Malaria elimination in West Java, Indonesia: A descriptive-and-qualitative study.

BACKGROUND OBJECTIVES: Following World Health Organization (WHO) plans for thirty-five malaria-endemic countries, Indonesia will eliminate malaria by 2030. As one of the Indonesian provinces, West Java targeted subnational malaria elimination in 2022. This article aims to describe malaria surveillance data and elimination programs, including weaknesses in sustaining the program. METHODS: This study used secondary data from malaria surveillance information system regencies/cities' case reports for 2019-2022 and achievement data of sub-national malaria elimination certification from each regency/city from 2014-2022. The data was confirmed from the evaluation study document, analysis of reported cases, and interviews. RESULTS: Most cases were confirmed by microscopic examination (84.1% in 2021 and 94.4% in 2022) and rapid diagnostic tests (57% in 2019 and 58.1% in 2020). Malaria is more prevalent among men (93% in 2019, 95% in 2020, 96% in 2021, and 95.9% in 2022) and productive ages of 15-64 years (98.8% in 2019, 100% in 2020, 99.2% in 2021, and 98.8% in 2022), frequently occurs in the military (56.3% in 2019, 75.7% in 2020, 45.2% in 2021) and police (40.5% in 2022), often uses passive case detection for identifying cases (97.9% in 2019 and 2020, 95.2% in 2021, and 97.6% in 2022), and the majority undergo inpatient treatment (86.4% in 2019, 81.7% in 2021, and 82.6% in 2022). Most positive cases originated from imported cases, and last indigenous cases were still found in 2019. Plasmodium vivax dominated malaria cases and and relapses were high (55.0% in 2020, and 47.3% in 2022). INTERPRETATION CONCLUSION: All regencies/cities have obtained sub-national malaria elimination certification in 2022. West Java has the potential to be verified for Java-Bali sub-national malaria elimination targeted in 2023, albeit cases of imported malaria still occur. It is imperative to address the issue of imported cases transitioning into locally transmitted cases (introduced) by effective coordination across all regencies/cities and inter-provincial efforts.

Mapping national information and communication technology (ICT) infrastructure to the requirements of potential digital health interventions in low- and middle-income countries.

Background: Digital health can support health care in low- and middle-income countries (LMICs) by overcoming problems of distance, poor infrastructure and the need to provide community practitioners with specialist support. We used five RESPIRE countries as exemplars (Bangladesh, India, Indonesia, Malaysia, Pakistan) to identify the digital health solutions that are valuable in their local setting, worked together with local clinicians and researchers to explore digital health policy, electricity/ICT infrastructure, and socio-cultural factors influencing users' ability to access, adopt and utilise digital health. Methods: We adopted the Joanna Briggs Institute's scoping review protocol and followed the Cochrane Rapid Review method to accelerate the review process, using the Implementation and Operation of Mobile Health projects framework and The Extended Technology Acceptance Model of Mobile Telephony to categorise the results. We conducted the review in four stages: (1) establishing value, (2) identifying digital health policy, (3) searching for evidence of infrastructure, design, and end-user adoption, (4) local input to interpret relevance and adoption factors. We used open-source national/international statistics such as the World Health Organization, International Telecommunication Union, Groupe Speciale Mobile, and local news/articles/government statistics to scope the current status, and systematically searched five databases for locally relevant exemplars. Results: We found 118 studies (2015-2021) and 114 supplementary online news articles and national statistics. Digital health policy was available in all countries, but scarce skilled labour, lack of legislation/interoperability support, and interrupted electricity and internet services were limitations. Older patients, women and those living in rural areas were least likely to have access to ICT infrastructure. Renewable energy has potential in enabling digital health care. Low usage mobile data and voice service packages are relatively affordable options for mHealth in the five countries. Conclusions: Effective implementation of digital health technologies requires a supportive policy, stable electricity infrastructures, affordable mobile internet service, and good understanding of the socio-economic context in order to tailor the intervention such that it functional, accessible, feasible, user-friendly and trusted by the target users. We suggest a checklist of contextual factors that developers of digital health initiatives in LMICs should consider at an early stage in the development process.

