Rapid Appraisals of the Transformation Strategy Required to Sustain Dengue Vector Control During and After the COVID-19 Pandemic in Indonesia.

Purpose: This research aimed to observe the gap for improvement in dengue vector control during COVID-19, considering two stakeholders: the government and society. We formulated two research questions: 1) How is the government managing dengue vector control during the COVID-19 pandemic? 2) What is the situation of dengue disease, its vectors, and vector control in the community? Methods: This study uses multiple approaches: policy review, social listening using Twitter analysis, and interviews. A policy review was employed to capture the journey of dengue vector control in Indonesia from dengue found in Indonesia until the COVID-19 pandemic. Twitter data captured public opinions through social media about dengue and vector control. Interviews involved program implementers that consider knowing the situation in the field of dengue and its vector control. The informant was selected through purposive sampling. Results: To control dengue disease, the Indonesian government has released regulations about dengue vector control that adjusts the COVID-19 situation, but vector control is still not running optimally, resulting in the data supply for policy not running well. Conclusion: Dengue cases continued during the COVID-19 pandemic, even in some places stated an outbreak occurred. Vector control does not work correctly during the COVID-19 pandemic due to social restrictions. It is recommended to encourage the implementation of community empowerment through one house, one jumantik, which is equipped with self-reporting to mitigate and respond to similar situations as the pandemic.

Introduction and implementation of an immunization information system in the Indonesian province of Daerah Istimewa Yogyakarta: lessons for scaling-up.

BACKGROUND: Immunization is critical to saving children from infections. To increase vaccination coverage, valid and real-time data are needed. Accordingly, it is essential to have a good report system that serves as defaulter tracking to prevent children's immunization failure. The Daerah Istimewa Yogyakarta (DIY) Health Office introduced an electronic immunization registry and successfully implemented it for more than five years. It is the only individual-based record system in Indonesia that has been sustainably operated for a long time. Yet, no systematic assessment of this system has been conducted to date. This study examines the Sistem Informasi Imunisasi Terpadu (SIMUNDU) introduction and implementation process with a view to extracting lessons that could inform scalability and sustainability across the country. METHODS: This study used an explanatory sequential mixed-method design, which collected quantitative data from 142 participants and qualitative data from nine participants. The data entry clerk at a health facility was systematically selected to participate in the survey, while in the key informant interview, the informant was selected based on the survey result. A descriptive and thematic approach was adopted to analyze the quantitative and qualitative data. Results from across the two approaches were integrated for comparison and contrast. RESULTS: Findings are presented according to three core themes that emerged from the data: system strengths, potential threats, weakness and opportunities for scaling-up. Strengths, i.e., factors contributing to the success of SIMUNDU, include management, system performance, people's behavior, and resources. Potential threats to sustaining the system include individual capacity, technical or system issues, and high workload. Opportunities - i.e., a promising factor that influences the SIMUNDU ability to operate sustainably - such as continuity, expectation, and the possibility of scaling up. CONCLUSIONS: SIMUNDU is a promising innovation for Indonesia, beyond DIY. There is agreement about the potential for scaling up this IIS to other provinces. The experience of implementing this system in DIY over the past five years has shown that the benefits outweigh the challenges, and SIMUNDU has grown into a robust yet user-friendly system.

Factors influencing stress during the second imposed of COVID-19 social restrictions in Indonesia.

Background: The spread of the COVID-19 virus has had a significant impact on the governmental and social aspects, as well as to the psychological status of the population. In Indonesia, social restriction was a strategy to limit people's mobility to reduce virus transmission. As social beings, the imposition of social restriction makes them fall into stress due to feeling lonely, and some cannot earn money. The aim of the study was to assess the factor association of stress level and resilience of the Indonesian people during the imposition of the second social restriction due to the COVID-19 pandemic. Design and method: A cross-sectional study was performed on respondents aged at least 18 years on 29 July-16 August 2021, when the social restriction was enforced for the second time. The online survey was conducted through several social media platforms (Facebook, Instagram, Twitter, and WhatsApp) to 256 respondents. The analysis was carried out descriptively and analytically using the chi-square and binary logistic regression. Results: This study shows that there is a significant relationship between age (p < 0.001), marital status (p < 0.001), occupation (p < 0.001), income before and during the pandemic (p < 0.001) and resilience level to stress level among Indonesian. Resilience level is the only protective factor for people to not get stressed. Being normal resilience put them at 0.05 times (95% CI 0.01-0.76) more likely to have low perceived stress than low resilience. Conclusion: Resilience level is the only factor that influence stress level among people in Indonesia during the second imposed social restriction in Indonesia.

