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Evaluation of a comprehensive home-based midwifery programme in South Kalimantan, Indonesia.

We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district-based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998-99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through in-service training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life-saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.

Delivery of Health Care↗

Epidemiology of leprosy on five isolated islands in the Flores Sea, Indonesia.

We conducted a population-based survey on five small islands in South Sulawesi Province (Indonesia) to collect baseline data previous to a chemoprophylactic intervention study aiming at interrupting the transmission of Mycobacterium leprae. Here we describe the present leprosy epidemiology on these geographically isolated islands. Of the 4774 inhabitants living in the study area 4140 were screened for leprosy (coverage: 87%). We identified 96 leprosy patients (85 new and 11 old patients), representing a new case detection rate (CDR) of 205/10 000 and a prevalence rate of 195/10 000. CDRs were similar for males and females. Male patients were more often classified as multibacillary (MB) than women. Of the new patients, 33 (39%) were classified as MB, 16 (19%) as paucibacillary (PB) 2-5 lesions and 36 (42%) as PB single lesion. In this area of high leprosy endemicity leprosy patients were extensively clustered, i.e. not equally distributed among the islands and within the islands among the houses.

Adolescent↗

Studies on Streptococcus agalactiae isolated from bovine mastitis in Indonesia.

All 83 bacterial strains isolated from seven farms in three areas of the island of Java in Indonesia investigated in the present study could be identified as Streptococcus agalactiae. Identification was performed by cultural, biochemical and serological properties and by polymerase chain reaction amplification of species-specific parts of the gene encoding the 16S rRNA, the 16S-23S rDNA intergenic spacer region and the CAMP factor (cfb) gene. All isolates were unpigmented. almost all of the isolates had the serotype pattern II/X. Despite these similarities a macrorestriction analysis of the chromosomal DNA of the bacteria revealed no significant homologies of the DNA-fingerprints of the S. agalactiae from the various areas. This last finding might possibly indicate that a single ancestral unpigmented serotype II/X S. agalactiae clone was responsible for the mastitis situation on Java and had evolved separately in the various farms and regions.

Animals↗

Improvement of family carers' knowledge, skills and attitudes in caring for older people following the implementation of a Family Carers' Training Program in the community in Indonesia.

The purpose of this study was to examine family carers' knowledge, skills and attitudes in caring for older people following the implementation of a Family Carers' Training Program (FCTP). Family carers (n = 240) from two villages in Indonesia were randomly selected. All participants were surveyed by questionnaires and their care behaviour observed at baseline, three and six months. Findings indicated significant increases in knowledge, skills and attitudes in the intervention group over six months compared to those of the control group. Hence, the FCTP demonstrated a positive effect on family carers' capabilities and attitudes in caring for older people living in the community in the study setting.

Aged↗

Use of a control chart to monitor diarrhoea admissions: a quality improvement exercise in West Kalimantan Provincial Hospital, Pontianak, Indonesia.

Data on the number of admissions for diarrhoea each week to the West Kalimantan Provincial Hospital, Pontianak, Indonesia over a 5 year period, 1992-1996, were collected. After cleaning and exclusion of extreme values, transformation was then performed to ensure that the data were free of special cause variation and normally distributed. A control chart was then constructed to provide an 'early warning' system for hospital authorities in order to facilitate the management of the epidemic and to improve patient care.

Adult↗

Contemporary Minangkabau food culture in West Sumatra, Indonesia.

