Development of the information quality scale for health information supply chain type 2 diabetes mellitus management using exploratory factor analysis

Background

Research on the quality scale of the healthcare supply chain is still limited. This study aimed to assess the information quality of the supply chain model with a focus on construct validity. Studies related to information quality measurement generally focus on measuring the dimensions of the completeness of medical records and consumer perspectives. We intended to assess the scale based on doctors needed as care coordinators on type 2 diabetes mellitus or the Non-Insulin-Dependent-Diabetes-Mellitus (NIDDM) program in primary healthcare.

Methods

Sixty-four primary healthcare doctors with an age range of 24-51 years were involved in this research. The scale obtained was formed from the assessment of the point of view of a panel of experts through the content validity index (CVI). The exploratory factor analysis (EFA) method was used to explore the scale of information quality in the information supply chain model for the NIDDM chronic disease management program.

Result

The data analysis results indicated three main factors that affected the quality of the information supply chain model of NIDDM, namely accessibility, safety, and efficiency of information related to NIDDM. The results of the validity and reliability of the data showed that the scale used in this research was valid and reliable with a Cronbach alpha coefficient of 0.861.

Conclusion

The scale developed in this research could be used to explore the quality of the information supply chain of NIDDM management in primary healthcare. Each item on the scale could explain the variables according to their respective groups.

FITRI's four steps in developing primary health cares' interprofessional collaborative: an intervention for fostering IPCP competencies

It is important to fill the gaps in collaborative practice due to the lack of the healthcare professionals' ability to work in collaboration with other disciplines. However, the current team training does not routinely address this important issue. This study aimed to identify how interactive interprofessional collaborative practice (IPCP) learning materials in a virtual course and community implementation called FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be used in primary healthcare settings to address IPCP competencies of healthcare providers. This research was a quasi-experimental study with an untreated control group design using a dependent pretest and posttest sample. A purposive sample of 50 primary healthcare providers consisting of general physicians, dentists, nurses, dietitians, and pharmacists were nonrandomly divided into the control and intervention groups. This study showed that IPCP competencies measured by the Interprofessional Collaborator Assessment Rubric (ICAR) in the intervention group were significantly higher after the training and implementation than before. The Mann-Whitney tests indicated that IPCP competencies were better in the intervention group than the control group. Based on effect size analysis, the intervention had a very strong impact and could significantly improve the participants' competencies, especially in the collaborative patient/client-family centered approach domain. The FITRI's four steps in developing primary health cares' interprofessional collaborative practice can be implemented and provide positive impacts in primary healthcare settings to improve and foster competencies of IPCP in primary healthcare.

Risk Assessment on the Release of Wolbachia-Infected Aedes aegypti in Yogyakarta, Indonesia

Wolbachia-infected Aedes aegypti is the latest technology that was developed to eliminate dengue fever. The Ministry of Research and Technology of the Republic of Indonesia (Kemenristekdikti) established an expert group to identify future potential risks that may occur over a period of 30 years associated with the release of Wolbachia-infected Ae. aegypti. The risk assessment consisted of identifying different hazards that may have impacts on humans and the environment. From the consensus among the experts, there were 56 hazards identified and categorized into 4 components, namely, ecological matters, efficacy in mosquito management, economic and sociocultural issues, and public health standards. There were 19 hazards in the ecological group. The overall likelihood in the ecology of the mosquito is very low (0.05), with moderate consequence (0.74), which resulted in negligible risk. For the efficacy in mosquito management group, there were 12 hazards that resulted in very low likelihood (0.11) with high consequence (0.85). The overall risk for mosquito management efficacy was very low (0.09). There were 14 hazards identified in the public health standard with very low likelihood (0.07), moderate consequence (0.50) and negligible risk (0.04). Lastly, 13 hazards were identified in the economic and sociocultural group with low likelihood (0.01) but of moderate consequence (0.5), which resulted in a very low risk (0.09). The risk severity level of the four components leading to the endpoint risk of "cause more harm" due to releasing Wolbachia-infected Ae. aegypti is negligible (0.01).

Effectiveness of collaboration in older adults: do interprofessional teams improve nutritional status more compared to usual care?

