Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation.

BACKGROUND: Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes. METHODS: Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival. RESULTS: Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days). CONCLUSIONS: Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

One health zoonotic disease prioritization and systems mapping: An integration of two One Health tools.

One Health is a collaborative approach that requires synergies between human, animal and environmental health sectors, other key sectors, and partners supporting these capacity-building efforts. Multiple One Health capacity-building tools are available that can be used independently or together. Two tools that have been used in sequence to inform each other include the US Centers for Disease Control and Prevention's One Health Zoonotic Disease Prioritization (OHZDP) Process and University of Minnesota/US Department of Agriculture's One Health Systems Mapping and Analysis Resource Toolkit™ (OH-SMART). In August 2017, a workshop was held in Islamabad, Pakistan, that integrated these two tools for the first time. In this integrated workshop, we used the OHZDP to develop a list of priority zoonotic diseases for Pakistan and OH-SMART™ to conduct a partner assessment and disease-specific gap analysis. Both tools were used to identify areas for One Health collaboration for the priority zoonotic diseases. Additionally, we trained 11 in-country facilitators representing the human and animal health sectors on both tools. This manuscript describes the integration of these two tools-using the Pakistan workshop as a process case study-to inform future efforts to implement One Health tools synergistically. Implementation of the technical and logistical aspects of the integrated workshop was detailed: (1) workshop preparation, (2) facilitator training, (3) workshop implementation and (4) workshop outcomes. Sixteen months after the workshop, we conducted an in-country facilitator survey to follow-up on the utility of both tools and the training for facilitators. We evaluated facilitator survey results using a qualitative analysis software Atlas.ti. Using the OHZDP Process and OH-SMART™ together achieved continuity between the two processes and provided a professional development opportunity for in-country facilitators. Based on the success of this integrated workshop, partners developing and implementing One Health tools should recognize the importance of collaboration to maximize outcomes.

Postpartum Care Behavior Improvement during COVID-19 Pandemic in Indonesia Using Mobile-Health Interactive Message.

Background: Since 2018, maternal mortality in Semarang City, Indonesia, has mostly (75%) occurred during the postpartum period. Therefore, a health intervention is necessary to improve safe and effective postpartum care. During the Covid-19 pandemic, a mobile-based health intervention is preferred due to the government's regulation of COVID-19 safety prevention. This study aimed to determine the effectiveness of the mobile-health interactive message on the postpartum care behavior of mothers and their husbands. Methods: The study was conducted in a quasi-experimental design. It includes the treatment group and the control group, in which each group consists of 46 pairs of pregnant women in the third trimester and their husbands. The research subjects were chosen through the purposive sampling technique. Data collection was conducted via interviews and observations. The m-health intervention is carried out in the form of text messages, images, videos, and interactive mentoring. The latter was carried out through group messaging via the WhatsApp application for the treatment group. Meanwhile, the control group received regular counseling from the local Community Health Center. Data analysis was performed by Mann-Whitney test, unpaired T-Test, Chi-Square Test dan Fisher Exact Test. Results: Intervention for 2.5 months increased the knowledge of mothers and husbands. The intervention for 3.5 months improved the mother's attitude, but not the husband's attitude. The intervention also improves maternal practices related to postpartum visits, such as Early Initiation of Breastfeeding assistance requests from health workers, iron tablets and nutritious food consumption, personal hygiene, postpartum danger signs monitoring, and the husband's practice of accompanying mothers during postpartum visits. Conclusion: Mobile-Health interactive messages effectively improved postpartum care behavior for mothers and their husbands.

Adolescent Riding Behavior During the COVID-19 Pandemic in Urban Area, Indonesia: A Cross-sectional Study.

