Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months

Background

Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia.

Methods

Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression.

Results

The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045).

Conclusion

Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.

Province clustering based on the percentage of communicable disease using the BCBimax biclustering algorithm

Indonesia needs to lower its high infectious disease rate. This requires reliable data and following their temporal changes across provinces. We investigated the benefits of surveying the epidemiological situation with the imax biclustering algorithm using secondary data from a recent national scale survey of main infectious diseases from the National Basic Health Research (Riskesdas) covering 34 provinces in Indonesia. Hierarchical and k-means clustering can only handle one data source, but BCBimax biclustering can cluster rows and columns in a data matrix. Several experiments determined the best row and column threshold values, which is crucial for a useful result. The percentages of Indonesia's seven most common infectious diseases (ARI, pneumonia, diarrhoea, tuberculosis (TB), hepatitis, malaria, and filariasis) were ordered by province to form groups without considering proximity because clusters are usually far apart. ARI, pneumonia, and diarrhoea were divided into toddler and adult infections, making 10 target diseases instead of seven. The set of biclusters formed based on the presence and level of these diseases included 7 diseases with moderate to high disease levels, 5 diseases (formed by 2 clusters), 3 diseases, 2 diseases, and a final order that only included adult diarrhoea. In 6 of 8 clusters, diarrhea was the most prevalent infectious disease in Indonesia, making its eradication a priority. Direct person-to-person infections like ARI, pneumonia, TB, and diarrhoea were found in 4-6 of 8 clusters. These diseases are more common and spread faster than vector-borne diseases like malaria and filariasis, making them more important.

Prevalence and associated factors for prehypertension and hypertension among Indonesian adolescents: a cross-sectional community survey

OBJECTIVE

To estimate the prevalence and determine the associated factors for developing prehypertension and hypertension among Indonesian adolescents.

DESIGN

National cross-sectional study.

SETTING

This study was conducted in all the provinces in Indonesia.

PARTICIPANTS

The population in this study were all household members in Basic Health Research 2013 aged 15-19 years. The sample was all members of the 2013 Riskesdas household aged 15-19 years with the criteria of not having physical and mental disabilities, and having complete data. The number of samples analysed was 2735, comprising men (n=1319) and women (n=1416).

MAIN OUTCOME

Dependent variables were prehypertension and hypertension in adolescents based on blood pressure measurements.

RESULTS

The results of the analysis showed that the prevalence of prehypertension in adolescents was 16.8% and hypertension was 2.6%. In all adolescents, the risk factors for prehypertension were boys (adjusted OR, aOR 1.48; 95% CI 1.10 to 1.97), 18 years old (aOR 14.64; 95% CI 9.39 to 22.80), and 19 years old (aOR 19.89; 95% CI 12.41 to 31.88), and obese (aOR 2.16; 95% CI 1.02 to 4.58). Risk factors for hypertension in all adolescents included the age of 18 years old (aOR 3.06; 95% CI 1.28 to 7.34) and 19 years (aOR 3.25; 95% CI 1.25 to 8.41) and obesity (aOR 5.69; 95% CI 2.20 to 14.8). In adolescent girls, the chance of developing prehypertension increased with increasing age and low-density lipoprotein (LDL) cholesterol levels. Several risk factors for hypertension in adolescent boys were age, central obesity and LDL cholesterol levels.

CONCLUSION

This study shows that the trend of prehypertension in adolescents has appeared, besides hypertension. There are distinct patterns of factors that influence it in adolescent girls and boys, which can be useful to sharpen of planning and implementing health programmes.

Sociodemographic and Healthcare Factors Associated with Stunting in Children Aged 6-59 Months in the Urban Area of Bali Province, Indonesia 2018

Stunting is a worldwide public health concern, including in Indonesia. Even when living in an urban area with urban characteristics, it is still possible for children to be at risk of stunting. The aim of this study was to determine the sociodemographic and healthcare factors associated with stunting in a province experiencing tourism growth, namely, Bali. Cross-sectional data on Bali Province from the Indonesian Basic Health Research Survey (Riskesdas, 2018) were used as the basis for the research analysis. A total of 846 respondents under five years of age were analyzed, indicating a stunting prevalence of 19.0%. Multivariate logistic regression demonstrated low maternal educational attainment (adjustedOR = 1.92; 95% Confidence Interval = 1.24-2.97), the inadequate consumption of iron tablets during pregnancy (adjustedOR = 1.56; 95% Confidence Interval = 1.08-2.24), and no extended family (adjustedOR = 1.55; 95% Confidence Interval = 1.07-2.26) as being significantly associated with stunting. According to these findings, sociodemographic and healthcare factors are associated with stunting in urban Bali. Improving women's education, ensuring sufficient iron tablets are consumed during pregnancy, and encouraging the involvement of the extended family in childcare are recommended.

Risk factors for the metabolic syndrome in non-obese older Indonesians

BACKGROUND AND OBJECTIVES

The problem of metabolic syndrome among non-obese older people is often ignored. This study examines the risk factors for metabolic syndrome in non-obese older people in Indonesia. We analyzed information collected from 3323 non-obese older respondents interviewed in the 2018 Basic Health Research program.

