Attempts to purchase misoprostol online in Indonesia: a mystery client study design.

BACKGROUND: Abortion is highly restricted in Indonesia; self-administered misoprostol can safely induce an abortion. Brick and mortar pharmacies, a common place to purchase misoprostol off-label in other parts of the world, are monitored closely by the government authority in Indonesia which controls drugs so that they cannot function outside the law without risking arrest and prosecution. An online marketplace has sprung up in response that sells misoprostol through in-country distributors. Such procurement offers a level of safety and anonymity to the buyer and seller. So as to understand online access to misoprostol, we created a protocol to identify the most visible universe of sellers. METHODS: We carried out a mystery client methodology to replicate the experiences of women procuring misoprostol online. Our study consisted of five stages: (1) identify the universe of online sellers using the most common search terms, drawn from multiple platforms to capture diversity in interactions as well as products sold (2) remove duplicates across sites as determined by their telephone numbers (3) draw a roughly probability proportional to size sample (4) contact sellers as mystery clients through text/chat, depending on the platform, and engage with them and (5) attempt to purchase drugs offered by the seller. Descriptive statistics are presented. RESULTS: The listing generated 727 sites: 441 websites, 153 marketplace sellers, and 133 Instagram profiles. After removing duplicate listings, we identified 281 unique sellers. We selected all sellers with greater than 12 listings, 60% of sellers with 4-12 listings, 50% of sellers with 2-3 listings, and 40% of sellers with only one listing. Mystery clients were able to send initial messages to 110 sellers, of which 16 never responded. The interaction progressed to purchasing misoprostol with 76 sellers, 64 of whom sent drugs. CONCLUSIONS: As women seek to terminate unwanted pregnancies in legally restrictive settings, online sales of misoprostol must be considered. With the Covid pandemic constraining movement, the importance of this way of procuring misoprostol will likely become more appealing. Understanding this unregulated landscape is important if we are to try to improve women's ability to safely conduct an abortion in highly restrictive settings.

Prevalence of, and factors associated with anaemia in children aged 1-3 years in Aceh, Indonesia: A cross-sectional study.

Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12-24 months (aOR: 2.00, 95% CI: 1.26-3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34-5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59-2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.

The impact of a package of behaviour change interventions on breastfeeding practices in East Java Province, Indonesia.

Suboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster-randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0-23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age-appropriate breastfeeding and bottle-feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35-2.53) and age-appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07-1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41-0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention.

Eating behaviour of Indonesian adolescents: a systematic review of the literature.

OBJECTIVES: Global evidence has shown that behaviour acquired during adolescence often lasts into adulthood. Diet quality of and malnutrition in Indonesian adolescents is a neglected area of research. The current study reviews all studies related to eating behaviour in Indonesian adolescents to support evidence-based policy to improve diets. DESIGN: We searched electronic databases (six international and one local), from January 2000 to April 2018. The search terms used were (1) prevalence (prevalence OR number* OR case*, incidence OR survey), (2) adolescents (adolescen* OR school-age OR young adult), (3) Indonesia (Indonesia*) and (4) eating pattern (eat* OR fruit OR vegetable OR food recall OR food OR frequenc* OR consumption OR dietary intake). Articles were assessed against a critical appraisal tool. SETTING: Indonesia. PARTICIPANTS: 10-19 years. RESULTS: We discovered 15 studies related to eating behaviour, 5 of which were secondary analyses of nationally representative surveys and one was a nationwide survey. Of the nine studies, one study was conducted in multiple cities, and the rest were conducted in a single city or smaller area. There were seven main topics from the included studies: nutrient adequacy, fruit and vegetable consumption, water and beverage intake, Na intake, breakfast habit, snacking frequency and western fast food consumption. CONCLUSIONS: Adolescents consume inadequate amounts of protein, fruits and vegetables, and excessive amounts of Na and western fast food. Measures are needed to improve and motivate adolescents to adopt healthier eating patterns. Furthermore, there is a need to have one standard definition and measurement of eating behaviour in Indonesia.

