Introducing a Regulatory Sandbox Into the Indonesian Health System Using e-Malaria as a Use Case: Participatory Action Study.

BACKGROUND: Regulatory sandboxes offer an alternative solution to address regulatory challenges in adopting disruptive technologies. Although regulatory sandboxes have been widely implemented in the financial sector across more than 50 countries, their application to the health sector remains limited. OBJECTIVE: This study aims to explore stakeholders' perspectives on introducing a regulatory sandbox into the Indonesian health system using e-malaria as a use case. METHODS: Using a participatory action research approach, this study conducted qualitative research, including desk reviews, focus group discussions, and in-depth interviews with stakeholders. This study sought to understand stakeholders' concerns and interests regarding the regulatory sandbox and to collaboratively develop a regulatory sandbox model to support the malaria program. RESULTS: The study revealed that most stakeholders had limited awareness of the regulatory sandbox concept. Concerns have been raised regarding the time required to establish regulations, knowledge gaps among stakeholders, data protection issues, and limited digital infrastructure in malaria endemic areas. Existing regulations have been found to be inadequate to accommodate disruptive healthtech for malaria. Nevertheless, through a collaborative process, stakeholders successfully developed a regulatory sandbox model specifically for e-malaria, with the crucial support of the Ministry of Health. CONCLUSIONS: The regulatory sandbox holds the potential for adoption in the Indonesian health system to address the limited legal framework and to facilitate the rapid and safe adoption of disruptive healthtech in support of the malaria elimination program. Through stakeholder involvement, guidelines for implementing the regulatory sandbox were developed and innovators were successfully invited to participate in the first-ever trial of a health regulatory sandbox for e-malaria in Indonesia. Future studies should provide further insights into the challenges encountered during the e-malaria regulatory sandbox pilot study, offering a detailed account of the implementation process.

Mapping and Visualization of Cancer Research in Indonesia: A Scientometric Analysis.

INTRODUCTION: The incidence of cancer and its prevalence are increasing in Indonesia. It is crucial to ensure national cancer policies are evidence-based and promote research. While cancer research is being conducted across Indonesia, the extent and focus of research activities are not known, with no existing synthesis of the cancer research landscape. We seek to address this gap by characterising trends in the extent and types of cancer research conducted in Indonesia. METHODS: Scientometric study using descriptive analyses to determine annual growth patterns in publications across all cancer research literature from Indonesia. We developed a classification system for both research type and study design which was applied to all included publications. A visualisation software tool (VOSviewer) was used to explore the geographical distribution of research activity. The Wilcoxon rank-sum test was used to determine the influence of international collaboration on the impact factor of journals in which articles were published. RESULTS: We retrieved 1773 cancer-related articles published by Indonesia-affiliated authors from 1961 to 2020, with notable year-on-year increases in the annual total number of published articles since 2015. Most articles (84.0%) were published by authors affiliated with institutions on Java Island. The most commonly published article type was basic research and discovery science (28.8%), using a one-group analytical study design (28.8%). International collaboration was significantly correlated with a higher h-index of the journal in which research was published (P < .0001, r = .317). CONCLUSION: An increase in the number and range of topics explored in cancer-related publications over time was identified. The summary of the current corpus of cancer-related research for Indonesia can be used to direct the development of the national cancer control plan alongside informing the national cancer research strategy. Our novel and feasible scientometric approach can be used to direct future national and regional mapping of cancer research.

Predicting New Daily COVID-19 Cases and Deaths Using Search Engine Query Data in South Korea From 2020 to 2021: Infodemiology Study.

