Economic Evaluation of COVID-19 Screening Tests and Surveillance Strategies in Low-Income, Middle-Income, and High-Income Countries: A Systematic Review

BACKGROUND Economic evaluation of the testing strategies to control transmission and monitor the severity of COVID-19 after the pandemic is essential. This study aimed to review the economic evaluation of COVID-19 tests and to construct a model with outcomes in terms of cost and test acceptability for surveillance in the post-pandemic period in low-income, middle-income, and high-income countries. MATERIAL AND METHODS We performed the systematic review following PRISMA guidelines through MEDLINE and EMBASE databases. We included the relevant studies that reported the economic evaluation of COVID-19 tests for surveillance. Also, we input current probability, sensitivity, and specificity for COVID-19 surveillance in the post-pandemic period. RESULTS A total of 104 articles met the eligibility criteria, and 8 articles were reviewed and assessed for quality. The specificity and sensitivity of COVID-19 screening tests were reported as 80% to 90% and 40% to 90%, respectively. The target population presented a mortality rate between 0.2% and 19.2% in the post-pandemic period. The implementation model of COVID-19 screening tests for surveillance with a cost mean for molecular and antigen tests was US$ 46.64 (min-max US $0.25-$105.39) and US $6.15 (min-max US $2-$10), respectively. CONCLUSIONS For the allocation budget for the COVID-19 surveillance test, it is essential to consider the incidence and mortality of the post-pandemic period in low-income, middle-income, and high-income countries. A robust method to evaluate outcomes is needed to prevent increasing COVID-19 incidents earlier.

In vitro investigation on Pennisetum purpureum leaf extracts grown in Indonesia of phytochemical components, optical characteristics, and antioxidant-antibacterial activities

Medicinal plants hold significant cultural significance and play a crucial role in the advancement of potentially safe drugs for the therapy of disease worldwide. Pennisetum purpureum or elephant grass has been used for traditional medications in Indonesia without understanding the phytochemicals of those plants. Herein, our report revolves around the qualitative and quantitative examination of phytochemical components, optical properties, antioxidants, and antibacterial assessments of solvent fractions derived from Pennisetum purpureum leaf. The Pennisetum purpureum leaf was successfully soaked with ethanol, n-hexane, and chloroform. The study aimed to assess the total phenolic content (TPC), total flavonoid content (TFC), and total alkaloid content (TAC) within different of extracts. The optical properties of extract were analyzed by absorption light and photoluminescent. Moreover, evaluation of antioxidant activities of extracts through DPPH free radical scavenging and FRAP assays, followed by an evaluation of their effectiveness in antibacterial therapy against different bacterial strains. The qualitative and quantitative phytochemical of Pennisetum purpureum presented as highest in ethanol TPC (85.5 mg GAE/g extracts), TFC (87.9 mg QE/g extracts), and TAC (86.2 mg ATE/g extracts) as compared to other solvents extract. Pennisetum purpureum extract had antioxidant capacity against DPPH radical and FRAP assay. Furthermore, each of the samples displayed antibacterial effectiveness that was dependent on the dosage towards different strains of bacteria. Our findings clearly demonstrated that Pennisetum purpureum leaf extracts grown in Indonesia containing alkaloid, flavonoid, glycoside, saponin, steroids, tannin, and terpenoids that support its capability as antioxidant and antibacterial.

Maternal, newborn, and children under-five health surveillance system: a scoping review protocol

BACKGROUND

Public health surveillance is crucial in monitoring the progress of maternal, newborn, and children under-five health outcomes (MNCH). Consequently, mapping the existing surveillance system from countries with different income and development levels is needed to learn and compare the effectiveness of surveillance. However, the current COVID-19 pandemic has disrupted the health system, including the healthcare services for pregnant women, neonates, infants, and children under five, as well as the recording, reporting, and surveillance system. The need to adapt to the new normal during the pandemic has stimulated innovation while incorporating new COVID-19-related indicators into the existing public health system. Therefore, this review aims to describe the existing implementation and the COVID-19 pandemic's influence on the MNCH surveillance system.

