Reflecting on Indonesia's young academy movement.

In the past three decades, there has been a rise in young academy movements in the Global North and South. Such movements, in at least Germany and the Netherlands, have been shown to be quite effective in connecting scientific work with society. Likewise, these movements share a common goal of developing interdisciplinary collaboration among young scientists, which contributes to the growth of a nation's-but also global-scientific endeavors. This paper focuses on the young academy movement in the fourth-largest country hosting the biggest Muslim population in the world, which is also the third-most populous democracy: Indonesia. We observe that there has been rising awareness among the young generation of scientists in Indonesia of the need to advocate for the use of sciences in responding to upcoming and current multidimensional crises. Science advocacy can be seen in their peer-based identification of Indonesia's future challenges, encompassing the fundamental areas for scientific inquiry, discovery, and intervention. We focus on the Indonesian Young Academy of Sciences (ALMI) and its network of young scientists. We describe ALMI's science communication practice, specifically SAINS45 and Science for Indonesia's Biodiversity, and how they have been useful for policymakers, media, and school engagements. The article closes with a reflection on future directions for the young academy movement in Indonesia and beyond.

"People are now working together for a common good": The effect on social capital of participatory design for community-level sanitation infrastructure in urban informal settlements.

Communities with higher levels of social capital perform better than communities with lower social capital in community-level water and sanitation interventions and have better health outcomes. Although research recommends bolstering social capital to improve intervention outcomes, few studies provide empirical evidence on the effect of intervention activities on social capital. This study aimed to evaluate the effect of participatory design and community engagement activities on social capital among urban informal settlements in Suva, Fiji and Makassar, Indonesia enrolled in the Revitalizing Informal Settlements and their Environments trial using the Short Adapted Social Capital Assessment Tool. We performed confirmatory factor analyses (CFA) to test tool performance and built structural equation models to assess intervention effect on CFA-informed, sub-scale scores for cognitive and structural social capital. Qualitative in-depth interviews in Fiji and Indonesia and focus group discussions in Fiji provided nuanced understanding of intervention effects on social capital from residents' perspectives. Results confirmed the hypothesized two-factor solution but revealed differences by country and by gender in Indonesia. The intervention appeared positively related to cognitive social capital among men and women in Indonesia and negatively related to cognitive and structural social capital among men and women in Fiji. While effect sizes were small and cluster-adjustment for a small number of settlements yielded non-significant effects, trends were consistent across models and bivariate analyses and were corroborated by qualitative findings. Several contextual factors may explain these results, including timing and duration of intervention activities and influence of COVID-19. Qualitative data suggested that the relationship between participatory design and social capital may be bidirectional, helping to explain why certain settlements appeared to be better equipped to benefit from intervention activities. Practitioners and program designers should carefully consider the social pre-conditions of communities in which they intend to work to optimize program outcomes and avoid unintended consequences.

Mothers' and Midwives' Experiences of Maternal and Child Health Services during the COVID-19 Pandemic in Banggai, Indonesia: A Qualitative Study.

Background: Maternal and child health (MCH) services have been affected by the Coronavirus disease (COVID-19) pandemic in all countries, including Indonesia. Information regarding the impact of COVID-19 on MCH service access and provision is limited, particularly in the context of rural Indonesian communities. This study aimed to explore the experiences of Indonesian mothers and midwives from a rural regency regarding MCH services delivery during the pandemic. Methods: This study was a sub-study of a pre-existing cohort study conducted in four sub-districts in Banggai, Indonesia, as the qualitative research. This study was conducted from November 2020 to April 2021, involving 21 mothers and six midwives. We selected the participants using snowball sampling. In-depth interviews were conducted in Bahasa. The study used both deductive and inductive approaches for analysis. Data analysis was performed using NVivo v.12. Results: The study identified three themes and eight sub-themes from the analysis incorporating the midwives' and mothers' data. The themes included health service change, perceived barriers to service delivery, and family impact. This study highlights health service changes due to the pandemic, such as relocating the MCH services. Mothers perceived barriers to accessing health services, including distance reasons and fear of COVID-19. Only the shortages of staff affected the midwives in providing optimal services. Conclusion: The pandemic triggered health service changes and caused some barriers to service delivery. This study recommends that the local government and stakeholders should pay more attention to the health service changes according to the mothers' experiences and address barriers to optimize access to MCH services during the pandemic.