BACKGROUND

Ageing is accompanied by many changes that make it more difficult for nutritional needs to be met. Management of malnutrition in older adults requires collaboration among multiple clinical disciplines.

OBJECTIVE

This study aimed to determine the effectiveness of interprofessional collaboration and practice (IPCP) implementation for older adults with malnutrition compared to usual care.

METHODS

This was a quasi-experimental study using an untreated control group design with dependent pretest and posttest sample of older adults with malnutrition. The intervention group worked as a team to give the intervention based on their own roles and responsibilities. The older adults of the control group received usual care from primary health care. Outcome measurement of nutritional status used the Mini Nutritional Assessment (MNA).

RESULTS

The study results show significant differences between before and after IPCP implementation in the intervention group which had better scores of MNA after implementation. In the control group, there was no significant difference between before and after implementation of usual care. The statistical analysis showed there was a significant difference between the control and intervention groups who had improved nutritional status after IPCP implementation. IPCP had strong correlation with nutritional status based on correlation analysis. These results demonstrate that the collaboration by more than one health profession can improve nutritional status better than usual daily care.

CONCLUSION

IPCP has a strong and significant correlation with the nutritional status in older adults. The IPCP implementation could significantly improve their nutritional status after the IPCP implementation compared to usual care.

Environmental Changed, Capacity of Adaptation, and The Levels of Community Resilience Post-Earthquake in Lombok, Indonesia: A Cross-Sectional study

BACKGROUND: Natural disasters led to environmental destruction, casualties, and fatality. Disasters have been associated with post-traumatic disorders among affected community, thus, it is important to understand capability and resilience level post-disasters. AIM: This study aims to determine the degree of environmental change and the capacity of adaptation associate to the levels of community resilience among earthquake victims in Lombok, Indonesia. METHODS: A number of 129 respondents were recruited using clustered random sampling design. Data were collected using the adaptation capacity framework and the resilience brief scale questionnaire by face-to-face interviews. Significant level was set as p = 0.05 with 95% confidence interval. A Chi-square statistical test and logistic regression were used to test hypothesis. RESULTS: A number of 129 respondents included in the study. Bivariate analysis indicated a significant correlation between environmental changed, adaptation capacity, and community resilience. Environmental changed was predictor that statistically significant predicted community resilience (ß = 2.425, p < 0.001). CONCLUSION: The level of environmental destruction was significantly predicted the level of community resilience.

Qualitative Analysis of Family-centered Care for Children with Cancer in Palliative Wards: An Evaluation of Needs and Barriers in Resource-limited Settings

Background: Many children with cancer are faced with fatal diagnosis and unbearable pain, and palliative care is highly needed. In Indonesia, the provision of palliative care is only accessible in a few major cities where most cancer treatment facilities are located and development has been slow. While, the implementation of family center care identified a number of challenges related to family empowerment to be included in the development and implementation of interventions. Objectives: This study aimed to assess the perspectives of nurses regarding family-centered treatment in Indonesia’s palliative wards for children with cancer. Methods: A qualitative approach to content analysis was employed. The study participants were 10 primary nurses in pediatric units who worked with cancer patients regularly. These participants were purposefully chosen. The interview session included 10 study participants. Participants’ work experience ranged from 2 to 11 years, and their age ranged from 27 to 51 years. Data were collected via face-to-face, semi-structured interviews that lasted for an average of 30 to 45 minutes. The interviews were performed to explore the participants’ understanding about the definition of family-centered palliative care, including the needs and obstacles to implementation. These were analyzed using content analysis methodology that includes five main segments: introduction, coding, theme creation, thematic classification, and reporting. Results: The themes from the study included an appreciation of palliative and family-centered care, palliative care capability and family-centered care, and multidisciplinary cooperation under three principles concerning needs and barriers. Conclusion: Integrating family-centered care approaches in providing palliative care for children with cancer as well as the resources required for such programs to be implemented by hospital management in working toward improved quality care for patients. Communication and continuity of care remain a challenge; training and equipping clinicians with skills and confidence to carry out family-centered care approaches and palliative care for children with cancer can aid in this process.

Malnutrition in older adults: how interprofessional teams see it? A systematic review of the qualitative research

BACKGROUND

The understanding of health care providers' experiences involved in malnutrition treatment is a key component that should be explored.

