Noncommunicable diseases risk factors and the risk of COVID-19 among university employees in Indonesia

Introduction

Noncommunicable diseases (NCDs) are still a major public health problem in Indonesia. Studies have shown that risk factors of NCDs are associated with coronavirus disease 2019 (COVID-19) severity and mortality. However, it is unclear whether NCD risk factors are also risks for new COVID-19 cases. This study aimed to obtain an NCD risk profile among university employees and its associations with contracting COVID-19.

Methods

A cross-sectional study was conducted in October 2021. Participants were administrative employees of Universitas Indonesia (UI), Depok City, West Java. Assessment of NCD risk factors was based on the World Health Organization STEPwise approach to NCD risk factor surveillance (WHO STEPS). Demographic, working, and medical-history data were obtained electronically by using a Google Form. Physical and laboratory examinations were done in the Integrated Post for NCDs. Risks were expressed as adjusted odds ratio (OR_adj) and 95% confidence interval (CI) in multivariate analyses.

Results

A total of 613 employees were enrolled. Men were predominant (54.8%), and about 36% of them work in shift as security personnel. About 66.7% were overweight or obese and 77.8% had hypertension. There were 138 (22.8%) employees who had COVID-19. Nearly all (95.6%) had been fully vaccinated against COVID-19. At-risk waist circumference (OR_adj 1.72, 95% CI 1.15–2.56, p = 0.008) and total cholesterol level of 200–239 mg/dL (OR_adj 2.30, 95% CI 1.19–4.44, p = 0.013) were independent risk factors, but shift work (OR_adj 0.52, 95% CI 0.34–0.80, p = 0.003) was protective against COVID-19.

Conclusion

The prevalence of NCD risk factors among university administrative employees was high, increasing the risk of contracting COVID-19. A behavioral intervention program to manage NCD risk factors at the university level is urgently needed according to the Health Promoting University framework.

Effectiveness of the Bacillus Calmette-Guerin vaccine in an Indonesian population with D543N NRAMP1 polymorphism

INTRODUCTION

Bacille Calmette-Guerin (BCG) vaccination remains a routine immunization in primary care in tuberculosis (TB)-endemic areas, though several studies found that its efficacy was inconclusive. Natural resistance-asociated machrophage protein 1 (NRAMP1) polymorphism has been shown to result in higher susceptibility to TB. Information on genetic susceptibility in populations will be useful in planning the application of the BCG vaccine. The present study explored BCG efficacy in a rural Timor population with specific NRAMP1 polymorphism in a TB-endemic region of eastern Indonesia.

METHODOLOGY

A case-control study with 64 newly diagnosed pulmonary TB patients and 65 healthy controls was performed. BCG scars were examined by a physician. NRAMP1 polymorphism was evaluated using molecular methods.

RESULTS

Half of the subjects (65; 50.4%) had a clear presenting BCG scar on the upper arm, suggesting a successful BCG vaccination. Among the subjects, D543N NRAMP1 polymorphism, history of contact with TB patients, and not having a clear BCG scar on the upper arm tended to be significantly association with active TB. The significant differences were more profound when subjects were divided based on presenting BCG scar. Subjects without clear BCG scars had significant association with developing TB disease (p = 0.014). In multivariate analysis, history of previous contact with TB patients and unclear presenting BCG scar were associated with active TB (OR 9.2; 2.0-43.8 95% CI, OR 4.8; 2.1-11.0 95% CI, respectively).

CONCLUSIONS

BCG vaccination in our population was effective for TB protection, especially in highly endemic areas of TB, regardless genetic susceptibility.

The social determinants of knowledge and perception on pulmonary tuberculosis among females in Jakarta, Indonesia

Background: Indonesia has not resolved tuberculosis burden since its prevalence and incidence has remained high. As the capital of Indonesia with a large population and a high number of tuberculosis cases, Jakarta has a distinctive condition of tuberculosis burden. This study aimed to obtain social determinants of knowledge and perception of pulmonary tuberculosis in an urban community.Methods: This study used 2,323 samples taken by random sampling in Jakarta during February-May 2011. Questionnaires were delivered to assess respondents’ knowledge and perception about pulmonary tuberculosis. Levels of knowledge were categorized into ‘poor’ and ‘good’. Perceptions about tuberculosis were measured by whether respondents perceived tuberculosis as a humiliating disease and a shunned disease.Results: Most respondents (88.7%) had good level of knowledge about tuberculosis, but misperception remained high (45.9%) in the community. Education level determined level of knowledge. The higher the education level the lower the risk of lack of knowledge. Tuberculosis perceptions were determined by family income and education level. Higher family income and education level were protective factors of misperception about tuberculosis as a humiliating disease and tendency to shun tuberculosis patients.Conclusion: People in urban area of Jakarta have good level of knowledge about tuberculosis, but it does not necessarily lead to proper perception of tuberculosis. Age, education level and having health insurance determined level of knowledge, while tuberculosis perceptions were determined much more by education level and family income. Tuberculosis control program should consider these determinants prior to developing a comprehensive strategy.

Primary Health Centre disaster preparedness after the earthquake in Padang Pariaman, West Sumatra, Indonesia

Background

The West Sumatra earthquake that occurred on September 30, 2009, caused severe damage in some districts, including Padang Pariaman. As Padang Pariaman is an earthquake-prone area, disaster and emergency management is necessary. Due to the limited health facilities, the health services completely rely on Puskesmas (Primary Health Centres, PHCs). This study is aimed at assessing the preparedness of PHCs to response to potential disasters in their surrounding area.