Joint Food and Water Insecurity Had a Multiplicative Effect on Women's Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic.

BACKGROUND: Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. OBJECTIVES: The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. METHODS: We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action's Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. RESULTS: In models with the full sample (n = 323), food insecurity (ß: 1.48; 95% CI: 0.79, 2.17), water insecurity (ß: 0.13; 95% CI: -0.01, 0.26), and joint food and water insecurity (ß: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (ß: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. CONCLUSIONS: Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women's mental health and well-being.

Predicting Obesity in Adults Using Machine Learning Techniques: An Analysis of Indonesian Basic Health Research 2018.

Obesity is strongly associated with multiple risk factors. It is significantly contributing to an increased risk of chronic disease morbidity and mortality worldwide. There are various challenges to better understand the association between risk factors and the occurrence of obesity. The traditional regression approach limits analysis to a small number of predictors and imposes assumptions of independence and linearity. Machine Learning (ML) methods are an alternative that provide information with a unique approach to the application stage of data analysis on obesity. This study aims to assess the ability of ML methods, namely Logistic Regression, Classification and Regression Trees (CART), and Naïve Bayes to identify the presence of obesity using publicly available health data, using a novel approach with sophisticated ML methods to predict obesity as an attempt to go beyond traditional prediction models, and to compare the performance of three different methods. Meanwhile, the main objective of this study is to establish a set of risk factors for obesity in adults among the available study variables. Furthermore, we address data imbalance using Synthetic Minority Oversampling Technique (SMOTE) to predict obesity status based on risk factors available in the dataset. This study indicates that the Logistic Regression method shows the highest performance. Nevertheless, kappa coefficients show only moderate concordance between predicted and measured obesity. Location, marital status, age groups, education, sweet drinks, fatty/oily foods, grilled foods, preserved foods, seasoning powders, soft/carbonated drinks, alcoholic drinks, mental emotional disorders, diagnosed hypertension, physical activity, smoking, and fruit and vegetables consumptions are significant in predicting obesity status in adults. Identifying these risk factors could inform health authorities in designing or modifying existing policies for better controlling chronic diseases especially in relation to risk factors associated with obesity. Moreover, applying ML methods on publicly available health data, such as Indonesian Basic Health Research (RISKESDAS) is a promising strategy to fill the gap for a more robust understanding of the associations of multiple risk factors in predicting health outcomes.

Implementing a One Health village volunteer programme in West Sulawesi, Indonesia: A pilot study.

ABSTRACTA pilot village volunteer programme (VVP) was implemented to produce new knowledge about the extent to which 24 trained village volunteers, taking an integrated One Health approach, could assist their communities by disseminating information on better agricultural and health practices. Just prior to the six-month pilot, the volunteers were mentored in a four-day training programme by local agricultural extension and public health experts. On returning to their villages, contacts and activities by volunteers with local community members were monitored using a CommCare application, enabling uploaded data to be accessed in real-time. The six volunteers in each village coordinated activities to address concerns of households. The VVP resulted in 960 actions (356 agricultural; 604 health), helping in 97% of contacts, most (55-61%) by providing information and others by advising community members where appropriate information could be sourced. Focus group meetings with village leaders, community health staff and local extension officers supported continuation of the VVP through local funding. Six months after the pilot, volunteers were continuing their activities and assisting with other government measures, such as district programmes to reduce childhood stunting and improve waste disposal. Community empowerment using local human resources is sustainable and could be supportive in government programmes.

What factors do make quality improvement work in primary health care? Experiences of maternal health quality improvement teams in three Puskesmas in Indonesia.

