Dynamic Changes of Platelet and Factors Related Dengue Haemorrhagic Fever: A Retrospective Study in Indonesian.

Dengue is a viral infection caused by the dengue virus (DENV). Dengue infection is a self-limited acute febrile illness caused by four serotypes of DENV (DENV-1~4). Early recognition of high-risk patients would be helpful to reduce mortality rates and prevent severe dengue. Our study aimed to identify factors related to dengue hemorrhagic fever (DHF) based on admission-day data, and further to understand the distribution of biochemical laboratory data in dengue patients. This retrospective study was conducted in hospitals in Yogyakarta city, Indonesia, and involved febrile patients who were admitted to the hospital with a diagnosis of dengue during 2018 and 2020. Logistic regression models were used to identify variables related to DHF. In this study, 1087 patients were included as suspected dengue patients, among them 468 had dengue fever (DF) and 619 had DHF. Over half of the DHF patients were males (55.9%) with an average age of 17.9 years, and with a secondary infection (71.3%). By a multivariate analysis, on-admission laboratory data of thrombocytopenia and hemoglobin showed significant association with DHF. Furthermore, DHF patients had significantly prolonged hospitalizations compared to DF patients. In conclusion, on-admission platelet counts and hemoglobin laboratory data are useful as predictors of DHF especially for suspected dengue patients with the limitations of diagnostic tests.

Cost-effectiveness and budget impact analyses of dengue vaccination in Indonesia.

Despite the fact that the incidence and mortality rates due to dengue virus (DENV) infection in Indonesia are relatively high, dengue vaccination has not yet been introduced. This study aimed to analyse the cost-effectiveness and the budget impact of dengue vaccination in Indonesia by taking the potential of pre-vaccination screening into account. An age-structured decision tree model was developed to assess the cost-effectiveness value by applying a single cohort of 4,710,100 children that was followed-up in a 10-year time horizon within a 1-year analytical cycle. The budget impact was analysed in a 5-year period (2020-2024) by considering provinces' readiness to introduce dengue vaccine and their incidence rate of DENV infection in the last 10 years. Vaccination that was coupled with pre-vaccination screening would reduce dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) by 188,142, 148,089 and 426 cases, respectively. It would save treatment cost at $23,433,695 and $14,091,642 from the healthcare and payer perspective, respectively. The incremental cost-effectiveness ratios (ICERs) would be $5,733 and $5,791 per quality-adjusted-life-year (QALY) gained from both perspectives. The most influential parameters affecting the ICERs were probability of DENV infection, vaccine efficacy, under-reporting factor, vaccine price, case fatality rate and screening cost. It can be concluded that dengue vaccination and pre-vaccination screening would be cost-effective to be implemented in Indonesia. Nevertheless, it seems unaffordable to be implemented since the total required cost for the nationwide vaccination would be 94.44% of routine immunization budget.

Lack of Awareness of the Impact of Improperly Disposed Of Medications and Associated Factors: A Cross-Sectional Survey in Indonesian Households.

Introduction: Disposal of unused medications through environmentally unsafe routes is common in Indonesia. The lack of awareness of the impact of improperly disposed of medications is a significant contributing factor. The objectives of this study were to identify factors associated with lack of awareness of the impact of improperly disposed of unused medications and to assess the associations of awareness with medication disposal practices among the general population in Indonesia. Patients and methods: An observational cross-sectional survey was conducted using nonprobability sampling in Bandung, Indonesia, from November 2017 to January 2018 among respondents who were older than 18 years, had used any medication in the past, were literate, and had signed an informed consent document. Disposal practices and awareness regarding the impact of improperly disposed of unused medications were collected using an online- and a paper-based pre-validated questionnaire. The paper-based questionnaires were distributed to respondents in public places such as city center, markets, and religious places. Binary logistic regression was performed to assess associations of sociodemographic and other related factors with a lack of awareness. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported. Results: Of 497 participating respondents, 433 and 64 respondents filled an online- or a paper-based questionnaire, respectively. Most respondents were female, aged between 18 and 30 years, and students/university students. Of 497 respondents, more than half (53.1%) were not aware that improper medication disposal could harm the environment and population health. Most respondents (79.5%) had never received information about proper medication disposal practices. The education level, the number of stored medications at home, and previous education about medication disposal practices were significantly associated with awareness of proper practices. In the multivariate analysis, only those with previous education about medication disposal practices were less likely to report a lack of awareness (OR: 0.043; 95% CI: 0.02-0.09). Respondents with a lack of awareness tended to dispose of their unused medications in the garbage or shared them with friends or relatives. Conclusion: There is a clear need to increase awareness of the importance of proper medication disposal practices, in particular among the student population of Bandung city, Indonesia. Healthcare providers can play an important role by educating this specific population on the proper disposal of unused medications.