OBJECTIVE

This systematic review aimed to explore the views and perceptions of community health care providers related to malnutrition and its management for older adults, through synthesizing the qualitative studies.

METHODS

Six electronic databases were used to search relevant articles. Qualitative research synthesis using Sandelowski and Barroso's method and thematic synthesis were used to broaden the range of methodology in this study. Joanna Briggs Institute (JBI) Critical Appraisal Tools for Qualitative Research was used to enable judgement about the strength of qualitative research.

RESULTS

A total of four qualitative studies of health care providers' views and perceptions related to malnutrition in older adults were analysed. The results showed that there are three main themes that reflect their malnutrition experiences: (i) knowledge and skills about malnutrition, (ii) management of malnutrition and (iii) the need for collaborative teams.

CONCLUSION

While health care professionals understand about the aetiology of malnutrition, however screening for malnutrition is not routine in their practice. Proper education and training about nutritional care is needed. Dietary changes and public education are preferable over oral nutritional supplements. Some solution and recommendations for management of malnutrition in older adult such as supportive interventions include environmental changes, nutritional counselling, food modification, oral nutrition supplement and pharmacotherapy if needed, routine screening and multidisciplinary approach.

Survey data of multidrug-resistant tuberculosis, Tuberculosis patients characteristics and stress resilience during COVID-19 pandemic in West Sumatera Province, Indonesia

This set of data presents a survey data describing multidrug-resistant tuberculosis, tuberculosis patients characteristics and stress resilience during COVID-19 pandemic in West Sumatera Province, Indonesia. The data were gathered from multidrug-resistant tuberculosis, tuberculosis patients through a survey distributed by an online questionnaire, assesing patients characteristics (age, sex, level of education, working status, history of close contact to patients with multidrug resistant tuberculosis and tuberculosis, smoking, alcohol consumption, cavitary pulmonary, diabetes mellitus, nutritional status and tuberculosis outside the lung) and stress resilience (3 items), from 15th July until 7th August 2020. The samples were collected 73 multidrug resistant tuberculosis patients and 219 tuberculosis patients in West Sumatera Province, Indonesia who were willing to fill an online questionnaire. SPSS version 23.0 was used to analyzed the data by descriptive and inferential statistics. The data will help to identify mental health problems and potentially as a warning sign that can support for health education interventions among multidrug-resistant tuberculosis and tuberculosis patients during COVID-19 pandemic.

Survey data of COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia

This dataset presents a survey data describing COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia. The data were collected from breast cancer patients through a survey distributed by an online questionnaire, assesing social-demographic characteristics (6 items), COVID-19 awareness (5 items), knowledge (2 items), preparedness (2 items) and related behaviors (2 items), from 20th June until 14th July 2020. The samples were gathered 500 breast cancer patients in Indonesia who were willing to fill an online questionnaire. SPSS version 23.0 was used to analyzed the data by descriptive and inferential statistics and SmartPLS 3 to created the partial least square path modeling. The data will help in preventing the transmission of COVID-19 among breast cancer patients and can support for health education and promotion interventions.

Cryptosporidium Infection Increases the Risk for Chronic Diarrhea Among People Living With HIV in Southeast Asia: A Systematic Review and Meta-Analysis

We conducted a systematic review research and meta-analysis to reveal the relationship between the risk of chronic diarrhea and Cryptosporidium infection in people living with HIV in Southeast Asia. We performed online peer-reviewed literature research from January 2005 to December 2017, which included PubMed, Science Direct, ProQuest, EBSCO, Cochrane, and Web of Science databases. Calculation of size effects in the meta-analysis was performed by STATA 13.0 software to estimate relative risks (RRs) with 95% confidence intervals (CIs) for any associations. Seven cross-sectional research articles were recruited in this study based on the inclusion and exclusion criteria. Our analysis revealed a significant relationship between cryptosporidiosis and the risk of chronic diarrhea in people living with HIV, with RR = 1.325; 95% CI = 1.157 to 1.517; and P < .000. Our results suggested that cryptosporidiosis increases the risk of chronic diarrhea, and low CD4⁺ lymphocyte cell counts aggravate the degree of diarrhea. Therefore, clinicians should be more aware in treating HIV-positive people, especially those with low CD4⁺ cell counts, and we suggest that Cryptosporidium laboratory examinations be conducted immediately.