METHODS AND STUDY DESIGN

The outcome variable was the metabolic syndrome consisting of three components: high lipid profile, diabetes mellitus, and hypertension. The potential predictors analyzed were socio-demographic and behavioral factors consisting of psychomotor (cigarette smoking + physical activity) and dietary behavior (consumption of fat + fruit/vegetable). Multinomial logistic regression analysis was employed to assess metabolic syndrome risk factors in non-obese older people.

RESULTS

We found that the proportion of non-obese older people in Indonesia with metabolic syndrome was 83.8% (95%CI: 82.4-85.2%). The odds of developing 2-3 components of metabolic syndrome increased in respondents from rural areas (aOR=1.26, p=0.033) and those with moderate psychomotor behavior problems (current smoker/ex-smoker with sufficient physical activity) (aOR=1.48, p=0.002).

CONCLUSIONS

Health promotion activities are vital to improve awareness and promote healthy behaviors, specifically for those living in rural areas and smoking cigarettes.

How Well Does Body Mass Index (BMI) Predict Undiagnosed Hypertension and Diabetes in Indonesian Adults Community Population?

BACKGROUND: Previous studies have reported that Body Mass Index (BMI) cut-off was related to non-communicable diseases. This study aimed to give the latest evidence related to the accuracy of BMI cut-off towards undiagnosed hypertension and diabetes in the Indonesian population. METHODS: This was A cross-sectional study that involved data of the 2018 national population-based health survey, with the samples were 15,516 male and female populations aged between 19 years old and above. This study only included those claimed to have never been diagnosed as suffering from diabetes and hypertension by health workers. Receiver operating characteristic (ROC) analysis was conducted to assess the optimal BMI cut-off. The logistic regression was performed to assess the association of BMI on undiagnosed hypertension and diabetes controlled by several variables. RESULTS: The average BMI sample was 24 kg/m2 (SD = 4.6 kg/m2. The proportion of undiagnosed hypertension was 36.9%, and 12.3% for the proportion of undiagnosed diabetes. According to the ROC, the result shows BMI was more sensitive to hypertension conditions compared to diabetes. BMI cut-off points at 23.9 kg/m2 (AUC=0.59;Se=64.3%;Sp=53.4%) was the optimum value to predict hypertension and 24.9 kg/m2 (AUC=0.55;Se=53.1%;Sp=56.4%) was the optimum for diabetes. CONCLUSIONS: Based on the optimal AUC cut-off points for BMI which is around 0.5, BMI needs to be reconsidered as an anthropometric index in predicting undiagnosed hypertension and diabetes. And an assessment can be made using other anthropometric indices, such as waist circumference to predict undiagnosed hypertension and diabetes.

Stigma during COVID-19 pandemic among healthcare workers in greater Jakarta metropolitan area: a cross-sectional online study

Background: COVID-19, which started in Wuhan, has become a global pandemic leading to a new global risk to human health. Lack of information or misinformation about COVID-19 can lead to stigmatization, including for health workers. This study aims to determine the stigmatization among health workers during the COVID-19 pandemic within the Greater Jakarta Metropolitan Area. Methods: This study was a cross-sectional study conducted online using Google Forms in the Jabodetabek area. The questionnaire’s link was distributed through social media, including Whatsapp, Facebook, Twitter, and Instagram. The study sample is health workers who live in Jabodetabek and carry out health practices. Stigma is measured using four dimensions: personalized stigma, disclosure concerns, public attitudes, and negative self-image. Result: The negative self-image dimension is the dimension most felt by health workers. More than half of health workers agreed that during the COVID-19 pandemic, they put their families at risk because of their status as health workers. The stigma of health workers who work in hospitals is higher than that of non-hospital health workers, such as health centers, clinics, and laboratories. Conclusion: There was any stigmatization among healthcare workers in Greater Jakarta Metropolitan Area. Stigmatization was higher among healthcare workers who work in hospitals compared to those who work in non-hospitals. Some efforts should be made to reduce stigmatization among health workers, such as provide correct information to the public, equip health personnel with adequate personal protective equipment, and give incentives periodically to the health workers. Keywords: Stigma, COVID-19, healthcare workers, Greater Jakarta Metropolitan Area Abstrak Latar belakang: COVID-19 yang bermula dari Wuhan telah menjadi pandemi global yang mengancam kesehatan umat manusia. Kurangnya informasi atau informasi yang salah mengenai COVID-19 dapat menyebabkan adanya stigmatisasi termasuk terhadap tenaga kesehatan. Penelitian ini menilai adanya stigmatisasi terhadap tenaga kesehatan selama pandemi COVID-19 di wilayah Jabodetabek. Metode: Penelitian ini merupakan penelitian potong lintang dan dilakukan secara daring menggunakan Google Form di wilayah Jabodetabek. Tautan pengisian kuesioner disebarkan melalui media sosial seperti Whatsapp, Facebook, Twitter dan Instagram. Sampel studi adalah tenaga kesehatan yang tinggal di Jabodetabek dan melakukan praktik kesehatan. Stigma diukur menggunakan empat dimensi yaitu personized stigma, disclosure concerns, concerns about public attitudes dan negative self-image. Hasil: Dimensi negative self-image merupakan dimensi yang paling dirasakan oleh tenaga kesehatan. Lebih dari separuh tenaga kesehatan setuju bahwa selama pandemi COVID-19 mereka membahayakan keluarga mereka karena status mereka sebagai tenaga kesehatan. Stigma pada tenaga kesehatan yang bekerja di rumah sakit lebih tinggi disbanding tenaga kesehatan yang bekerja bukan di rumah sakit seperti puskesmas, klinik dan laboratorium. Kesimpulan: Terdapat stigmatisasi pada petugas kesehatan di jabodetabek. Stigmatisasi lebih tinggi di antara petugas kesehatan yang bekerja di rumah sakit dibandingkan dengan mereka yang bekerja tidak di rumah sakit. Beberapa upaya yang perlu dilakukan untuk mengurangi stigmatisasi di kalangan petugas kesehatan, seperti memberikan informasi yang benar kepada masyarakat, melengkapi tenaga kesehatan dengan alat pelindung diri yang memadai, dan memberikan insentif kepada mereka secara berkala. Kata Kunci:   Stigma, COVID-19, tenaga kesehatan, jabodetabek        

