Measuring leprosy case detection delay and associated factors in Indonesia: a community-based study.

BACKGROUND: Leprosy is a public health burden in Indonesia with a high number of new cases every year and a high proportion of disability among new cases. Case detection delay (CDD) can contribute to ongoing transmission and increased disability chances among leprosy patients. This study aimed to establish the CDD of leprosy and the factors associated with detection delay in Indonesia. METHOD: Community-based study with a cross-sectional design. Data were collected through interviews about sociodemographic and behavioral factors, anticipated stigma, and duration of CDD. Leprosy classification and case detection methods were obtained from health service records. A random sample was taken of 126 leprosy patients registered between 1st October 2020 and 31st March 2022 in the Tegal regency in the Central Java Province. Data were analysed by descriptive and analytical statistics using multiple linear regression. RESULTS: The mean CDD, patient delay, and health system delay were 13.0 months, 9.7 months, and 3.2 months, respectively. Factors associated with longer CDD are younger age (below 35 years), male, found through passive case detection, and not having a family member with leprosy. Factors associated with longer patient delay were being younger (below 35 years), being male, not having a family member with leprosy, and anticipated stigma of leprosy. It was not possible to reliably identify factors associated with health system delay. CONCLUSION: CDD in leprosy should be reduced in Indonesia. The Indonesian National Leprosy Control Program (NLCP) is advised to adopt an integrated intervention programme combining active case detection with targeted health education to reduce CDD and thereby preventing disabilities in people affected by leprosy.

Systematic review: risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions.

In many countries, there is a high number of teenage pregnancies, Sexually Transmitted Infections (STIs), and unsafe sexual behavior, so there is a need for adolescent health intervention programs to change behavior. The effectiveness of comprehensive interventions in various contexts to reduce teenage pregnancy, STIs, and related sexual risk behaviors is reviewed in this systematic. This study aimed to identify risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions. Literature search strategy from January 2008 to December 2022 through electronic databases. Key words 'teenage prenancy' OR 'teen pregnancy' OR 'pregnancy adolescence', AND 'maternal education', AND 'randomised clinical trial', AND 'risk behavior'. Articles that were deemed worthy of following the PRISMA guidelines were 28 articles. Most studies looked at school-based, individual, community, clinic, and family-based care. Most studies were followed up after intervention at intervals from one month to seven years, and the majority of the population and sample were adolescents with ages ranging from 13 to 18 years. Implementation of research in urban, suburban, and rural areas. This program has proven successful in preventing pregnancy, contraceptive use, STI and HIV, sexual behavior, dropping out of school, knowledge about pregnancy, sexuality, attitudes towards sexuality, intention to change risky sexual behavior, self-efficacy, and increasing parent-children. This article describes some basic trends in adolescent pregnancy prevention interventions in several countries that can be used as a reference for health programs. Unproven effectiveness can be implemented in conjunction with other interventions that have a high-quality impact.

High Prevalence of Prediabetes and Associated Risk Factors in Urban Areas of Pontianak, Indonesia: A Cross-Sectional Study.

Uncontrolled prediabetes can develop into Type 2 Diabetes mellitus (T2DM). The incidence of T2DM among adults in Pontianak, Indonesia was reported remarkably high. Therefore, this study aimed to investigate the risk factors for prediabetes in adults living in urban areas of Pontianak, Indonesia. A cross-sectional study was conducted in 5 subdistricts of Pontianak. A total of 506 adults underwent screening to obtain subjects with fasting blood glucose (FBS) of ≤124 mg/dL and aged >30 years. Blood pressure and body mass index (BMI) were measured. Interview using a structured questionnaire were performed to obtain data on predictor variables (age, sex, education, income, health insurance, tobacco use, history of hypertension, gout, high cholesterol level, frequency of exercise per week, and diabetic education). The prevalence of prediabetes among subjects was significantly high (76.4%). Subjects were predominantly above 40 years, female, had low income, low education level, and had health insurance. About a third of the subjects had a history of hypertension, gout, and high cholesterol level, respectively. The exercise frequency was mostly less than 3 times/week, and the BMI was mainly classified as overweight and obese. The result of spearman's rho correlation showed that age (r = 0.146; p=0.022) and BMI (r = 0.130; p=0.041) significantly correlated with prediabetes incidence. Moreover, the chi-square analysis demonstrated that health insurance ownership (OR = 4.473; 95% CI 1.824-10.972; p ≤ 0.001), history of hypertension (OR = 3.096; 95% CI 1.542-6.218; p=0.001), and history of gout (OR = 2.419; 95% CI 1.148-5.099; p=0.018), were associated with prediabetes incidence. For all these significant risk predictors except BMI, the significant associations were found only among female subjects after specific sex analysis. Moreover, multivariate logistic regression showed that health insurance ownerships (OR = 5.956; 95% CI 2.256-15.661; p ≤ 0.001) and history of hypertension (OR = 3.257; 95% CI 1.451-7.311; p=0.004), and systolic blood pressure (OR = 2.141; 95% CI 1.092-4.196; p=0.027) were the risk factors for prediabetes. It is concluded that the prevalence of prediabetes is probably high especially among urban people in Pontianak, Indonesia. Health insurance ownership and hypertension may have an important role in prediabetes management. The risk factors might be different between male and female.