Social Determinants of Health of Child Marriage (Analysis of IFLS 2000, 2007, 2014)

Early marriage is defined as a marriage of women aged <18 years old. The current world prevalence is declining, but when compared with the growth in population, the total number of married children tends to increase. Today, early marriage reaches 41.000 every day, especially in Sub-Saharan Africa and South Asia. This research aims to identify the social determinants of health that encourage early marriage. This research used a quantitative observational analytic study with cross-sectional design. The number of <18 year-old married women were 1.96% (IFLS5), <18 year-old married men were 0.15% (IFLS5). The average age at first birth was 22.96 years old. The economic status of early marriage was mostly in Quintile 1, and the majority of residences were in rural area. The ratio of married women and men aged <18 years old was 11-14: 1. Employment, education, residence and poverty were associated with early marriage and were statistically significant.

Neurofibromatosis type 2 gene mutation and progesterone receptor messenger RNA expression in the pathogenesis of sporadic orbitocranial meningioma

AIM

To investigate neurofibromatosis type 2 (NF2) gene mutation at mRNA levels in sporadic orbitocranial meningioma and its association with progesterone receptor (PR) mRNA expression.

METHODS

This was a case-control study. Thirty-four sporadic meningioma patients with no familial NF2-related meningioma history were recruited. They were interviewed for their obstetric, gynecologic, and contraception history. PR investigation was performed with real-time polymerase chain reaction (PCR). NF2 mutation was investigated using Qbiomarker Somatic Mutation PCR Assay at NF2 mRNA level after its cDNA extraction (four mRNA mutation cytoband coordinates for nucleotide change: c.634C>T/p.Q212, c.655G>A/p.V219M, c.784C>T/p.R262 and c.1228C>T/p. Q410).

RESULTS

After mutation analysis at mRNA level, NF2 gene mutation was found in 35.29% patients. Non-mutation group was strongly associated with exogenous hormonal exposure (non-mutation vs mutation: 95.5% vs 83.3%, P<0.001). PR mRNA was found significantly lower in non-mutation group (P=0.033) which presumed as long term exogenous progesterone exposure. However, mutation group was associated with higher rate of progression to grade II (mutation vs non-mutation, 18.2% vs 5%, P<0.001) and was associated more in fibrous and anaplastic tumor tissue.

CONCLUSION

NF2 mutation-meningioma is associated with higher grade of meningioma. Non NF2 mutation-meningioma is strongly associated with exogenous progesterone exposure and lower PR expression.

Validity and Reliability of Quality of Nursing Work Life Instrument for Hospital Nurses

Introduction: The validity and reliability of the quality of nursing work life (QNWL) instrument in hospitals that suitable to treatment needs include: trust, care, respect, learn, and contribute need, have to be assessed. Therefore, in order to perform good care, it is necessary to notice QNWL aspect, which the implementation may be assessed by using valid and reliable instruments. This study aimed to evaluate the construct validity of the QNWL scale in hospital.Methods:  The research used a cross-sectional approach and the respondents were 100 experts in nursing and 400 nurses working in four hospitals in Gresik, Indonesia, who have been working for minimum one year. The sampling technique was purposive sampling. We analyzed the data using content analysis, the validity of item discrimination using Pearson products moment, reliability with Cronbach’s alpha, and construct validity with Confirmatory Factor Analysis.Results: The results based on content validity index QNWL instrument was 0.2075-0.915, with an average 0.7059 (high). Item discrimination capacity was 0.339-0.79 (high), while the reliability was 0.9374 (very high) and the validity of the construct meets the goodness of fit criteria.Conclusion: All constructs are able to explain and support the QNWL instrument model. This research can be used to measure the quality of work life of nurses in all classes of hospitals in Indonesia.

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.

Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females

Background: The pathogenesis of meningioma in females and its association with exogenous progesterone is remained unclear. This study was aimed to examine expression of Progesterone receptor (PR) and Neurofibromatosis-2 (NF2) and assess their relationships to history of exogenous progesterone use and risk of meningioma.