Boesenbergia pandurata application in Goldfish ( Cyprinus carpio) Feed to Enhancing Fish Growth, Immunity System, and Resistance to Bacterial Infection.

Background: This study investigated how the inclusion of Boesenbergia pandurata extract (BPE) in goldfish feed affects fish growth, immunity, and resistance to infection by Aeromonas hydrophila and Pseudomonas fluorescens.   Methods: Four fish feeds, were prepared by adding BPE at the concentrations of 0 (control), 2, 4, and 6 g kg-1, respectively, and 120 goldfish (Cyprinus carpio; initial weight 5 g) were separated into 12 boxes and fed with specific pellets and examined thrice. The experiment lasted 12 weeks, beginning with the different feeds, fish growth was measured at Weeks 4 and 8 after the feeding period. Moreover, a challenge test with pathogen bacteria to assay disease resistance was administered at Week 8 after the feeding period, and the survival rate and relative percentage of survival were quantified at Week 12.   Results: At Week 8, the goldfish that were fed BPE-containing feeds were significantly heavier than the fish that received the control feed (pellet without BPE), and the highest weight gain, reaching 72.44 g, was obtained with Pellet 3; accordingly, the specific growth rate after BPE treatment (5.7%) was higher than that after control treatment. Conversely, the feed conversion ratio in the control group, 2.03, was higher than the ratios in the BPE groups, which were decreased to 0.55-0.90. Lastly, BPE treatment consistently enhanced the immunity parameters of goldfish (relative to control treatment) at weeks 4 and 8, and following BPE treatment, the rate of resistance against bacterial infection, 68.3%-77.0%, was higher than that after control treatment.   Conclusions: BPE addition in goldfish feed clearly produces a positive effect by enhancing fish growth, immunity, and resistance to infection by pathogenic bacteria, and 4 g kg-1 is the optimal BPE concentration in feed prepared for goldfish.

Risk Factors for Tuberculosis in an Urban Setting in Indonesia: A Case-control Study in Umbulharjo I, Yogyakarta.

The rate of incidence of Tuberculosis (TB) in Indonesia is the ninth highest in the world. Poor environmental conditions, mainly related to air circulation and improper behaviour, were recognized as the risk factors in this country. A case-control study of 69 participants was conducted in the Umbulharjo I Public Health Centre of Yogyakarta during January-August 2019. Data collection was conducted using a tested questionnaire. Analysis was performed using Chi-square and Logistic regression. Three variables were identified as potential risk factors for TB: family history of TB, smoking behaviour, and ventilation condition. The results of the logistic regression test revealed that people who smoke have the greatest risk of TB infection. Health promotion needs to be enforced to educate both patients and their family to prevent the transmission of TB.

Knowledge, Attitudes, Practices and Information Needs During the COVID-19 Pandemic in Indonesia.