Online Abortion Drug Sales in Indonesia: A Quality of Care Assessment.

This study sought to understand the experience of buying misoprostol online for pregnancy termination in Indonesia. We conducted a mystery client study August through October, 2019. Interactions were analyzed quantitatively and qualitatively, along with the contents of the packages. One hundred ten sellers were contacted, from whom mystery clients made 76 purchases and received 64 drug packages. Almost all sellers sold "packets" containing multiple drugs; 73 percent of packets contained misoprostol, and 47 percent contained at least 800 mcg of misoprostol. Thirty-four packets contained insufficient drugs to complete an abortion. When compared to WHO standards, 87 percent of sellers imparted incomplete information about potential physical effects; no seller provided information about possible complications. Women buying misoprostol from informal online drugs sellers will be underprepared for understanding potential side effects and complications. Educational activities are needed to increase women's access to information about safe use of misoprostol as a harm reduction strategy.

COVID-19 in Indonesia: Where Are We?

Since the 1st case officially confirmed on the last March 2020, Indonesia recorded more than 1000 new cases daily. The national trend shows no sign of decrease as 19 September 2020 the report sets a new mark of 4000 new cases in a day. The concept of controlling disease transmission relies on contacts suppression; and on the longer end, relies on vaccinations. As 27 September 2020, no vaccine is approved for use in the general population. Until then, countries should implement early, widespread, and strict disease mitigation strategies. While much remains to be learned on COVID-19, global evidence assert at least three strategies at the population level contributes to flatten the curve: mobility restriction, testing and isolation and rigorous contact-tracing.Indonesia is not on entire absences of actions, but the epidemic calls for more. The central government called for social distancing two weeks after the first case confirmed and regulation on the large scale social distancing (Pembatasan Sosial Berskala Besar/ PSBB) that restrict non-essential population mobility is enacted by April 2020. Recent evidence outlines test, tracing and isolation are effective in suppressing COVID-19 transmission. Minimizing testing and tracing delay, less than four days with coverage of 80% close contacts could prevent and reduce onwards transmission.That we need to more is indisputable. The vaccine is not a magic bullet; it is a long-term control measure and should be a complete series of careful and precise examinations. Indonesia will also likely require high coverage of vaccination to achieve herd immunity. At present, if there is no significant improvement in the coverage of preventive measures in the population and disease surveillance system, our hospital will be overwhelmed, and case fatality will be devastating.

COVID-19 in Indonesia: Challenges and Multidisciplinary Perspectives for a Safe and Productive New Normal.

The COVID-19 pandemic has caused disruption in all aspects of life, and countries around the world have been combating this pandemic using multiple approaches. Success in one country does not guarantee a transferable approach to other countries with different contexts. This review describes the challenges of COVID-19 management in Indonesia as a populous, socially and culturally diverse, and archipelagic country. It aims to provide multidisciplinary perspectives for a safe, evidence-based, and productive new normal as well as a comprehensive and integrated actionable policy for COVID-19 control.

Feeding practices of young children aged 12-23 months in different socio-economic settings: a study from an urban area of Indonesia.

