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PubMed2004

Comparison of multidrug therapy treatment results between multibacillary leprosy patients in hyperendemic and hypoendemic areas in Gowa Regency, South Sulawesi, Indonesia.

We studied 88 multibacillary (MB) leprosy patients, who received multidrug therapy (MDT) treatment in hyperendemic (44 persons) and hypoendemic (44 persons) areas in Gowa Regency, South Sulawesi, Indonesia. Bacteriological examinations were carried out (bacteria index and morphology index), immunological examinations (MLPA and TNF-alpha) and genetic variation in blood and ear lobe slit skin smears of MB leprosy patients, which had been treated by MDT, were performed. The collected data were analyzed with the chi-square test and discriminant analysis. Eight persons (9.1%) had a positive bacteria index and 2 persons (2.4%) had a morphology index. All patients (100%) increased their TNF-alpha concentration. All the samples (100%) showed an increase in the TNF-alpha concentration, compared to controls. MLPA positive conversion was found in 4 persons (47.7% samples) and TNF-alpha gene genetic variation at the position of -308, occurred in 12 persons (13.6% samples). Statistic test results showed a significant difference (p<0.01) in the TNF-alpha concentration between hyperendemic and hypoendemic areas. On the basis of a positive conversion by bacteriological results and its association with immunological results, it can be concluded that multibacillary leprosy patients with MDT treatment did not become a source of leprosy transmission.

Adult↗
PubMed2005

Epidemiology of dengue and dengue hemorrhagic fever in a cohort of adults living in Bandung, West Java, Indonesia.

A prospective study of dengue fever (DF) and dengue hemorrhagic fever (DHF) was conducted in a cohort of adult volunteers from two textile factories located in West Java, Indonesia. Volunteers in the cohort were bled every three months and were actively followed for the occurrence of dengue (DEN) disease. The first two years of the study showed an incidence of symptomatic DEN disease of 18 cases per 1,000 person-years and an estimated asymptomatic/ mild infection rate of 56 cases per 1,000 person-years in areas of high disease transmission. In areas where no symptomatic cases were detected, the incidence of asymptomatic or mild infection was 8 cases per 1,000 person-years. Dengue-2 virus was the predominant serotype identified, but all four serotypes were detected among the cohort. Four cases of DHF and one case of dengue shock syndrome (DSS) were identified. Three of the four DHF cases were due to DEN-3 virus. The one DSS case occurred in the setting of a prior DEN-2 virus infection, followed by a secondary infection with DEN-1 virus. To our knowledge, this is the first report of a longitudinal cohort study of naturally acquired DF and DHF in adults.

Adult↗
PubMed2005

A large outbreak of probable rotavirus in Nusa Tenggara Timur, Indonesia.

An outbreak of acute diarrheal disease was reported in Kupang, Nusa Tenggara, Indonesia, in August 2002. An investigative team carried out a retrospective historical review of records, and a case-control study involving data and specimen collections. Etiologic determination involving stool specimens was based on an enzyme-linked immunosorbent assay, with a reverse transcriptase-polymerase chain reaction performed for serotyping purposes. Two thousand six hundred probable cases were identified from hospital records during the outbreak months of June, July, August, and September 2002. Previous enteric outbreaks were recognized from the same months in the preceding years and all annual outbreak episodes following a period of prolonged, low rainfall. In contrast to previous outbreaks discerned from trend analysis, the overwhelming burden of disease fell upon the pediatric population versus the young and old in previous outbreak instances. Rotavirus was found to be the causative etiology, with serotype 1 predominating.

Disease Outbreaks↗
PubMed2005

Malaria in Indonesia: a summary of recent research into its environmental relationships.

A review of the literature was carried out to evaluate malaria and its environmental relationships. Research, in 6 parts of Indonesia, addressed the relationship between malaria incidence and physical and socioeconomic environmental factors, using longitudinal and cross-sectional approaches. Physical factors, which are generally important for malaria, included rainfall, mosquito breeding and resting sites, their distance from human habitation, and elevation, though the latter was not statistically significant. Housing conditions were occasionally important. Social and economic factors of importance were income, education, use of bednets and pattern of outdoor activities, especially at night. Use of repellents, mosquito coils and sleeping arrangements were significant in some of the studies.

