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PubMed1976

Control of Schistosoma japonicum infection in Lindu Valley, Central Sulawesi, Indonesia.

In Indonesia, schistosomiasis is presently confined to two endemic areas in Central Sulawesi; Lindu (1,500) and Napu (5,000 inhabitants) valleys. Because of various development schemes now underway, it is feared that the natural balance which existed for many years between the parasite, the snail intermediate hosts and man, will be upset and will place some 70,000 people of the adjoining Palu and Palolo areas at risk. Measures are being taken to control and prevent the spread of the disease. A pilot control programme is planned for two years in the village of Anca in Lindu with a population of 391 and a prevalence rate of 70.5%. Langko village with a population of 464 and a prevalence rate of 53.7% will be utilized as the comparison area. Baseline data on human, malacological and animal reservoir hosts are being collected and control operations are anticipated to commence in July 1975. Measures to be applied to control schistosomiasis in the order of priorities are: (a) agro-engineering or modification of the environment; (b) environmental sanitation through the provision of adequate water supply and construction of latrines; (c) mollusciciding of remaining snail infested areas; (d) chemotherapy, and (e) health education campaign. At the end of the two-year control programme, the following activities will be carried out to determine the degree of intervention achieved; (a) human data: calculation of prevalence rates, incidence rates, and changes in the intensity of infection based on quantitative egg counts; (b) malacological data: changes in the number and extent of snail foci; snail density, and snail infection rates; (c) reservoir hosts: changes in the prevalence rates among domestic and wild animals. Calculation of reclaimed areas and increase in agricultural production will also be assessed together with the overall cost/benefit analysis of the project undertaking.

Adolescent↗
PubMed1976

Intestinal and blood parasites of man in Bireuen and Takengon, Aceh Province, Sumatra, Indonesia.

A survey for blood and intestinal parasites was carried out in Aceh Province of North Sumatra, Indonesia. A total of 348 stool specimens were obtained from 167 males and 181 females ranging in age from 6 months to 70 years. Over 98% of the population sampled were found infected with at least one intestinal parasite. Ascaris lumbricoides, Trichuris trichiura, hookworm and Entamoeba coli, in that order, were the most common parasites detected. Other intestinal parasites found less frequently were Entamoeba histolytica, Iodamoeba bütschlii, Entamoeba hartmanni, Endolimax nana and Giardia lamblia, Brugia malayi microfilaraemias were detected in 2% of those examined and only in the coastal villages of Cot Ketapang and Rusip Dayah. No malaria was found.

Adolescent↗
PubMed1999

Six new nematodes of the Heligmonellidae (Trichostrongylina) collected from endemic murines of Sulawesi, Indonesia.

Nematodes in Odilia and Paraheligmonelloides (Trichostrongylina: Heligmonellidae) are first recorded from Sulawesi, Indonesia, with 6 new species from the small intestine of endemic murines: Odilia sulawesiensis n. sp. and Odilia moatensis n. sp. from Rattus xanthurus; Odilia mamasaensis n. sp. and Odilia maxomyos n. sp. from Maxomys musschenbroekii; Paraheligmonelloides eropeplios n. sp. from Eropeplus canus; Paraheligmonelloides paruromyos n. sp. from Paruromys dominator. The 6 species are readily distinguished from congeners in the arrangement and number of the synlophe ridges, dilatation of cuticle, shape of the bursa copulatrix and the spicules, and length ratio of the spicules or the ovejector to body. The intestinal heligmonellid fauna of Sulawesi rats shows affinity to both Sundaland and Australian representatives, reflecting dispersal and speciation history of the nematodes and their hosts.

Animals↗
PubMed1999

Rare quadruple malaria infection in Irian Jaya Indonesia.