Poor feeding practices among young children lead to malnutrition, and the poor are at a greater risk than the better off groups. Child-feeding practices in various socio-economic strata, especially in urban settings, have not yet been well studied in Indonesia. This study aims to explore the feeding practices of 12-23 months old children from different socio-economic status (SES) groups. A cross-sectional survey was conducted, which included low (n 207), medium-high (n 205), medium-low (n 208) and high SES households (n 194) in forty-three villages within thirty-three sub-districts of Bandung city. Two non-consecutive 24 h recall and eight core indicators of child-feeding practices were assessed through interviews. The results showed that children from the high SES group were more likely to be exclusively breast-fed and to continue breast-feeding up to 1 year of age, met minimum dietary diversity and minimum acceptable diet, and also consumed Fe-rich or Fe-fortified foods. In contrast, children from low SES consumed more energy-rich food (grain) but fewer foods from the other food groups. Consumption of major nutrients differed across the SES groups. Inadequate nutrition was higher among children from the lower SES groups. Fortified foods were consumed by a larger proportion of children from the high SES group and contributed considerably to their overall nutrient intake. This study shows that young children's feeding practices were not adequate, most notably among the low SES households. However, after adjusting with potential confounders, there was not enough evidence to conclude SES as a risk factor for feeding practice.

Determinants of early neonatal mortality: secondary analysis of the 2012 and 2017 Indonesia Demographic and Health Survey.

Background: Most neonatal deaths occur during the first week of life (i.e., early neonatal deaths). In this analysis, we aimed to investigate the determinants of early neonatal deaths in a nationally representative sample of births in Indonesia over the five years before each survey. Methods: Data were obtained from the 2012 and 2017 Indonesia Demographic and Health Survey (IDHS), including information from 58,902 mothers of children aged <5 years of age. The outcome variable was early neonatal death (death of a newborn within the first six days of life). Explanatory variables were categorized into environmental, household, maternal, pregnancy, childbirth, and child characteristics. Multivariate regression methods were employed for analysis. Results: Increased odds of early neonatal deaths were associated with mothers who lacked formal education or had incomplete primary schooling (adjusted odd ratio [OR] = 2.43, 95% confidence interval [CI]: 1.18-5.01), worked outside the house in agricultural (aOR = 5.94, 95% CI: 3.09-11.45) or non-agricultural field (aOR = 2.98, 95% CI: 1.88-4.72), and were required to make a joint decision about health care with their partner or another household member (aOR = 1.79, 95% CI: 1.12-2.84). Increased odds were also observed in smaller-than-average infants, particularly those who received low-quality antenatal care services (aOR = 9.10, 95% CI: 5.04-16.41) and those whose mothers had delivery complications (aOR = 1.72, 95% CI: 1.10-2.68) or who were delivered by cesarean section (aOR = 1.74, 95% CI: 1.07-2.82). Furthermore, male infants showed higher odds than female infants (aOR = 1.85, 95% CI: 1.23-2.76). Conclusions: A multifaceted approach is essential for curtailing early neonatal mortality in Indonesia. Enabling workplace policies, promoting women's empowerment, strengthening the health system, and improving the uptake of high-quality antenatal care services are among the critical steps toward preventing early neonatal deaths in Indonesia.

Conducting nationwide cohort COVID-19 serology surveys on a nation with limited resources and decentralized governance: Evidence from Indonesia.

Knowing the level of SARS-CoV-2 transmission is crucial for decision-making on Coronavirus disease (COVID-19) handling. Guidelines for measuring SARS-CoV-2 antibodies to estimate seroprevalence are conceptually straightforward and internationally available. However, challenges exist for developing countries with limited laboratory capacity, diverse geographical topography, fragmented health information systems and limited resources such as Indonesia. One year after the first case was confirmed in Indonesia, approximately ten infections were undiagnosed or underreported for every reported case. Under those circumstances, we described the method and lessons learned in conducting nationwide cohort COVID-19 serology surveys in a nation with limited resources, such as Indonesia. •Strong cross-sectoral collaboration between ministries and levels of governance (central and subnational) enables strategic use of civil registration database for efficient sampling.•All agglomeration districts (highly dense population and urban area) were selected as study sites, and additional non-agglomeration districts were selected using probability-proportional-to-size (PPS).•Involving the experienced phlebotomist in community health service provider and district laboratory cut down preparation time.

The multiple factors of suboptimal early feeding practices among infants aged 0-5 months in Indonesia.

