The Effort to Rationalize Antibiotic Use in Indonesian Hospitals: Practice and Its Implication.

An effective strategy for combatting AMR in Indonesia is to make the use of antibiotics in hospitals more rational with the help of an Antimicrobial Resistance Control Program (AMR-CP). This study aims to analyze the implementation of the AMR-CP in hospitals by conducting in-depth interviews with health professionals from ten hospitals and health officers of ten provincial health offices in ten different provinces and observation towards its documents. The sample location was selected by purposive sampling. Informants at the hospitals were hospital directors, chairmen of the AMR-CP team, chairmen of the medical committee, persons in charge of the microbiology laboratory, clinicians, nurses, clinical pharmacists, and those program managers at the provincial health offices who are responsible for administering antibiotics. Information is first collected and then a thematic analysis is applied along with triangulation to confirm the validity of information from multiple sources, including document observation results. The analysis is adapted to the framework of the system (i.e., input, process, and output). Results show that hospitals in Indonesia already have the resources to implement AMR-CP, including AMR-CP team and microbiology laboratories. Six hospitals examined also have clinicians trained in microbiology. Though hospital leadership and its commitment to implementing AMR-CP are favorable, there is room for improvement. AMR-CP teams organize routine activities for socialization and training, develop standard operating procedures (SOPs) for antibiotic use, antibiotic patterns surveillance, and bacterial mapping. Some obstacles to implementing AMR-CP policies are posed by the human resources, facilities, budget, antibiotics and reagent shortages, and clinician compliance with SOPs. The study concludes that there was an improvement in antibiotic sensitivity patterns, rational use of antibiotics, use of microbiological laboratories, and cost-efficiency. It recommends the government and healthcare providers continue to improve AMR-CP in hospitals and promote AMR-CP policy by making the regional health office of the hospital a representative of the regional government.

Effectiveness of the inactivated COVID-19 vaccine (CoronaVac) in adult population in Indonesia

BackgroundInactivated SARS-CoV-2 vaccine has been included in the national COVID-19 vaccination program in Indonesia since January 2021. The study aims to assess the impacts of inactivated COVID-19 vaccine on infection, hospitalization, and death among adult population aged [≥]18 years in Bali, Indonesia. MethodsTest-negative, case control study was conducted by linking SARS-CoV-2 laboratory records, vaccination, and health administrative data for the period of January 13 to June 30, 2021. Case-subjects were defined as individuals who had a positive RT-PCR test for SARS-CoV-2 during the period; they were matched with controls (tested negative) (1:1) based on age, sex, district of residence, and week of testing. We estimated the odds of vaccination in PCR confirmed, hospitalization and death due to COVID-19, accounting for the presence of comorbidities and prior infection. Vaccine effectiveness was estimated as (1-odds ratio) x 100%. ResultsTotal 109,050 RT-PCR test results were retrieved during the January 13 to June 30, 2021. Of these, 14,168 subjects were eligible for inclusion in the study. Total 5518 matched case-control pairs were analyzed. Adjusted vaccine effectiveness (VE) against laboratory-confirmed SARS-CoV-2 infection was 14.5% (95% confidence interval -11 to 34.2) at 0-13 days after the first dose; 66.7% (95% CI: 58.1-73.5) at [≥]14 days after the second dose. The adjusted effectiveness against hospitalization and COVID-19-associated death was 71.1% (95% CI: 62.9-77.6) and 87.4% (95% CI: 65.1-95.4%) at [≥]14 days after receiving the second dose, respectively. ConclusionsTwo-dose of inactivated CoronaVac vaccine showed high effectiveness against laboratory confirmed COVID-19 infection, hospitalization, and death associated with COVID-19 among adults aged [≥]18 years.

An Evaluation of Health Policy Implementation for Hajj Pilgrims in Indonesia.

BACKGROUND: For last decades, the mortality rate of hajj pilgrims from Indonesia was between 2.1 and 3.2 per 1000 hajj pilgrims. At the same time, morbidity affected 87% of the elderly (>65 years old), of which 83% faced high risk of health problems. This is a complex problem affecting hajj health care in Indonesia. The study was aimed to understand what extent of the hajj implementation on health care in Indonesia. METHODS: This review was conducted by abstracting of three studies in Indonesian hajj health care. Two of the studies were based on cross-sectional reviews, while one was a case-control study. The majority of the studies performed laboratory tests to evaluate the disease conditions among hajj pilgrims through secondary data. RESULTS: First study presented that hajj Posbindu (integrated post-coaching) was not functional in managing the health problems of the pilgrims. It shows that the stroke prevalence is 10.9 per 1000 people, Diabetes Mellitus (DM) 10.9% of the people, and coronary heart disease 1.5%. The second study expressed that, according to health isthitaah (policy implementation), there were 20% hajj pilgrims who delayed their trip because of health issues. Most of them had chronic kidney disease, dementia, or lung tuberculosis. The policy implementation of health isthitaah was not smooth; there was little collaboration between the Ministry of Health and Ministry of Religious Affairs, and the population was not sufficiently educated in the area, resulting in hajj pilgrims with poor knowledge, attitude, and practice in health isthitaah. This notion was enforced in the third study. CONCLUSION: The coaching according to health isthitaah should be encouraged alongside collaboration between the Ministry of Health and Ministry of Religious Affairs. Socialization in public health has to increase according to health isthitaah, which can be done by district health centers.

Decision Tree Clinical Algorithm for Screening of Mild Cognitive Impairment in the Elderly in Primary Health Care: Development, Test of Accuracy, and Time-Effectiveness Analysis.

Mild cognitive impairment (MCI) is predicted to be a common cognitive impairment in primary health care. Early detection and appropriate management of MCI can slow the rate of deterioration in cognitive deficits. The current methods for early detection of MCI have not been satisfactory for some doctors in primary health care. Therefore, an easy, fast, accurate and reliable method for screening of MCI in primary health care is needed. This study intends to develop a decision tree clinical algorithm based on a combination of simple neurological physical examination and brief cognitive assessment for distinguishing elderly with MCI from normal elderly in primary health care. This is a diagnostic study, comparative analysis in elderly with normal cognition and those presenting with MCI. We enrolled 212 elderly people aged 60.04-79.92 years old. Multivariate statistical analysis showed that the existence of subjective memory complaints, history of lack of physical exercise, abnormal verbal semantic fluency, and poor one-leg balance were found to be predictors of MCI diagnosis (p ≤ 0.001; p = 0.036; p ≤ 0.001; p = 0.013). The decision trees clinical algorithm, which is a combination of these variables, has a fairly good accuracy in distinguishing elderly with MCI from normal elderly (accuracy = 89.62%; sensitivity = 71.05%; specificity = 100%; positive predictive value = 100%; negative predictive value = 86.08%; negative likelihood ratio = 0.29; and time effectiveness ratio = 3.03). These results suggest that the decision tree clinical algorithm can be used for screening of MCI in the elderly in primary health care.