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PubMed2005

Lung injury in uncomplicated and severe falciparum malaria: a longitudinal study in papua, Indonesia.

BACKGROUND: In patients with severe malaria, acute respiratory distress syndrome usually develops after the start of drug treatment and is a major cause of death. Its pathogenesis is not well understood. METHODS: Respiratory symptom, spirometry, and gas transfer analyses were performed longitudinally in adults in Papua, Indonesia, with uncomplicated (n=50) and severe (n=30) falciparum malaria; normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary vascular (Vc) components, to characterize the site of impaired gas transfer. RESULTS: Cough was frequent in both patients with uncomplicated malaria (50%) and those with severe malaria (30%) and resolved by day 14. Reduced midexpiratory flow indicated obstruction of the small airways. Gas transfer was significantly impaired in patients with severe malaria. D(M) was reduced in patients with severe malaria but not in those with uncomplicated malaria and only returned to normal levels after 2 weeks. In patients with uncomplicated malaria, Vc was reduced at presentation but improved thereafter. In patients with severe malaria, Vc decreased with treatment and was lowest at day 7. CONCLUSIONS: Our results suggest that pulmonary vascular occlusion occurs in both patients with uncomplicated malaria and those with severe malaria, likely from sequestration of both red blood cells (RBCs) and white blood cells. There was also impaired alveolar-capillary membrane function in patients with severe malaria but not in those with uncomplicated malaria. Persistent impairment long after clearance of parasitized RBCs suggests prolonged posttreatment inflammatory alveolar-capillary injury.

Adolescent↗
PubMed2006

Mefloquine is highly efficacious against chloroquine-resistant Plasmodium vivax malaria and Plasmodium falciparum malaria in Papua, Indonesia.

BACKGROUND: During the period of 1996-1999, we prospectively monitored 243 Javanese adults and children after arriving in Papua, Indonesia, and microscopically documented each new case of malaria by active surveillance. METHODS: In a randomized, open-label, comparative malaria treatment trial, 72 adults and 50 children received chloroquine for each incident case of malaria, and 74 adults and 47 children received mefloquine. RESULTS: Among 975 primary treatment courses, the cumulative 28-day curative efficacies were 26% and 82% for chloroquine against Plasmodium falciparum malaria and Plasmodium vivax malaria, respectively. Mefloquine cure rates were far superior (96% against P. falciparum malaria and 99.6% against P. vivax malaria). CONCLUSIONS: Mefloquine is a useful alternative treatment for P. vivax malaria and P. falciparum malaria in areas such as Papua, where chloroquine is still recommended as the first-line therapeutic agent.

Adult↗
PubMed1998

Impact of epidemic influenza A-like acute respiratory illness in a remote jungle highland population in Irian Jaya, Indonesia.

A suspected epidemic of unknown etiology was investigated in April/May 1996 in the remote jungle highlands of easternmost Indonesia. Trend analysis demonstrates the area-wide occurrence of a major respiratory infection outbreak in November 1995 through February 1996. The monthly mean rate of respiratory infection episodes for the peak outbreak months (2,477 episodes/100,000 persons) was significantly higher (P < .0001) than for the 34 months leading up to the outbreak (109 episodes/100,000 persons). Notable were the high attack rates, particularly among adults: 202 episodes/1,000 persons aged 20-50 years in one community. Excess morbidity attributed to the outbreak was an estimated 4,338 episodes. The overall case-fatality rate was 15.1% of outbreak cases. Laboratory evidence confirmed the circulation of influenza A/Taiwan/1/86-like viruses in the study population, and high hemagglutination inhibition titer responses were indicative of recent infections. Historical documents from neighboring Papua New Guinea highlight the role of influenza A virus in repeated area outbreaks.

Adolescent↗
PubMed2001

Importation of multiple HIV type 1 strains into West Papua, Indonesia (Irian Jaya).