BACKGROUND: Given the ongoing COVID-19 pandemic situation, accurate predictions could greatly help in the health resource management for future waves. However, as a new entity, COVID-19's disease dynamics seemed difficult to predict. External factors, such as internet search data, need to be included in the models to increase their accuracy. However, it remains unclear whether incorporating online search volumes into models leads to better predictive performances for long-term prediction. OBJECTIVE: The aim of this study was to analyze whether search engine query data are important variables that should be included in the models predicting new daily COVID-19 cases and deaths in short- and long-term periods. METHODS: We used country-level case-related data, NAVER search volumes, and mobility data obtained from Google and Apple for the period of January 20, 2020, to July 31, 2021, in South Korea. Data were aggregated into four subsets: 3, 6, 12, and 18 months after the first case was reported. The first 80% of the data in all subsets were used as the training set, and the remaining data served as the test set. Generalized linear models (GLMs) with normal, Poisson, and negative binomial distribution were developed, along with linear regression (LR) models with lasso, adaptive lasso, and elastic net regularization. Root mean square error values were defined as a loss function and were used to assess the performance of the models. All analyses and visualizations were conducted in SAS Studio, which is part of the SAS OnDemand for Academics. RESULTS: GLMs with different types of distribution functions may have been beneficial in predicting new daily COVID-19 cases and deaths in the early stages of the outbreak. Over longer periods, as the distribution of cases and deaths became more normally distributed, LR models with regularization may have outperformed the GLMs. This study also found that models performed better when predicting new daily deaths compared to new daily cases. In addition, an evaluation of feature effects in the models showed that NAVER search volumes were useful variables in predicting new daily COVID-19 cases, particularly in the first 6 months of the outbreak. Searches related to logistical needs, particularly for "thermometer" and "mask strap," showed higher feature effects in that period. For longer prediction periods, NAVER search volumes were still found to constitute an important variable, although with a lower feature effect. This finding suggests that search term use should be considered to maintain the predictive performance of models. CONCLUSIONS: NAVER search volumes were important variables in short- and long-term prediction, with higher feature effects for predicting new daily COVID-19 cases in the first 6 months of the outbreak. Similar results were also found for death predictions.

Understanding the Community Risk Perceptions of the COVID-19 Outbreak in South Korea: Infodemiology Study.

BACKGROUND: South Korea is among the best-performing countries in tackling the coronavirus pandemic by using mass drive-through testing, face mask use, and extensive social distancing. However, understanding the patterns of risk perception could also facilitate effective risk communication to minimize the impacts of disease spread during this crisis. OBJECTIVE: We attempt to explore patterns of community health risk perceptions of COVID-19 in South Korea using internet search data. METHODS: Google Trends (GT) and NAVER relative search volumes (RSVs) data were collected using COVID-19-related terms in the Korean language and were retrieved according to time, gender, age groups, types of device, and location. Online queries were compared to the number of daily new COVID-19 cases and tests reported in the Kaggle open-access data set for the time period of December 5, 2019, to May 31, 2020. Time-lag correlations calculated by Spearman rank correlation coefficients were employed to assess whether correlations between new COVID-19 cases and internet searches were affected by time. We also constructed a prediction model of new COVID-19 cases using the number of COVID-19 cases, tests, and GT and NAVER RSVs in lag periods (of 1-3 days). Single and multiple regressions were employed using backward elimination and a variance inflation factor of <5. RESULTS: The numbers of COVID-19-related queries in South Korea increased during local events including local transmission, approval of coronavirus test kits, implementation of coronavirus drive-through tests, a face mask shortage, and a widespread campaign for social distancing as well as during international events such as the announcement of a Public Health Emergency of International Concern by the World Health Organization. Online queries were also stronger in women (r=0.763-0.823; P<.001) and age groups ≤29 years (r=0.726-0.821; P<.001), 30-44 years (r=0.701-0.826; P<.001), and ≥50 years (r=0.706-0.725; P<.001). In terms of spatial distribution, internet search data were higher in affected areas. Moreover, greater correlations were found in mobile searches (r=0.704-0.804; P<.001) compared to those of desktop searches (r=0.705-0.717; P<.001), indicating changing behaviors in searching for online health information during the outbreak. These varied internet searches related to COVID-19 represented community health risk perceptions. In addition, as a country with a high number of coronavirus tests, results showed that adults perceived coronavirus test-related information as being more important than disease-related knowledge. Meanwhile, younger, and older age groups had different perceptions. Moreover, NAVER RSVs can potentially be used for health risk perception assessments and disease predictions. Adding COVID-19-related searches provided by NAVER could increase the performance of the model compared to that of the COVID-19 case-based model and potentially be used to predict epidemic curves. CONCLUSIONS: The use of both GT and NAVER RSVs to explore patterns of community health risk perceptions could be beneficial for targeting risk communication from several perspectives, including time, population characteristics, and location.

Spatiotemporal patterns of malaria at cross-boundaries area in Menoreh Hills, Java, Indonesia.