We report an exceptional finding from a blood slide collected in a remote area in the western half of New Guinea Island (Irian Jaya Province, Indonesia). One adolescent patient was found patently coinfected with all 4 known human malaria species, Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. Diagnostic erythrocytic stages of all 4 species were clearly seen in the peripheral blood. A nested polymerase chain reaction, using species-specific primer pairs to detect DNA, helped substantiate this finding. Previous reports from Africa, Thailand, and New Guinea have detected all 4 species in a population but not simultaneously in an individual with a patent, microscopically detectable infection. We believe this quadruple infection represents the first reported natural case of all 4 human malaria parasites observed concurrently in the peripheral blood from a single Giemsa-stained slide.

Animals↗
PubMed1999

Prevalence of allergic sensitization to regional inhalants among allergic patients in Jakarta, Indonesia.

Sensitization towards a panel of eight regional inhalant allergens was evaluated among 107 patients with allergic rhinitis and/or asthma. A total of 32 children (age 5-13 years, mean 9 years; 18 male, 14 female), 75 adolescents and adults (aged 14-66 years, mean 32 years; 21 male, 54 female) and 20 normal control volunteers (aged 16-46, mean 30 years; 4 male, 16 female) were evaluated via skin prick test. A weal response of 3 x 3 mm or greater was taken to be positive. The sensitization rates among individuals to these allergens were: house dust mites, Dermatophagoides pteronyssinus (77.57%), Blomia tropicalis (71.96%), Austroglycyphagus malaysiensis (33.64%), pollen, palm oil Elaeis guineensis (22.43%), Acacia auriculiformis (12.15%), fern spore, resam Dicranopteris spp (11.21%), fungal spores: Curvularia fallax (8.41%) and Exserohilum rostratum (13.08%). There were significantly higher frequencies of sensitization to these allergens among allergic individuals compared to normal controls, and among atopic individuals with two allergy manifestations (rhinitis and asthma) compared to those with only one. No difference was noted between children and adults in the allergic group. In conclusion, the allergic patients were highly sensitized to dust mites and sensitization to regional pollen and spores was also documented. They should be considered as relevant and be included in skin test batteries in Indonesia.

Adolescent↗
PubMed1998

An outbreak of El Tor cholera associated with a tribal funeral in Irian Jaya, Indonesia.

An outbreak of El Tor biotype cholera occurring in a rural village in Irian Jaya, Indonesia was evaluated for risk factors associated with death from cholera. Among those dying in the village during the epidemic, a significant association between membership in one of the five tribal groups in the village complex was associated with an elevated risk of suffering a cholera death (odds ratio = 5.9). Interviews with members of the decedents' families revealed a very strong association (odds ratio = 11.6) between risk of cholera death and having attended the two day funeral of a woman who died of a cholera-like illness a few days prior to an outbreak of cholera-like diarrheal disease in the village complex. Recent flooding may have contributed to the creation of an environment conducive to cholera transmission.

Cholera↗
PubMed1999

High cure rates in smear-positive tuberculosis patients using ambulatory treatment with once-weekly supervision during the intensive phase in Sulawesi, Republic of Indonesia.

SETTING: The four provinces of Sulawesi, Republic of Indonesia. OBJECTIVE: Treatment of smear-positive pulmonary tuberculosis patients using ambulatory treatment with supervision once weekly during the intensive phase and once fortnightly during the continuation phase. DESIGN: Pilot projects with gradual expansion of activities according to defined quantitative criteria. RESULTS: During the period January 1993-December 1997, 11,879 new smear-positive and 320 smear-positive previously treated patients, of whom 259 were relapses, were placed on short-course chemotherapy. At the end of the intensive phase, 87.5% of new patients and 80.0% of retreatment patients had become sputum smear-negative. During the period January 1993-December 1996, of 7,251 new smear-positive patients placed on treatment 85.2% were cured and an additional 7.9% had completed treatment, giving a total success rate of 93.1%. For 239 patients placed on retreatment the total success rate was 86.6%. CONCLUSION: The treatment results show that the policy introduced in Sulawesi is effective. In two provinces priority will now be given to increasing case detection, while in the other two provinces the emphasis will be on reaching full coverage. The reasons for the success of the projects are discussed, as are the prerequisites for introducing the policy in other areas.