INTRODUCTION: In the absence of vaccines and specific drugs, prevention effort has been attributed as the primary control mechanism of COVID-19. Knowledge, attitude, and practice are used to determine the current situation and formulate appropriate control interventions as well as risk communication. This study, therefore, aims to assess knowledge, attitude, practice and information needs about COVID-19 in Indonesian society. METHODS: A cross-sectional study was conducted through an online survey in the third week of August 2020. Purposive and random sampling was used to select the respondents. People with a minimum age of 18 years and residing in Indonesia were allowed to participate in this study. The survey was conducted with an online questionnaire that spread on several platforms such as WhatsApp, Instagram and Facebook by distributing the link and continuous chain messages on that platform. Data were analysed using descriptive, chi-square and logistic regression test. RESULTS: A total of 816 respondents were included in this study. In general, public knowledge about COVID-19 was sufficient, but some topic areas were still low. Most people had a positive attitude about the COVID-19, but they provided a negative response to government policies. Most of the community has taken preventive measures for COVID-19. However, some behaviours received a low percentage. Information about how to prevent COVID-19 was the most wanted information during this pandemic. Social media was a favourite source of information, with the most popular type of visualisation was a table containing numbers. Age and education were significantly associated with knowledge. Some attitudes were affected by age and occupation scope. Gender and health insurance ownership significantly associated with preventive measures. CONCLUSION: This research highlights the importance of providing valid, effective, efficient, and continuous information to the public through appropriate channels to increase understanding about COVID-19 precautions.

Understanding Community Involvement on Dengue Prevention in Sleman, Indonesia: A Free Listing Approach.

To reach the target of ending the dengue epidemic by 2030, all effort shall be made to minimize the dengue transmission across the country through effective, efficient, low-cost and sustainable programs. In Indonesia, the evidence of community empowerment on dengue prevention is insufficient. The objective of this study is to explore the opinion of community and larva monitoring workers (Jumantik cadre) on dengue prevention. A structured free listing interview was conducted in April-May 2019 by targeting two groups: the community and larva workers in one village of Sleman, Yogyakarta. Door to door interviews were done until the quota and saturation were reached. Each group was asked four free listing questions. The analysis was performed in these stages: transcribing, coding, combining by the question, and calculating the salience score. The most salient score about vector control in the larva cadre was not hanging up dirty clothes; in the community it was cleaning the bathtub. Both groups cited themself as the salient motivator in joining the vector control. Protecting the environment and keeping healthy were the reasons for participating in the vector control. The larva cadre stated community refusal as the main challenge. The community cited the importance of larva cadre: to monitor the presence of larva. Community empowerment on dengue vector control has not been effortlessly executed at the bottom level.

Malaria Risk Factors in Banjarnegara, Indonesia: A Matched Case-Control Study.

Malaria is a matter of concern in public health worldwide. Identifying its risk factors is essential to determine control efforts. We studied the potential environmental and human behaviour risk factors in malaria by a matched case-control study conducted in the Banjarmangu I Public Health Centre area, Banjarnegara, from June to August 2018. A structured questionnaire and checklist were employed to collect data from 50 participants. Data were analysed by Chi-Square, Fisher exact and logistic regression. A positive association was found between malaria and not sleeping under bed mosquito netting (OR=2.087 [95% CI: 1.148 - 3.795]), not using wire netting in the house ventilation (OR = 3.907 [95% CI: 0.647 - 24.452]), and inadequate prevention practices during outdoor activities (OR = 2.020 [95% CI: 1.033 - 3.953]). These three factors were identified as independent risk factors for malaria.

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System.

The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis "Dengue surveillance stands and falls by the rigor of the health system." The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.

Pneumonia a neglected disease: A mixed-method study on the case-finding program in Indonesia.

Pneumonia eradication program has been implemented, but the incidence rate remains high. This research aims to evaluate the Pneumonia finding program in Sleman district of Indonesia. A mixed-method using sequential explanatory design was conducted during July-August 2019. Input, Process and Output were used as the evaluated methods. Input component were human resource quality, facilities, infrastructure and funding. Process aspect was planning, implementation, monitoring and evaluation. Output was the Pneumonia finding coverage. The quantitative study that employed a survey was done among the Pneumonia officer in 25 primary health centres in the research area. Qualitative study used a semi-structured interview to explore the Pneumonia officer's opinion about the case finding program. Analysis was performed in two stages: 1) Quantitative analysis was started with input data to the spreadsheet, clean the data, and classify into the cut-off. 2) Qualitative analysis was done using a content analysis approach. Input and process found sufficient. But we found poor in the output (Pneumonia finding coverage). Pneumonia finding program has not executed as the expected. The coverage was inadequate since only one out 25 reaches the target of Pneumonia finding coverage. Pneumonia is considered not severe disease become a reason for the inadequate coverage.