BACKGROUND: Comprehensive reports of malaria in Menoreh Hills, Central Java, Indonesia, a unique district cross-boundaries area under three districts and two provinces have been published previously. However, no study was performed to identify the hotspots of malaria in this cross-boundaries area, Kaligesing and Bagelen Subdistricts in Purworejo, Jawa Tengah Province and Kokap Subdistrict in Kulon Progo, Yogyakarta Province, using a longitudinal spatial data. METHODS: Monthly reports of malaria cases at primary health centres during 2005-2015 were collected and processed with ArcGIS and SaTScan to identify the malaria distribution at the village level. Malaria distribution was analysed using global spatial autocorrelation (Moran index) in ArcGIS. Cluster analysis was conducted using SaTScan purely spatial clustering and purely temporal clustering. Cluster characteristics resulted from three different approach were compared and analysed. RESULTS: During the last 11 years, 3812 malaria cases were reported and the number of high case incidence (HCI) villages were increased continuously. Malaria spatial distribution in Menoreh Hills was clustered spatially. Using three different approaches of time period ranges, consistent conclusion was found i.e. most likely clusters always occurred in the Purworejo district while the secondary clusters appeared later in the cross-boundaries districts. CONCLUSION: Spatiotemporal analysis of an 11 years surveillance data showed that hotspots of malaria cases in Menoreh Hills were continuously located in Purworejo district. The success of malaria elimination in the cross boundaries area of Menoreh Hills might be depended on the success in malaria case management and surveillance in this hotspot area.

Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

BACKGROUND: Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced "My health bank," a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. OBJECTIVE: This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. METHODS: This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 ("disagree strongly") to 5 ("Agree strongly"). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. RESULTS: This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design. CONCLUSIONS: Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection.

Metadata Correction: Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

[This corrects the article DOI: .].

Change of strategy is required for malaria elimination: a case study in Purworejo District, Central Java Province, Indonesia.

BACKGROUND: Malaria has been targeted for elimination from Indonesia by 2030, with varying timelines for specific geographical areas based on disease endemicity. The regional deadline for malaria elimination for Java island, given the steady decrease of malaria cases, was the end of 2015. Purworejo District, a malaria-endemic area in Java with an annual parasite incidence (API) of 0.05 per 1,000 population in 2009, aims to enter this elimination stage. This study documents factors that affect incidence and spatial distribution of malaria in Purworejo, such as geomorphology, topography, health system issues, and identifies potential constraints and challenges to achieve the elimination stage, such as inter-districts coordination, decentralization policy and allocation of financial resources for the programme. METHODS: Historical malaria data from 2007 to 2011 were collected through secondary data, in-depth interviews and focus group discussions during study year (2010-2011). Malaria cases were mapped using the village-centroid shape file to visualize its distribution with geomorphologic characteristics overlay and spatial distribution of malaria. API in each village in Purworejo and its surrounding districts from 2007 to 2011 was stratified into high, middle or low case incidence to show the spatiotemporal mapping pattern. RESULTS: The spatiotemporal pattern of malaria cases in Purworejo and the adjacent districts demonstrate repeated concentrated occurrences of malaria in specific areas from 2007 to 2011. District health system issues, i.e., suboptimal coordination between primary care and referral systems, suboptimal inter-district collaboration for malaria surveillance, decentralization policy and the lack of resources, especially district budget allocations for the malaria programme, were major constraints for programme sustainability. CONCLUSIONS: A new malaria elimination approach that fits the local disease transmission, intervention and political system is required. These changes include timely measurements of malaria transmission, revision of the decentralized government system and optimizing the use of the district capitation fund followed by an effective technical implementation of the intervention strategy.

Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia.

BACKGROUND: Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case. METHODS: All malaria cases (2007-2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control. RESULTS: After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011-2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence. CONCLUSION: Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase.

Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia.