Background: Optimal early infant feeding practices are critical to ensure adequate nutrition for infants' growth and development. This study aimed to examine the determinants of suboptimal early feeding practices (i.e., delayed initiation of breastfeeding, prelacteal feeding, and non-exclusive breastfeeding) among infants aged 0-5 months in Indonesia. Methods: We used data collected in the 2012 and 2017 Indonesia Demographic and Health Surveys. Analyses were conducted using information from 3,198 live-born singleton infants aged 0-5 months. The primary outcomes used were: (1) delayed initiation of breastfeeding in the first hour after birth, (2) prelacteal feeding in the first 3 days, and (3) non-exclusive breastfeeding in the last 24 h preceding the survey. Potential predictors analyzed were categorized into the environmental, household, maternal, pregnancy, delivery, and child characteristics. Logistic regression analyses were performed to identify factors significantly associated with each outcome. Results: Approximately 78,6% of infants aged 0-5 months in Indonesia had at least one of the three suboptimal early infant feeding practices. We found a strong association between the three outcome indicators analyzed. The determinants of delayed initiation of breastfeeding included infants from Sumatera region (adjusted odds ratios (aOR) = 2.02, p < 0.001), infants delivered by Cesarean section (aOR = 2.78, p < 0.001), and in non-health facilities (aOR = 1.53, p = 0.003). The determinants of prelacteal feeding in the first 3 days included infants living in urban areas (aOR = 1.32, p = 0.035), the first birth-ranked infants (aOR = 1.32, p = 0.019), and infants who had delayed initiation of breastfeeding in the first hour of life (aOR = 3.90, p < 0.001). The determinants of non-exclusive breastfeeding in the last 24 h included infants whose mothers worked in non-agricultural fields (aOR = 1.52, p < 0.001), infants delivered by Cesarean section (aOR = 1.33, p = 0.044), and the first birth-ranked infants (aOR = 1.28, p = 0.039). Conclusion: There was a high percentage of infants aged 0-5 months who had suboptimal feeding practices in Indonesia. As we found multiple factors associated with suboptimal early feeding practices among infants, integrated approaches, including health promotion and supportive public policy, are required to ensure infants receive adequate nutrition in the early stages of life.

Evidence-Based Nutrition Interventions Improved Adolescents' Knowledge and Behaviors in Indonesia.

Adolescence is a nutritionally vulnerable and critical life stage. However, few programs and policies focus on improving adolescent nutrition in Indonesia. To address this gap, we implemented a gender-responsive package of interventions: (1) breakfast and weekly iron-folic acid supplementation (WIFS), (2) a school-based nutrition education program, and (3) a social behavior change communication strategy. We surveyed 514 adolescents at baseline (2019) and endline (2020) in Klaten and Lombok Barat districts in Indonesia. The survey included a knowledge assessment on nutrition, as well as indicators of attitudes and behaviors on diet, physical activity, and WIFS. We employed multivariable linear and logistic regression to test for pre-post intervention differences. Overall knowledge was significantly higher post-intervention (ß: 3.3; 95% confidence interval [CI]: 2.6, 3.9). Diet diversity was high at both timepoints, however, at post-intervention there was significantly higher odds of consuming vitamin A-rich fruits and vegetables (Odds Ratio [OR]: 1.5; 95% CI: 1.1, 2.0) and lower odds of consuming sugar-sweetened beverages (OR: 0.4; 95% CI: 0.3, 0.5). Post-intervention, there was higher odds of reporting 60 min of daily physical activity (OR: 2.3; 95% CI: 1.7, 3.2) and WIFS among girls (OR: 6.7; 95% CI: 1.5, 30.9). The package of interventions may be a promising first step to improving adolescent nutrition in Indonesia.

Assessment of factors related to individuals who were never treated during mass drug administration for lymphatic filariasis in Ambon City, Indonesia.