METHODS

We will search published literature (from MEDLINE, Embase, and Portal Garuda), manually search from all reference lists of included studies, and conduct a targeted search of relevant gray literature. This review will include studies of surveillance systems or describe COVID-19 surveillance or routine reports involving MNCH (morbidity and mortality). The studies included will be in English or Indonesian language, observational study designs, and published or documented from 2010 to 2023. Two investigators will independently screen the title and abstract, including each full article to determine the eligibility of studies. The data will be assessed using a narrative approach. Data will be reported in simple descriptive tables.

DISCUSSION

Our findings are expected to map the existing implementation of MNCH surveillance systems before and during the pandemic, including the influence of the COVID-19 pandemic on MNCH surveillance across countries with different income levels. This may contribute to existing knowledge on the MNCH health surveillance system that could be integrated into the surveillance of emerging diseases, such as COVID-19.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered on the Open Science Framework ( https://osf.io/bc6t4 ).

Effectiveness of an online mental health strengthening module to build resilience and overcome stress for transitional aged medical students

Introduction

Transitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience.

Methods

A pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week.

Results

Compared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P < .001] and interaction effect between intervention and time in resilience score [F(3, 309) = 5.056, P = .002]. Additionally, compared to the control group, there were significant increases in knowledge [F(1, 103) = 66.805, P < .001], attitudes and behavior towards mental-health [F(1, 103) = 5.191, P = .025], and a significant decrease in stress perception score [F(1, 103) = 27.567, P < .001]. The mean salivary delta cortisol during pre-test and post-test at week 12 in the intervention group showed significant difference (P < .001). However, there was no significant difference in the mean delta salivary alpha-amylase between pre-test and post-test at week 12, both in the intervention and control groups.

Conclusion

The mental-health strengthening module was accepted and applicable to first-year medical students and was found to be effective in increasing resilience from various biopsychosocial aspects. It is also advisable to have similar modules throughout the medical school to maintain sustainability.

Evidence-based interventions to improve the psychological well-being of pregnant mothers: a scoping review

OBJECTIVE

Supporting the psychological well-being of pregnant mothers is critical. The purpose of this study was to map the intervention to improve the psychological well-being of pregnant mothers.

MATERIALS AND METHODS

This research method uses a scoping review with five stages, i.e., problem identification, identification of relevant studies, study selection, data mapping, compiling, summarizing, and reporting results. A systematic search strategy was applied to check for relevant papers dated 2011 until 2021, based on Pubmed, Scopus, Web of Science, Cochrane, Science Direct, Google Scholar, and Grey Literature. PRISMA flowchart was used to select and summarize the studies, and the PCC framework was used for the search strategy. Criteria for inclusion were studies with pure experimental or quasi-experimental designs, focusing on improving women's psychological well-being or mental health, utilizing psychological well-being measures, and written in English with full-text availability.

RESULTS

From 32 articles, 56.24% used randomized control trials (RCT), 28.12% used quasi-experimental, 9.38% used experimental, and 3.13% used a clustered randomized trial and case study methods. 50% of the articles used developed countries, while the remaining 50% used developing countries. 12.50% of the articles used online or web-based for intervention, physical activities, and antenatal education, 9.38% used Cognitive Behavior Therapy (CBT), 21.85% used psychoeducation, 6.25% used mindfulness, Interpersonal Therapy (IPT), training-based, and 3.13% used psychodrama, relaxation, counseling, and happiness therapy. Intervention facilitators were engaged in 25% of the articles, no information regarding facilitators in another 25% of the articles, 21.85% engaged midwives, 12.50% engaged psychologists and physiotherapists, 6.25% engaged health workers, the researchers did 15.63%, and community workers and lectures did the remaining 3.13%.

CONCLUSIONS

Further empirical research to improve the psychological well-being of pregnant mothers needs to be done with a psychoeducational approach considering such communications, the role of the facilitator in intervention, and the research media used.