Methods: Our study was a case-control study that involves 115 females, 40 cases who diagnosed with orbito-cranial meningioma and 75 controls of healthy, that has been presented in previous study. The demographic characteristics, reproductive factors, and history of progesterone use were obtained in–depth face-to-face interviews. PR and NF2 mRNA were assessed by real-time quantitative polymerase chain reaction (RT-qPCR) on serum specimens.

Results: The mean age of participants in cases vs. controls were 46.6 ± 6.2 vs. 46.5 ± 7.45 (P = 0.969). The expression of PR and NF2 in cases was significantly lower than in controls. The longer duration of progesterone exposure was significantly associated with lower expression of PR and NF2. Significant association between lower expression of PR (OR 11.7; 95% CI 4.17–32.9; P < 0.001 comparing the lowest quartile vs. 3 highest quartile of PR) and NF2 (OR 4.23; 95% CI 1.85–9.67; P = 0.001 comparing the 2 lowest quartiles vs. 2 highest quartiles) with increased risk of meningioma were also reported.

Conclusion: In this study we showed that the longer the exposure to exogenous progesterone, the lower the expression of PR and NF2 mRNA in the serum. Low expression of PR and NF2 were associated with higher risk of meningioma, suggesting that low PR expression and inactivation of NF2 might play a key role in progesterone-associated meningioma tumorigenesis and may be potential clinical marker for females at higher risk of meningioma.

The Indonesian general practitioners' perspectives on formal postgraduate training in primary care

BACKGROUND

To be recognized as a primary care physician (PCP), an Indonesian general practitioner (GP) has to follow a formal postgraduate training in primary care. However, 4 years since the regulation was published, the progress of the training is slow. There is a need to deeply investigate the doctors' perspectives, particularly to explore factors associated with their willingness to follow this training.

AIM

This study aims to explore the GPs' views and perspectives related to the formal postgraduate training in primary care that may influence their enrolment in PCP program.

METHODS

We conducted semi-structured interviews with a topic guide. The study took place in Yogyakarta from January to December 2016. The participants were GPs practicing in Yogyakarta primary care clinics who were recruited using purposive-maximum variation sample design. The interviews were audio-recorded and transcribed. The data were analysed using interpretative phenomenological analysis approach.

RESULTS

Nineteen GPs participants were involved in this study. Three major themes were identified, namely unfamiliarity, resistance, and positivism. Almost all the GP participants were unfamiliar with the primary care training program. They were also pessimistic if the training could change the health service in the country while it lacked resources and infrastructures. However, exposure to the training brought positive insights that it could improve the doctors' knowledge and skills in primary care practice.

DISCUSSION

The government intention to establish PCP training is currently on the right tract. However, information dissemination and more supports in primary care are also essential.

CADRES COMPETENCE IN COMMUNITY-BASED MANAGEMENT OF CHILD ILLNESS IN BANYUMAS DISTRICT, CENTRAL JAVA, INDONESIA

Background: One of the efforts in the health sector for programs to reduce infant and under-five mortality and morbidity rates is by the competence-based integrated management childhood illness (CB-IMCI) program. However, the program has been poorly implemented by health workers at the health center. Thus, the involvement of cadres is needed and their competency remains important to be improved.Objective: To quantitatively analyze cadre knowledge and competencies in the CB-IMCI program, and its relationship with the implementation of CB-IMCI, as well as to qualitatively explore and analyze the responses of cadres, health workers, and the community to the addition of cadre roles to the management of sick children.Methods: This was a mixed methods study with randomized controlled trials and qualitative method. For randomized controlled trials, 100 cadres were selected, which 50 randomly assigned in the intervention and control group. And for quantitative methods, informants included 10 cadres, 4 health workers, and 20 mothers. Paired t-test and independent t-test were employed for quantitative analysis, and triangulation was used for qualitative analysis.Results: The improvement of knowledge in the intervention group was better (I=14.42/C=4.44/p-value 0.00). The intervention group was more competent in the management of child illness (p-value 0.00). In addition, the cadres have additional competencies assisted by health workers to confidently detect cases earlier, and health center services reach a wider coverage in the community.Conclusion: The addition of cadres roles and competencies in the management of child illness in the community can be implemented in Banyumas Regency. It is suggested that the implementation of this program should be followed up in other health centers by the health department of Indonesia.