Diet has a strong relationship with food culture and changes in it are likely to be involved in the pathogenesis of newly emergent degenerative diseases. To obtain in-depth opinions about the food culture of Minangkabau people, focus group discussions were conducted in a Minangkabau region, represented by four villages in West Sumatra, Indonesia, from January to March 1999. The members of the discussion groups were principally women aged from 35 to 82 years old. Minangkabau culture is matriarchal and matrilineal which accounts for female gender dominants in the discussions. Rice, fish, coconut and chilli are the basic ingredients of the Minangkabau meals. Meat, especially beef and chicken, is mainly prepared for special occasions; pork is not halal and therefore not eaten by Muslim Minangkabau people; and for reasons of taste preference and availability, lamb, goat and wild game are rarely eaten. However, rendang, a popular meat dish, has been identified as one of the Minangkabau food culture characteristic dishes. Vegetables are consumed daily. Fruit is mainly seasonal, although certain kinds of fruit, such as banana, papaya and citrus, can be found all year around. Coconut has an important role in Minangkabau food culture and is the main source of dietary fat. While almost all food items consumed by the Minangkabau can be cooked with coconut milk, fried food with coconut oil is considered to be a daily basic food. Desiccated coconut is also used as a food ingredient on about a weekly basis and in snack foods almost every day. Although there have been no changes in food preparation and there is a slight difference in taste preference between the young and the old generations, there has been a dramatic shift in food preferences, which is reflected in the changing percentage of energy consumed over the past 15 years. The traditional combination of rice, fish and coconut in Minangkabau culture goes back hundreds of years, long before the emergence of the degenerative diseases of the newer economies, and is likely to offer food security and health protection to the Minangkabau for as long as the lifestyle remains traditional. Whether or not a recent increase in energy intake from fat and the quality of fat may contribute to the shift of disease pattern is fundamentally important for the Minangkabau, it seems unlikely the traditional use of coconut and its products was a health issue. Moreover, it was clear from the focus group discussions that the use of coconut encouraged the consumption of fish and vegetables.

Adult↗

Stratification and seasonal stability of diverse bacterial communities in a Pinus merkusii (pine) forest soil in central Java, Indonesia.

In Java, Indonesia, many nutrient-poor soils are intensively reforested with Pinus merkusii (pine). Information on nutrient cycles and microorganisms involved in these cycles will benefit the management of these important forests. Here, seasonal effects on the stratification of bacterial community structure in the soil profile of a tropical pine forest are described, and differences in bacterial communities are related to chemical and physical soil parameters. Culture-independent community profiles of litter, fragmented litter and mineral soil layers were made by denaturing gradient gel electrophoresis (DGGE) of 16S rDNA-specific polymerase chain reaction (PCR) fragments. The community profiles of the different soil layers clustered separately, correlating with significant differences in organic matter content between the three layers. The bacterial communities appeared to be stable during the wet season of 1998. The drought in 1997, caused by the El Niño climatic effect, did not influence the bacterial communities in fragmentation and mineral soil, although moisture content and other soil parameters were markedly lower than in the wet season. However, communities in litter were influenced by drought. In the litter layer, the moisture content was significantly lower than in the fragmentation and mineral layers during the dry season. A clone library was made from a litter sample taken during the wet season. Partial sequencing of 74 clones and linking the DGGE banding positions of these clones to bands in the DGGE profile of the sample from which the clone library was derived showed considerable bacterial diversity. Alpha-proteobacteria (40.5% of the clones, of which 57% belonged to the Rhizobium-Agrobacterium group) and high-G+C content, Gram-positive bacteria (36.5%) dominated the clone library.

Bacteria↗

Syphacia longaecauda n. sp. (Nematoda: Oxyuridae) syphacinea from Melomys spp. (Muridae: Hydromyinae) from Papua New Guinea and Irian Jaya, Indonesia.

A new oxyurid nematode Syphacia (Syphacia) longaecauda n. sp. is described from the caecum and colon of the hydromyine rodents Melomys monktoni (type host) and M. rubex from Papua New Guinea and Irian Jaya, Indonesia. Syphacia longaecauda has an oval, laterally extended, relatively large cephalic plateau and can be distinguished from other species of Syphacia with similar characters by, amongst other features, tail length. The significance of the distribution of S. longaecauda, apparently restricted to New Guinea, is discussed.

Animals↗

[Two new species of Stivalius (Siphonaptera--Pygiopsyllidae--Pygiopsyllinae) from Indonesia].

