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PubMed1999

In vitro evaluation of cefepime and other broad-spectrum beta-lactams against bacteria from Indonesian medical centers. The Indonesia Antimicrobial Resistance Study Group.

The in vitro activity of cefepime and six other broad-spectrum beta-lactams (cefpirome, ceftazidime, ceftriaxone, imipenem, piperacillin/tazobactam (4 micrograms/mL fixed concentration), and oxacillin was evaluated against 191 isolates of clinical bacteria from Indonesia. Susceptibility testing was performed using Etest (AB BIODISK, Solna, Sweden) methodology. Isolates from 10 species groups were selected for analysis: Escherichia coli, Klebsiella spp., Enterobacter spp., indole-positive Proteae, Serratia spp., Acinetobacter spp., Pseudomonas aeruginosa, and oxacillin-susceptible staphylococci. The overall rank order of spectrum of activity was (% resistant): imipenem (2.2%) > cefepime (7.3%) > piperacillin/tazobactam > cefpirome > ceftazidime > ceftriaxone (16.2%). The "fourth-generation" cephalosporins, cefepime and cefpirome, displayed greater activity compared with the "third-generation" cephalosporins, ceftazidime, and ceftriaxone, against the 60 E. coli and Klebsiella spp. (30 each) isolates. Phenotypic extended spectrum beta-lactamase occurrence rates among the E. coli and Klebsiella spp. were 23.3 and 33.3%, respectively. Imipenem, cefepime, and cefpirome inhibited 95.7% of the 46 isolates of inducible Amp C cephalosporinase producing Enterobacteriaceae. The majority of the resistance observed to imipenem and cefepime among tested Indoneisian strains was attributable to the nonfermentative Gram-negative bacilli, P. aeruginosa and Acinetobacter spp. These results indicate the presence of beta-lactam resistance in Indonesia and the need for continued antimicrobial surveillance in this nation and region of the world, preferably using accurate quantitative methods.

Anti-Bacterial Agents↗
PubMed2001

Management development of clinicians in Indonesia.

This paper evaluates an open learning and applied learning programme for health professionals delivered by the authors in Indonesia. It also highlights the importance of the active involvement of Indonesian health professionals in the delivery and the need for the programme to be contextualised. The background is a pilot programme for the management development of clinicians in Indonesia. As a country facing huge political, economic and social problems there is an urgent need to improve the health status of the population, for example, by reducing the maternal mortality rate. The objectives of the Indonesian Health Referral and Hospital Programme in the 6th Five Year Development Strategy includes not only this type of health improvement target but also the need for improvement in the management of resources.

Journal Article↗
PubMed1986

Trypanosomiasis in Indonesia. A review of research, 1900-1983.

This review describes research conducted from 1900-1983 on trypanosomiasis due to Trypanosoma evansi in Indonesia. Clinical signs and post-mortem findings in horses, cattle, buffaloes, pigs and dogs, experimental transmission tests to establish possible surra vectors in Indonesia, and research on chemotherapy and chemoprophylaxis are discussed.

Animals↗
PubMed2004

Comparative efficacy of chloroquine and sulfadoxine-pyrimethamine for uncomplicated Plasmodium falciparum malaria and impact on gametocyte carriage rates in the East Nusatenggara province of Indonesia.

The efficacy of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) was evaluated in 89 subjects greater than one year of age with uncomplicated P. falciparum malaria in the East Nusatenggara Province of Indonesia. Fever clearance time was longer in the SP group than in the CQ group. However, parasite clearance time was extended in subjects who received CQ compared with those who received SP. Major adverse events were not observed in either group, and no hospitalizations were required during the study. Treatment failure rates at day 28 were 69% for CQ and 8.5% for SP. In both treatment groups, gametocytemia developed during the follow-up period, but was more pronounced in the SP group, peaking at 94% on day 7. Regardless of treatment group, children < 10 years of age had significantly higher treatment failure rates than subjects >/=10 years of age (relative risk = 2.49), suggesting that acquired immunity influenced treatment outcomes in the presence of parasite drug resistance. Although a highly effective alternative to CQ for clearing infection, SP treatment also presented some potential drawbacks (e.g., increased and persistent gametocytemia). Replacement of CQ with SP as a first-line therapy, either alone or in combination with CQ, in those areas of Indonesia with high levels of CQ resistance should significantly improve treatment outcomes, particularly in vulnerable populations lacking clinical immunity. More efficacious and rapidly acting asexual stage treatments are generally associated with increased gametocyte clearance and combination therapy in areas where drug resistance is high or emerging may provide an additional means for reducing transmission.