Cost-Effectiveness of Telemedicine in Asia: A Scoping Review.

BACKGROUND: In the area where there is a lack of medical experts, telemedicine gives a lot of benefits to deal with the distance and limited public infrastructure. OBJECTIVE: This study aimed to review the literature on the cost-effectiveness of telemedicine in Asian countries and possibly to provide recommendations on implementing telemedicine in this region. METHODS: Articles were independently screened in two selected databases (PubMed and EBSCO). The framework of patient, intervention, comparison, and outcome (PICO) was applied by considering Asian population, the intervention of telemedicine, current situation (without telemedicine) as the comparator, and cost per QALY gained as the major outcome. RESULTS: A total of 870 articles were identified from two databases: PubMed (n = 689 articles) and EBSCO (n = 181 articles). After removing 181 duplicates, 689 articles were screened by title and abstract, excluding 665 records. After the full-text screening on 24 articles, 8 articles were selected for further analysis. Various perspectives were applied in the included studies, such as societal, healthcare, and program perspectives. All studies applied different time horizons, such as 3-month, 25-year, 40-year, and lifetime. Among all included studies, several studies applied mathematical modeling. CONCLUSION: The implementation of telemedicine in Asia can be a promising intervention since it can enhance the effectiveness of health services by saving time and travel costs. It also can reduce the overall costs of treatment, improve patients' quality of life, and expand access to essential health services.

Improper disposal practice of unused and expired pharmaceutical products in Indonesian households.

BACKGROUND: Improperly disposed medicines could adversely affect the environment and increase the risk of drug misuse or accidental poisoning. OBJECTIVE: To evaluate the disposal practices of unused and expired medicines among the general population in Bandung, Indonesia. METHOD: This was a descriptive cross-sectional survey conducted among 497 respondents in Bandung, Indonesia. Data were collected through interviews using a prevalidated structured questionnaire. Descriptive statistics were calculated using the Statistical Package for Social Science (SPSS) version 23. Ethics approval was obtained. MAIN OUTCOME MEASURE: General public knowledge and attitude regarding unused and expired medication disposal practice. RESULTS: Approximately 95% of the respondents had unused medicines stored in their homes, with nonsteroidal anti-inflammatory drugs (NSAIDs), vitamins/nutritional supplements, and antibiotics were the most common types of medicines left unused. The majority of the respondents checked the expiration date of the drugs before purchasing (72.8%). The most common disposal method of unwanted medicines was throwing away in household garbage (82.1%). A significant percentage of them never received information about proper medication disposal practice (79.5%). Furthermore, more than half of the respondents were unaware that unsafe medication disposal practices could harm the environment and population health (53.1%). CONCLUSION: Disposal of unwanted pharmaceutical products through environmentally unsafe route was prevalent among the respondents. There is also a lack of awareness of the impact of improperly disposed of medicines for the ecosystem. These findings call upon the strategies to strengthen the pharmaceutical waste management program.

Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education.

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9,995, $4,460, and $6,399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.

Economic Evaluations of Dengue Vaccination in the Southeast Asia Region: Evidence From a Systematic Review.