Adolescent↗
PubMed2003

Newborn screening in Indonesia.

In Indonesia, newborn screening is not yet a policy, and the incidence of preventable causes of mental retardation detected by newborn screening is not known. Congenital hypothyroidism (CH) is not infrequent. Without a screening program, unrecognized CH patients were neglected for years. Since May 1999, the International Atomic Energy Agency (IAEA) has assisted in starting a CH Newborn Screening Project to estimate the local incidence of CH and to evaluate the problems associated with the screening. In June 2000, a pilot study was conducted using primary TSH measurement, supplemented by T4 in infants with elevated TSH. The target was to screen 12,000 newborn infants, using cord blood serum taken at birth, or a heel prick between 2 to 6 days of age. Between June 2000 and February 2001, 3,534 neonates born in 4 hospitals were screened using cord blood serum taken at birth (recall rate 3.3%). From March 2001 onwards, the heel prick method was used and participating hospitals increased from 4 to 7. Using this approach, until August 2001, 3,309 samples were analysed and the recall rate was much lower (0.64%). The number of unsatisfactory samples was relatively high due to an unstable process of blood collection. Parental refusal and low acceptance of screening among policy makers resulted from lack of awareness of the dangers of CH, and the screening program was not considered a health priority. Recall of patients after screening was a major barrier, with problems in tracking patients arising from urbanization and a high rate of relocation. To advance the CH screening program nationwide, infrastructure must be improved along with the recall system, and education as well as information campaigns for parents and medical professionals must be intensified. The Department of Health must be persuaded to give a national mandate.

Attitude to Health↗
PubMed2005

[Experience of Handicap International in providing humanitarian relief in region near Aceh, Indonesia from March 1 to 27, 2005].

This report describes the experience of the author in March 2005 during the relief efforts deployed in the region near Aceh, Indonesia (North Sumatra) by Handicap International, one of the 400 NGO that provided humanitarian aid following the tsunami disaster that struck Southeast Asia on December 26, 2004. Working in Banda Aceh and Meulaboh, the author was confronted with the extent of the devastation both in terms of property damage and human suffering. Clinical cases were often severe and rarely encountered in industrialized countries. The tsunami worsened the already poor sanitary conditions: rundown care facilities, poorly trained health care personnel, tropical disease, poor hygiene, and AVP.

Delivery of Health Care↗
PubMed2005

Disaster relief and initial response to the earthquake and tsunami in Meulaboh, Indonesia.

The Singapore Humanitarian Assistance Support Group deployed a team of 32 medical relief workers to Meulaboh, Indonesia to provide medical assistance for victims of the 26 December earthquake and tsunami disaster. The team was deployed at a primary healthcare clinic at an internally displaced persons' (IDP) camp and at the sole hospital's emergency and surgical departments. The team saw a total of 1841 patients, 1371 at the clinic and 446 at the hospital's emergency department, and performed surgery on 24 patients. Tsunami-related trauma cases accounted for 31.8% (142) of cases at the emergency department, 1.6% (22) of cases at the clinic, and 91.7% (22) of surgeries. This paper details the difficulties and lessons learnt by the team, including the lack of important resources for healthcare delivery. Water, sanitation, hygiene, and vector control were some of the problems faced, with the goal to provide the most effective public health for the greatest number of people given the limited resources available.

Disasters↗
PubMed2006

Medical practitioner regulation in Indonesia.

Against a background of little by way of health practitioner regulation, Indonesia's Medical Practice Act 2004 has introduced a regime of both ethical obligations for medical practitioners and a system of disciplinary oversight over practitioners' conduct. This editorial describes the Indonesian initiatives and evaluates the challenges that are likely to confront their implementation.

Government Regulation↗
PubMed2006

Rapid onset of transmission-reducing antibodies in javanese migrants exposed to malaria in papua, indonesia.