BACKGROUND: One challenge to achieving Lymphatic filariasis (LF) elimination is the persistent coverage-compliance gap during annual mass drug administration (MDA) and the risk of ongoing transmission among never treated individuals. Our analysis examined factors associated with individuals who were never treated during MDA. METHODS: Data were derived from two cross-sectional surveys conducted in Waihaong and Air Salobar Health Center in 2018 and 2019. We analyzed information from 1915 respondents aged 18 years or above. The study outcome was individuals who self-reported never treatment during any round of MDA. All potential predictors were grouped into socio-demographic, health system, therapy and individual factors. Logistic regression analyses were used to examine factors associated with never treatment in any year of MDA. RESULTS: Nearly half (42%) of respondents self-reported they were never treated during any round of MDA. Factors associated with increased odds of never treatment were respondents working in formal sectors (aOR = 1.75, p = 0.040), living in the catchment area of Waihaong Health Center (aOR = 2.33, p = 0.029), and those perceiving the possibility of adverse events after swallowing LF drugs (aOR = 2.86, p<0.001). Respondents reporting difficulty swallowing all the drugs (aOR = 3.12, p<0.001) and having difficulties remembering the time to swallow the drugs (aOR = 1.53, p = 0.049) also had an increased odds of never treatment. The highest odds of never treatment were associated with respondents reporting almost none of their family members took LF drugs (aOR = 3.93, p<0.001). Respondents confident that they knew how to swallow LF drugs had a reduced odds (aOR = 0.26, p<0.001) of never treatment. CONCLUSIONS: Efforts to reassure community members about adverse events, specific instructions on how to take LF drugs, and improving awareness that MDA participation is part of one's contribution to promoting community health are essential drivers for uptake with LF drugs during MDA.

Factors affecting vaccination demand in Indonesia: a secondary analysis and multimethods national assessment.

OBJECTIVES: Vaccine hesitancy remains a major barrier to immunisation coverage worldwide. We explored influence of hesitancy on coverage and factors contributing to vaccine uptake during a national measles-rubella (MR) campaign in Indonesia. DESIGN: Secondary analyses of qualitative and quantitative data sets from existing cross-sectional studies conducted during and around the campaign. METHODS: Quantitative data used in this assessment included daily coverage reports generated by health workers, district risk profiles that indicate precampaign immunisation programme performance, and reports of campaign cessation due to vaccine hesitancy. We used t-test and χ2 tests for associations. The qualitative assessment employed three parallel national and regional studies. Deductive thematic analysis examined factors for acceptance among caregivers, health providers and programme managers. RESULTS: Coverage data were reported from 6462 health facilities across 395 districts from 1 August to 31 December 2018. The average district coverage was 73%, with wide variation between districts (2%-100%). One-third of districts fell below 70% coverage thresholds. Sixty-two of 395 (16%) districts paused the campaign due to hesitancy. Coverage among districts that never paused campaign activities due to hesitancy was significantly higher than rates for districts ever-pausing the campaign (81% vs 42%; p<0.001). Precampaign adequacy of district immunisation programmes did not explain coverage gaps (p=0.210). Qualitative analysis identified acceptance enablers including using digital health monitoring and feedback systems, increasing caregiver knowledge and awareness, making immunisation social norm, effective cross-sectoral collaboration, conducive service environment and positive experiences for mothers and children. Barriers included misinformation diffusion on social media, halal-haram issues, lack of healthcare provider knowledge, negative family influences and traditions, previous poor experiences and misinformation on adverse events. CONCLUSION: Barriers to vaccine uptake contributed to coverage gaps during national MR campaign in Indonesia. A range of supply-related and demand-related strategies were identified to address hesitancy contributors. Advancing a portfolio of tailored multilevel interventions will be critical to enhance vaccine acceptance.

A longitudinal study of allergy and intestinal helminth infections in semi urban and rural areas of Flores, Indonesia (ImmunoSPIN Study).