Adolescent↗
PubMed2005

Fluoroquinolone-resistant Escherichia coli, Indonesia.

In a recent, population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%). Molecular typing showed extensive genetic diversity with only limited clonality among isolates. This finding suggests that independent selection of resistant mutants occurs frequently. FQ-resistant isolates exhibited a higher rate of spontaneous mutation, but sparser virulence profiles, than FQ-susceptible isolates from the same population. The resistant isolates belonged predominantly to phylogenetic groups A (57%) and B1 (22%) but also to the moderately virulent group D (20%). Hypervirulent strains from the B2 cluster were underrepresented (1%). Because FQ-resistant E. coli can cause disease, especially nosocomial infections in immunocompromised patients, spread of such strains must be stopped.

Anti-Infective Agents↗
PubMed2005

The costs of home delivery of a birth dose of hepatitis B vaccine in a prefilled syringe in Indonesia.

OBJECTIVE: To provide global policy-makers with decision-making information for developing strategies for immunization of infants with a birth dose of hepatitis B vaccine, this paper presents a retrospective cost analysis, conducted in Indonesia, of delivering this vaccine at birth using the Uniject prefill injection device. METHODS: Incremental costs or cost savings associated with changes in the hepatitis B immunization programme were calculated using sensitivity analysis to vary the estimates of vaccine wastage rates and prices for vaccines and injection devices, for the birth dose of hepatitis B vaccine. FINDINGS: The introduction of hepatitis B vaccine prefilled in Uniject (HB-Uniject) single-dose injection devices for use by midwives for delivering the birth dose is cost-saving when the wastage rate for multidose vials is greater than 33% (Uniject is a trademark of BD, Franklin Lakes, NJ, USA). CONCLUSION: The introduction of HB-Uniject for birth-dose delivery is economically worthwhile and can increase coverage of the critical birth dose, improve resource utilization, reduce transmission of hepatitis B and promote injection safety.

Child Health Services↗
PubMed2004

Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia.

CONTEXT: The proportion of paratyphoid fever cases to typhoid fever cases may change due to urbanization and increased dependency on food purchased from street vendors. For containment of paratyphoid a different strategy may be needed than for typhoid, because risk factors for disease may not coincide and current typhoid vaccines do not protect against paratyphoid fever. OBJECTIVE: To determine risk factors for typhoid and paratyphoid fever in an endemic area. DESIGN, SETTING, AND PARTICIPANTS: Community-based case-control study conducted from June 2001 to February 2003 in hospitals and outpatient health centers in Jatinegara district, Jakarta, Indonesia. Enrolled participants were 1019 consecutive patients with fever lasting 3 or more days, from which 69 blood culture-confirmed typhoid cases, 24 confirmed paratyphoid cases, and 289 control patients with fever but without Salmonella bacteremia were interviewed, plus 378 randomly selected community controls. MAIN OUTCOME MEASURES: Blood culture-confirmed typhoid or paratyphoid fever; risk factors for both diseases. RESULTS: In 1019 fever patients we identified 88 (9%) Salmonella typhi and 26 (3%) Salmonella paratyphi A infections. Paratyphoid fever among cases was independently associated with consumption of food from street vendors (comparison with community controls: odds ratio [OR], 3.34; 95% confidence interval [CI], 1.41-7.91; with fever controls: OR, 5.17; 95% CI, 2.12-12.60) and flooding (comparison with community controls: OR, 4.52; 95% CI, 1.90-10.73; with fever controls: OR, 3.25; 95% CI, 1.31-8.02). By contrast, independent risk factors for typhoid fever using the community control group were mostly related to the household, ie, to recent typhoid fever in the household (OR, 2.38; 95% CI, 1.03-5.48); no use of soap for handwashing (OR, 1.91; 95% CI, 1.06-3.46); sharing food from the same plate (OR, 1.93; 95% CI, 1.10-3.37), and no toilet in the household (OR, 2.20; 95% CI, 1.06-4.55). Also, typhoid fever was associated with young age in years (OR, 0.96; 95% CI, 0.94-0.98). In comparison with fever controls, risk factors for typhoid fever were use of ice cubes (OR, 2.27; 95% CI, 1.31-3.93) and female sex (OR, 1.79; 95% CI, 1.04-3.06). Fecal contamination of drinking water was not associated with typhoid or paratyphoid fever. We did not detect fecal carriers among food handlers in the households. CONCLUSIONS: In Jakarta, typhoid and paratyphoid fever are associated with distinct routes of transmission, with the risk factors for disease either mainly within the household (typhoid) or outside the household (paratyphoid).