Ambulatory Care↗
PubMed1999

Questionnaire survey and prevalence of intestinal helminthic infections in Barru, Sulawesi, Indonesia.

A questionnaire survey with parasitological study was carried out on the inhabitants of 4 villages in Barru district, Sulawesi, Indonesia from 1994 to 1995. The questionnaire dealt with life style and sanitary conditions. In 482 houses in the 4 villages, interviews for the items of the questionnaire were conducted with the owner, housekeeper and children of the same family. In Pancana and Lalolang, 37.7% and 50% respectively of man inhabitants surveyed were fishermen, while in Lompo Riaja and Pattappa, 38.6% and 65.5% respectively were farmers. The highest proportion of official workers was 33.7% in Lompo Riaja. Educational level was low; 88.4% in Pancana, 90.4% in Lalolang, 62.1% in Lompo Riaja and 91.2% in Pattappa had elementary or below elementary school education. In Lompo Riaja, 30.8% of the inhabitants graduated from senior high school or university. The percentage of families having their own latrine was 30.3% in Pancana, 13.2% in Lalolang, 31.9% in Pattapa and 60% in Lompo Riaja. The people without latrines usually defecated in rice fields, seaside or riverside. A total of 654 fecal samples was examined by the modified Kato-Katz thick smear method. Five nematode species, Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Strongyloides stercoralis and unidentified Rhabditoids of free-living nature were detected. Cestode, Hymenolepis nana infection was confirmed. All the hookworms examined by the modified Harada-Mori culture technic were Necator americanus. Trichuris infection was most common, followed by hookworm and Ascaris infections, both in young (aged 4-14) and older (aged over 15) age groups. The prevalence of hookworm infection was significantly higher in males than in females of older age. Among the older age group, the prevalence of Trichuris infection was significantly lower in Lompo Riaja, while hookworm infection was the highest in Pattappa. Among all the inhabitants examined for parasite infection, 17.4% had 3 kinds of nematode, Ascaris, Trichuris and hookworm. However, egg counts revealed that most of the inhabitants with Trichuris or hookworm had light infections. The inhabitants with higher education background had significantly lower infection rates of Ascaris and Trichuris. The prevalence of hookworm infection was not significantly different between the inhabitants owning latrine and without it, but the prevalence of Ascaris and Trichuris, differed significantly.

Adolescent↗
PubMed1998

Humoral immune responses against Plasmodium vivax MSP1 in humans living in a malaria endemic area in Flores, Indonesia.

The aim of this study was to evaluate the relationship among age, parasitemia status, spleen size, hematocrit, and antibody levels to Plasmodium vivax merozoite surface protein 1 (MSP1) in individuals chronically exposed to P. vivax. Subjects were recruited from the population of three adjacent villages on the Island of Flores in Indonesia where malaria transmission is hyperendemic and tropical splenomegaly syndrome is highly prevalent. Subjects were evaluated for spleen size, hematocrit, presence of parasitemia, and presence of antibodies to a recombinant peptide consisting of 90 amino acids from the carboxy terminus of MSP1. Fifty-seven percent of 2-4 year olds, 45% of 5-9 years old, and 7% of > or = 15 years old were parasitemic; 99% of the > or = 15 years old had splenomegaly, and 31% of them had Hackett 4 or 5 spleens. The frequency of antibody positivity to MSP1 antigen in ELISA increased with age reaching a maximum of 89% in > or = 20 years old. The frequency of antibody positivity to MSPI also increased with spleen size, and with a decline in the prevalence of parasitemia.

Adolescent↗
PubMed1999

Efficacy of permethrin-impregnated bed nets on malaria control in a hyperendemic area in Irian Jaya, Indonesia: differentiation between two age groups.