Dengue Vector Control through Community Empowerment: Lessons Learned from a Community-Based Study in Yogyakarta, Indonesia.

Effort to control dengue transmission requires community participation to ensure its sustainability. We carried out a knowledge attitude and practice (KAP) survey of dengue prevention to inform the design of a vector control intervention. A cross-sectional survey was conducted in June⁻August 2014 among 521 households in two villages of Yogyakarta, Indonesia. Demographic characteristics and KAP questions were asked using a self-managed questionnaire. Knowledge, attitudes and practice scores were summarized for the population according to sex, age, occupation and education. The average knowledge score was rather poor-3.7 out of 8-although both attitude and practice scores were good: 25.5 out of 32 and 9.2 out of 11 respectively. The best knowledge within the different groups were found among women, the age group 30⁻44 years, people with a university degree and government employees. Best practice scores were found among retired people and housewives. There were several significant gaps in knowledge with respect to basic dengue symptoms, preventive practices and biting and breeding habits of the Aedes mosquito. In contrast, people's practices were considered good, although many respondents failed to recognize outdoor containers as mosquito breeding sites. Accordingly, we developed a vector control card to support people's container cleaning practices. The card was assessed for eight consecutive weeks in 2015, with pre-post larvae positive houses and containers as primary outcome measures. The use of control cards reached a low engagement of the community. Despite ongoing campaigns aiming to engage the community in dengue prevention, knowledge levels were meagre and adherence to taught routines poor in many societal groups. To increase motivation levels, bottom-up strategies are needed to involve all community members in dengue control, not only those that already comply with best practices.

Malaria Risk Factors in Kaligesing, Purworejo District, Central Java Province, Indonesia: A Case-control Study.

OBJECTIVES: Malaria remains a public health concern worldwide, including Indonesia. Purworejo is a district in which endemic of malaria, they have re-setup to entering malaria elimination in 2021. Accordingly, actions must be taken to accelerate and guaranty that the goal will reach based on an understanding of the risk factors for malaria. Thus, we analysed malaria risk factors based on human and housing conditions in Kaligesing, Purworejo, Indonesia. METHODS: A case-control study was carried out in Kaligesing subdistrict, Purworejo, Indonesia in July to August 2017. A structured questionnaire and checklist were used to collect data from 96 participants, who consisted of 48 controls and 48 cases. Univariate, bivariate, and multivariate analyses were performed. RESULTS: Bivariate analysis found that education level, the presence of a cattle cage within 100 m of the house, not sleeping under a bednet the previous night, and not closing the doors and windows from 6 p.m. to 5 a.m. were significantly (p≤0.25) associated with malaria. Of these factors, only not sleeping under a bednet the previous night and not closing the doors and windows from 6 p.m. to 5 a.m. were significantly associated with malaria. CONCLUSIONS: The findings of this study demonstrate that potential risk factor for Malaria should be paid of attention all the time, particularly for an area which is targeting Malaria elimination.

Assessment of Knowledge regarding Climate Change and Health among Adolescents in Yogyakarta, Indonesia.

This research was aimed at providing evidence on climate change and health knowledge among adolescents. A cross-sectional study was conducted in Yogyakarta city from June to September 2016. A structured questionnaire was used to collect data among 508 adolescents who were in the second grade of a senior high school. This study revealed that participants had a low and inconsistent understanding regarding climate change and its impact on health. They reported that they prefer to get climate change information via talking with family. In summary, adolescent knowledge regarding climate change and health needs to improve with proper content and appropriate media.

Measles Cluster Detection Using Ordinal Scan Statistic Model.