Findings

Padang Pariaman district was used in a case study setting to assess the readiness and preparedness of the PHCs there to face disasters. Self-administered questionnaire, key informant interview, and direct observation were used to obtain the data on human resources, facilities preparedness, and the procedures. The investigation focused on measuring four aspects, i.e. human resources, facilities preparedness, standard operating procedure (SOP), and policy. Due to the limited co-operation of the head of the PHCs, three PHCs were directly observed as a subsample. The evaluation was performed six months after the impact phase of the earthquake and three months after the PHCs' health staff training on improving the primary health care services. The number and quality of health staff in Padang Pariaman was far below ideal. Fewer than half of the PHCs had emergency facilities and only one considered the need for triage and fire management, whereas the transportation mode was still limited. An SOP and policy for facing disasters were not available in any of the PHCs. Therefore, promoting disaster preparedness, technical provision, including health staff training, is necessary.

Conclusions

Padang Pariaman district has not yet prepared its PHCs to face disaster, so it is apparent that PHCs' disaster preparedness in Padang Pariaman and also other earthquake-prone areas in Indonesia should be promoted. This should include increasing the number of doctors, providing training for health staff, and developing a comprehensive approach as well as coordination among government, hospitals, PHCs, and NGO's for disaster preparedness.

Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia

Background

A previous study showed that combination of zinc and vitamin A reduced sputum conversion time in pulmonary tuberculosis (TB) patients.

Objective

We studied the efficacy of which single micronutrient contributed more to the sputum conversion time.

Methods

In a double-blind randomized community trial, newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc, vitamin A, zinc + vitamin A or placebo on top of TB treatment. Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria. Nutritional status, chest x-ray, hemoglobin, C-reactive protein (CRP), retinol and zinc level were examined prior to, after 2 and 6 months of treatment.

Results

Initially, 300 patients were enrolled, and 255 finished the treatment. Most patients were severely malnourished (mean BMI 16.5 ± 2.2 Kg/m²). Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant. Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.

Conclusions

This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.

Malnutrition and socio-demographic factors associated with pulmonary tuberculosis in Timor and Rote Islands, Indonesia

OBJECTIVE

To identify nutritional and socio-demographic factors for the development of tuberculosis (TB) in Timor and Rote Island, Indonesia, so that intervention programmes can be developed to address these factors.

METHODS

In a case-control study, we enrolled new sputum smear-positive pulmonary TB patients as cases, and neighbours matched for sex and age as controls. Data obtained included history of TB, socio-demographic factors and nutritional status.

RESULTS

In the study, 121 TB patients and 371 controls participated. The mean age was 30 years: 56.3% were male and 43.7% female. Of the TB patients, 87% had malnutrition compared to 33% among controls. The mean body mass index (BMI) of the patients was significantly lower than that of the controls (16.1 +/- 2.3 kg/m(2) vs. 19.4 +/- 3.0 kg/m(2)). Factors associated with the development of TB were BMI (OR 0.5, 95%CI 0.4-0.6), family history of TB (OR 3.2, 95%CI 1.6-6.4), living in an extended family (OR 2.7, 95%CI 1.5-4.8), being non-indigenous to Timor and Rote Islands (OR 2.9, 95%CI 1.2-6.8) and being unemployed (OR 3.8, 95%CI 1.7-8.6).

CONCLUSION

Among patients with active pulmonary TB, the prevalence of malnutrition was very high. Malnutrition, which is a general problem for the whole community and particularly among people not indigenous to Timor and Rote, should be addressed in the fight against TB.

Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia

BACKGROUND

Plasma zinc and vitamin A concentrations have been reported to be low in tuberculosis (TB) patients in some studies, although it is not clear whether this constitutes a risk for a more severe clinical presentation among TB patients. The acute phase reaction may also deplete zinc and vitamin A in the plasma. Therefore, we further studied these associations.

METHODS

We carried out a cross-sectional study among newly diagnosed sputum smear-positive TB patients in East Nusa Tenggara. The patients were categorized as either mild TB when Karnofsky Score (KS) > or =80 or severe TB (KS <80). Body mass index (BMI), mid upper arm circumference (MUAC), chest radiograph, and the results of hemoglobin, erythrocyte sedimentation rate, albumin, C-reactive protein (CRP), zinc and vitamin A in plasma were correlated with TB category.

RESULTS

A total of 300 TB patients participated in the study (63% male and 37% female), and were categorized as mild TB (53%) or severe TB (47%). Vitamin A, hemoglobin and plasma albumin were significantly lower, and CRP was significantly higher, in severe TB than in mild TB, and the active lesion area on the chest radiograph was greater among severe TB patients. In a multiple regression analysis, after adjustment for CRP, low vitamin A (beta=3.2, 95%CI (confidence interval) 1.6-4.9, P=0.000) but not zinc, correlated with the severity of TB. MUAC was better than BMI as a predictor of TB severity (beta=1.3, 95%CI 0.6-6.2, P=0.000).

CONCLUSIONS

Severe TB was associated with vitamin A deficiency. MUAC can be applied as a measure of TB severity.