The implementation of smoke-free workplace policy and the determinants affecting indoor smoking in Indonesia

A smoke-free workplace is important to reduce secondhand smoke exposure, raise awareness, encourage smoking cessation, and increase productivity. This study aimed to assess indoor smoking in the workplace as part of a smoke-free policy implementation and the factors associated. This was a cross-sectional study at workplaces in Indonesia from October 2019 to January 2020. The workplaces were divided into private workplaces owned by a company for business and government workplaces that run for public services. Samples were selected using stratified random sampling. Data collection follows time and area observation guidelines, starting in the indoor area and then outdoor. The observation was conducted for at least 20 min for each workplace in 41 districts/cities. Of the 2900 observed workplaces, 1097 (37.8%) were private and 1803 (62.92%) were government workplaces. The proportion of indoor smoking at government workplaces was 34.7%, higher compared to private (14.4%). The results were consistent for each indicator such as people smoking (14.7% vs. 4.5%), electronic cigarette use (0.7% vs. 0.4%), cigarette butts presence (25.8% vs. 9.5%), and smell of cigarette smoke (23.0% vs. 8.6%). The factors associated with indoor smoking were indoor ashtray availability (adjusted odds ratio [AOR] =13.7; 95% confidence interval [CI]: 10.6-17.5), indoor designated smoking area (AOR = 2.4; 95% CI: 1.4-4.0), presence of indoor tobacco advertising, promotion and sponsorships (AOR: 3.3; 95% CI: 1.3-8.89), whereas the presence of no smoking sign was a preventive factor (AOR = 0.6; 95% CI: 0.5-0.8). Indoor smoking remains high, particularly in government workplaces in Indonesia.

The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding

The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.

Factors associated to referral of tuberculosis suspects by private practitioners to community health centres in Bali Province, Indonesia

BACKGROUND

The contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners.

METHODS

We conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time.

RESULTS

The following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1-3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0-4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0).

CONCLUSIONS

Education and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.