HIV-1 from 16 sexually transmitted disease clinic patients in Timika, West Papua, Indonesia was amplified by RT-PCR and subtyped by a combination of envelope and gag region heteroduplex mobility analysis (HMA) and direct PCR DNA sequencing. HMA showed the presence of 14 subtype E (CRF01_AE) and 2 subtype B HIV-1. Phylogenetic analysis of a 540-bp V3-V4 region of gp120 showed that 9 of 10 CRF01_AE variants clustered tightly with a median distance of 1.3% (range, 0.5 to 2.2%) whereas 1 CRF01_AE variant diverged significantly from the others (median distance, 10.7%; range, 10.1 to 11.8%). One subtype B virus envelope was typical of United States/European strains whereas the other appeared to be related to Thai subtype B' variants. These results reflect the independent introduction of multiple HIV-1 strains into West Papua, with the rapid spread in the majority of infected patients tested of a single strain of HIV-1E (CRF01_AE).

Adolescent↗
PubMed2003

Syphilis and HIV prevalence among commercial sex workers in Central Java, Indonesia: risk-taking behavior and attitudes that may potentiate a wider epidemic.

A cross-sectional study was conducted on 200 commercial sex workers (CSWs) from two brothel communities in Central Java, Indonesia, to determine the seroprevalence of syphilis and HIV and characterize associated knowledge, beliefs, and risk-taking behaviors. A questionnaire was administered and blood drawn for HIV and syphilis serologies. Focus groups with a total of 20 women were also conducted at both communities to supplement survey data. The mean CSW age was 27.3 years; mean number of clients seen per day was 2.27. The prevalence of syphilis and HIV were 7.5% and 0.5%, respectively. Thirty percent said they and their partners never used condoms during sex, and only 3.0% said they always used condoms. The most common client groups were truck drivers and sailors. While Central Java appears to remain in a pre-epidemic state, there is enormous potential for a significant increase in HIV and STD transmission.

Adolescent↗
PubMed1989

Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia.

A double-blind clinical trial was conducted in Indonesia to assess effects of iron supplementation on performance of iron-depleted and iron-deficient anemic children in discrimination and oddity learning tasks. Half these children received elemental Fe for 8 wk; the others received a placebo. There were significant changes from pre- to postintervention evaluations in ferritin, transferrin saturation, free erythrocyte protoporphyrin, and hemoglobin among the anemic and iron-depleted children; no changes were observed among the placebos or any of the iron-replete children. The magnitude of hematological changes in anemic children treated with iron was small; yet, after treatment the children's mean ferritin, transferrin saturation, and hemoglobin values were above the cutoff points used for the definition of iron-deficiency anemia (IDA). Pre- and posttreatment psychological test data show that IDA produces alterations in cognitive processes related to visual attention and concept acquisition, alterations reversed with iron treatment.

Adult↗
PubMed1992

Cross-sectional study on the iron and vitamin A status of pregnant women in West Java, Indonesia.

A cross-sectional study of the prevalence of iron and vitamin A deficiency in normal pregnant women in West Java, Indonesia, was carried out. Of the 318 women studied, 49.4% were anemic and, according to multiple criteria, 43.5% had iron-deficiency anemia, 22.3% had iron-deficient erythropoiesis, and 6.6% had iron depletion. Serum retinol values revealed that 2.5% of the pregnant women were vitamin A deficient and 31% had marginal vitamin A status. The relative dose-response test carried out on 45 women showed that 4 (8.9%) had deficient vitamin A liver stores. After gestational stage, parity, and subdistrict were adjusted for, serum retinol concentrations were significantly positively associated (P < 0.01) with hemoglobin concentrations, hematocrit, and serum iron concentrations. The suboptimal vitamin A status associated with nutritional-deficiency anemia suggests that pregnant women in the area should be supplemented not only with iron but also with vitamin A. This proposal should be tested in an intervention study.

Cross-Sectional Studies↗
PubMed1993

Low compliance with an iron-supplementation program: a study among pregnant women in Jakarta, Indonesia.

The efficiency of an established iron-supplementation program for pregnant women in Jakarta, Indonesia was investigated. Hemoglobin, serum ferritin, and packed cell volume (PCV) were measured at the start of the study and after 2 mo supplementation with 300 mg ferrous sulphate/d. The women (n = 45) were questioned about compliance and stool samples were checked for iron content to control for tablet intake. Twelve women dropped out. Prevalence of anemia (42%) did not decrease during the study period. Of the remaining 33 women, 64% (n = 21) claimed to have taken all iron tablets. This was only confirmed by positive stool tests in 12 women. Serum ferritin and PCV increased in women with positive stool tests (P < 0.05 and P < 0.01, respectively) after supplementation. It is concluded that compliance was low and that the iron dose needs to be increased. Supplementation programs need reliable monitoring and evaluation systems.