The Effect of Vibration on the Acceleration of Wound Healing of Diabetic Neuropathic Foot Ulcer: A Prospective Experimental Study on Human Patients

Diabetic foot ulcers are a common complication that occurs in approximately 15 percent of patients with diabetes mellitus. Over 60% of diabetic foot ulcers are caused by underlying neuropathy. Former studies on diabetic animals with foot wounds found that vibration platforms significantly accelerate wound healing by catalyzing epithelization, promoting angiogenesis, and enhancing muscle bulk. This result suggests that there is evidence that vibrations may accelerate diabetic neuropathic ulcer healing in human patients. However, to the best of our knowledge, the effect of vibration on the enhancements of diabetic foot ulcer healing in human patients is rarely investigated. Hence, in this work, we conducted an experimental study with human subjects to investigate whether vibration therapy, as a complement to the standard wound treatment, can accelerate the wound healing rate of diabetic neuropathic foot ulcers. In this prospective experimental study, 80 participants diagnosed with Wagner grades I−III diabetic neuropathic foot ulcers were randomly distributed to experimental (n = 40) and control groups (n = 40). Patients in the intervention group received standard wound treatment and vibration wound therapy (VWT), whereas patients in the control group retrieved only standard wound treatment. The results (p = 0.024, α = 0.05) show notable differences in the median healing rate between the intervention group (25 days, 95% CI: 20.3−29.7) and control group (33 days, 95% CI: 25.6−40.4), with the effect-size r, Cohen’s d, Glass’s Δ, and Hedges’ g, respectively, being 0.810, 2.764, 2.311, and 2.772. Moreover, the nitric oxide (NO) level, wound closure area, and wound healing score after intervention significantly differed between the two groups (p < 0.05), putting the intervention group on a higher level than the control group. Furthermore, positive associations were found between the NO level and wound healing closure rates. These findings suggested that VWT enhances diabetic neuropathic foot ulcer healing in terms of healing rate, wound closure area, healing score, and elevated NO level. Considering that no clinically adverse effects were found in the patients induced with vibration intervention, VWT can be regarded as a complementary therapy to the existing ones to accelerate the healing of DFUs.

Emergency Management System in Indonesia: An evaluation of emergency patient management in 2020

Indonesia has its emergency patient management system regulated in Public Safety Center (PSC) 119 as stated in Indonesia’s Health Ministry Regulation No. 19 (2016). An evaluation to assess the ongoing management of this system is a must to ensure its continuous development. This study assessed the ongoing emergency patient management system using instrument indicator questionnaires developed by the authors. The questionnaire consists of 28 indicators from 8 assessment aspects including: policy, planning, program implementation, communication, transportation, referral, management reviews, and emergency services. Questionnaires were distributed and completed questionnaires were received from 88 respondents from 21 provinces of Indonesia. Validity test results counted the coefficient correlation of all indicators above r value table (0.2096) and all Alpha Cronbach’s indicators value above 0,80. The value indicator is considered poor if its average score is below the average score of the overall indicators and is considered good if it is above the average overall indicator score. The assessment result there is twelve indicators from this study shows a below average value (66) . Data acquired in this study can be used as a preliminary reference for continuous improvement of Indonesia’s emergency management system operated by the PSC.

Role of Alphacalcidol to Reduce Pain and Serum Cartilage Oligomeric Matrix Protein in Elderly with Knee Osteoarthritis

Objective : To determine the effect of Alphacalcidol supplementation on pain based on WOMAC pain index and joint cartilage condition based on cartilage oligomeric matrix protein (COMP) serum markers in knee osteoarthritis (OA) elderly patients. Materials andMethods : This is a randomized, double-blind, and placebo-controlled trial. Symptomatic knee OA elderly subjects visited our clinic in Jakarta July-December 2017 were recruited. History taking, physical examinations, and knee radiology were performed. Serum Vitamin D (25(OH)D) and COMP were analysed using chemiluminescent immunoassay and enzyme-linked immunosorbent assay, respectively. Body mass index, physical activity, sun exposure frequency, and dietary vitamin D were assessed. Subjects were randomly allocated to either intervention group to be given 1 μg Alphacalcidol or control group to be given placebo for 12 weeks. Comparation analysis of WOMAC pain index and serum COMP concentration between both groups was performed. Results : There were 146 subjects participated this study. Increases of 25(OH)D were found in intervention group (2.63 ±11.24 nmol/L, p=0.05) and control groups (1.09±9.42 nmol/L, p=0.28). Alphacalcidol significantly reduced pain based on WOMAC indicator with mean reduction differences of intervention group compared to control group was 2.174±1.060 (p=0.00). COMP serum level was reduced with mean reduction differences of intervention group compared to control group was 38.15±87.553 ng/ ml (p=0.39). Alphacalcidol and gender were the determinants of WOMAC pain index reduction (p=0.00 and p=0.06, respectively) while Alphacalcidol was the only serum COMP level change determinant (p=0.39). Conclusions :Alphacalcidol administration reduced pain based on WOMAC indicator and COMP serum in knee OA elderly subjects. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 759-771