The Effects of Chitosan-PEG Nanoparticles Based on Channa striata Protein Hydrolyzate on Decreasing Diabetes Mellitus in Diabetic Rats.

Background: Channa striata has several good nutrients, including 70% protein, 20% albumin, complete amino acids, zinc, selenium, and iron. However, no study has investigated the chitosan-PEG nanoparticles based on Channa striata protein hydrolyzate. This study's purpose was to determine the role of 10% Channa striata protein hydrolyzate, chitosan-PEG 4000 nanoparticles, and chitosan-PEG 6000 nanoparticles in reducing diabetes mellitus in diabetic rats. Method: A randomized pretest-posttest control group design was used, with male Sprague-Dawley rats being divided into five groups: STZ, acarbose, hydrolyzate, chitosan-PEG 4000 nanoparticles, and chitosan-PEG 6000 nanoparticles. Diabetes was induced by a single injection of streptozotocin at 1 ml in each formulation. Blood glucose levels were analyzed using a glucometer 7, 14, and 21 days after treatment. The CHOD-PAP method was used to analyze the lipid profile. Pancreas and liver histology analyses were carried out using a microscope. Results: The formulation of 10% Channa striata protein hydrolyzate and PEG 6000 was the most effective in lowering blood glucose concentrations, and the response was close to the acarbose result. The glucose concentration decreased after daily oral administration of chitosan-PEG nanoparticles for 21 days. The plasma cholesterol, triglycerides, LDL, and HDL concentrations were lower in treated than in untreated diabetic rats. Conclusion: This study concluded that the formulation of 10% Channa striata protein hydrolyzate and chitosan-PEG 6000 nanoparticles was more effective than acarbose.

Reduction of Fatigue and Musculoskeletal Complaints in Garment Sewing Operator through a Combination of Stretching Brain Gym® and Touch for Health.

The purpose of this study was to assess the effect of using a combination of stretching and Brain Gym®(BG) + Touch for Health (TfH) movements to reduce fatigue and musculoskeletal complaints (MSCs) in garment-sewing operators. A quasi-experimental study was performed on 53 respondents with two sessions of stretching movements and BG + TfH movements of 5 min duration, three times a week for four weeks. Fatigue was measured using a reaction timer and MSCs were measured using a Nordic Body Map questionnaire. Wilcoxon and Mann-Whitney U tests were performed to examine the differences of pre/post and between the intervention group (IG) and control group (CG). A significant difference was found in IG for pre- and post-fatigue (p < 0.001) and MSCs (p < 0.001), while in CG there was no difference in fatigue (p = 0.200) and MSCs (p = 0.086). Significant differences were found between the IG and CG groups in terms of fatigue (p = 0.046), as well as in MSCs (p < 0.001). A significant decrease in MSCs per part body in IG was found on the left wrist, left hand, and left knee. The percentage of MSC severity decreased in all parts of the body, except the right shoulder, left elbow, and right thigh.

Adolescent Riding Behavior During the COVID-19 Pandemic in Urban Area, Indonesia: A Cross-sectional Study.

Background: According to police reported crash, in 2020 there have been 510 road traffic accidents among adolescents aged 16-25 years. The problem is that although restrictions on social activities have been implemented, 9.80% of accidents have caused deaths in Semarang City. There were many factors that influence the occurrence of road traffic accidents; one of those is the poor knowledge about safe riding behavior. The aim of this study is to determine the factors that contribute to the occurrence of road traffic accidents in adolescents during the pandemic. Methods: This was a cross-sectional study, collected data using an online questionnaire distributed to adolescents aged 15-20 years in Semarang City, Indonesia. It was distributed during February-April 2021. The data included participant's demographic information, riding behavior, and knowledge about safe riding. We analyzed using chi-square and logistic regression to determine the most influential factors. Results: The sample included 725 participants with a mean age of 17.4 years (SD=0.97); 260 (35.9%) males. We have found that gender was associated with the incidence of road traffic accidents (AOR=1.455, 95% CI [1.048-2.020], P=0.025) after adjusting for experience road safety education, vehicle type, and knowledge of safe riding. Conclusion: It is necessary to carry out Road Safety Education efforts to male students during the pandemic to reduce the incidence of traffic accidents.