INTRODUCTION: Measles a very contagious disease which responsible for the thousand's mortality in the world, including Indonesia. Even though vaccination has been claimed victorious to reduce the transmission, but it does not mean that the world is free from Measles. GIS is offering a powerful method to support the decision maker in generating the Measles program. AIM: This research aimed to investigate Measles clustering in Bantul, Yogyakarta, Indonesia by considering population density and income level. This study was essential to support decision maker to develop a proper intervention for preventing Measles. MATERIAL AND METHODS: Quantitative approach was used in this study. Secondary data that consisted of measles cases, population density and income level were collected from the district health office and related government office in Bantul District. Ordinal Scan Statistic Model by using SaTScan v9.6 was applied to detect the cluster and to test the association between the cases and the variables. RESULTS: This research revealed that population density and income level are the two predictors of Measles hotspot cluster. People who live in the very high-income level district will have 4.8 higher possibility to be exposed with Measles. People who live in the district with medium and high population density predicted to have 4.5 fewer risks to be infected with Measles. CONCLUSION: There is a correlation between income level and Measles cases. Geographic Information System (GIS) can contribute to a decision support system for disease prevention such as on Measles.

Malaria Risk Factors in Kaligesing, Purworejo District, Central Java Province, Indonesia: A Case-control Study / 예방의학회지

OBJECTIVES: Malaria remains a public health concern worldwide, including Indonesia. Purworejo is a district in which endemic of malaria, they have re-setup to entering malaria elimination in 2021. Accordingly, actions must be taken to accelerate and guaranty that the goal will reach based on an understanding of the risk factors for malaria. Thus, we analysed malaria risk factors based on human and housing conditions in Kaligesing, Purworejo, Indonesia. METHODS: A case-control study was carried out in Kaligesing subdistrict, Purworejo, Indonesia in July to August 2017. A structured questionnaire and checklist were used to collect data from 96 participants, who consisted of 48 controls and 48 cases. Univariate, bivariate, and multivariate analyses were performed. RESULTS: Bivariate analysis found that education level, the presence of a cattle cage within 100 m of the house, not sleeping under a bednet the previous night, and not closing the doors and windows from 6 p.m. to 5 a.m. were significantly (p≤0.25) associated with malaria. Of these factors, only not sleeping under a bednet the previous night and not closing the doors and windows from 6 p.m. to 5 a.m. were significantly associated with malaria. CONCLUSIONS: The findings of this study demonstrate that potential risk factor for Malaria should be paid of attention all the time, particularly for an area which is targeting Malaria elimination.

Seasonal changes in the antibody responses against Plasmodium falciparum merozoite surface antigens in areas of differing malaria endemicity in Indonesia.

BACKGROUND: The transmission of malaria in Indonesia is highly heterogeneous spatially and seasonally. Anti-malaria antibody responses can help characterize this variation. In the present study antibody responses to Plasmodium falciparum MSP-1 and AMA-1 were measured to assess the transmission intensity in a hypo-endemic area of Purworejo and a meso-endemic area of Lampung during low and high transmission seasons. METHODS: Filter-paper blood spot samples collected from Purworejo and Lampung by cross-sectional survey during high and low transmission season were stored at -20°C. Indirect ELISA assays were carried out using PfMSP1-19 and PfAMA1 antigens. A positivity threshold was determined by samples from local unexposed individuals, and the differences in seroprevalence, antibody level and correlation between antibody level and age in each site were statistically analysed. RESULTS: Prevalence of antibodies to either PfMSP1-19 or PfAMA1 was higher in Lampung than in Purworejo in both the low (51.3 vs 25.0%) and high transmission season (53.9 vs 37.5%). The magnitude of antibody responses was associated with increasing age in both sites and was higher in Lampung. Age-adjusted seroconversion rates showed an approximately ten-fold difference between Lampung and Purowejo. Two different seroconversion rates were estimated for Lampung suggesting behaviour-related differences in exposure. In both settings antibody responses to PfMSP1-19 were significantly lower in the low season compared to the high season. CONCLUSION: Seasonal changes may be detectable by changes in antibody responses. This is particularly apparent in lower transmission settings and with less immunogenic antigens (in this case PfMSP1-19). Examination of antibody levels rather than seroprevalence is likely to be a more sensitive indicator of changes in transmission. These data suggest that sero-epidemiological analysis may have a role in assessing short-term changes in exposure especially in low or seasonal transmission settings.