BACKGROUND: Indonesia has been shifting from ensuring access to health services towards improving service quality. Accreditation has been used as quality assurance (QA) mechanism, first in hospitals and subsequently in primary health care facilities, including Puskesmas (community health centres). QA provides measures of whether services meet quality targets, but quality improvement (QI) is needed to make change and achieve improvements. QI is a cyclical process with cycles of problem identification, solution testing and observation. We investigated the factors which influenced the process of QI based on experience of maternal health QI teams in three Puskesmas in Cianjur district, West Java province, Indonesia. METHODS: Qualitative data were collected using 28 in-depth interviews at two points of time: pre- (April 2016) and post- QI intervention (April 2017), involving national, provincial, district and Puskesmas managers; and Puskesmas QI team members. Thematic analysis of transcripts was conducted. RESULTS: We found four main factors contributed to the process of QI: 1) leadership, including awareness and attitude of leader(s) towards QI, involvement of leader(s) in the QI process and decision-making in budget allocation for QI; 2) staff enthusiasm and multidisciplinary collaboration; 3) a culture where QI is integrated in existing responsibilities; and 4) the ongoing Puskesmas accreditation process, which increased the value of QI to the organisation. CONCLUSION: Making QI a success in the decentralised Indonesian system requires action at four levels. At individual level, leadership attributes can create an internal quality environment and drive organisational cultural change. At team level, staff enthusiasm and collaboration can be triggered through engaging and tasking everyone in the QI process and having a shared vision of what quality should look like. At organisational level, QI should be integrated in planned activities, ensuring financial and human resources. Lastly, QI can be encouraged when it is implemented by the wider health system as part of national accreditation programmes.

A one health exploration of the reasons for low cocoa productivity in West Sulawesi.

We conducted an interdisciplinary One Health study of potential links between agricultural, health and associated livelihood factors on the livelihoods of smallholder cocoa-growing families in West Sulawesi. Our 2017 survey of 509 cocoa smallholder family members in 120 households in Polewali-Mandar District, West Sulawesi, Indonesia showed that farmers face many challenges to improving their livelihoods, including land management, agricultural practices, nutrition and human health, animal health, aging and demographic changes. Price fluctuations, limited access to capital and poor health deterred farmers from applying agricultural inputs and resulted in levels of low cocoa production (275 kg/annum per household). While market demand for live goats in the region is substantial and expected to increase, uptake of mixed farming with goats by smallholders was low. However, most households kept chickens. Bank accounts were held by 31% of households. Inadequate sanitation and unsafe water were reported in >50% households. Anthropometric measures showed that 42% of children under five years were significantly stunted and 32% of women were overweight. Joint, back pain and blurry vision were reported by 30% of adult respondents. High blood pressure contributed to complications in 20% of pregnancies. Primary health care provided by district health services mainly focuses on maternal and child health, leaving chronic health problems such as Type 2 diabetes, cataracts, arthritis and mental illness under-diagnosed, and if diagnosed, with inadequate treatment. Availability of food was a source of worry for 58% of households with 63% reporting limited food variety. Dietary diversity was low with an average of four out of ten food categories consumed in each household. Positive correlations were recorded for household cocoa productivity, land size, dietary diversity and perceptions that food availability and variety was sufficient. The results showed that an integrated One Health approach provides deep understanding of priority areas for improving livelihoods.

Diversity of Dengue Virus Serotype in Endemic Region of South Sulawesi Province.

The objective of this research was to investigate serotype diversity pattern of dengue hemorrhagic fever virus by using real-time-polymerase chain reaction (RT-PCR) method. It was an explorative laboratory research in endemic dengue fever area in South Sulawesi Province, Indonesia, that is, Makassar municipality and Maros and Gowa region. Serological examination was carried out using real-time-polymerase chain reaction (RT-PCR) method to determine the serotype of dengue virus. The data showed that, of 30 patients, 20 patients (66.67%) were from Makassar municipality: 10 patients (33.33%) from Gowa region and 10 patients (33.33%) from Maros region. The serotypes found were DENV-2 and DENV-4 and no DENV-1 and DENV-3 serotypes were found. Makassar municipality and Gowa region have higher infection with serotype DENV-2, that is, 40% of cases compared with Maros, which is 20.0%. Statistical test results showed no significant differences between the three endemic areas. Maros region has the highest infection with serotype DENV-4, that is, 40% of cases compared with Makassar municipality (5.0%) and Gowa region (0%). Statistical test results showed significant differences between the three endemic areas. This result revealed that serotypes obtained in endemic areas of dengue fever in South Sulawesi are DENV-2 and DENV-4 and not serotypes DENV-1 and DENV-3. Makassar municipality has DENV-2 and DENV-4 serotype, infection dominated by DENV-2, while Maros region also has DENV-2 and DENV-4, but DENV-4 is the dominant serotype. Gowa municipality only has DENV-2 serotype infection.