BACKGROUND: Indonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. The Municipality of Sabang which historically had one of the highest levels of malaria in Aceh province aims to achieve elimination by the end of 2013. METHOD: From 2008 to 2010, baseline surveys of malaria interventions, mapping of all confirmed malaria cases, categorization of residual foci of malaria transmission and vector surveys were conducted in Sabang, Aceh, a pilot district for malaria elimination in Indonesia. To inform future elimination efforts, mass screening from the focal areas to measure prevalence of malaria with both microscopy and PCR was conducted. G6PD deficiency prevalence was also measured. RESULT: Despite its small size, a diverse mixture of potential malaria vectors were documented in Sabang, including Anopheles sundaicus, Anopheles minimus, Anopheles aconitus and Anopheles dirus. Over a two-year span, the number of sub-villages with ongoing malaria transmission reduced from 61 to 43. Coverage of malaria diagnosis and treatment, IRS, and LLINs was over 80%. Screening of 16,229 residents detected 19 positive people, for a point prevalence of 0.12%. Of the 19 positive cases, three symptomatic infections and five asymptomatic infections were detected with microscopy and 11 asymptomatic infections were detected with PCR. Of the 19 cases, seven were infected with Plasmodium falciparum, 11 were infected with Plasmodium vivax, and one subject was infected with both species. Analysis of the 937 blood samples for G6PD deficiency revealed two subjects (0.2%) with deficient G6PD. DISCUSSION: The interventions carried out by the government of Sabang have dramatically reduced the burden of malaria over the past seven years. The first phase, carried out between 2005 and 2007, included improved malaria diagnosis, introduction of ACT for treatment, and scale-up of coverage of IRS and LLINs. The second phase, from 2008 to 2010, initiated to eliminate the persistent residual transmission of malaria, consisted of development of a malaria database to ensure rapid case reporting and investigation, stratification of malaria foci to guide interventions, and active case detection to hunt symptomatic and asymptomatic malaria carriers.

Comparison of Non-AI and AI-Enabled M-Health Platforms for COVID-19 Self Screening in Indonesia.

This study aimed to analyze and differentiate the role of AI and no AI-supported m-health platforms for COVID-19 self-screening in Indonesia. We utilized a mysterious shopping method to develop four standardized cases with various severity levels of COVID-19 tested in Indonesia's most popular mHealth platforms. We selected seven apps from the top 200 free mHealth apps in the "Medical" category in the Google Play Store equipped with COVID-19 symptom checkers. A total of 36 teleconsultations were performed in four chatbot-based, two apps supported with AI combined with a human-based approach, and three apps with the human-based process. Teleconsultations were recorded, classified, and analyzed compared with the COVID-19 guideline by the MoH of Indonesia. The study indicated that most of the self-screening provided questions that had consistently led to the COVID-19 condition such as cough, fever, and shortness of breath and followed the guideline from the national health authority.

Mental Health Teleconsultation Patterns on the Most Popular mHealth Platforms in Indonesia.

Access to telehealth services increased significantly during the COVID-19 pandemic in Indonesia, including for mental health. This study aims to analyze the patterns and variations of mental health teleconsultation (especially for insomnia and depression) on selected Android-based mHealth platforms in Indonesia. We performed 32 teleconsultation sessions on 8 most popular mHealth platforms. About 88% of doctors recommend that patients with depression visit a psychiatrist. On the other hand, 38% of doctors recommended visiting a psychiatrist for insomnia cases. Our findings show differences and similarities in handling depression and insomnia cases in the Indonesian mHealth apps. These variations include case history exploration, clinical decision, and therapeutic. With the growth of telehealth developments, we recommend policy actions and further studies related to the implementation of telehealth in Indonesia.

Community Mobility and COVID-19 Dynamics in Jakarta, Indonesia.

In response to the COVID-19 pandemic, mobile-phone data on population movement became publicly available, including Google Community Mobility Reports (CMR). This study explored the utilization of mobility data to predict COVID-19 dynamics in Jakarta, Indonesia. We acquired aggregated and anonymized mobility data sets from 15 February to 31 December 2020. Three statistical models were explored: Poisson Regression Generalized Linear Model (GLM), Negative Binomial Regression GLM, and Multiple Linear Regression (MLR). Due to multicollinearity, three categories were reduced into one single index using Principal Component Analysis (PCA). Multiple Linear Regression with variable adjustments using PCA was the best-fit model, explaining 52% of COVID-19 cases in Jakarta (R-Square: 0.52; p < 0.05). This study found that different types of mobility were significant predictors for COVID-19 cases and have different levels of impact on COVID-19 dynamics in Jakarta, with the highest observed in "grocery and pharmacy" (4.12%). This study demonstrates the practicality of using CMR data to help policymakers in decision making and policy formulation, especially when there are limited data available, and can be used to improve health system readiness by anticipating case surge, such as in the places with a high potential for transmission risk and during seasonal events.

Social media sentiment analysis to monitor the performance of vaccination coverage during the early phase of the national COVID-19 vaccine rollout.