Transmission of Plasmodium falciparum malaria is initiated by sexual stages in the mosquito. Anti-Pfs48/45 and anti-Pfs230 sexual stage antibodies that are ingested together with parasites can reduce parasite development and subsequently malaria transmission. Acquisition of sexual stage immunity was studied in a cohort of 102 non-immune Javanese individuals migrating to hyperendemic Papua Indonesia. Seroprevalence of antibodies against Pfs48/45 and Pfs230 and functional transmission-reducing activity (TRA) were measured upon arrival and at 6, 12, and 24 months. Asexual parasitemia and gametocytemia were assessed every two weeks. The TRA and seroreactivity increased with the number of P. falciparum infections. The longitudinally sustained association between TRA and antibodies against Pfs48/45 (odds ratio [OR] = 3.74, 95% confidence interval [CI] = 1.51-9.29) and Pfs230 (OR = 3.72, 95% CI = 1.36-10.17) suggests that functional transmission reducing immunity is acquired after limited exposure to infection.

Adult↗
PubMed2005

Field trial on the spatial repellency of metofluthrin-impregnated plastic strips for mosquitoes in shelters without walls (beruga) in Lombok, Indonesia.

Field trials on the spatial repellency of metofluthrin-impregnated plastic strips for mosquitoes present in shelters without walls (beruga) were carried out in Lombok, Indonesia. A major reduction in the incidence of human biting by Culex quinquefasciatus was achieved, and the use of two strips per beruga repelled >60% of the mosquitoes for at least 11 wk while four strips repelled >60% of the mosquitoes for more than 15 weeks. The technique was found to be a practical long-term solution for the prevention of mosquito bites without using electricity or heat to evaporate the metofluthrin.

Animals↗
PubMedDate not supplied

Post-tsunami medical care: health problems encountered in the International Committee of the Red Cross Hospital in Banda Aceh, Indonesia.

INTRODUCTION: When the Tsunami struck Asia on 26 December 2004, Aceh, Indonesia suffered more damage than did any other region. After the Tsunami, many humanitarian organizations provided aid in Aceh. For example, the International Committee of the Red Cross (ICRC), along with the Indonesian and Norwegian Red Cross opened a field hospital in Banda Aceh on 16 January 2005. This study describes the illnesses seen in the out-patient department/casualty department (OPD/CD) of the ICRC hospital nine weeks after the Tsunami. It describes the percentage of people seen for problems directly related to the Tsunami, and includes a basic screening for depression and post-traumatic stress disorder (PTSD). METHODS: A prospective, five-day study was performed from 01-05 March 2005. Patients registering in the ICRC field hospital in Banda Aceh were considered for the study. Data collected included: (1) age; (2) gender; (3) diagnosis in the OPD/CD; and (4) whether or not the problem was related directly to the Tsunami. Seven basic questions were asked to screen for depression and PTSD symptoms. RESULTS: Twelve percent of the problems seen in the OPD/CD nine weeks after the Tsunami still were related directly to the Tsunami. Sixty-three percent of patients in the study were male. The medical problems included: (1) urological (19%); (2) digestive (16%); (3) respiratory (12%); and (4) musculoskeletal (12%). Although <2% of patients were diagnosed with a mental health problem, 24% had at least four or more of the seven depression/PTSD symptoms addressed in the study. CONCLUSIONS: Post-earthquake and post-tsunami health problems and medical needs differ from those found in conflict zones. After the Tsunami, both surgical and primary healthcare teams were needed. Many problems were chronic medical problems, which may be indicative of the lack of healthcare infrastructure before the Tsunami. The findings suggest that mental health issues must be taken into consideration for future planning. The ethical issues of performing research in complex emergencies also need further development at the international level.

Adult↗
PubMed2006

Malaria in Wanokaka and Loli sub-districts, West Sumba District, East Nusa Tenggara Province, Indonesia.