Use of most significant change (MSC) technique to evaluate health promotion training of maternal community health workers in Cianjur district, Indonesia.

Maternal health promotion is a defined activity in the community integrated posts (Posyandu) in Indonesia. However, it is often neglected due to limited knowledge and skills of the community health workers (kader). We conducted health promotion training for the kader and village midwives in four villages in Cianjur district. This study describes the use of "most significant change" (MSC) technique to evaluate impact of health promotion to the beneficiaries and community at large. The MSC uses stories as raw data. Through interviews focused on perception of change, stories were collected from four pregnant women, eight kader and three village midwives. A Panel consisting of policy and programme managers and implementers read all the stories. The story by a pregnant woman who routinely attended Posyandu was selected as the story with most significant change. Her story highlighted changes in kader's knowledge and communication of health messages and attitude towards pregnant women. She expressed these changes impacted community awareness about health and to seek help from kader.The MSC technique enabled stakeholders to view raw data and evaluate the impact of health promotion from the beneficiary's perspective. At the same time, recipients of health promotion contributed to the decision process of evaluation through their stories. The different perspectives on the MSC reflected individual's objectives of the health promotion. The application of this technique is limited in maternal health promotion programme in Indonesia, and none have been published in peer reviewed journals.

Limits and opportunities to community health worker empowerment: A multi-country comparative study.

BACKGROUND: In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving 'Empowerment of communities'. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW's empowerment experience. METHODS: We present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used. RESULTS: CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by - the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact. CONCLUSIONS: While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters.

The social context of controlled drug use amongst young people in a slum area in Makassar, Indonesia.

BACKGROUND: There are few studies exploring the social context of controlled drug use amongst young people in Indonesia. This qualitative study examines the experience of young people in a slum area (lorong) in Makassar, eastern Indonesia, who use drugs but are not drug dependent and who employ various forms of self regulation to control their use. METHODS: Semi-structured interviews were conducted with eight controlled drug users. RESULTS: The study found that whilst controlled drug users lived in a drug risk environment, they were not deeply embedded in the street culture, risk-taking practises and drug scene within their locality. Their employment, albeit in the informal economy and in low-paid jobs, facilitated their perspective that the status of rewa (a local construct of masculinity) and gaul (being sociable and up-to-date) could and should be accomplished through conventional means such as jobs and halal (legitimate) income. Their employment generated both direct benefit (legitimate income) and indirect benefit, including meaningful activities, structured time, positive identity and wider social networks (bridging social capital). This enabled them to have a stake in mainstream society and provided an incentive to control drug use. All factors which are protective against escalation into problematic drug use. CONCLUSION: The study showed the importance of sociological concepts of direct and indirect benefits of employment and of social capital in understanding the social context of controlled drug use amongst young people in the lorong. Additionally, drug policy should be more cognizant of the social vulnerability in the lorong and of the need to increase access to employment amongst young people in order to potentially decrease the likelihood of problematic drug use.

The social context of initiation into injecting drugs in the slums of Makassar, Indonesia.

BACKGROUND: The association between socio-economic marginalisation in urban poor neighbourhoods and the prevalence of violence, crime, drug use and drug dealing has been well documented. However few studies have explored the social context of the transition to, initiation and maintenance of drug injection career in slum areas in developing countries. This study examines the lived experience of young men in initiating and maintaining drug injection in slum areas, commonly named lorong, in the city of Makassar, Indonesia. METHOD: In-depth interviews were conducted with 18 male injecting drug users who attended a drop-in centre for drug users in the city. RESULTS: The interviews revealed that the pharmacological effects of putaw (street grade heroin) and the economics of injection were factors in initiating and maintaining injection. Importantly, the intersection of socio-economic deprivation with pursuing the status of rewa (local concept of masculinity) and the dynamics of gang participation led many members of the lorong into a drug injection career, making them vulnerable for HIV and other blood-borne viral infections. CONCLUSION: To be more effective, the existing harm reduction programmes in Makassar that focus on individualistic behavioural changes need to be complemented with community-based programmes that take into consideration the social and structural context of risk-taking practices amongst young people in the lorong.