The fleas, S. meridionalis n. sp. from Timor and S. franciscae n. sp. from Sulawesi, Indonesia are described and illustrated. S. meridionalis was collected in Central Timor (Timor Tengah) at elevations between 930 m and 1,520 m, mainly from the murine rodent Rattus tanezumi, although one specimen was recovered from a house shrew, Suncus murinus. S. franciscae was collected in Central Sulawesi (Sulawesi Tengah) at known elevations between 950 m and 2,255 m from six species of native endemic murine rodents, especially Rattus hoffmanni, and from two species of commensal murine rodents. One specimen of S. franciscae was also collected from the native endemic murine Paruromys dominator in North Sulawesi (Sulawesi Utara) at 1,780 m. These two new flea species are compared with the previously described taxa included in the genus Stivalius sensu stricto.

Animals↗

Changing incidence of oral and maxillofacial tumours in East Java, Indonesia, 1987-1992. Part 2: Malignant tumours.

A total of 2193 tumours of the mouth and jaw diagnosed at the Laboratorium Patologi Anatomi Fakultas Kedokteran Universitas Airlangga, Indonesia from 1987 to 1992, inclusive, was studied. Malignant tumours constituted 45.3% of the lesions. Almost 71% of the malignant tumours were squamous cell carcinomas. The remainder were salivary gland tumours (21.5%) and sarcomas (4.5%). The male to female ratio for malignant tumours was 5.1:4.7. The incidence of malignant tumours per 100,000 population over the 6-year study period was 2.64. The yearly incidence seemed to increase except in 1990, when it dropped. The incidence of squamous cell carcinoma over the 6 years was 2.1. Calculation of the odds ratio suggested that people aged 40 and over are 5.8 times more likely to develop squamous cell carcinoma.

Adolescent↗

Natural pollution caused by the extremely acidic crater lake Kawah Ijen, East Java, Indonesia.

BACKGROUND, AIMS AND SCOPE: Lakes developing in volcano craters can become highly acidic through the influx of volcanic gases, yielding one of the chemically most extreme natural environments on earth. The Kawah Ijen crater lake in East Java (Indonesia) has a pH < 0.3. It is the source of the extremely acidic and metal-polluted river Banyupahit (45 km). The lake has a significant impact on the river ecosystem as well as on a densely populated area downstream, where agricultural fields are irrigated with water with a pH between 2.5 and 3.5. The chemistry of the river water seemed to have changed over the past decade and the negative effect in the irrigation area increased. A multidisciplinary approach was used to investigate the altered situation and to get insight in the water chemistry and the hydrological processes influencing these alterations. Moreover, a first investigation of the effects of the low pH on ecosystem health and human health was performed. METHODS: Water samples were taken at different sites along the river and in the irrigation area. Sampling for macroinvertebrates was performed at the same sites. Samples of soil and crop were taken in the irrigation area. All samples were analysed for metals (using ICP-AES) and other elements, and concentrations were compared to local and international standards. RESULTS AND DISCUSSION: The river carries a very high load of SO4, NH4, PO4, Cl, F, Fe, Cu, Pb, Zn, Al and other potentially toxic elements. Precipitation and discharge data over the period of 1980-2000 clearly show that the precipitation on the Ijen plateau influences water chemistry of the downstream river. Metal concentrations in the river water exceed the concentrations mentioned in Indonesian and international quality guidelines, even in the downstream river and the irrigation area. Some metal concentrations are extremely high, especially iron (up to 1,600 mg/l) and aluminium (up to 3,000 mg/l). The food-webs in the acidic parts of the river are highly underdeveloped. No invertebrates were present in the extremely acidic water and, at pH 2.3, only chironomids were found. This also holds true for the river water with pH 3.3 in the downstream area. Agricultural soils in the irrigation area have a pH of 3.9 compared to a pH of 7.0 for soils irrigated with neutral water. Decreased yields of cultivated crops are probably caused by the use of Al containing acidic irrigation water. Increased levels of metals (especially Cd, Co, Ni and Mn) are found in different foodstuffs, but still remain within acceptable ranges. Considering local residents' diets, Cd levels may lead to an increased risk for the human health. Fluoride exposure is of highest concern, with levels in drinking water exceeding guideline values and a lot of local residents suffering from dental fluorosis. CONCLUSIONS, RECOMMENDATIONS AND OUTLOOK: In short, our data indicate that the Ijen crater lake presents a serious threat to the environment as well as human health and agricultural production.