Malaria has long been known as one of the major public health problems in West Sumba District, East Nusa Tenggara Province, Indonesia. To obtain baseline data for establishment of a suitable malaria control program in the area, malariometric surveys were conducted in two sub-districts, Wanokaka and Loli, during the periods of January, May, and August 2005. The survey included three selected villages in each sub-district, and blood smear analyses of 701, 921, and 894 randomly selected subjects in January, May, and August revealed 30.5%, 25.3%, and 28.2% malaria positives, respectively, consisting mainly of Plasmodium falciparum and P. vivax, and in a few cases, P. malariae. Analysis of malaria prevalence at different age groups clearly reflected the common phenomenon that younger individuals are more vulnerable by infection of either P. falciparum or P. vivax. In falciparum malaria, the frequency of cases carrying gametocytes was also relatively high involving all age groups. The findings indicate that the malaria incidence and transmission in the area are relatively high and that further exploration is warranted to establish a precise malaria control program.

Adolescent↗
PubMed2006

Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia.

End-stage renal disease (ESRD) has significantly increased in developing countries such as Indonesia. Chronic glomerulonephritis is still the leading cause of ESRD, while the numbers of diabetes mellitus patients have significantly risen. Data presented in this article were obtained from various nephrology centers in response to the specific questionnaires distributed by Indonesian Society Nephrology (InaSN). These data give the impression that both incidence and prevalence rates in various areas of Java and Bali are increasing over time, although the rates presented here are far lower than expected. Hemodialysis is available in most parts of the country. Continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation programs have been performed in few nephrology centers. Costs for dialysis and renal transplantation are still unaffordable for most ESRD patients. Since the cost burden has significantly increased, nephrology services should be changed from curative to the preventive medicine. Currently InaSN plans to have a detection and prevention program for chronic kidney disease.

Health Care Costs↗
PubMed2006

Anaemia and iron deficiency anaemia among young adolescent girls from the peri urban coastal area of Indonesia.

Anaemia due to iron deficiency is still a widespread problem. Among adolescent girls, it will bring negative consequences on growth, school performance, morbidity and reproductive performance. This cross sectional study aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10-12 years old with iron deficiency anaemia and anaemia without iron deficiency in the rural coastal area of Indonesia. Anaemic girls (N =133) were recruited out of 1358 girls from 34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status, whilst weight and height were measured for their nutritional status. General characteristics and dietary intake were assessed through interview. Out of 133 anaemic subjects, 29 (21.8%) suffered from iron deficiency anaemia, which was not significantly related to age and menarche. About 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher (P < 0.05) among subjects who suffered from iron deficiency anaemia (51.7% vs. 29.8%). Furthermore, thin subjects had a 5 fold higher risk of suffering from iron deficiency anaemia (P< 0.05) than non-thin subjects (OR: 5.1; 95%CI 1.34-19.00). Further study was recommended to explore other factors associated with anaemia and iron deficiency anaemia, such as the thalassemia trait and vitamin A deficiency. The current iron-folate supplementation program for pregnant women should be expanded to adolescent girls.

Adolescent↗
PubMedDate not supplied

Hormone receptor status of operable breast cancers in Indonesia: correlation with other prognostic factors and survival.

OBJECTIVE: The aim of this study was to evaluate the hormone receptor status of operable breast cancers in Yogyakarta, Indonesia , and its correlation with other established prognostic factors and overall survival. MATERIALS AND METHODS: Operable breast cancers in Yogyakarta were studied clinically, pathologically and immunohistochemically for tumor size, lymph node status, histological grade, mitotic index, ER, PR, c-erbB2, p53 and MIB-1 proliferation index. Correlations of ER and PR with those prognostic factors were determined, and patients were longitudinally followed for overall survival. RESULTS: Breast cancer showed an aggressive phenotype with large tumor size, positive lymph nodes, high histologic grade, high mitotic index, positive c-erbB2, p53 and MIB- 1 proliferation index. Positive ER and PR did not improve the prognosis significantly, and adjuvant treatment with tamoxifen did not increase overall survival.

Breast Neoplasms↗
PubMed2006

Characteristics of chronic gout in Northern Sulawesi, Indonesia.