Adult↗
PubMed1998

Orange fruit is more effective than are dark-green, leafy vegetables in increasing serum concentrations of retinol and beta-carotene in schoolchildren in Indonesia.

The objectives of this study were to quantify the effectiveness of dietary retinol sources, orange fruit, and dark-green, leafy vegetables in improving vitamin A status, and to test whether orange fruit is a better source of vitamin A and carotenoids than are leafy vegetables. Anemic schoolchildren aged 7-11 y (n = 238) in West Java, Indonesia, were randomly allocated to 1 of 4 groups to consume 2 complete meals/d, 6 d/wk, for 9 wk: 1) 556 retinol equivalents (RE)/d from retinol-rich food (n = 48); 2) 509 RE/d from fruit (n = 49); 3) 684 RE/d from dark-green, leafy vegetables and carrots (n = 45); and 4) 44 RE/d from low-retinol, low-carotene food (n = 46). Mean changes in serum retinol concentrations of the retinol-rich, fruit, vegetable, and low-retinol, low-carotene groups were 0.23 (95% CI: 0.18, 0.28), 0.12 (0.06, 0.18), 0.07 (0.03,0.11), and 0.00 (-0.06, 0.05) micromol/L, respectively. Mean changes in serum beta-carotene concentrations in the vegetable and fruit groups were 0.14 (0.12, 0.17) and 0.52 (0.43, 0.60) micromol/L, respectively. Until now, it has been assumed that 6 microg dietary beta-carotene is equivalent to 1 RE. On the basis of this study, however, the equivalent of 1 RE would be 12 microg beta-carotene (95% CI: 6 microg, 29 microg) for fruit and 26 microg beta-carotene (95% CI: 13 microg, 76 microg) for leafy vegetables and carrots. Thus, the apparent mean vitamin A activity of carotenoids in fruit and in leafy vegetables and carrots was 50% (95% CI: 21%, 100%) and 23% (95% CI: 8%, 46%) of that assumed, respectively. This has important implications for choosing strategies for controlling vitamin A deficiency. Research should be directed toward ways of improving bioavailability and bioconversion of dietary carotenoids, focusing on factors such as intestinal parasites, absorption inhibitors, and food matrixes.

Anthropometry↗
PubMed1998

Reappraisal of the role of vegetables in the vitamin A status of mothers in Central Java, Indonesia.

Food-based approaches for controlling vitamin A deficiency and its consequences, such as increased mortality, more severe morbidity, and anemia, have become increasingly important, thus prompting a reassessment of the relation between vitamin A intake and status. A nutrition surveillance system in Central Java, Indonesia, assessed the vitamin A intake and serum retinol concentration of women with a child < or =24 mo old with a semiquantitative 24-h recall method that categorized vitamin A-containing foods into 3 categories of plant foods and into 2 categories of animal foods and identified portions as small, medium, or large. Median vitamin A intake was 335 retinol equivalents (RE)/d (n = 600) and vitamin A intake from plant foods was 8 times higher than from animal foods. Serum retinol concentration was related to vitamin A intake in a dose-response manner. The multiple logistic regression model for predicting the chance for a serum retinol concentration greater than the observed median (> or = 1.37 micromol/L) included physiologic factors, vitamin A intake from plant [odds ratio (95% CI) per quartile: 1st, 1.00: 2nd, 1.23 (0.75, 2.02); 3rd, 1.60 (0.97, 2.63); and 4th, 2.06 (1.25, 3.40)] and animal [1st and 2nd, 1.00; 3rd, 1.31 (0.86, 2.02); and 4th, 2.18 (1.40. 3.42)] foods, home gardening [(no, 1.00; yes, 1.71 (1.12, 2.60)], and woman's education level [< or =primary school, 1.00; > or =secondary school, 1.51 (1.02, 2.22)]. Despite the fact that plant foods contributed 8 times as much vitamin A as did animal foods, serum retinol concentrations did not reflect this large difference. Home gardening and woman's education level seemed to reflect longer-term consumption of vitamin A-rich plant and animal foods, respectively.

Adult↗
PubMed2001

Concurrent micronutrient deficiencies in lactating mothers and their infants in Indonesia.