Preparatory graduate professional training in general practice by using the 'experiential learning' framework

BACKGROUND

General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the 'experiential learning' framework.

METHODS

This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the 'weekly clinical updates on primary care medicine' (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant's knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning.

RESULTS

Participants' knowledge regarding clinical problems in general practice was moderately increased (p < 0.05) after the training from a mean score of 50.64-72.77 (Yogyakarta's doctors) and 39.37-51.81 (Jakarta's doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training.

CONCLUSIONS

A graduate educational framework for GP based on the 'experiential learning' framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.

Biopsychosocial model of illnesses in primary care: A hermeneutic literature review

Biopsychosocial model is a useful worldview for primary care or family doctors. However, it is often considered as impractical or too complicated. The objective of this study is to review the implementation of the biopsychosocial model in clinical practice, and its contributions to clinical outcomes. Hermeneutic circle literature review was conducted to provide experiential learning in an attempt to understand biopscyhosocial model, first developed by George Engel. Literature search started with review articles in Medline and Scopus as search engines. Citations from previous articles, editorials, and research articles were identified and interpreted in the context of the knowledge derived from all identified relevant articles. The progress of biopsychosocial model has been slow, and primary care doctors do not implement biopsychosocial medicine in their practice, while biomedical thinking and approach are still the dominant model. Biopsychosocial research addressed chronic illnesses and functional disorders as conditions in need for biopsychosocial model implementation. As payment scheme, clinical guidelines and clinical performance indicators are biomedically oriented, there is no incentive for primary care doctors to adopt biopsychosocial model in their practice. Workload and lack of competence in primary care may hinder the implementation of biopsychosocial model. Biopsychosocial model helps primary care doctors to understand interactions among biological and psychosocial components of illnesses to improve the dyadic relationship between clinicians and their patients and multidisciplinary approaches in patient care. Biopsychosocial model potentially improves clinical outcomes for chronic diseases and functional illnesses seen in primary care.

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

BACKGROUND

Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health.

METHODS

Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data.

RESULTS

On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension.

CONCLUSIONS

Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.

Interpretation of Clinical Data Based on C4.5 Algorithm for the Diagnosis of Coronary Heart Disease

Objectives

The interpretation of clinical data for the diagnosis of coronary heart disease can be done using algorithms in data mining. Most clinical data interpretation systems for diagnosis developed using data mining algorithms with a black-box approach cannot recognize examination attribute relationships with the incidence of coronary heart disease.

Methods

This study proposes a system to interpretation clinical examination results for the diagnosis of coronary heart disease based the decision tree algorithm. This system comprises several stages. First, oversampling is carried out by a combination of the synthetic minority oversampling technique (SMOTE), feature selection, and the C4.5 classification algorithm. System testing is done using k-fold cross-validation. The performance parameters are sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV) and the area under the curve (AUC).

Results

The results showed that the performance of the system has a sensitivity of 74.7%, a specificity of 93.7%, a PPV of 74.2%, an NPV of 93.7%, and an AUC of 84.2%.

Conclusions

This study demonstrated that, by using C4.5 algorithms, data can be interpreted in the form of a decision tree, to aid the understanding of the clinician. In addition, the proposed system can provide better performance by category.

Prediction of Dengue Outbreaks Based on Disease Surveillance and Meteorological Data

Research is needed to create early warnings of dengue outbreaks to inform stakeholders and control the disease. This analysis composes of a comparative set of prediction models including only meteorological variables; only lag variables of disease surveillance; as well as combinations of meteorological and lag disease surveillance variables. Generalized linear regression models were used to fit relationships between the predictor variables and the dengue surveillance data as outcome variable on the basis of data from 2001 to 2010. Data from 2011 to 2013 were used for external validation purposed of prediction accuracy of the model. Model fit were evaluated based on prediction performance in terms of detecting epidemics, and for number of predicted cases according to RMSE and SRMSE, as well as AIC. An optimal combination of meteorology and autoregressive lag terms of dengue counts in the past were identified best in predicting dengue incidence and the occurrence of dengue epidemics. Past data on disease surveillance, as predictor alone, visually gave reasonably accurate results for outbreak periods, but not for non-outbreaks periods. A combination of surveillance and meteorological data including lag patterns up to a few years in the past showed most predictive of dengue incidence and occurrence in Yogyakarta, Indonesia. The external validation showed poorer results than the internal validation, but still showed skill in detecting outbreaks up to two months ahead. Prior studies support the fact that past meteorology and surveillance data can be predictive of dengue. However, to a less extent has prior research shown how the longer-term past disease incidence data, up to years, can play a role in predicting outbreaks in the coming years, possibly indicating cross-immunity status of the population.

