On the road to universal health care in Indonesia, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care. METHODS: We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results. FINDINGS: In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3-8·8) to 71·7 years (71·0-72·3): the increase was 7·4 years (6·4-8·6) for males and 8·7 years (7·8-9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6-61·6), from 43·8 million (95% UI 41·4-46·5) to 18·1 million (16·8-19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8-15·4) of DALYs in 2016. INTERPRETATION: Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity. FUNDING: The Bill & Melinda Gates Foundation.

Responding to measles outbreak: closing the immunity gap in children of Timor-Leste

Background: An outbreak of measles was reported in Timor-Leste during 2011. A concertedresponse at national level utilized this opportunity to improve measles immunization coveragerates.Methods: Health Management Information System and Surveillance System data were utilized todescribe the outbreak. Attack rates and case fatality rates (CFR) were calculated using standardmethods. Evaluation surveys were used to access immunization coverage. Proceedings of weeklymeetings of the National Committee for Control of Disease Outbreaks were reviewed.Results: A total of 739 cases and 8 deaths were reported to the Surveillance Unit. Most (>82%)of the measles cases were reported from Dili and Ermera districts. The attack rate was 1.3 per1000 population and CFR was 1.1%. The response was coordinated by the National Committee forControl of Disease Outbreaks, which included case management, active and passive surveillance,communication and measles immunization among six-month to 14-year old children. Immunizationactivity targeted 495 000 children, i.e. almost one-half of the Timor-Leste population and achievedhigh coverage (85%).Conclusions: The outbreak highlighted gaps in the immunity against measles. The NationalCommittee for Control of Disease Outbreaks ensured a coordinated response which led to preventionof deaths from measles due to early case management with vitamin A supplementation, and highmeasles immunization coverage