A malaria intervention trial was conducted for two years to evaluate the efficacy of permethrin-impregnated bed nets in reducing malaria infection and splenomegaly in two different age groups, ie below and over age of ten, in a hyperendemic area in Irian Jaya, Indonesia. Permethrin-impregnated or placebo-treated bed nets were provided to a treated and a control village, respectively. Immediately after periods with moderate rainfall in the first year, treated bed nets decreased P. falciparum and P. vivax density in the blood of children <10 years (group 1) but did not reduce the percentage of infection with either species. Children >10 and adults (group 2) showed significant reduction only in P. falciparum infection rates and density, whereas P. vivax was not influenced. After an excessive rainfall season in the second year, the risk for P. falciparum infections in both age groups using treated nets was less than half of that in the control village. P. vivax infection rates were significantly lower in the treated village at the beginning of and after these heavy rainfalls. In the treated village, spleen enlargement was markedly reduced in the younger age group during the second year.

Adolescent↗
PubMed1999

Country report: Clinical chemistry in Indonesia.

Seven hundred clinical laboratories in all over 27 provinces in Indonesia participated the Indonesian External Quality Assurance Scheme (Program Nasional Pemantapan Kualitas Laboratorium Kesehatan bidang Kimia Klinik). Among those laboratories, the government laboratory account for 288 (41%), and the rest 412 (59%) are private laboratories. Automatic analyzer was used by approximately 22% of the participating laboratories. Seventeen analytes were included in the program: bilirubin, cholesterol, creatinine, glucose, total protein, urea, uric acid, triglycerides, AST, ALT, calcium, albumin, alkaline phosphatase, gamma-GT, sodium, potassium, and chloride. Using WHO scoring system, median overall VIS of 128 was obtained. It means that the all over performance was fairly good . Bilirubin got the best median VIS (33). Sodium (median VIS 177), potassium (162) and chloride (209) got the worst VIS compared to the other parameters.

Blood Chemical Analysis↗
PubMed1999

El Niño and associated outbreaks of severe malaria in highland populations in Irian Jaya, Indonesia: a review and epidemiological perspective.

Perennial malaria is a major public health problem for most coastal, lowland and foothill populations in Irian Jaya (western New Guinea), the largest and easternmost province of Indonesia. Malaria at higher elevations above 1,500 m is considered intermittent and highly unstable, providing a constant threat of epidemics. Beginning in late August 1997, a significant increase of unexplained deaths was reported from the central highland district of Jayawijaya. The alarming number of fatalities rapidly escalated into September, dropping off precipitously by late October. More than 550 deaths due to "drought-related" disease had been officially reported from the district during this 10-week period. The outbreaks occurred in extremely remote areas of steep mountainous terrain inhabited by primitive shifting agriculturist populations. Microscopical evidence and site survey data implicated malaria as the principal cause of the excess morbidity and mortality at elevations between approximately 1,000 and 2,200 m. The dramatic increase in malaria and associated deaths was indirectly related to the prolonged and severe drought created by the prevailing 1997-98 El Niño Southern Oscillation (ENSO) affecting the Australasian region. Clinical cases of malaria were described as severe, due, in large part to the low level of naturally acquired immunity (NAI) in these highland populations and the predominance of Plasmodium falciparum infection. Disease may have been further exacerbated by the population's compromised nutritional status because of severe shortages of staple foods affected by the drought. Based on a retrospective investigation, an 'a posteriori' epidemiological explanation of the probable, interrelated causes of the epidemic is presented. Beginning in late July 1997, drought conditions resulted in numerous, transient pools of standing water along zones of steep gradient streams normally associated with fast-flowing water. This permitted sufficient and rapid increases in vector populations (Anopheles punctulatus complex) that either could sustain recently introduced or intensified local low-level malaria transmission. Moreover, water and food shortages contributed to increased demographic movement and exposure to high risk malaria endemic lowlands, thus increasing the prevalence of human infections and infectious reservoirs in those populations returning to the highlands. The eventual rapid drying and elimination of the vector larval habitats along stream beds, combined with mass antimalarial drug distribution are believed, in part, to be responsible for the rapid decline of severe malaria and related deaths. Area delimited and isolated focal outbreaks of malaria are recognized as occasional, periodic events in these highlands. This epidemic produced great concern because of the broad regionalized extent of the problem, the culmination of many independent outbreaks occurring during the same period that overwhelmed the local health care and control capabilities. We predict communicable disease outbreaks, including malaria, may likely increase in periodicity in the Irian Jaya highlands as socioeconomic development and population movements increase. This investigation further underscores the importance of malaria and its impact on presumed NAI deficient highland populations. Furthermore, the association of ENSO-related climatic anomalies and heightened infectious disease transmission is illustrative of how rapidly changing local weather events can dramatically alter disease patterns. These circumstantial findings, albeit important, point to the urgent need for more definitive understanding of highland malaria dynamics, the development of a sustainable longitudinal surveillance system, and appropriate outbreak response capabilities for the highlands of Irian Jaya.