BACKGROUND: Deficiencies of vitamin A, iron, and zinc are prevalent worldwide, affecting vulnerable groups such as lactating women and infants. However, the existence of concurrent deficiencies has received little attention. OBJECTIVE: The aim was to investigate the extent to which deficiencies of vitamin A, iron, and zinc coexist and the nutritional relation between lactating mothers and their infants. DESIGN: In a cross-sectional survey in rural West Java, Indonesia, 155 lactating mothers and their healthy infants were assessed anthropometrically and blood, urine, and breast-milk samples were obtained. RESULTS: Marginal vitamin A deficiency was found in 54% of the infants and 18% of the mothers. More than 50% of the mothers and infants were anemic and 17% of the infants and 25% of the mothers were zinc deficient. There was a strong interrelation between the micronutrient status of the mothers and infants and the concentrations of retinol and beta-carotene in breast milk. Vitamin A deficiency in infants led to an increased risk of anemia and zinc deficiency (odds ratios: 2.5 and 2.9, respectively), whereas in mothers the risk of anemia and iron deficiency (odds ratios: 3.8 and 4.8, respectively) increased. In infants, concentrations of insulin-like growth factor I were related to concentrations of plasma retinol and beta-carotene but not to zinc. CONCLUSIONS: Micronutrient deficiencies were prevalent in West Java. The micronutrient status of lactating mothers and that of their infants were closely related; breast milk was a key connecting factor for vitamin A status. Furthermore, concurrent micronutrient deficiencies appeared to be the norm.

Adolescent↗
PubMed2001

Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia.

BACKGROUND: Iron deficiency anemia is the most prevalent nutrition problem in young children. One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food. OBJECTIVE: This study was designed to assess whether iron-fortified candies can improve iron status and are acceptable to children aged 4-6 y. DESIGN: A double-blind, placebo-controlled intervention study was conducted in Jakarta, INDONESIA: The children were randomly assigned to 1 of 2 treatment groups: a fortified group (n = 57) and a placebo group (n = 60). Every week for 12 wk, 30 g (10 pieces) candy was given to the children. The candy given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals. RESULTS: The hemoglobin concentration of the fortified group increased by 10.2 g/L (95% CI: 8.3, 12 g/L) whereas that of the placebo group increased by 4.0 g/L (2.0, 6.0 g/L; P < 0.001). Anemia prevalence decreased from 50.9% at the start of the intervention to 8.8% after 12 wk of intervention in the fortified group (P < 0.001) and from 43.3% to 26.7% in the placebo group (P < 0.05). After 12 wk of intervention, the serum ferritin concentration was 71% higher than at baseline in the fortified group and 28% higher in the placebo group (P < 0.001). Acceptability of the iron-fortified candies was good. The per capita cost of the supplement was approximately US$0.96-1.20 for the 12 wk of intervention. CONCLUSION: Iron-fortified candies were effective for improving the iron status of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups.

Anemia, Iron-Deficiency↗
PubMed2006

Responses of crown development to canopy openings by saplings of eight tropical submontane forest tree species in Indonesia: a comparison with cool-temperate trees.

BACKGROUND AND AIMS: Growth in trunk height in canopy openings is important for saplings. How saplings increase height growth in canopy openings may relate to crown architectural constraints. Responses of crown development to canopy openings in relation to trunk height growth were studied for saplings (0.2-2.5 m tall) of eight tropical submontane forest tree species in Indonesia. The results of this study were also compared with those of temperate trees in northern Japan. METHODS: The crown architecture differed among the eight tropical species, i.e. they had sparsely to highly developed branching structures. Crown allometry was compared among the eight species in each canopy condition (closed canopy or canopy openings), and between closed canopy and canopy openings within a species. A general linear regression model was used to analyse how each species increases height growth rate in canopy openings. Crown allometry and its plasticity were compared between tropical and temperate trees by a nested analysis of covariance. KEY RESULTS: Tropical submontane trees had responses similar to cool-temperate trees, showing an increase in height in canopy openings, i.e. taller saplings of sparsely branched species increase height growth rates by increasing the sapling leaf area. Cool-temperate trees have a wider crown projection area and a smaller leaf area per crown projection area to avoid self-shading within a crown compared with tropical submontane trees. Plasticity of the crown projection area is greater in cool-temperate trees than in tropical submontane trees, probably because of the difference in leaf longevity. CONCLUSIONS: This study concluded that interspecific variation in the responses of crown development to canopy openings in regard to increasing height related to the species' branching structure, and that different life-forms, such as evergreen and deciduous trees, had different crown allometry and plasticity.