Adolescent↗
PubMed1997

Developmental age and taxonomic affinity of the Mojokerto child, Java, Indonesia.

An increasing number of claims place hominids outside Africa and deep in Southeast Asia at about the same time that Homo erectus first appears in Africa. The most complete of the early specimens is the partial child's calvaria from Mojokerto (Perning I), Java, Indonesia. Discovered in 1936, the child has been assigned to Australopithecus and multiple species of Homo, including H. modjokertensis, and given developmental ages ranging from 1-8 years. This study systematically assesses Mojokerto relative to modern human and fossil hominid growth series and relative to adult fossil hominids. Cranial base and vault comparisons between Mojokerto and H. sapiens sapiens (Hss) (n = 56), Neandertal (n = 4), and H. erectus (n = 4) juveniles suggest a developmental age range between 4 and 6 years. This range is based in part on new standards for assessing the relative development of the glenoid fossa. Regression analyses of vault arcs and chords indicate that H. erectus juveniles have more rounded frontals and less angulated occipitals than their adult counterparts, whereas Hss juveniles do not show these differences relative to adults. The growth of the cranial superstructures and face appear critical to creating differences in vault contours between H. erectus and Hss. In comparison with adult H. erectus and early Homo (n = 27) and adult Hss (n = 179), the Mojokerto child is best considered a juvenile H. erectus on the basis of synapomorphies of the cranial vault, particularly a metopic eminence and occipital torus, as well as a suite of characters that describe but do not define H. erectus, including obelion depression, supratoral gutter, postorbital constriction, mastoid fissure, lack of sphenoid contribution to glenoid fossa, and length and breadth ratios of the temporomandibular joint. Mojokerto is similar to other juvenile H. erectus in the degree of development of its cranial superstructures and its vault contours relative to adult Indonesian specimens. The synapomorphies which Mojokerto shares with H. erectus are often considered autapomorphies of Asian H. erectus and confirm the early establishment and long-term continuity of the Asian H. erectus bauplan. This continuity does not, however, necessarily reflect on the pattern of origin of modern humans in the region.

Adolescent↗
PubMed1999

Phenotypic variability of Filipino beta(o)-thalassemia/HbE patients in Indonesia.

Three Indonesian patients with identical genotypes, each compound heterozygotes for Filipino beta(o)-thalassemia/HbE, expressed different clinical severities. One patient has mild disease and is transfusion independent, while the other two are severely affected and transfusion dependent. The size of the Filipino beta(o)-globin gene deletion was confirmed to be 45 kb, resolving conflicting values given in the literature. Neither ameliorating genetic factors such as alpha-globin gene deletions or the XmnI restriction site polymorphism at position -158 upstream of the (G)gamma-globin gene, nor differences in beta-globin gene haplotype, explain the phenotypic variation. These observations have implications for the development of antenatal diagnosis in Indonesia, as at present it is not possible to give an accurate prediction of severity of phenotype for this common genotype.

Child↗
PubMed1996

Infection with GB virus C (GBV-C) in patients with chronic liver disease or on maintenance hemodialysis in Indonesia.

RNA of a non-A to E hepatitis virus identified recently and designated provisionally GB virus C(GBV-C), was sought in patients in Indonesia by reverse-transcription polymerase chain reaction with nested primers deduced from a helicase-like region. GBV-C RNA was detected in 32 (55%) of 58 patients on maintenance hemodialysis at a frequency significantly higher (P < 0.001) than that in seven (5%) of 149 patients with chronic liver disease. Co-infection with hepatitis C virus was observed in 26 (81%) of the 32 patients on hemodialysis and in five (71%) of the seven patients with liver disease who were infected with GBV-C. Complete identity was observed in a sequence of 100 base pairs in the helicase-like region for GBV-C cDNA clones from some patients on maintenance hemodialysis. These results indicate that the patients on hemodialysis would be at high risk for GBV-C infection, which would be transmitted by transfusion and patient-to-patient routes.

Antigens, Viral↗
PubMed1997

Confirmation and location of the hybrid zone between wild populations of Macaca tonkeana and Macaca hecki in central Sulawesi, Indonesia.