Physician's self-perceived abilities at primary care settings in Indonesia

BACKGROUND

Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities.

MATERIALS AND METHODS

This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations.

RESULTS

This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking.

DISCUSSIONS AND CONCLUSIONS

Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

Intelligence System for Diagnosis Level of Coronary Heart Disease with K-Star Algorithm

OBJECTIVES

Coronary heart disease is the leading cause of death worldwide, and it is important to diagnose the level of the disease. Intelligence systems for diagnosis proved can be used to support diagnosis of the disease. Unfortunately, most of the data available between the level/type of coronary heart disease is unbalanced. As a result system performance is low.

METHODS

This paper proposes an intelligence systems for the diagnosis of the level of coronary heart disease taking into account the problem of data imbalance. The first stage of this research was preprocessing, which included resampled non-stratified random sampling (R), the synthetic minority over-sampling technique (SMOTE), clean data out of range attribute (COR), and remove duplicate (RD). The second step was the sharing of data for training and testing using a k-fold cross-validation model and training multiclass classification by the K-star algorithm. The third step was performance evaluation. The proposed system was evaluated using the performance parameters of sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), area under the curve (AUC) and F-measure.

RESULTS

The results showed that the proposed system provides an average performance with sensitivity of 80.1%, specificity of 95%, PPV of 80.1%, NPV of 95%, AUC of 87.5%, and F-measure of 80.1%. Performance of the system without consideration of data imbalance provide showed sensitivity of 53.1%, specificity of 88,3%, PPV of 53.1%, NPV of 88.3%, AUC of 70.7%, and F-measure of 53.1%.

CONCLUSIONS

Based on these results it can be concluded that the proposed system is able to deliver good performance in the category of classification.

Genetic variation of Leptospira isolated from rats catched in Yogyakarta Indonesia

OBJECTIVE

To detect genetic variations among pathogenic Leptospira isolated from rats using 16S rRNA gen as chronometer.

METHODS

This is an observational study with cross sectional design. Rats samples were taken in Yogyakarta Special Region of Indonesia. Leptospira in the rats was detected by two methods i.e. real time PCR (qPCR) by using primers correspond to16S rRNA gene of Leptospira, and standard PCR by using different set of primer correspond to the 16S rRNA gene of Leptospira. The standard PCR amplicon then subjected for DNA sequencing. Analysis genetic variation was performed using MEGA 6.2. Software.

RESULTS

There were 99 DNA samples from rats included in this study. Detection of Leptospira by using qPCR revealed 25 samples positive for pathogenic Leptospira, while only 6 samples were able to be detected using standard PCR. The new primer set correspond to 16S rRNA gene was able to detect specifically pathogenic Leptospira in the rats. Sequencing analysis of 6 PCR amplicons showed that the Leptospira which infect the rats catched in Yogyakarta genetically close related with pathogenic Leptospira which were isolated from human, animal, rodents, and environment.

CONCLUSIONS

It can be considered that rats are the most important vector and reservoir of Leptospira.

Millennium development goal four and child health inequities in indonesia: a systematic review of the literature

Introduction

Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

Methods and Findings

We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

Conclusion

This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.

The effect of gender and social capital on the dual burden of malnutrition: a multilevel study in Indonesia

Introduction

The paradoxical phenomenon of the coexistence of overweight and underweight individuals in the same household, referred to as the “dual burden of malnutrition”, is a growing nutrition dilemma in low- and middle-income countries (LMICs).

Aims

The objectives of this study were (i) to examine the extent of the dual burden of malnutrition across different provinces in Indonesia and (ii) to determine how gender, community social capital, place of residency and other socio-economic factors affect the prevalence of the dual burden of malnutrition.