To What Extent Do Ecological Factors of Behavior Contribute to the Compliance of the Antenatal Care Program in Dumai City, Indonesia?

PURPOSE: Maternal mortality rate (MMR) in Indonesia is still relatively high, at 305 per 100.000 live births (2015). Routine visit to antenatal care is the best way to reduce MMR. Inspite of this, the number of antenatal care visits among pregnant women is still low. This study aimed to measure the influence of behavioral ecological factors with the compliance of pregnant women to visit antenatal care. PATIENTS AND METHODS: Study population was pregnant women living in Dumai City, Indonesia. This study was a quantitative research design with a cross-sectional. We used the cluster system to select participants. A total of 369 subjects participated with a gestation age between >12 until 40 weeks. The data were collected by face-to-face interviews using validated questioners. The analysis was done by bivariate analysis using the Spearman correlation test. Multivariate using multiple linear regression. RESULTS: This study showed that factors of the ecological model of behavior were related to antenatal care compliance (p value<0.05) with a coefficient correlation (0.330-0.569). Multivariate analysis showed that all variables associated significantly (adjusted R2; 0.104-0.311). Five variables were dominant; knowledge, cultural beliefs, family support, friend support, and health facilities with adjusted R2= 0.518. CONCLUSION: Five factors in an ecological model of behavior, such as knowledge, cultural beliefs, family support, friend support, and health facilities, proportion (51,8%) of contributing to antenatal care compliance. We recommend a health district program to make services more accessible to pregnant women. Health education programs need to increase the knowledge of pregnant women and families to provide support in antenatal care compliance. Local governments shall improve antenatal care quality by mapping, planning, and evaluating this program.

Perceived threat and benefit toward community compliance of filariasis' mass drug administration in Pekalongan district, Indonesia.

PURPOSE: Lymphatic filariasis (LF) is a chronic infection of Brugia malayi, Brugia timori, and Wuchereria bancrofti and is a mosquito-transmitted disease. Mass drug administration (MDA) needs to be done annually to control LF and requires adherence of endemic populations to take medication properly. Maintaining high coverage of MDA is a challenge because the activity needs to be done in several years. This study would like to know the compliance of the community in taking medication during MDA periods in Pekalongan district using the health belief model (HBM) approach. PATIENTS AND METHODS: Study population was people living in endemic areas in Pekalongan district, Central Java Province. This was a cross-sectional study. HBM approach was used to analyze community perceived in regard to MDA. There were six of the 19 subdistrict selected as study location, and 100 subjects were selected from each sub-district. Therefore, a total of 600 subjects participated in this study. Data were collected using the structured questionnaire. Data were analyzed quantitatively using the Chi-squared test. Multivariate analysis was used for logistic regression. RESULTS: Results of this study showed that the mean age of subjects was 38.6 years and had been staying in their villages for more than 30 years. Gender, marital status, history of LF, history of LF in the family, and external cues to action did not relate to MDA compliance. Perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were factors related to the compliance of MDA. After multivariate analysis, the perceived susceptibility did not have relationship with compliance. CONCLUSION: This study showed HBM variables, ie, perceived susceptibility, perceived severity, perceived benefit, and perceived barrier associated with the medication adherence of LF. The role of elimination officers was important to increase community knowledge about MDA program and the benefit to control LF disease.

Social multiplier effects: academics' and practitioners' perspective on the benefits of a tuberculosis operational research capacity-building program in Indonesia.

BACKGROUND: The Tuberculosis Operational Research Group (TORG) implemented a capacity-building model involving academics and practitioners (i.e. clinicians or program staff) in an operational research (OR) team in Indonesia. OBJECTIVE: This study explored academics' and practitioners' perspectives regarding the benefits of participating in a tuberculosis (TB) OR capacity-building program in Indonesia. METHODS: We conducted a qualitative study involving in-depth interviews with 36 academics and 23 practitioners undertaking the TORG capacity-building program. We asked open-ended questions about their experience of the program. Data were analyzed via content analysis. RESULTS: The findings demonstrated the social multiplier effects of the OR capacity-building program. Both academics and practitioners reported perceived improvements in research knowledge, skills, and experience, and described additional individual- and institutional-level benefits. The individual-level benefits level included improvements in understanding of the TB program, motivation for research and self-satisfaction, the development/enhancement of individual networking, receipt of recognition, and new opportunities. The additional benefits reported at an institutional level included improvement in research curricula, in-house training, and program management and the development/enhancement of institutional partnerships. CONCLUSIONS: The program improved not only individuals' capacity for conducting OR but also the quality of the TB program management and public health education. OR should be included in research methodology curricula for postgraduate public health/disease control programs. The capacity-building model, in which academics and program staff collaborated within an OR team, should be promoted.