The Role of the Midwife in Postpartum Family Planning Services : A Case Study on Three Different Health Facilities in South Central Java

Postpartum family planning coverage in Central Java is below the national standard, or it only reached 26.8%. Postpartum mothers are at risk of getting pregnant if they do not use contraception. Modern contraceptives prevent 3.2 million of 5.6 million under-five deaths and 109,000 of 155,000 (70%) maternal deaths. Continuity of Midwifery Care during the extended postpartum period encourages mothers to use modern contraception to manage the pregnancy gap. This study aimed to explore midwifery services for Family Planning Postpartum from the perspective of providers and clients in three health facilities: hospitals (RS), Public Health Centers, and Independent Midwifery Practice (PMB). The research was implemented through a qualitative descriptive, a case study approach design in 2021. informants were ten postpartum mothers, nine midwives, two heads of Puskesmas, head division of Family Planning, Women and Children Empowerment (KBPPA) conducted an in-depth interview. The interviews were digitally recorded, transcribed, and analyzed using the Miles and Huberman method. Providers and clients identified several benefits of Postpartum Family Planning (KBPP). Midwives stated several obstacles in providing services, such as limited counseling time during labor and lack of support from hospital management. The competence of midwives constrained KBPP services at the Puskesmas. There were still few midwives at the Puskesmas certified to provide Long Term Contraception Method services. Midwives were also overloaded with work during the pandemic. Obstacles in the Independent Midwifery Practice were the lack of IMP with clinical networks and the limited authority of the midwife. Meanwhile, postpartum mothers' barriers included lack of knowledge about fertility and KBPP, worry about side effects, and the husband's lack of support. Therefore, optimizing the referral mechanism for long-term contraception in advanced health facilities is necessary. Continuity of care midwives and integration of services will increase coverage of postpartum contraception.

Translation, Validity, and Reliability of Mental Health Literacy and Help-Seeking Behavior Questionnaires in Indonesia

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia. Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability). Results: The content validity test produced positive results with an I-CVI scores of 0.7-1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521. Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable.

Urban-Rural Dimension of Falls and Associated Risk Factors among Community-Dwelling Older Adults in West Java, Indonesia

Falls are one of the common problems among older adults; it is estimated that 684,000 fatal cases of falls occur every year. Furthermore, falls constitute one of the leading causes of mortality due to accidental injury. This study aims to identify the risk factors for falls in the older adults who live in the community, according to the dimensions of the living area: in urban and rural. The proportional sampling method was used to identify the rural and urban areas in West Java Prefecture; meanwhile, the incidence of fall in the last 12 months was selected as the outcome variable. Furthermore, sociodemographic background, chronic medical condition, fear of falling, visual and hearing impairments, Activity of Daily Living (ADL), Barthel index, physical performance (Short Performance Physical Battery (SPPB)), and living environment were analyzed to identify the risk factors that contribute to the incidence of falls. A total of 611 older adults participated in this study: 62% of them are living in rural area and 38% of them are living urban areas. More than 70% of study participants were aged 60-69 years, while 73% were females. There is no significant difference in fall prevalence in rural (16.5%) and urban (10.7%) areas (p value = 0.228). Furthermore, the multiple logistic regression analysis showed that the male gender (OR = 0.29, 95%CI [0.09-0.88]), chronic illness (OR = 3.25, 95%CI [1.24-8.53]), and visual impairment (OR = 3.6, 95%CI [1.52-8.54]) were associated with fall among older adults in urban areas. Meanwhile, visual impairment (OR = 1.81, 95%CI [1.03-3.18]) and living environment (OR = 3.36, 95% CI [1.14-9.93]) were significantly associated with falls in rural areas. Based on the associated risk factors identified in this study, a different approach is needed to reduce the falling risk among older adults in urban and rural areas in Indonesia.