Methods

The current study utilized data from the fourth wave of the Indonesian Family Life Survey (IFLS) conducted between November 2007 and April 2008. The dataset contains information from 12,048 households and 45,306 individuals of all ages. This study focused on households with individuals over two years old. To account for the multilevel nature of the data, a multilevel multiple logistic regression was conducted.

Results

Approximately one-fifth of all households in Indonesia exhibited the dual burden of malnutrition, which was more prevalent among male-headed households, households with a high Socio-economic status (SES), and households in urban areas. Minimal variation in the dual burden of malnutrition was explained by the community level differences (<4%). Living in households with a higher SES resulted in higher odds of the dual burden of malnutrition but not among female-headed households and communities with the highest social capital.

Conclusion

To improve household health and reduce the inequality across different SES groups, this study emphasizes the inclusion of women's empowerment and community social capital into intervention programs addressing the dual burden of malnutrition.

Clustered tuberculosis incidence in Bandar Lampung, Indonesia

BACKGROUND

The incidence of tuberculosis (TB) in the city of Bandar Lampung, Indonesia, increased during the period 2009-2011, although the cure rate for TB cases treated under the directly observed treatment, short course (DOTS) strategy in the city has been maintained at more than 85%. Cluster analysis is recognized as an interactive tool that can be used to identify the significance of spatially grouping sites of TB incidence. This study aimed to identify space-time clusters of TB during January to July 2012 in Bandar Lampung, and assess whether clustering co-occurred with locations of high population density and poverty.

METHODS

Medical records were obtained of smear-positive TB patients who were receiving treatment at DOTS facilities, located at 27 primary health centres and one hospital, during the period January to July 2012. Data on home addresses from all cases were geocoded into latitude and longitude coordinates, using global positioning system (GPS) tools. The coordinate data were then analysed using SaTScan.

RESULTS

Two significant clusters were identified with P value of 0.05 for the primary cluster and 0.1 for the secondary cluster. Clusters occurred in areas with high population density and a high proportion of poor families and poor housing conditions. The short radius of the clusters also indicated the possibility of local transmission of TB.

CONCLUSIONS

The incidence of TB in Bandar Lampung was not randomly distributed, but significantly concentrated in two clusters. Identification of clusters of TB, together with its etiological factors such as social determinants, and risk factors, can be used to support TB control programmes, particularly those aiming to reach vulnerable populations, and intensified case-finding.

Bringing evidence to policy to achieve health-related MDGs for all: justification and design of the EPI-4 project in China, India, Indonesia, and Vietnam

BACKGROUND

The Millennium Development Goals (MDGs) are monitored using national-level statistics, which have shown substantial improvements in many countries. These statistics may be misleading, however, and may divert resources from disadvantaged populations within the same countries that are showing progress. The purpose of this article is to set out the relevance and design of the "Evidence for Policy and Implementation project (EPI-4)". EPI-4 aims to contribute to the reduction of inequities in the achievement of health-related MDGs in China, India, Indonesia and Vietnam through the promotion of research-informed policymaking.

METHODS

Using a framework provided by the Commission on the Social Determinants of Health (CSDH), we compare national-level MDG targets and results, as well as their social and structural determinants, in China, India, Indonesia and Vietnam.

RESULTS

To understand country-level MDG achievements it is useful to analyze their social and structural determinants. This analysis is not sufficient, however, to understand within-country inequities. Specialized analyses are required for this purpose, as is discussion and debate of the results with policymakers, which is the aim of the EPI-4 project.

CONCLUSION

Reducing health inequities requires sophisticated analyses to identify disadvantaged populations within and between countries, and to determine evidence-based solutions that will make a difference. The EPI-4 project hopes to contribute to this goal.

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.

An input and process evaluation of Internet-based distance learning education for hospital managers in Indonesia

An evaluation study was carried out to describe the input and process of internet-based distance learning graduate education program for hospital managers in indonesia. The main research question addressed in the study was whether the program supported quality learning among students who were working full time and could not leave their jobs for the whole study period. The results of the study indicated that the program benefited those who lived in remote areas and women who could not leave their family for long period of time. The study suggests that interactions between students and their peers or tutors motivated better learning processes. Variability of performances were observed among students who were not equally supported by technological helps and with different learning motivations. It needs another year to evaluate whether the internet-based program is no less effective and efficient or even better than the in-class programs.