OBJECTIVES: To review the literature on the cost-effectiveness of dengue vaccination in Southeast Asian countries and possibly to provide recommendations on promoting dengue vaccination in this region. METHODS: A systematic search was conducted to identify relevant articles in 3 major databases (ProQuest, American Society of Tropical Medicine and Hygiene, and PubMed). Complete economic evaluation studies, including willingness-to-pay (WTP) studies, that were conducted in any Southeast Asian country were included in this study. Systematic review, non-full-text, and non-English studies were specifically excluded. RESULTS: Nine selected studies highlighted the economic evaluation of dengue vaccination in Southeast Asian countries by considering many parameters (eg, vaccine cost, vaccine efficacy, cost-effectiveness threshold, economic assessment, public acceptance, and WTP). All studies confirmed that dengue vaccine can be used as a prevention strategy to reduce the incidence rate of dengue cases by providing a variance of high cost-effectiveness values. In addition, communities provided a good assessment, acceptance, and WTP value for the vaccine. CONCLUSIONS: The use of dengue vaccine could reduce the burden of disease and economic burden due to dengue infection in Southeast Asian countries. The efficacy of dengue vaccine was estimated to be 50-95% for those <9 years, 9 years, and >9 years. In particular, several studies reported that dengue vaccine could be categorized as a cost-effective intervention in Southeast Asian countries within certain conditions.

Cost of Illness Study of Patients with Dengue Hemorrhagic Fever at One of the Private Hospitals in Yogyakarta.

Dengue hemorrhagic fever (DHF) caused by the dengue virus is one of the high-prevalence diseases in tropical countries, such as Indonesia. It has been highlighted that high-prevalence diseases are strongly correlated with high-treatment costs. In particular, Yogyakarta has been reported as one of the provinces with a high prevalence of DHF. This study aimed to estimate the cost of illness because of DHF and to analyze the correlation between the use of drugs with its cost and length of stay, with total hospital administrative cost at one of the private hospitals in Yogyakarta. A cross-sectional study was applied in this study by collecting patients' medical record and financial data, such as demographic characteristic, medication, length of stay, and direct medical cost health-care perspective. The numbers of dengue patients were applied in this study by considering 87 patients and 143 patients with DHF in 2015 and 2016, respectively. Indirect medical costs were collected from a questionnaire by 20 respondents. Spearman's statistical test was used in this study to conduct the bivariate test. The average direct medical cost from the perspective of health care in 2015 and 2016 in DHF patients with Badan Penyelenggara Jaminan Sosial (BPJS) insurance and non-BPJS insurance was US$243.6; US$363.41 and US$368.13; US$427.03. The indirect medical costs showed that the highest percentage productivity loss was US$70.98-212.95. Correlation between the numbers of drug with drug cost was significant (P < 0.05) with correlation coefficient (value ρ) of 0.527 and 0.603. Correlation between lengths of stay with the cost of hospitalization was significant (P < 0.05) with correlation coefficient (value ρ) of 0.375 and 0.562. It can be concluded that DHF has a relatively high cost of illness both in direct and indirect costs.

Impact of organophosphate exposure on farmers' health in Kulon Progo, Yogyakarta: Perspectives of physical, emotional and social health.

OBJECTIVE: The exposure of organophosphate could be caused by the absorption in some parts of the body like skin and breath. Toxicity may cause nausea, vomiting and dizziness which are not too specific related with the pesticide toxicity. The purpose of this study is to understand the association between organophosphate exposure and farmers' health in Kulon Progo County from the perspectives of physical, emotional and social health. METHODS: This study was conducted using descriptive observational design. The blood sample was collected during harvesting periods in 2016. The inclusion criterion of farmers was using organophosphate-contained pesticide during the planting period of red onion. The farmers who had renal disease, liver disease and cancer were excluded. The organophosphate exposure parameters were the duration and frequency of pesticide application, width of the area, serum cholinesterase activity and the completeness of personal protective equipment. RESULTS: Among 84 farmers, most of them were male (85.7%), and the mean age was 49.1 (standard deviation: 12.5) years; 71.4% of the subjects experienced tremor, 17.86% experienced dizziness and 8.33% subjects experienced nausea-vomiting after pesticide application. According to the pesticide application, in average, subjects used pesticide 1.4 h/day with the area of 1.285 m2. The frequency of pesticide used is three times per week. Around 97.6% subjects used incomplete personal protective equipment. The average of serum cholinesterase activity in subjects with tremor is higher than subjects without tremor (p > 0.05). There is a significant association between serum cholinesterase activity and creatinine content (p < 0.05). The farmers' quality-of-life domain scores are lower than the scores of the normal population in Yogyakarta. CONCLUSION: Organophosphate exposure may affect the farmers' physical health and quality of life.