Tuberculosis control within Indonesia's hospital accreditation

Background: Tuberculosis (TB) is an infectious disease that is a major problem in Indonesia, placing Indonesia among the three major countries with the highest TB cases in the world. In addition, reporting of TB data from health service facilities, especially hospitals, is still weak. Since the implementation of Directly Observed Treatment Shortcourse (DOTS) in hospitals in 1995, the number of new TB case reports from hospitals is still low. In order to increase hospital participation in TB control, the government has made a breakthrough strategy, which is the integration of the DOTS strategy in hospital accreditation.

Design and methods: This study conducted a literature review and document analysis related TB control standards in hospital accreditation and the implication for the involvement of hospitals in national TB program. This study analyzed regulations, policies, and procedures, including hospital accreditation instruments and annual reports of TB.

Results:Accreditation standards related to TB control include: i) Hospital must implement a tuberculosis control program in the hospital, including monitoring and evaluation through activities such as health promotion, tuberculosis surveillance, controlling risk factors, detection and treatment of tuberculosis cases, providing immunity and preventive drugs; ii) Hospital prepares resources for service delivery and tuberculosis control; iii) hospital provides facilities and infrastructures for tuberculosis services in accordance with regulations; and iv) hospital conducts tuberculosis services and efforts to control tuberculosis risk factors in accordance with regulations.

Conclusions: Standards and elements of the assessment of TB control components in accreditation are adjusted to the national TB control guidelines.

Mental Health Problems and Needs among Transitional-Age Youth in Indonesia

“Transitional-age youth” describes those whose ages range from 16–24 years old. In this phase, the youth face new challenges and new experiences which may increase the risk for having mental health problems, yet not very many seek help from mental health professionals. In Indonesia, no data are available about mental health problems and the needs of transitional-age youth. This study explores common mental health problems experienced during this stage and assesses how they cope with problems and their expectations from health services. This was a cross-sectional study involving 393 Indonesians aged 16–24 years in May 2020. More than 90% of students had financial and academic difficulties and felt lonely. The most prevalent mental health problem among students was anxiety (95.4%). Most of the students, ranging from 90% to 96.4%, had positive coping strategies. However, around 50% of respondents reported self-harming and having suicidal thoughts. The results of subcategories analysis between ages and faculties were similar. Their most important expectations from mental health services included confidentiality (99.2%) and being welcoming and friendly (99.2%). In conclusion, this study highlighted the most common problems transitional-age youth experience in Indonesia. While some of them already knew how to deal with their problems, not all the participants had good coping mechanisms. Their healthcare expectations were also explored, thereby providing a useful background to revise and amend the current conditions.

Effect of premature rupture of membranes on preterm labor: a case-control study in Cilegon, Indonesia

OBJECTIVES

The global prevalence of preterm labor is approximately 11.1% of live births. However, preterm labor contributes to 75-80% of neonatal morbidity and mortality. The morbidity experienced by preterm infants may continue to influence their subsequent development, imposing physical, psychological, and economic burdens. Premature rupture of membranes (PROM) is a causal factor that may affect preterm birth. Previous studies have shown an association between PROM and preterm labor, but this association should be investigated in more diverse populations. Therefore, this study was conducted in Cilegon, Indonesia to determine the magnitude of the risk of preterm labor associated with PROM at Cilegon Hospital from July 2014 to December 2015.

METHODS

This case-control study used data from patients’ medical records. The cases were all mothers who delivered at less than 37 weeks of gestation, while the control population comprised all mothers who delivered at greater or equal to 37 weeks. The data were analyzed using logistic regression.