Adolescent↗
PubMed2000

The comparison of tuberculosis treatments: a short course therapy and the directly observed short course treatment (DOTS), East Java Province, Indonesia.

Tuberculosis has been given great attention as HIV/AIDS has increased. Because HIV causes a higher tuberculosis risk is becoming more and more important better tuberculosis treatment. This study aimed to compare the smear conversion rate between short course therapy and the tuberculosis treatment with directly observed short course therapy (DOTS), in East Java, Indonesia. The average smear conversion rate in short course therapy among 35,292 cases was 94.40% over 5 year period (1989/90-1993/94). The tuberculosis treatment with DOTS was started in 1994/95. In the first 2 years the smear conversion rate were 97.67% (42/43) and 98.00% (196/200), respectively. The smear conversion rate of the treatment with DOTS was significantly higher compared to a short course therapy (p-value: <0.001). Thus, tuberculosis treatment with DOTS should be promoted. The concept of supervision by health workers or health cadres should be applied considering mostly are given by family members. And there should be readiness of tuberculosis staff to do the treatment with DOTS in all levels to expand the coverage.

Antitubercular Agents↗
PubMed2001

Reproductive health and STDs among clients of a women's health mobile clinic in rural Bali, Indonesia.

Recent studies in Indonesia have reported significant levels of STDs in low-risk urban groups. To gather data on rural women, a prevalence study was undertaken in Bali utilizing a women's health mobile clinic. Rural (n=312) women were tested for vaginal reproductive tract infections (RTIs) by on-site wet mount, for Neisseria gonorrhoeae and Chlamydia trachomatis by unamplified DNA (Gen-Probe) test, and for syphilis by rapid plasma reagin (RPR). Results were: candidiasis 5.8%; bacterial vaginosis (BV) 37.2%; trichomoniasis 15.1%; gonorrhoea 0.7%; chlamydial infection 5.6%; syphilis 0%. Overall 55.1% had at least one RTI and 19.2% had at least one STD. Reported non-monogamy, pain with urination and genital lesions, observed cervical friability and cervical motion tenderness were associated with cervical STD infection (P<0.05). We conclude that there is a need for improved services for STD prevention and RTI/STD management in rural Bali, and for condom promotion.

Candidiasis↗
PubMed2000

High prevalence of antibody to Toxoplasma gondii among humans in Surabaya, Indonesia.

Infection with Toxoplasma gondii is of medical importance in relation to a recent increase in cases of acquired immunodeficiency syndrome (AIDS). In the present study, we surveyed antibody to Toxoplasma among 1,761 people in Surabaya, Indonesia. The overall prevalence was 58% with significant differences between males (63%) and females (52%; P < 0.001). Although antibody prevalences at 0-9 years in both genders were less than 10%, those at ages over 10 years were more than 50% in males or more than 40% in females, suggesting an extremely high transmission rate of the parasite to humans in this area. A bimodal pattern in the frequency distribution of Toxoplasma antibody levels suggested a persistent feature of Toxoplasma infection in humans.