Animals↗

Condom use among brothel-based sex workers and clients in Bali, Indonesia.

BACKGROUND: The objective of this paper is to describe the situation among Indonesian sex workers and clients in Bali, Indonesia, through a series of studies conducted during the 1990s. METHODS: Five surveys of sex workers and clients were conducted from 1992 through to 1999. RESULTS: The proportion of female sex workers who have heard about AIDS and condom use has increased tremendously in this area. In 1992-93, 51% of women reported ever hearing of AIDS and this had increased to 97% by 1999 (P < 0.01). Reported condom use with clients increased from 19% in 1992-93 to 78% in 1999 (P < 0.01). However, condom use is still far from 100% and perceived susceptibility towards HIV infection among female sex workers and their male clients remains low. Ineffective preventive strategies such as medication use remain common. HIV infection was very low in this population, although the prevalence of other sexually transmitted infections such as gonorrhea and chlamydia was very high. CONCLUSIONS: Educational interventions have been conducted with the sex workers, but the main source of education for clients has been through the media. Future programs need to develop more focused efforts to reach clients. These interventions may include worksite interventions, mass media campaigns, youth programs or other models.

Acquired Immunodeficiency Syndrome↗

Underreporting of energy intake is less common among pregnant women in Indonesia.

OBJECTIVES: To evaluate the ratio of reported energy intake to basal metabolic rate (EI/BMR) among pregnant Indonesian women, as well as identifying risk factors for being an underreporter. DESIGN: Longitudinal study of dietary intake, using six repeated 24-hour diet recalls each trimester. Basal metabolic rate was estimated from body weight and physical activity from occupation. The lower 95% confidence interval for plausible EI/BMR was calculated and the proportion of underreporters estimated. Risk factors for being an underreporter were assessed in multivariate logistic regression analyses. SETTING: Purworejo District, central Java, Indonesia. SUBJECTS: Pregnant women RESULTS: For the three trimesters, EI/BMR ratio was and (mean+/-standard deviation), respectively. The proportion of underreporters was 29.7%, 16.2% and 17.6%. Characteristics significantly associated with underreporting in at least one trimester included high body mass index and low education. CONCLUSIONS: Levels of underreporting were low among the pregnant Indonesian women during the second and third trimesters. The low EI/BMR ratio during the first trimester likely reflects a true low intake due to nausea, rather than underreporting. Risk factors for being an underreporter included those known from developed countries, i.e. obesity and low education.

Adult↗

A survey for arboviral antibodies in sera of humans and animals in Lombok, Republic of Indonesia.

Sera were collected from humans, cattle, horses, goats, ducks, chickens, wild birds, bats and rats in Lombok, Indonesia, and were tested by haemagglutination inhibition (HI) for antibodies to JE, ZIKA, CHIK and RR. Selected sera were tested by microneutralization tests for antibodies to the following viruses: JE, ZIKA, MVE, TMU, LGT, KUN, SEP, DEN-2, CHIK, RR, GET, SIN, BUN, BAT and BAK. Human sera had JE HI antibody in 135 (30%) of 446 tested. Neutralization tests indicated that DEN-2, ZIKA, TMU, KUN and SEP may have caused flavivirus infections. Antibodies to other arboviruses tested for were not found. HI and neutralization tests on animal sera indicated possible flavivirus infections with JE, MVE, KUN and SEP, and also that infections with BAT and BUN had occurred among domestic animals. No neutralizing antibodies were found for alphaviruses or other viruses used in the tests.

Alphavirus↗

Detection of malaria endemicity in community villages in North Sumatra, Indonesia by enzyme linked immunosorbent assay.

An enzyme linked immunosorbent assay for malaria was used in North Sumatra, Indonesia as an epidemiological survey tool. The seroepidemiological investigation was concentrated on junior high schools. Serum samples obtained were classified according to the villages of origin of the students. The mean of ELISA values of each village group was compared with the parasite rate in primary schools in their native villages. A good correlation was observed between them (r = 0.96). The present results indicate that a survey of malaria in junior high schools by ELISA could give useful information on malaria prevalence in several peripheral villages. Province-wide information on malaria prevalence could easily be obtained by malaria-ELISA in junior high schools in tropical rural area.