BACKGROUND AND OBJECTIVE: Social media sentiment analysis based on Twitter data can facilitate real-time monitoring of COVID-19 vaccine-related concerns. Thus, the governments can adopt proactive measures to address misinformation and inappropriate behaviors surrounding the COVID-19 vaccine, threatening the success of the national vaccination campaign. This study aims to identify the correlation between COVID-19 vaccine sentiments expressed on Twitter and COVID-19 vaccination coverage, case increase, and case fatality rate in Indonesia. METHODS: We retrieved COVID-19 vaccine-related tweets collected from Indonesian Twitter users between October 15, 2020, to April 12, 2021, using Drone Emprit Academic (DEA) platform. We collected the daily trend of COVID-19 vaccine coverage and the rate of case increase and case fatality from the Ministry of Health (MoH) official website and the KawalCOVID19 database, respectively. We identified the public sentiments, emotions, word usage, and trend of all filtered tweets 90 days before and after the national vaccination rollout in Indonesia. RESULTS: Using a total of 555,892 COVID-19 vaccine-related tweets, we observed the negative sentiments outnumbered positive sentiments for 59 days (65.50%), with the predominant emotion of anticipation among 90 days of the beginning of the study period. However, after the vaccination rollout, the positive sentiments outnumbered negative sentiments for 56 days (62.20%) with the growth of trust emotion, which is consistent with the positive appeals of the recent news about COVID-19 vaccine safety and the government's proactive risk communication. In addition, there was a statistically significant trend of vaccination sentiment scores, which strongly correlated with the increase of vaccination coverage (r = 0.71, P<.0001 both first and second doses) and the decreasing of case increase rate (r = -0.70, P<.0001) and case fatality rate (r = -0.74, P<.0001). CONCLUSIONS: Our results highlight the utility of social media sentiment analysis as government communication strategies to build public trust, affecting individual willingness to get vaccinated. This finding will be useful for countries to identify and develop strategies for speed up the vaccination rate by monitoring the dynamic netizens' reactions and expression in social media, especially Twitter, using sentiment analysis.

High variability in model performance of Google relative search volumes in spatially clustered COVID-19 areas of the USA.

OBJECTIVE: Incorporating spatial analyses and online health information queries may be beneficial in understanding the role of Google relative search volume (RSV) data as a secondary public health surveillance tool during pandemics. This study identified coronavirus disease 2019 (COVID-19) clustering and defined the predictability performance of Google RSV models in clustered and non-clustered areas of the USA. METHODS: Getis-Ord General and local G statistics were used to identify monthly clustering patterns. Monthly country- and state-level correlations between new daily COVID-19 cases and Google RSVs were assessed using Spearman's rank correlation coefficients and Poisson regression models for January-December 2020. RESULTS: Huge clusters involving multiple states were found, which resulted from various control measures in each state. This demonstrates the importance of state-to-state coordination in implementing control measures to tackle the spread of outbreaks. Variability in Google RSV model performance was found among states and time periods, possibly suggesting the need to use different frameworks for Google RSV data in each state. Moreover, the sign of correlation can be utilized to understand public responses to control and preventive measures, as well as in communicating risk. CONCLUSION: COVID-19 Google RSV model accuracy in the USA may be influenced by COVID-19 transmission dynamics, policy-driven community awareness and past outbreak experiences.

Design and prototype of TOMO: an app for improving drug resistant TB treatment adherence.

Background: Drug resistance and multi drugs tuberculosis (DR/MDR-TB) are associated with patients' low adherence to undergoing complex treatment. Driven by the increasing use and penetration of a smartphone and the End of TB Strategy that seeks for digital health solution, Center for Tropical Medicine Universitas Gadjah Mada has developed TOMO, an Android-based app for improving medication adherence in MDR-TB. Objective: This paper aims to present the sequential steps to develop the app, its general architecture, and its functionalities. Methods: It is a design thinking process involving two MDR-TB referral centers, district health offices, primary health centers, and MDR-TB patients in Central Java and Yogyakarta, Indonesia. We adopted the Principles for Digital Development to develop and design the app. MDR-TB treatment guideline from the Indonesian Ministry of Health was used to develop functionalities of the app for improving adherence. Results: TOMO app could be used by patients, primary health centers, clinical teams, and case managers. The app prototype features include adverse event records and reports, medication-taking reminders, and communication between the patient and the TB-MDR case manager. We have successfully tested the functionalities based on four use cases: patients with high adherence, patients with low adherence, patients with adverse events, and patients following treatment in the primary health center without any visit to the MDR-TB center. Conclusion: TOMO app has contributed to the limited body of literature on improving TB-MDR adherence with digital health intervention, especially using a health app. The app has been tested using four scenarios. We will follow up with usability testing before implementing the app in a real setting.