Adolescent↗
PubMed2003

Low-cost on-the-job peer training of nurses improved immunization coverage in Indonesia.

In Indonesia responsibility for immunizations is placed on local government health centres and on the nurses who provide the immunizations at each centre. An on-the-job peer training programme for these nurses, which was designed to improve the immunization performance of poorly performing health centres in terms of coverage and practice in Maluku province, was evaluated. Experienced immunization nurses were sent to health centres where nurses were inexperienced or performing poorly; the experienced nurses spent 1-2 weeks providing on-the-job training for the less experienced ones. An evaluation of the 13 centres that participated in the programme and the 95 that did not found that the programme increased both immunization coverage and the quality of practice. Coverage of diphtheria/pertussis/tetanus (DPT), polio, and measles vaccinations rose by about 39% in all 13 participating centres when compared with non-participating centres, and by about 54% in the 11 centres that had a functioning transportation system during the year after training. These results reflect increases in the actual number of doses given and improvements in the accuracy of reports. Potential threats to the study's validity were examined and found not to be significant. The out-of-pocket cost of the training programme was about US$ 53 per trainee or about US$ 0.05 per additional vaccine reported to have been given. The marginal cost per additional fully immunized child was estimated to be US$ 0.50.

Cost-Benefit Analysis↗
PubMed2001

Impact of intestinal helminth infection on anemia and iron status during pregnancy: a community based study in Indonesia.

A cohort study was carried out in Purworejo District, Central Java, Indonesia to investigate prevalence of anemia and low iron stores during pregnancy in relation to intestinal helminth infection. 442 pregnant women were followed until 5-10 weeks postpartum, during the period of April 1996 - August 1998. Information on intestinal helminths, hemoglobin and serum ferritin was collected each trimester. Highest prevalence of anemia in pregnancy (37.1%) was found in the second trimester, while the highest prevalence of low iron stores (49.5%) was found in the third trimester. Most pregnant women (69.7%) were infected with at least one species of pathogenic intestinal helminths. The most common helminth detected was Trichuris trichiura followed by Necator americanus (hookworm) and Ascaris lumbricoides. A significant negative association was found between hookworm infection and serum ferritin at the first trimester (p = 0.010). It is concluded that hookworm infection can interfere iron stores. Other causes of anemia among pregnant women should be considered. Anthelminthic therapy could be given to infected women before conception as public health strategy to improve iron status.

Adult↗
PubMed2001

High tuberculosis notification and treatment success rates through community participation in central Sulawesi, Republic of Indonesia.

SETTING: Central Sulawesi Province, Republic of Indonesia. OBJECTIVE: To increase tuberculosis case notification and maintain high treatment success rates through community participation in a tuberculosis field programme. DESIGN: Comparison of tuberculosis case notification and treatment results in a community based tuberculosis programme (CBTP), before and after introduction of the programme and between areas where the programme was and was not introduced. RESULTS: During 1998, the CBTP was introduced in two of the four rural districts of the Central Sulawesi province, covering 224 (29%) of the 772 villages and 362,700 (33%) of the 1,109,100 population in these districts. In the CBTP villages the notification rate of new smear-positive patients per 100,000 population increased from SI in 1996 and 48 in 1997 to 166 in 1998. In the 548 non-CBTP villages the rates were 62, 60 and 70, respectively. The sputum conversion rate at the end of the first 2 months of the treatment was over 85% in both the CBTP and the non-CBTP villages. In the CBTP villages the treatment success rate (cure and treatment completion) was 90.4%, 89.5% and 93.7% in 1996, 1997, and 1998. For the non-CBTP villages these rates were respectively 85.4%, 86.8% and 85.9%. In 1998 the sputum conversion and treatment success rates were significantly higher in the CBTP villages than in the non-CBTP villages. CONCLUSION: Through community participation, the notification of new smear-smear positive patients increased substantially, while sputum conversion and treatment success rates remained high.

Community Participation↗