Background: According to police reported crash, in 2020 there have been 510 road traffic accidents among adolescents aged 16-25 years. The problem is that although restrictions on social activities have been implemented, 9.80% of accidents have caused deaths in Semarang City. There were many factors that influence the occurrence of road traffic accidents; one of those is the poor knowledge about safe riding behavior. The aim of this study is to determine the factors that contribute to the occurrence of road traffic accidents in adolescents during the pandemic. Methods: This was a cross-sectional study, collected data using an online questionnaire distributed to adolescents aged 15-20 years in Semarang City, Indonesia. It was distributed during February-April 2021. The data included participant's demographic information, riding behavior, and knowledge about safe riding. We analyzed using chi-square and logistic regression to determine the most influential factors. Results: The sample included 725 participants with a mean age of 17.4 years (SD=0.97); 260 (35.9%) males. We have found that gender was associated with the incidence of road traffic accidents (AOR=1.455, 95% CI [1.048-2.020], P=0.025) after adjusting for experience road safety education, vehicle type, and knowledge of safe riding. Conclusion: It is necessary to carry out Road Safety Education efforts to male students during the pandemic to reduce the incidence of traffic accidents.

Reduction of Fatigue and Musculoskeletal Complaints in Garment Sewing Operator through a Combination of Stretching Brain Gym® and Touch for Health.

The purpose of this study was to assess the effect of using a combination of stretching and Brain Gym®(BG) + Touch for Health (TfH) movements to reduce fatigue and musculoskeletal complaints (MSCs) in garment-sewing operators. A quasi-experimental study was performed on 53 respondents with two sessions of stretching movements and BG + TfH movements of 5 min duration, three times a week for four weeks. Fatigue was measured using a reaction timer and MSCs were measured using a Nordic Body Map questionnaire. Wilcoxon and Mann-Whitney U tests were performed to examine the differences of pre/post and between the intervention group (IG) and control group (CG). A significant difference was found in IG for pre- and post-fatigue (p < 0.001) and MSCs (p < 0.001), while in CG there was no difference in fatigue (p = 0.200) and MSCs (p = 0.086). Significant differences were found between the IG and CG groups in terms of fatigue (p = 0.046), as well as in MSCs (p < 0.001). A significant decrease in MSCs per part body in IG was found on the left wrist, left hand, and left knee. The percentage of MSC severity decreased in all parts of the body, except the right shoulder, left elbow, and right thigh.

Strengthening multi-sectoral collaboration on critical health issues: One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) for operationalizing One Health.

Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving.

Periodic re-emergence of endemic strains with strong epidemic potential-a proposed explanation for the 2004 Indonesian dengue epidemic.

Indonesia experienced a severe dengue epidemic in the first quarter of 2004 with 58,301 cases and 658 deaths reported to the WHO. All four dengue virus (DENV) serotypes were detected, with DENV-3 the predominant strain. To ascertain the molecular epidemiology of the DENV associated with the epidemic, complete genomes of 15 isolates were sequenced from patient serum collected in Jakarta during the epidemic, and two historical DENV-3 isolates from previous epidemics in 1988 and 1998 were selectively sequenced for comparative studies. Phylogenetic trees for all four serotypes indicate the viruses are endemic strains that have been circulating in Indonesia for a few decades. Whole-genome phylogeny showed the 2004 DENV-3 isolates share high similarity with those isolated in 1998 during a major epidemic in Sumatra. Together these subtype I DENV-3 strains form a Sumatran-Javan clade with demonstrated epidemic potential. No newly-acquired amino acid mutations were found while comparing genomes from the two epidemics. This suggests re-emergence of little-changed endemic strains as causative agents of the epidemic in 2004. Notably, the molecular evidence rules out change in the viral genomes as the trigger of the epidemic.

Piloting the One Health Systems Mapping and Analysis Resource Toolkit in Indonesia.

As a global network, countries are being asked to meet goals set forth in the Global Health Security Agenda (GHSA) for a workforce capable of effective and efficient prevention, detection and response to infectious disease threats. There is great need for a cross-sectoral workforce that can innovate and problem-solve. To achieve GHSA goals, countries need a way to visualize their existing system, identify opportunities for improvement, and achieve improved cross-sectoral interactions. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) was successfully piloted in West Sumatra, Indonesia, and was used to enhance multi-agency collaboration around infectious disease outbreaks and proved to be an adaptable, scalable process requiring minimal resources. The authors present OH-SMART as a potential tool to help countries analyze their existing health system and create relevant action steps to improve cross-sectoral collaborations.