BACKGROUND: The prevalence of asthma and atopic disease has been reported to be low in low income countries, however helminth infections are likely to be high among these communities. The question of whether helminth infections play a role in allergic diseases can best be addressed by intervention studies. None of the studies so far have been based on a large scale placebo-controlled trial. METHOD/DESIGN: This study was designed to assess how intestinal helminth infections can influence the immune response and atopic and allergic disorders in children in Indonesia. The relations between allergic outcomes and infection and lifestyle factors will be addressed. This study was set up among school-age children in semi urban and rural areas, located in Ende District of Flores Island, Indonesia. A randomized placebo-controlled anthelmintic treatment trial to elucidate the impact of helminth infections on the prevalence of skin prick test (SPT) reactivity and symptoms of allergic diseases will be performed. The children living in these semi-urban and rural areas will be assessed for SPT to allergens before and after 1 and 2 years of treatment as the primary outcome of the study; the secondary outcome is symptoms (asthma and atopic dermatitis); while the tertiary outcome is immune responses (both antibody levels to allergens and cellular immune responses). DISCUSSION: The study will provide information on the influence of helminth infections and anthelmintic treatment on immune response, atopy and allergic disorders. TRIAL REGISTRATION: Current Controlled Trials ISRCTN: ISRCTN83830814.

Soil-transmitted helminth infection, anemia, and malnutrition among preschool-age children in Nangapanda subdistrict, Indonesia.

BACKGROUND: Soil-transmitted helminth (STH) infections are still prevalent in Indonesia, with roughly one-third of infected population being preschool-age children (PSC), which are generally at higher risk of morbidity such as malnutrition and anemia. This study aimed to investigate the association of STH infections with nutritional status and anemia among PSC in Nangapanda subdistrict, Ende, East Nusa Tenggara. METHODS: A cross-sectional survey involving PSC ranging from 12 to 59 months old from Nangapanda subdistrict, Ende district, East Nusa Tenggara was performed. Socio-demographic, breastfeeding, and complementary feeding information was obtained from structured questionnaires, while nutritional and anemia status was determined from anthropometry and hemoglobin measurements, respectively. Anthropometric z-scores were calculated based on the World Health Organization 2006 standards and stool samples were examined using Kato-Katz method. RESULTS: A total of 393 PSC randomly selected from 22 villages were examined. The prevalence of underweight, stunting, wasting, and anemia were 33.1%, 40.2%, 17.1%, and 60.3%, respectively. STH infection, predominated by Ascaris lumbricoides, was found in 160 (58.8%) PSC. Single STH infection, but not multiple infection, was independently associated with a lower risk of anemia (odds ratio [OR] 0.320, 95% confidence interval [CI]: 0.126-0.809, p = 0.016). Similar association with anemia was also found on mild STH infection (OR 0.318 [95% CI: 0.114-0.887], p = 0.029). On the other hand, younger children were found to have a higher risk of anemia and stunting. None of the examined variables were independently associated with underweight and wasting. CONCLUSION: STH infection as well as anemia and malnutrition were prevalent in this region. However in this study, current STH infections seemed to have minimal negative impact on children's nutritional status.

Improving Communication Messages by Using Perceptual Mapping: Family Planning Survey in East Java and West Nusa Tenggara, Indonesia.