Midwifery Continuity of Care in Indonesia: Initiation of Mobile Health Development Integrating Midwives' Competency and Service Needs.

Midwives' competence in providing continuity of care using mobile health (mHealth) applications is limited in developing countries. This study identified and explored midwives' competency and service needs to develop mHealth in Midwifery Continuity of Care (MCOC) education and training. It used an explanatory sequential mixed method, and was conducted from August to December 2021. A cross-sectional approach was used to find the characteristics and competency scope of 373 midwives in West Java, and continued with a qualitative design through a Focus Group Discussion (FGD) of 13 midwives. Descriptive data analysis (frequency, mean, deviation standard) and qualitative data analysis (coding, sub-themes, and theme) were conducted. In terms of the midwives who participated in this study, more than half were aged ≤ 35 years (58.98%), with a working period > 10 years (56.30%), had diploma degrees (71.12%), and used smartphones on average 1-12 h/day (78.28%). Most midwives needed to develop competency in the MCOC scope, including its early detection of the risk factor of complications and treatment management. They were concerned about the purposes, benefits, and design of mHealth. In summary, midwives' competency indicators for early detection are more needed in MCOC using mHealth. Further research is required to evaluate midwives' competence in MCOC using mHealth.

Exploration of Telemidwifery: An Initiation of Application Menu in Indonesia.

The midwifery continuity-of-care model improves the quality and safety of midwifery services and is highly dependent on the quality of communication and information. The service uses a semi-automated chatbot-based digital health media service defined with the new term "telemidwifery". This study aimed to explore the telemidwifery menu content for village midwives and pregnant women in the Purwakarta Regency, West Java, Indonesia. The qualitative research method was used to explore with focus group discussion (FGD). The data collection technique was purposive sampling. The research subjects were 15 village midwives and 6 multiparous pregnant women. The results of this study involved 15 characteristics of menu content: (1) Naming, (2) Digital Communication, (3) Digital Health Services, (4) Telemidwifery Features, (5) Digital Check Features, (6) Media Services, (7) Attractiveness, (8) Display, (9) Ease of Use, (10) Clarity of Instructions, (11) Use of Language, (12) Substances, (13) Benefits, (14) Appropriateness of Values, and (15) Supporting Components. The content characteristics of this telemidwifery menu were assigned to the ISO 9126 Model standards for usability, functionality, and efficiency. The conclusion is that the 15 themes constitute the characteristic menu content required within the initiation of telemidwifery.

Technology-Based (Mhealth) and Standard/Traditional Maternal Care for Pregnant Woman: A Systematic Literature Review.

The world of health has changed significantly since the advent of smartphones. Smartphones have been widely known to facilitate the search for health information in the mobile Health (mHealth) system, which is used to improve the quality of life for patients, such as communication between doctors and patients. This systematic literature review aims to identify the use of mHealth as a digital communication tool for pregnant women by comparing technology-based and standard-based pregnancy care. The method used is a systematic review of articles related to pregnancy care that utilize mHealth for pregnant women. The articles were obtained from the database based on the PICO framework; we searched articles using seven databases. The selection was adjusted to the inclusion criteria, data extraction, study quality evaluation, and results from synthesis. From the disbursement, 543 articles were obtained and 10 results were obtained after the screening. After a critical appraisal was carried out, four articles were obtained. Advantages can be in the form of increasing knowledge of pregnant women who use mHealth due to the availability of information needed by pregnant women in the mHealth application. mHealth also provides information about their babies, so the impact of mHealth is not only for mothers. mHealth is a promising solution in pregnancy care compared to the standard of maternal care.

Rear-seat seatbelt use in urban Southeast Asia: results from Bandung and Bangkok.

Road traffic injuries (RTIs) remain a leading cause of morbidity and mortality in Southeast Asia. We aim to estimate the prevalence and predictors of rear seatbelt use, a key behavioural risk factor for RTI, in Bandung and Bangkok, two cities in Southeast Asia. Roadside observational studies were conducted to provide a representative picture of the prevalence in each city. From eight rounds of observations (July 2015 to April 2019), 39,479 and 7,207 rear-seat passengers were observed in Bandung and Bangkok. Across all rounds, 4.2% of rear-seat passengers used seatbelts in Bandung, compared to 8.4% in Bangkok. In both cities, males and adults, as compared to females and adolescents (aged 12-17 years), had higher odds of rear seatbelt use, as did passengers with a restrained driver. Findings highlight the need for rear seatbelt laws in Bandung and improved enforcement of existing rear seatbelt laws in Bangkok.

Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build "a bridge" from the community to the national scale.

BACKGROUND: Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. METHODS: A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. RESULTS: (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs' knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. CONCLUSIONS: The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs' book. Hence, its implementation is promising for use at the national level.

Feasibility of Indonesia Family Life Survey Wave 5 (IFLS5) Data for Air Pollution Exposure-Response Study in Indonesia.

BACKGROUND: Air pollution is an important risk factor for the disease burden; however there is limited evidence in Indonesia on the effect of air pollution on health, due to lack of exposure and health outcome data. The objective of this study is to evaluate the potential use of the IFLS data for response part of urban-scale air pollution exposure-health response studies. METHODS: Relevant variables were extracted based on IFLS5 documentation review. Analysis of the spatial distribution of respondent, data completeness, prevalence of relevant health outcomes, and consistency or agreement evaluation between similar variables were performed. Power for ideal sample size was estimated. RESULTS: There were 58,304 respondents across 23 provinces, with the highest density in Jakarta (750/district). Among chronic conditions, hypertension had the highest prevalence (15-25%) with data completeness of 79-83%. Consistency among self-reported health outcome variables was 90-99%, while that with objective measurements was 42-70%. The estimated statistical power for studying air pollution effect on hypertension (prevalence = 17%) in Jakarta was approximately 0.6 (α = 0.1). CONCLUSIONS: IFLS5 data has potential use for epidemiological study of air pollution and health outcomes such as hypertension, to be coupled with high quality urban-scale air pollution exposure estimates, particularly in Jakarta.

Land Use Changes and Cluster Identification of Dengue Hemorrhagic Fever Cases in Bandung, Indonesia.

Dengue Hemorrhagic Fever (DHF) in Indonesia has increased steadily with Bandung as a hyper-endemic area holding a high number of cases for years. This study aimed to identify cluster areas and their correlation with land use changes which was indicated by changes of Normalized Difference Vegetation Index (NDVI). Hospital surveillance of 28,327 cases during 2008-2013 was geo-coded into sub-district levels and analyzed to find cluster areas over time and space using SaTScan and ArcGIS. Spearman correlation was used to analyze NDVI with Incidence Rate (IR) in each area. IR of DHF cases tended to increase over 6 years during high precipitation period. Cases were concentrated in several cluster areas in 2009 then moved to eastern part of the city in 2013. NDVI had negative correlation with IR in 2008 (r = -0.258; p = 0.001) and positive correlation in 2012 (r = 0.193; p = 0.017). Clear geographical pattern by cluster identification overtime is beneficial for targeting appropriate vector-control program.

Evaluation of Health Information System (HIS) in The Surveillance of Dengue in Indonesia: Lessons from Case in Bandung, West Java.

This study was performed to evaluate the health information system regarding the dengue surveillance system in Indonesia. Major obstacles to the implementation of an effective health information system regarding dengue cases in Bandung are examined, and practical suggestions on measures to overcome them are discussed. The study utilized a mixed-method research design using qualitative approaches: document analysis, key informants and focus group interviews. Thirty key informants were selected, comprised of policymakers, senior managers, and staff at the Ministry of Health. Data from documents and transcripts were evaluated through a modified Institutional Analysis and Development (IAD) framework described by Ostrom. Through this study, we have identified several issues that hinder the effective implementation of the health information system in the case of dengue in Bandung. In the end, we propose several recommendations for reform that encompasses motivational, strategic, and structural approaches to each component of the analysis. Through evaluation of the health information system for dengue surveillance in Indonesia, we conclude that well-coordination in multi-level governance in a country as large as Indonesia is the key in the implementation of the health information system in different levels of agencies. Furthermore, the adaptability of human resources in adopting a new information system also plays an important part.