RESULTS

The bivariate analysis yielded an odds ratio (OR) of 2.97 (95% confidence interval [CI], 1.92 to 4.59) before controlling for covariates. The model derived through multiple regression analysis after controlling for education, history of preterm labor, and anemia resulted in an OR of 2.58 (95% CI, 1.68 to 3.98).

CONCLUSIONS

Mothers who experience PROM during pregnancy were at a 2.58 times higher risk of preterm labor after controlling for education, history of preterm labor, and anemia.

Collaborative Model of Teachers, Students, and Families to Improve Parents Knowledge and Skills on Food Safety of Elementary School Students

Introduction: School-age children in Indonesia are at risk of health problems due to food insecurity. Parents have a very important role in preparing safe food, both at home and for lunch at school. The aim of this study was to determine the effect of a collaboration model of teachers, students, and their families (KOGUSIGA) towards the parents’ knowledge and skills on the food safety of elementary school students.Methods: This study applied a quasi-experiment design pre- and post-test with a control group. The subject sample used was the total sampling method, involving 206 parents. The study was conducted for over 10 weeks, supported with modules for nurses and parents, textbooks for the students and their families, and a student workbook.Results: The results showed that the KOGUSIGA model is associated significantly with greater knowledge (p-value = 0.000; with a mean difference of 20.23) and the parent’s skills (p-value = 0.000; with a mean difference of 12.3) to do with food insecurity.Conclusions: The KOGUSIGA model tends to improve the knowledge and skills parents significantly, in relation to the food safety of the students. It is expected that the KOGUSIGA model will be applied under the community health nursing/school health nurses’ supervision.

Capacity building for health inequality monitoring in Indonesia: enhancing the equity orientation of country health information system

BACKGROUND

Inequalities in health represent a major problem in many countries, including Indonesia. Addressing health inequality is a central component of the Sustainable Development Goals and a priority of the World Health Organization (WHO). WHO provides technical support for health inequality monitoring among its member states. Following a capacity-building workshop in the WHO South-East Asia Region in 2014, Indonesia expressed interest in incorporating health-inequality monitoring into its national health information system.

OBJECTIVES

This article details the capacity-building process for national health inequality monitoring in Indonesia, discusses successes and challenges, and how this process may be adapted and implemented in other countries/settings.

METHODS

We outline key capacity-building activities undertaken between April 2016 and December 2017 in Indonesia and present the four key outcomes of this process.

RESULTS

The capacity-building process entailed a series of workshops, meetings, activities, and processes undertaken between April 2016 and December 2017. At each stage, a range of stakeholders with access to the relevant data and capacity for data analysis, interpretation and reporting was engaged with, under the stewardship of state agencies. Key steps to strengthening health inequality monitoring included capacity building in (1) identification of the health topics/areas of interest, (2) mapping data sources and identifying gaps, (3) conducting equity analyses using raw datasets, and (4) interpreting and reporting inequality results. As a result, Indonesia developed its first national report on the state of health inequality. A number of peer-reviewed manuscripts on various aspects of health inequality in Indonesia have also been developed.

CONCLUSIONS

The capacity-building process undertaken in Indonesia is designed to be adaptable to other contexts. Capacity building for health inequality monitoring among countries is a critical step for strengthening equity-oriented national health information systems and eventually tackling health inequities.

PENGEMBANGAN MEDIA CETAK PENDIDIKAN PENCEGAHAN KEKERASAN SEKSUAL BALITA DI KOTA BOGOR

Indonesia menjadi darurat kejahatan seksual sejak tahun 2014 dan terus meningkat tiap tahunnya. Dinegara- negara maju media edukasi pencegahan kejahatan seksual dinilai efektif menurunkan angka kasus tersebut. Tujuan penelitian ini adalah untuk mengembangkan media edukasi pencegahan kekerasan seksual pada balita untuk ibu dan kader posyandu. Media yang diuji coba terdiri dari poster, modul dan booklet. Jenis penelitian dengan Rappid Assesment Procedure (RAP) melalui diskusi kelompok pada 10 kader dan wawancara mendalam pada 20 ibu balita. Desain kualitatif ini dimodifikasi dengan pengembangan media (pre testing methods), yaitu tahapan ujicoba dan mengukur hasil media selama 3 kali. Hasil penelitian menemukan terdapat perubahan bahasa serta gambar dalam poster dan modul, sedangkan hanya bahasa dalam booklet. Sebagian besar ibu balita sangat membutuhkan booklet dibandingkan poster. Booklet terbukti lebih efektif digunakan untuk edukasi dibandingkan poster dan modul.

