, and practice in health isthitaah. This notion was enforced in the third study. CONCLUSION: The coaching according to health isthitaah should be encouraged alongside collaboration between the Ministry of Health and Ministry of Religious Affairs. Socialization in public health has to increase according to health isthitaah, which can be done by district health centers.

Sunlight exposure increased Covid-19 recovery rates: A study in the central pandemic area of Indonesia.

This study aims to present the correlation between sunlight exposure and Covid-19 statuses in Jakarta, Indonesia. The secondary data analysis was derived from surveillance data for Covid-19 from government authorities, including the Ministry of Health, the Meteorological, Climatological, and Geophysical Agency, and the local government of Jakarta. Three statuses related to Covid-19 were examined in the study: incidence, death, and recovered. Meanwhile, sunlight exposure was presented as daily duration of it. Only the number of recovered patients correlated significantly with sunlight exposure (p-value = .025; r = 0.350). This study's findings showed that sunlight exposure was associated with recovery from Covid-19.

Predicting transmission of pulmonary tuberculosis in Daerah Istimewa Yogyakarta Province, Indonesia.

This study aims to explain the current dispersion of tuberculosis (TB) and provide evidence that could help predicting its future transmission in Daerah Istimewa Yogyakarta (DIY) Province, Java Island, Indonesia. One hundred thirty-two adult (>14 years old) individuals, with TB diagnosed by health professionals using the Directly Observed Treatment, Short Course strategy, were identified Their residential addresses and geographical patterns of movement were investigated by global positioning systems and descriptive spatial analysis using standard deviation ellipse analysis and kernel estimation. The dispersion of TB cases was studied by ellipse regression, which showed a pattern extending in a direction oriented from north-west to south-east centred on Kasihan District, Bantul Regency, DIY Province, located near Yogyakarta City. Levels of TB risk in the study area varied from non-existent to high as calculated by kernel estimation. We conclude that suburban communities, followed by densely populated residential areas, enabled by socio-economic factors, are more likely to see increased TB transmission in the future.