Obesity in Older Adults Indonesia: The Role of Healthy Behaviour Factors and Metabolic Syndrome

Obesity in older adults has been a health problem in both developed and developing countries. This study aimed to determine the problem of obesity in the older adults group according to behavioral factors and metabolic syndrome. This study used a cross-sectional design. The number of samples analyzed was 5120 people, all of which were older adults aged 60 years and over. The prevalence of obesity in older adults was 17.6 percent. The results of the advanced analysis also showed a correlation between the variables gender, age, region, education, smoking behavior, and levels of LDL cholesterol, triglycerides, HDL cholesterol, hypertension, and diabetes mellitus with the incidence of obesity in the older adults.

Changes in Diet Quality of Adults Patients with Type Two Diabetes : Cohort Study of Non-Communicable Diseases Risk Factors

Background:   The compliance of Alternate Healthy Eating Index (AHEI) 2010 influences their risk of complications in type two diabetes mellitus (T2DM). In Indonesia, AHEI-2010 has not been widely used in evaluating the diet quality in people after diagnosed T2DM.Objectives: To analyze changes in diet quality of adults patients with T2DM. Methods: This study was analyzed using a secondary data from “Cohort Study of Non-Communicable Diseases Risk Factors” by Indonesian Ministry of Health, on 105 adults newly diagnosed with T2DM. The diagnosis of T2DM was assessed based on the results laboratory tests of fasting blood glucose (FBG) ≥126 mg/dL and 2-hours post-75-g glucose load (2h-PG) ≥200 mg/dL. Dietary intake data was collected twice (at the beginning and the end of monitoring) using a 24-hour recall. The assessment of diet quality uses modified AHEI-2010 USA according to the Indonesians Dietary Guidelines, especially in the portion of the food components.   Results: The total score for diet quality was higher at the beginning of monitoring 54.9 than the end of monitoring 53.3 and there was no statistical significance differences (p≥0.05). The total score from diet quality decreased 1.1 points, 53.4% of subjects showed score deterioration (deteriorating diet quality) and 46.7% showed score improvement (improved diet quality). There was a significant differences at the beginning and the end of monitoring only to components score of red/processed meat (p <0.05).Conclusions: Changes in diet quality that deteriorating over time during monitoring, characterized by a decrease in the total score for diet quality. 

High carbohydrate intake increases risk of coronary heart disease in adults: a prospective cohort study

BackgroundCoronary heart disease (CHD) ranks second after diabetes mellitus (DM) based on hazard rate, and after stroke (based on number of deaths caused). Our aim was to determine the risk factor and magnitude of CHD among adults. Methods A cohort study on risk factors of non-communicable diseases (CS-RFNCD) was conducted on subjects aged ≥25 years. Initiated by screening, follow-up (FU) was done 3 times yearly and complete health examination every 2 years. CHD cases screened by electrocardiographic examination on subjects aged ≥40 years and <40 years with history of hypertension and/or heart disease. Screening results found 840 of 5690 subjects with CHD diagnosis who were excluded from cohort study sample. Non-CHD subjects and those aged <40 years without a history of hypertension and/or heart disease, totalling 4840 people, were included in study sample and followed up for 6 years. Data were analyzed using Cox regression.ResultsCarbohydrate intake of ≥60% of total energy had a 2.8-fold higher CHD risk [HR=2.790; 95% CI: 1.962 - 3.967; p=0.000] than that of an intake of <60% of total energy. Age of ≥55 years had 2.6-fold higher CHD risk [HR=2.573; 95% CI: 1.803 - 3.671; p=0.000] than age of <55 years. Blood total cholesterol of ≥200 mg/dL had 1.9-fold higher CHD risk [HR=1.893; 95% CI: 1.319 - 2.715; p=0.001] than that of <200 mg/dL.ConclusionHigher intake of carbohydrate increases CHD incidence among adults. Efforts in controlling CHD risk factors are still needed especially in consumption behavior through a family approach.