Reports of hybridization between Macaca tonkeana and Macaca hecki were investigated in Central Sulawesi, Indonesia. We defined sets of morphological traits that were diagnostic for M. tonkeana and M. hecki and then located an areas where animals had intermediate or mosaic features. Hybridization as indicated by morphology was detected between M. tonkeana and M. hecki. The hybrid zone appeared to be strongly centered at the road that crosses the isthmus of Central Sulawesi from Tawaeli to Toboli. Macaques in this region were not morphologically uniform; animals from the western area of the Tawaeli-Toboli road resembled M. hecki, while animals from the eastern area resembled M. tonkeana. The hybrid zone was found to be smaller than previously thought, with maximum dimensions of approximately 15 and 7.5 km. Clines for diagnostic morphological features were broadly coincident, suggesting that the hybrid zone originated by secondary contact. Analysis of three museum specimens collected in 1916 provided evidence that the hybrid zone has been in existence since at least then. The narrow width of the hybrid zone, along with its age, suggested that some prezygotic or postzygotic barrier must exist to full introgression between M. tonkeana and M. hecki.

Animals↗
PubMedDate not supplied

Improving quality in public sector hospitals in Indonesia.

Indonesia has successfully expanded its health system to improve access and quality of care for the population, promote equity, and expand primary health care. More recently, it has sought to undertake policy initiatives to promote involvement of the private sector and to introduce both incentives for efficiency and payment mechanisms which will increase sustainability. Certain public health sector facilities have been given financial autonomy to set prices, introduce and retain user fees, and promote prepayment mechanisms. The autonomous hospitals, Unit Swadana hospitals, have increased revenue sustainability while promoting quality assurance practices. The managers of these hospitals have become adept at introducing business practices into the hospital's operations to promote efficiency. These have attracted private investors to invest in public hospitals.

Developing Countries↗
PubMed2005

Disproportionate participation by age/sex classes in aggressive interactions between long-tailed macaques (Macaca fascicularis) and human tourists at Padangtegal monkey forest, Bali, Indonesia.

We observed 420 aggressive interactions between tourists and Macaca fascicularis at the Padangtegal Wanara Wana Temple forest site in Bali, Indonesia, during the months of June and July 2001. The data collected included patterns of aggression, presence or absence of food, and demographic information on resident macaques and human visitors. Analyses of the interactions suggest that macaques respond differentially to humans according to the age/sex classes involved. Additionally, adult and subadult male macaques participated in more aggressive behaviors than expected, while adult female macaques and immatures participated in such behaviors less than expected. These variations in interaction patterns between macaques and tourists may have substantial implications for management issues and the potential for pathogen transmission.

Age Factors↗
PubMed2006

Calling in wild silvery gibbons (Hylobates moloch) in Java (Indonesia): behavior, phylogeny, and conservation.

Hardly any behavioral data are available for the silvery gibbon (Hylobates moloch), an endangered primate that is endemic to the island of Java, Indonesia. We studied the singing behavior of the easternmost population of this species in the Dieng mountains, central Java, in 1998-1999. We aimed to document the timing of singing, quantify the amount of singing by the respective sexes, and explore the role of bioacoustics in density estimation. A total of 122 song bouts in at least 12 groups were monitored. No duet songs were heard. Most of the song bouts (91.5%) were female solo song bouts or female scream bouts. In contrast to an earlier study on the westernmost population of silvery gibbons, during which few if any male songs were heard, at least 8.5% of the song bouts in our study were male solo song bouts. They were significantly longer in duration than the female songs. All male song bouts uttered before dawn (0520 hr) were produced in a chorus fashion, with at least three individuals participating. Choruses occurred about once every 8.5 days, and lasted longer and occurred earlier than female solo song bouts. Most male songs (60%) started between 0355-0440 hr, when it was still dark. All female songs, in contrast, started after 0500 hr, and female singing activity peaked around 0600. Regular male singing, male chorusing, and regular predawn singing have not previously been reported for silvery gibbons. Similarly separated periods of male and female solo songs and the absence of duetting have been observed in Kloss's gibbons (H. klossii) on the Mentawai Islands, and may represent synapomorphies shared by both species. The pronounced individual-specific song characteristics of silvery gibbons allow accurate mapping of groups. The density of gibbons at our study site was established to be 1.9-3.7 groups/km2, corresponding to 6.7-13.1 individuals/km2. We reassess the suitability of gibbon songs as a means of estimating the density and size of gibbon populations, and discuss the proximate causes for the absence of duetting in silvery gibbons.

Acoustics↗
PubMed2001

Endocast of Sambungmacan 3 (Sm 3): a new Homo erectus from Indonesia.