OBJECTIVES: Contraceptive methods vary in effectiveness, actions required of users, and side effects. This article aims to analyze the perceptions about contraceptive methods among family planning clients of the East Java and West Nusa Tenggara (NTB) provinces in Indonesia. METHODS: The data were obtained from the operational research of the Improving Contraceptive Method Mix Project in Indonesia, conducted in 2015-2016 in six districts in East Java and West Nusa Tenggara. The total sample size was 12,190 women aged 15-49 years. The perceptual mapping method uses cross-sectional surveys that require the respondent to rate the level to which they associate specific elements with each other, based on similarities and differences of perceived association. The correlation matrices for six contraceptive methods and five attributes were subjected to a multidimensional scaling analysis. RESULTS: The results showed injectable to be the most preferred method, which was positioned closest to the attributes 'easy to use' and 'easy to get', followed by pills. Implants ranked higher than other long-acting and permanent method. CONCLUSION: Injectables and pills were the most preferred because people believe that they were 'easy to use' and 'easy to get'. The least preferred methods were tubectomy and vasectomy because the respondents thought those were not close to any attributes at all. To increase the demand for the long-acting and permanent method choice in the provinces of East Java and West Nusa Tenggara, the attributes 'easy to use' and 'easy to get' should be emphasized in the long-acting and permanent method Information Education and Communication messages.

Seroprevalence of antibodies against SARS-Cov-2 in the high impacted sub-district in Jakarta, Indonesia.

BACKGROUND: Understanding the actual prevalence of COVID-19 transmission in the community is vital for strategic responses to the pandemic. This study aims to estimate the actual infection of COVID-19 through a seroprevalence survey and to predict infection fatality rate (IFR) in Tanjung Priok, the hardest-hit sub-district by the COVID-19 in Jakarta, Indonesia. METHODS: We conducted a venous blood sampling (phlebotomy) to 3,196 individuals in Tanjung Priok between Nov 23, 2020, and Feb 19, 2021 to detect their antibodies against SARS-CoV-2. Using an enumerator-administered questionnaire, we collected data on the respondents' demographic characteristics, COVID-19 test history, COVID-19 symptoms in the last 14 days, comorbidities, and protective behaviours during the last month. We employed descriptive analysis to estimate the seroprevalence and IFR. FINDINGS: The prevalence of Antibody against SARS-CoV-2 was 28.52% (95% CI 25.44-31.81%), with the result being higher in females than males (OR 1.20; 95% CI 1.02-1.42). By the end of the data collection (February 9, 2021), the cumulative cases of COVID-19 in Tanjung Priok were reported to be experienced by 9,861 people (2.4%). Those aged 45-65 were more likely to be seropositive than 15-19 years old (OR 1.42; 95% CI 1.05-1.92). Nearly one third (31%) of the subjects who developed at least one COVID-19 symptom in the last 14 days of the data collection were seropositive. The estimated IFR was 0.08% (95% CI 0.07-0.09), with a higher figure recorded in males (0.09; 95% CI 0.08-0.10) than females (0.07; 95% CI 0.06-0.08), and oldest age group (45-65) (0.21; 95% CI 0.18-0.23) than other younger groups. CONCLUSION: An under-reporting issue was found between the estimated COVID-19 seroprevalence and the reported cumulative cases in Tanjung Priok. More efforts are required to amplify epidemiological surveillance by the provincial and local governments.

Determinants of low breastfeeding self-efficacy amongst mothers of children aged less than six months: results from the BADUTA study in East Java, Indonesia.