Profile of glycated-hemoglobin, antioxidant vitamin and cytokine levels in pulmonary tuberculosis patients: A cross sectional study at Pulmonary Diseases Center Semarang City, Indonesia.

BACKGROUND: Uncontrolled blood glucose, which marked by high level of HbA1c, increases risk of pulmonary TB because of cellular immunity dysfunction. This study aimed to analyze profile of glycated hemoglobin, antioxidant vitamins status and cytokines levels in active pulmonary TB patients. METHODS: This was a cross sectional study, conducted at Pulmonary Diseases Center Semarang City, Indonesia. Study subject consisted of 62 pulmonary TB patients, diagnosed with positive acid fast bacilli and chest X-ray. ELISA was used to measure IFN-γ and IL-12. Status of antioxidant vitamins was determined by concentration of vitamin A and E using HPLC. Blood glucose control was determined by HbA1c concentration (HbA1c ≥7% is considered as uncontrolled). RESULTS: A significant difference of age between pulmonary tuberculosis patients with normal and uncontrolled blood glucose (p = 0.000) was showed, while all other characteristics (sex, education, occupation) did not differ with p = 0.050, 0.280, 0.380 respectively. Mean HbA1c was 7.25 ± 2.70%. Prevalence of uncontrolled glucose among pulmonary TB patients was 29%. Levels of IFN-γ and IL-12 did not differ according to HbA1c concentration (p = 0.159 and p = 0.965 respectively). Pulmonary tuberculosis patients with uncontrolled blood glucose has higher vitamin E (p = 0.006), while vitamin A did not differ significantly (p = 0.478). CONCLUSIONS: This study supports the importance of performing diabetes screening among pulmonary TB patients. Further study needs to be done to determine the feasibility of TB-DM co-management.

How do laboratory technicians perceive their role in the tuberculosis diagnostic process? A cross-sectional study among laboratory technicians in health centers of Central Java Province, Indonesia.

PURPOSE: Detection of acid-fast bacilli in respiratory specimens serves as an initial pulmonary tuberculosis (TB) diagnosis. Laboratories are the essential and fundamental part of all health systems. This study aimed to describe how laboratory technicians perceived their own self and work. This included perceived self-efficacy, perceived role, perceived equipment availability, perceived procedures, perceived reward and job, and perceived benefit of health education, as well as level of knowledge and attitudes related to work performance of laboratory technicians. METHODS: This was a cross-sectional quantitative study involving 120 laboratory technicians conducted in Central Java. Interviews and observation were conducted to measure performance and work-related variables. RESULTS: Among 120 laboratory technicians, 43.3% showed fairly good performance. They complied with 50%-75% of all procedures, including sputum collection, laboratory tools utilization, sputum smearing, staining, smear examination, grading of results, and universal precaution practice. Perceived role, perceived self-efficacy, and knowledge of laboratory procedures were significantly correlated to performance, besides education and years of working as a laboratory technician. Perceived equipment availability was also significantly correlated to performance after the education variable was controlled. CONCLUSION: Most of the laboratory technicians believed that they have an important role in TB patients' treatment and should display proper self-efficacy in performing laboratory activities. The result may serve as a basic consideration to develop a policy for enhancing motivation of laboratory technicians in order to improve the TB control program.

The path to impact of operational research on tuberculosis control policies and practices in Indonesia.

BACKGROUND: Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. OBJECTIVE: We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. DESIGN: Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. RESULTS: Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. CONCLUSIONS: Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.

Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia.

There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme.

Factors that influence treatment adherence of tuberculosis patients living in Java, Indonesia.

BACKGROUND AND OBJECTIVE: Due to nonadherence of tuberculosis (TB) patients to treatment, complications may arise and if remaining infectious, these patients may infect other people with TB. To obtain information about factors associated with nonadherence, we performed a study comparing adherent and nonadherent TB patients. METHODS: Adherent and nonadherent patients randomly selected from hospital records in one urban and two rural districts were interviewed using semi-structured questionnaires. Key informant interviews were done with TB nurses and doctors. RESULTS: The most frequently mentioned reason for nonadherence to treatment was feeling better. Although the drugs were given free of charge, many patients were nonadherent because of lack of money. Social support was considered very important for adherence. The study indicated that some patients had a negative image about the health care staff, treatment, and quality of medication. CONCLUSION: Treatment adherence of TB patients receiving treatment in hospitals in Central Java might be improved by providing health education about treatment duration and side effects, facilitating procedures for receiving treatment free of charge and reducing costs of transportation and consultation. Qualified friendly health care staff able to motivate patients might further improve adherence.