Four dengue virus serotypes found circulating during an outbreak of dengue fever and dengue haemorrhagic fever in Jakarta, Indonesia, during 2004.

Periodic outbreaks of dengue have emerged in Indonesia since 1968, with the severity of resulting disease increasing in subsequent years. In early 2004, a purported dengue outbreak erupted across the archipelago, with over 50,000 cases and 603 deaths reported. To confirm the disease aetiology and to provide an epidemiological framework of this epidemic, an investigation was conducted in ten hospitals within the capital city of Jakarta. Clinical and laboratory findings were determined from a cohort of 272 hospitalised patients. Exposure to dengue virus was determined in 180 (66.2%) patients. When clinically assessed, 100 (55.6%) of the 180 patients were classified as having dengue fever (DF), 31 (17.2%) as DF with haemorrhagic manifestations and 49 (27.2%) as dengue haemorrhagic fever (DHF). Evidence from haemagglutination inhibition assays suggested that 33/40 (82.5%) of those with DHF from which laboratory evidence was available suffered from a secondary dengue infection. All four dengue viruses were identified upon viral isolation, with DEN-3 being the most predominant serotype recovered, followed by DEN-4, DEN-2 and DEN-1. In summary, the 2004 outbreak of dengue in Jakarta, Indonesia, was characterised by the circulation of multiple virus serotypes and resulted in a relatively high percentage of a representative population of hospitalised patients developing DHF.

The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance.

BACKGROUND: In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area. METHODS: We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea. RESULTS: Infants had the highest incidences of diarrhoea (759/1,000/year) and cholera (4/1,000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1,000/year) than girls under 5 years (309/1,000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1,000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1,000/year. Cholera was most common in children, with the highest incidence at 4/1,000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards. CONCLUSION: Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations.

Enteric fever burden in North Jakarta, Indonesia: a prospective, community-based study.

INTRODUCTION: We undertook a prospective community-based study in North Jakarta, Indonesia, to determine the incidence, clinical characteristics, seasonality, etiologic agent, and antimicrobial susceptibility pattern of enteric fever. METHODOLOGY: Following a census, treatment centre-based surveillance for febrile illness was conducted for two-years. Clinical data and a blood culture were obtained from each patient. RESULTS: In a population of 160,261, we detected 296 laboratory-confirmed enteric fever cases during the surveillance period, of which 221 (75%) were typhoid fever and 75 (25%)  were paratyphoid fever.  The overall incidence of typhoid and paratyphoid cases was 1.4, and 0.5 per thousand populations per year, respectively. Although the incidence of febrile episodes evaluated was highest among children under 5 years of age at 92.6 per thousand persons per year, we found that the burden of typhoid fever was greatest among children between 5 and 20 years of age. Paratyphoid fever occurred most commonly in children and was infrequent in adults. CONCLUSION: Enteric fever is a public health problem in North Jakarta with a substantial proportion due to paratyphoid fever. The results highlight the need for control strategies against enteric fever.

Confirmation of Japanese encephalitis as an endemic human disease through sentinel surveillance in Indonesia.

Japanese encephalitis (JE) results in significant mortality and disability in children in Asia. In Indonesia, despite recognition of JE virus transmission, reports of human disease have been few and from limited geographic areas. Hospital-based surveillance for acute encephalitis syndrome (AES) and JE in children 15 years of age and under was undertaken in 15 hospitals in six provinces from 2005 to 2006. High- and low-risk provinces in geographically dispersed areas were included. Health center-based surveillance also was undertaken in one province. Eighty-two JE cases were confirmed among 1,496 AES cases detected. JE cases were confirmed in all provinces, but the proportion varied between 18% and 2% among provinces of different risk levels. Children younger than 10 years of age represented 95% of JE cases, and 47% of all cases either died or were disabled. The study shows JE is an endemic human disease across Indonesia. Immunization strategies are being considered.