BACKGROUND: Despite the increasing rate of exclusive breastfeeding in Indonesia, there is still a need for supportive interventions. The breastfeeding self-efficacy of mothers is a key factor positively associated with optimum breastfeeding practices. Our analysis aims to assess the determinants of low breastfeeding self-efficacy amongst a sample of women with children aged under 6 months in Malang and Sidoarjo Districts, East Java, Indonesia. METHODS: We used information from 1210 mothers of children aged < 6 months recruited in the BADUTA study conducted in 2015-2016 in Malang and Sidoarjo Districts. The outcome variable in this analysis was mothers' self-efficacy for breastfeeding using the 14 statements in the Breastfeeding Self-Efficacy-Short Form. We evaluated 17 potential predictors of breastfeeding self-efficacy, organized into six sub-groups of variables: (1) context/demographic; (2) household factors; (3) maternal characteristics; (4) child characteristics; (5) breastfeeding practices; and (6) antenatal and delivery care. Logistic regression analyses were employed to examine factors associated with mothers' self-efficacy with breastfeeding. RESULTS: More than half of the women in this study had a low level of self-efficacy. One of the factors associated with low breastfeeding self-efficacy found in this study was mothers' problems related to breastfeeding. Mothers who had problems with breastfeeding not related to illness (adjusted odds ratio [aOR] 3.27; 95% CI 2.45, 4.36) or problems related to both illness and non-illness conditions (aOR 3.57; 95% CI 1.37, 9.33) had higher odds of low breastfeeding self-efficacy than those who did not have any problems. Compared to mothers who completed university education, there was a significantly higher odds of low breastfeeding self-efficacy in mothers who completed primary school or lower (aOR 1.88; 95% CI 1.16, 3.05); completed junior high school (aOR 2.27; 95% CI 1.42, 3.63); and completed senior high school (aOR 1.94; 95% CI 1.29, 2.91). Other significant predictors of low breastfeeding self-efficacy were mothers not exposed to any breastfeeding interventions (aOR 1.87; 95% CI 1.09, 3.22); working outside the house (aOR 1.69; 95% CI 1.23, 2.32); not obtaining any advice on breastfeeding (aOR 1.40; 95% CI 1.08, 1.82); with low knowledge of breastfeeding (aOR 1.38; 95% CI 1.03, 1.84); and delivered by Caesarean section (aOR 1.34; 95% CI 1.05, 1.70). CONCLUSIONS: Multipronged breastfeeding education programs and support are required to improve women's self-efficacy with breastfeeding. Improved access to breastfeeding counselors, active support for mothers following cesarean delivery, and increased supporting facilities at workplaces are essential to improve self-efficacy with breastfeeding.

Does treatment of intestinal helminth infections influence malaria? Background and methodology of a longitudinal study of clinical, parasitological and immunological parameters in Nangapanda, Flores, Indonesia (ImmunoSPIN Study).

BACKGROUND: Given that helminth infections are thought to have strong immunomodulatory activity, the question whether helminth infections might affect responses to malaria antigens needs to be addressed. Different cross-sectional studies using diverse methodologies have reported that helminth infections might either exacerbate or reduce the severity of malaria attacks. The same discrepancies have been reported for parasitemia. METHODS/DESIGN: To determine the effect of geohelminth infections and their treatment on malaria infection and disease outcome, as well as on immunological parameters, the area of Nangapanda on Flores Island, Indonesia, where malaria and helminth parasites are co-endemic was selected for a longitudinal study. Here a Double-blind randomized trial will be performed, incorporating repeated treatment with albendazole (400 mg) or placebo at three monthly intervals. Household characteristic data, anthropometry, the presence of intestinal helminth and Plasmodium spp infections, and the incidence of malaria episodes are recorded. In vitro cultures of whole blood, stimulated with a number of antigens, mitogens and toll like receptor ligands provide relevant immunological parameters at baseline and following 1 and 2 years of treatment rounds. The primary outcome of the study is the prevalence of Plasmodium falciparum and P. vivax infection. The secondary outcome will be incidence and severity of malaria episodes detected via both passive and active follow-up. The tertiary outcome is the inflammatory cytokine profile in response to parasite antigens. The project also facilitates the transfer of state of the art methodologies and technologies, molecular diagnosis of parasitic diseases, immunology and epidemiology from Europe to Indonesia. DISCUSSION: The study will provide data on the effect of helminth infections on malaria. It will also give information on anthelminthic treatment efficacy and effectiveness and could help develop evidence-based policymaking. TRIAL REGISTRATION: This study was approved by The Ethical Committee of Faculty of Medicine, University of Indonesia, ref:194/PT02.FK/Etik/2006 and has been filed by ethics committee of the Leiden University Medical Center. CLINICAL TRIAL NUMBER: ISRCTN83830814. The study is reported in accordance with the CONSORT guidelines for cluster-randomized studies.