Animals↗

Malaria transmission by Anopheles punctulatus in the highlands of Irian Jaya, Indonesia.

A 21-month (1991-1992) assessment of malaria and the relative contribution of Anopheles punctulatus and An. koliensis to its transmission was conducted in Oksibil, a highland community in Irian Jaya, Indonesia. Nearly all (98%) of the 2577 Anopheles from indoor or outdoor human-landing collections were An. punctulatus. Nineteen (0.75%) of the 2518 An. punctulatus tested were positive when tested for malaria circumsporozoite protein (CSP) by ELISA: nine (45% of positives) for Plasmodium vivax-210, six (30%) for Plasmodium falciparum, three (15%) for P. vivax-247 and two (10%) for P. malariae. One mosquito was positive for both P. vivax 210 and P. falciparum. All 59 An. koliensis tested were negative. All mosquitoes positive for CSP were from indoor collections, 89% from the main houses and the remaining 11% from the traditional dwellings (bokams). These findings are discussed with respect to highland malaria epidemiology and transmission in the Oksibil Valley.

Animals↗

Intestinal parasites of humans in a highland community of Irian Jaya, Indonesia.

An indigenous, highland community in the Oksibil Valley of Irian Jaya, Indonesia, was examined on two occasions to determine the prevalence of intestinal parasites. Overall, 478 subjects from three villages in the study area, about 10% of the available population, were sampled. Using a standard, wet-mount technique, 15 different species of parasites were found. Hookworm was predominant in all age groups, with prevalences of 51%-86%, followed by Ascaris lumbricoides (46%-57%) and Trichuris trichiura (15%-25%). Strongyloides stercoralis was only seen infrequently (< 1%). In general, intestinal protozoa were uncommon. Entamoeba histolytica (14%-20%) and Entamoeba coli (12%-17%) were the most frequent. Sex- and age-specific differences were not dramatic but prevalences and species diversity both increased with age up to 6-15 years, then decreased slightly into adulthood. Rarely were faecal samples free of detectable parasites and some adult subjects had as many as six species. The results are discussed with respect to previous studies in the highlands of New Guinea and the local transmission of soil- and water-borne parasites.

Adolescent↗

Halofantrine and primaquine for radical cure of malaria in Irian Jaya, Indonesia.

The combination of halofantrine and primaquine therapies was calculated as a regimen for achieving radical curve of falciparum or vivax malaria in Irian Jaya, Indonesia, and compared with combined chloroquine and primaquine therapies. The patients who volunteered for the study [adult, male, Indonesian immigrants with no previous exposure to endemic malaria, normal glucose-6-phosphate dehydrogenase (G6PD) activity, uncomplicated malaria illness, no prior use of antimalarials, and parasitaemias of 0.001%-1.1%] were randomized to receive either halofantrine (24 mg base/kg bodyweight, in three equal doses over 12 h) or chloroquine (25 mg base/kg bodyweight over 48 h, in doses of 10, 10 and 5 mg base/kg at 24-h intervals). Each patient also received concurrent daily primaquine (0.5 mg base/kg bodyweight) for 14 days followed by the same dose on alternate days to day 28. A recurrent parasitaemia during the 28 days of follow-up constituted drug failure. Of the 40 cases of falciparum malaria and 26 cases of vivax malaria treated with halofantrine-primaquine, none had a recurrent parasitaemia (100% efficacy). In contrast, 20 of 30 patients with falciparum malaria and three of 27 with vivax malaria had recurrent parasitaemias after chloroquine-primaquine, giving efficacies of 33% and 89%, respectively. Halofantrine-primaquine was significantly more effective than chloroquine-primaquine against falciparum malaria (P < 0.001) but was similarly efficacious against vivax malaria (P = 0.23). On average, fever associated with falciparum or vivax malaria cleared 17 h faster with halofantrine-primaquine (P < 0.01) although there were no significant differences (P > 0.4) in parasite-clearance times between the two regimens. The halofantrine-primaquine regimen was also associated with a more rapid and significant decline in malaria-related physical complaints.

Adult↗