A new fossil calvaria, Sambungmacan 3 (Sm 3), described in New Fossil Hominid Calvaria From Indonesia--Sambungmacan 3 by Márquez et al., this volume, yields one of the most advanced and complete endocasts yet recovered from Java. This communication provides a thorough interpretation of the external anatomical landmarks observable on Sm 3. Using computer tomography (CT) and traditional morphological measurements, our comparative paleoneurological analyses show that while Sm 3 has a mosaic of features that are similar to both Indonesian and Chinese H. erectus, it also possesses significant characters reminiscent of later hominins. These include a greater degree of asymmetry characterized by a possible left-occipital, right-frontal petalial pattern, left-right volumetric cerebral asymmetry, and marked asymmetry in Broca's cap. Moreover, the frontal lobe offers a more rounded, shortened appearance in contrast to the flat, elongated appearance of other Indonesian fossils (e.g., Sangiran 17). Another unique trait is exhibited in the transverse plane where the widest breadth of Sm 3 occurs more superiorly than in other Indonesian H. erectus. Thus, the endocast of Sm 3 presents a unique morphology not seen previously in the hominin fossil record. While the strong modern human characteristics in this endocast may not represent a particular ancestry, they do allow us to recognize a new dimension of the remarkable variation in Indonesian Homo erectus.

Animals↗
PubMedDate not supplied

A possible association of Pro12Ala polymorphism in peroxisome proliferator-activated receptor gamma2 gene with obesity in native Javanese in Indonesia.

BACKGROUND: Peroxisome proliferators-activated receptor gamma (PPAR gamma) is a nuclear hormone receptor that serves as a master regulator of adipocytes-specific genes contributing to adipocytes differentiation, susceptibility to obesity, and insulin sensitivity. The substitution of proline to alanine at codon 12 of the PPAR gamma2 gene (Pro12Ala polymorphism) is most frequently identified and the associations with diabetes, obesity, and other clinical parameters have been reported and discussed in several ethnic groups. Among native Javanese ethnicity, however, there is no report about this polymorphism. AIMS AND METHODS: Aims of this study were to estimate the allele frequency of the Pro12Ala polymorphism of PPAR gamma2 gene among native Javanese in Indonesia and to investigate the relationship between this polymorphism and obesity or diabetes. This study included 540 native Javanese subjects consisting of 337 diabetic patients and 203 normal glucose tolerance subjects. Both groups included totally 160 obese subjects (body mass index > or = 25 kg/m(2)). PCR-restriction fragment length polymorphism was used for the genotype determination. RESULTS: The allele frequency of Pro12Ala polymorphism in PPAR gamma2 gene among native Javanese is lower than that in other ethnic groups. No association is seen between the Pro12Ala and diabetes (0.01 vs 0.017%, p = 0.404), a trend of the higher BMI was observed in Pro12Ala carriers in nondiabetic subjects, although this association is limited by small numbers. CONCLUSION: In this study, no association is seen between the Pro12Ala polymorphism in PPAR gamma2 gene and diabetes; a weak association with obesity is seen.

Aged↗
PubMed2002

Social risk management options for medical care in Indonesia.

This paper investigates the extent to which price subsidies for medical care are a suitable instrument to reduce household's exposure to catastrophic financial risks associated with ill-health in Indonesia. Using the 1995 SUSENAS household survey, the observed distribution of user fees and health expenditures is used to derive a distribution of 'needed' medical expenditures. The trade-off between the tax burden and effectiveness in reducing the exposure to catastrophic risk is analyzed for two existing price regimes along with a number of hypothetical regimes. We find that the existing regimes significantly reduce the exposure to catastrophic shocks but do not eliminate them. Simulations suggest that further reductions could be achieved if a larger proportion of government subsidies were directed to inpatient care. Subsidizing outpatient treatment is a cost effective policy to reduce exposure to catastrophic risks only for the very poor.

Adult↗
PubMedDate not supplied

Who gets what? Utilization of health services in Indonesia.

An evaluation of health service utilization patterns was carried out in five rural districts and a number of urban areas in Indonesia. The study was part of a larger effort to develop economically-related information about the health care services. Utilization levels were then related to such selected population variables as distance from health facilities, insurance status and income. The annual contact rate, curative plus preventive, with all public sector facilities was found to be 0.8 per capita. The geographic catchment areas of the facilities were also found to be very limited. The insured population (civil servants and their families) used services about four times more frequently, on average, than did the rest of the population. In one provincial study, the top 9 per cent of income earners made up one-third of all hospital inpatients, one-half of all hospital outpatients, and one-quarter of all health centre visitors. The implications of these results for equity and efficiency are discussed.

Catchment Area, Health↗