OBJECTIVE: To identify associations and possible risk factors for gout that may contribute to chronic tophaceous gout in rural and urban districts of North Sulawesi, Indonesia. METHODS: A total of 190 patients with chronic gout and 190 age and sex matched controls were selected from 28 community health centers. Potential risk factors including alcohol consumption, food habits, family history, body weight, related medical conditions, drug use, and laboratory investigations were sought. RESULTS: Alcohol consumption and certain food habits were associated with gout. A positive family history of gout and overweight were also significant risk factors. Renal impairment was found in 86.3% of patients and hyperuricemia in 92.1%. In controls, renal impairment and hyperuricemia were 7.4% and 32.6%, respectively. Patients with hypertension and nephrolithiasis were more at risk of having associated gout. There was a significant association between gout, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, and higher levels of creatinine and urea. There was also a significantly lower level of urine uric acid in gout cases compared with controls. Gouty tophi were found in 91% of these cases with chronic gout. The use of diuretics for treating hypertension, continuing excessive alcohol consumption and purine-rich food habits in untreated gout, and hyperuricemia were associated with chronic and tophaceous gout. Urate-lowering drugs were not available in the community health centers. CONCLUSION: Severe tophaceous gout with deformities and disability is found in North Sulawesi. Prominent risk factors include alcohol, obesity, renal impairment, diet, hypertension, and family history. Improved education about gout seems needed. Urate-lowering drugs are not available in community health centers but are needed, especially in rural areas, as studied here.

Demography↗
PubMed2006

Normal spirometry, gas transfer and lung volume values in Papua, Indonesia.

Spirometry is an efficient and clinically useful tool in the diagnosis and management of chronic lung disease. It relies on an appreciation of normal lung function that can vary between populations. In order to improve the utility of spirometry, gas transfer and lung volume measures for clinical and research use in Papua, Indonesia, we determined lung function in Papuan and non-Papuan Indonesian adults who did not have evidence of lung disease. A cross-sectional survey of Papuan and non-Papuan Indonesians 18 years or older with no history of chronic cough or recent wheeze was made. Spirometry, gas transfer and total lung capacity (TLC) were determined and regression models developed for normal values. The spirometry values were similar but not directly comparable to similar studies in Papua New Guinea populations. Papuan highland residents demonstrated independently greater values of gas transfer and total lung capacity in comparison to lowland Papuans. Values for lung function in apparent respiratory health were shown to differ between Papuan and non-Papuan Indonesian populations and in comparison to reference values derived from non-indonesian populations. Differences in age-related decline in lung function would suggest that simple proportional correction based on values derived from non-Indonesian populations may be inappropriate and would support the development of similar reference values in other populations. Whether differences seen here are innate or occur as a consequence of in-utero and post-partum environmental exposure remains to be accurately elucidated.

Adult↗
PubMed2006

Survey of community knowledge, attitudes, and practices during a malaria epidemic in central Java, Indonesia.

We surveyed adults in a randomly selected sample of 1,000 households in 50 villages in nine malarial sub-districts in Purworejo, central Java, Indonesia from May to July 2001. The survey assessed malaria knowledge, attitudes, and practices in communities experiencing epidemic malaria to begin exploring broad strategies for controlling the disease in the region. A pre-tested survey instrument consisting of 93 questions addressed demographic characteristics, socioeconomic factors, knowledge and perceptions of malaria, burden and severity of disease, treatment-seeking behavior, malaria prevention practices, and perceptions of government malaria control efforts. The survey was taken by in-person interview of all subjects. Most (97%) subjects were aware of malaria and more than two-thirds correctly identified mosquitoes as the vector. Forty-one percent of households in both forest/hilly and agricultural/urban areas reported malaria illness in the past year. Thirty-six percent (357 households) owned at least one bed net, 92% of these had been purchased by the owners. However, only 36% of households with bed nets affirmed their use as a means of preventing malaria. Nearly all respondents reported a willingness to accept spraying of residual insecticides for malaria prevention, yet less than 5% were willing to pay a nominal fee (US $3) for this service. Fifty-two percent of respondents reported self-treatment of malaria illness without visiting a health facility. This assessment of knowledge, attitudes, and practices showed a broad awareness of malaria and its consequences among residents of malarial areas in the Menoreh Hills of Central Java.

Antimalarials↗