Socio-economic factors and use of maternal health services are associated with delayed initiation and non-exclusive breastfeeding in Indonesia: secondary analysis of Indonesia Demographic and Health Surveys 2002/2003 and 2007

This analysis aims to examine factors associated with delayed initiation and non-exclusive breastfeeding in Indonesia. Data were derived from the 2002/2003 and 2007 Indonesia Demographic and Health Survey. Information from 12,191 singleton live-born infants aged 0-23 months was used to examine factors associated with delayed initiation of breastfeeding. Furthermore, information from 3,187 singleton live-born infants aged 0-5 months was used to identify factors associated with non-exclusive breastfeeding. Associations between potential predictors and study outcomes were examined using logistic regression. Our study found that infants from high household wealth-index had significantly increased odds of both delayed initiation and non-exclusive breastfeeding. Other factors associated with an increased odds of delayed initiation of breastfeeding included infants from Sumatera region (OR=1.64, 95% CI: 1.38-1.95), Caesarean-section deliveries (OR=1.84, 95% CI: 1.39-2.44) and deliveries in government-owned (OR=1.38, 95% CI: 1.08-1.76) and non-health facility (OR=1.20, 95% CI: 1.00-1.43). Other factors associated with an increased odds for non-exclusive breastfeeding included parents who were in the workforce (OR=1.37, 95% CI: 1.06-1.78) and mothers with obstetric complication at childbirth (OR=1.35, 95% CI: 1.05-1.74). However, the odds reduced for infants from Eastern Indonesia (OR=0.64, 95% CI: 0.49-0.85). Poor breastfeeding practices are associated with environmental, socio-economic, pregnancy-birthing characteristics and maternal health services factors. Efforts to promote breastfeeding practices should be conducted comprehensively to target population at risk for poor breastfeeding practices.

Water preparation practices in south Kalimantan, Indonesia

This study investigated water preparation practices, water sources, and sanitation measures in 400 households in four villages in Banjar district of South Kalimantan, Indonesia. A survey of randomly selected households in each of the four villages was undertaken during the season of low prevalence of diarrhoeal disease (February-March 1989). A follow-up survey of the same households was conducted 6 months later to measure prevalence during the peak season. Twenty-three in-depth interviews were carried out with key persons in local villages. Observations on behaviour in the local food stalls were recorded. The results of the study indicate that 97% of the households report that they regularly boil their drinking water. However, 37% of the households regularly or occasionally mix boiled with unboiled water for drinking, or use unboiled water alone. The mixing of boiled with unboiled water is particularly frequent in the preparation of 'cold tea', a popular drink in households and food stalls. The occasional or regular use of unboiled water varies by ethnicity, education and literacy, and economic status. The use of unboiled water is associated with higher rates of childhood diarrhoeas in the households studied.

Effect of chronic heat load during pregnancy on birth weight, behaviour and body composition of Australian feral goat kids

Six feral does maintained at elevated ambient temperatures (27.2 degrees - 34.8 degrees) for the last half of pregnancy had rectal temperatures (Tr) elevated by 0.4 degrees above 10 unstressed does. Heat-stressed twin-bearers were 0.15 degrees hotter than single-bearers and bore lighter kids (1.70 kg), than unstressed does (2.24 kg) while singles were less affected (2.22 kg versus 2.28 kg). Birth weight was more highly correlated (P less than 0.001) with the daily minimum Tr of the dam than with the mean or maximum Tr. Kids from heated does stood and began sucking as quickly as control kids but during the first six hours scored significantly (P less than 0.01) lower on a scale of general activity. There were no significant differences in body content of nitrogen, fat and ash or, when birth weight was considered, weight of hide, CNS and liver.