Applications of Google Search Trends for risk communication in infectious disease management: A case study of the COVID-19 outbreak in Taiwan.

OBJECTIVE: An emerging outbreak of a novel coronavirus, COVID-19, has now been detected in at least 211 countries worldwide. Given this pandemic situation, robust risk communication is urgently needed, particularly in affected countries. Therefore, this study explored the potential use of Google Trends (GT) to monitor public restlessness toward COVID-19 infection in Taiwan. METHODS: We retrieved GT data for the specific locations and subregions in Taiwan nationwide using defined search terms related to the coronavirus, handwashing, and face masks. RESULTS: Searches related to COVID-19 and face masks in Taiwan rapidly increased following the announcements of Taiwan's first imported case and reached a peak as locally acquired cases were reported. However, searches for handwashing gradually increased during the period of face-mask shortage. Moreover, high to moderate correlations between Google relative search volumes (RSVs) and COVID-19 cases were found in Taipei (lag-3), New Taipei (lag-2), Taoyuan (lag-2), Tainan (lag-1), Taichung (lag0), and Kaohsiung (lag0). CONCLUSION: In response to the ongoing outbreak, our results demonstrated that GT could potentially define the proper timing and location for practicing appropriate risk communication strategies for affected populations.

Improving Dengue Surveillance System with Administrative Claim Data in Indonesia: Opportunities and Challenges.

Administrative claim data is believed as one of the promising data set to augment the mandatory surveillance system which suffered from under-reporting and delay in reporting. Therefore, this study aims to examine whether the Indonesian National Health Insurance (INHI) sample data could complement dengue case-based surveillance system in a more practical way. Afterwards, this analysis also identified several future opportunities and challenges in improving the dengue surveillance system. We utilized the referral care table linked with capitation and non-capitation-based primary care service table from 2015-2016. Data cleaning, query and visualization were performed using Tableau Public and Microsoft Power BI. Result shows that dengue referral pattern is indicating the opportunity to detect dengue cases in an earlier stage and high utilization of referral care disclose the patient behaviour. Therefore, anonymous INHI sample data set potentially to complement dengue traditional surveillance system. A huge number of health facilities as data providers, bridging and interoperability chance and opportunity of early detection are identified as future opportunities. However, we also determine challenges involving how to provide the mechanism for the quick and interoperable reporting system, how to construct supportive regulation and anticipatory approach regarding the change in dengue diagnosis criteria as the implementation of ICD 11 code. Thus, practical approaches should be prepared to support the utilization of INHI sample data.

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia.

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.

Epidemiology and risk factors of Strongyloides stercoralis infection in Papua, Indonesia: a molecular diagnostic study.

Strongyloides stercoralis is a parasitic worm that is of considerable clinical relevance. Indeed, it may persist asymptomatically for many years, but can lead to potentially fatal dissemination when the host's immune status is impaired. As commonly employed stool microscopy techniques (e.g. Kato-Katz thick smear) fail to detect S. stercoralis, the epidemiology is poorly understood. In 2013, we conducted a cross-sectional household survey in the district of Mimika in Papua, Indonesia. A total of 331 individuals, aged 1 month to 44 years, had a single stool sample subjected to real-time polymerase chain reaction (PCR) for S. stercoralis diagnosis. The prevalence of S. stercoralis infection was 32.0% (106/331 individuals); higher than any of the three main soil-transmitted helminths (Ascaris lumbricoides, 23.9%; Trichuris trichiura, 18.4%; and hookworm, 17.2%). Amongst the S. stercoralis-infected individuals, 73.6% were concurrently infected with another helminth, with hookworm being the most frequent co-infection (27.4%). Fourteen percent of the S. stercoralis infections had low cycle threshold values on real-time PCR, which may indicate a higher infection intensity. Multivariate logistic regression analysis revealed that age ≥5 years (adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 3.1-10.8) was significantly associated with S. stercoralis infection. There is a need for in-depth clinical and diagnostic studies to elucidate the public health impact of S. stercoralis infection in Indonesia.