Indonesia↗
PubMed1993

Antimicrobial susceptibility patterns and resistance transferability among Bacteroides fragilis group isolates from patients with appendicitis in Bali, Indonesia.

Patterns of antimicrobial susceptibility were determined for 155 clinical isolates of the Bacteroides fragilis group from patients with acute appendicitis in Bali, Indonesia. The transfer of drug resistance was also studied, and plasmid analyses were undertaken. Metronidazole and chloramphenicol were the most active drugs against these isolates (resistance rate, < or = 0.6%). Among the beta-lactam drugs, cefoxitin was the most active (resistance rate, 2%). Rates of resistance to tetracycline were high (16%). Resistance to clindamycin (rate, 10%) increased during the 2-year study period. Except in the case of beta-lactam agents, overall susceptibility patterns were comparable to those reported from other countries. Tetracycline resistance was more frequently transferred after tetracycline induction than without such induction (P < .05, chi 2 test). Resistance to tetracycline and clindamycin was co-transferred by five of 12 donor strains. In one of these five strains, transferability was constitutive, with a high transfer frequency (10(-5) per input donor). Plasmid analysis indicated that the transfer of resistance to tetracycline and clindamycin among the strains studied was not plasmid mediated.

Acute Disease↗
PubMed1998

The Center for Epidemiological Studies Depression Scale in older community samples in Indonesia, North Korea, Myanmar, Sri Lanka, and Thailand.

Cultural differences in the reporting of depressive symptoms among older people were examined using the Center for Epidemiological Studies Depression (CES-D) scale in five Southeast Asian countries: Indonesia, Korea, Myanmar, Sri Lanka, and Thailand. Previous work in Asian samples--principally North American immigrants--suggested differential functioning of the CES-D. The four-factor solution established in the original studies of the CES-D was replicated for all countries using a confirmatory factor analytic approach. It was, however, demonstrated that little information was lost in considering full-scale scores rather than the four subscales separately. The behavior of the CES-D in older Asian populations was found to be comparable to results obtained in North American and European cultures. Significant somatization of depression in these Asian samples was not found. There appears to be a general factor measuring depressed mood across older populations. The results support the validity of comparing responses on the CES-D across cultures.

Affect↗
PubMed2001

Cost recovery beds in public hospitals in Indonesia.

A policy of allowing public hospitals to provide some better quality, higher priced hospital beds for those able to pay was introduced as government policy in Indonesia after 1993. A study was conducted in 1998 in three public hospitals in East Java to investigate if the policy objective of cost-recovery was being achieved. Hospital revenue from these commercial beds was less than both the recurrent and total costs of providing them in all three hospitals, but exceeded recurrent costs minus staff salaries in two hospitals. One reason for the low cost-recovery ratios was that between 55% and 66% of the revenue was used as staff incentives, mostly to doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low. The policy may be contributing to the retention of doctors within public sector employment; however, it is not achieving its stated objective, especially over the longer term where full recovery of salaries and investment costs needs to be considered. Public hospitals that wish to invest in commercial beds need effective management and accounting systems so as to be able to monitor and control costs and set fees at levels that recoup the costs incurred. Further research is required to determine if this form of public-private mix has negative effects on equity and access for poorer patients.

Accounting↗
PubMed2004

The effects of mandatory health insurance on equity in access to outpatient care in Indonesia.

This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.

Adolescent↗
PubMed1981

Estimate of the risk of post transfusion hepatitis B in Jakarta, Indonesia.

The prevalences of hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) were determined in blood donors and transfusion recipients in Jakarta, Indonesia. In blood donors the prevalence of HBsAg was 10% while anti-HBs was 43%. In transfusion recipients the prevalence of HBsAg and anti-HBs was 67%. The prevalence of susceptible recipients or those without detectable HBsAg or anti-HBs was 33%. Thus, the probability that a susceptible recipient would receive HBsAg from a blood donor was calculated at 3.3%. Published data from other studies were used to estimate the risk of clinical post transfusion hepatitis in Jakarta at between 0% and 2%.

Adolescent↗