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PubMed1994

Health practices and indices of a poor urban population in Indonesia. Part I: Patterns of health service utilization.

This first section in a two-part study of health indices and practices among residents living in a Jakarta slum describes the use of public and private primary health care services in relation to socioeconomic and health status. As problems associated with urban poverty rapidly increase in developing countries, it is important to study the ethnic and economic diversity which exists in slums and shanty towns: results of such studies should inform the development of effective strategies for outreach and service delivery. Through a survey of 690 mothers and 593 children, we found that 1) poorer residents were more likely than relatively affluent ones to rely on local government clinics (posyandus) for primary health care; 2) regular posyandu users were more likely than non-users to be fully immunized and to use ORT correctly; 3) delivery in hospital was common among all residents, but especially among the more affluent; and 4) prevalence of contraception was high and not associated with socioeconomic status or type of primary health care service used. Strengthening primary health care services at the government's local health posts could benefit all groups in the community if wealthier residents participated more in the posyandus. Standards of care in the private sector should also be improved.

Child Welfare↗
PubMed2004

Community-based school feeding during Indonesia's economic crisis: implementation, benefits, and sustainability.

The Indonesian Government initiated a community-based national school-feeding program in 1996. Implementation was decentralized and involved multiple participants. In 1998 we evaluated the implementation of the program and the perceived benefits for community stakeholders using a survey of principals in 143 randomly selected schools and follow-up with in-depth interviews and observations in a subsample of 16 communities. The evaluation covered the period of the 1998 Asian economic crisis, affording the opportunity to assess its impact on the program. The program was implemented in all targeted schools, with excellent community participation. Feeding was sustained through the crisis, in spite of a dramatic escalation in food costs. The families of schoolchildren, farmers, and those who prepared food received economic benefits. The snacks replaced those sold at schools and were of better nutritional value. The children benefited because the snacks compensated for losses in the home diet resulting from the economic crisis. Characteristics of the program that may be important in explaining its success include the involvement of a range of community stakeholders, engagement with existing village administrative structures, scope for local community adaptation and innovation, and the use of local foods that dispersed benefits and ensured sustained implementation during the crisis.

Adolescent↗
PubMedDate not supplied

Community monitoring of integrated pest management versus conventional pesticide use in a World Bank project in Indonesia.

Pesticide Action Network North America (PANNA) collaborated with a local Indonesian nongovernmental organization (NGO), Yayasan Duta Awam (YDA), in monitoring impacts of the World Bank-financed Integrated Swamps Development Project (ISDP). This paper reports the results of the community-based investigation, which found wide disparities between the World Bank's policy on pest management and its implementation. Instead of reducing farmers' reliance on pesticides as required, the ISDP led to increased intensity and frequency of pesticide use and adverse health and environmental effects from pesticide exposures. YDA and PANNA presented the findings to the Indonesian government and World Bank officials, and farmers requested training in IPM among other recommendations. After NGOs undertook joint advocacy efforts to reduce pesticide dependence in the project, the World Bank withdrew hazardous pesticides from input packages, IPM training was initiated, and community monitors became local leaders in their villages. The study demonstrates the importance and efficacy of independent community-based monitoring in documenting pesticide problems and replacing pesticides with IPM in World Bank development projects.

Agriculture↗
PubMed2005

The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance.

BACKGROUND: In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area. METHODS: We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea. RESULTS: Infants had the highest incidences of diarrhoea (759/1,000/year) and cholera (4/1,000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1,000/year) than girls under 5 years (309/1,000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1,000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1,000/year. Cholera was most common in children, with the highest incidence at 4/1,000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards. CONCLUSION: Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations.

Adolescent↗
PubMed2005

Genetic, household and spatial clustering of leprosy on an island in Indonesia: a population-based study.

BACKGROUND: It is generally accepted that genetic factors play a role in susceptibility to both leprosy per se and leprosy type, but only few studies have tempted to quantify this. Estimating the contribution of genetic factors to clustering of leprosy within families is difficult since these persons often share the same environment. The first aim of this study was to test which correlation structure (genetic, household or spatial) gives the best explanation for the distribution of leprosy patients and seropositive persons and second to quantify the role of genetic factors in the occurrence of leprosy and seropositivity. METHODS: The three correlation structures were proposed for population data (n = 560), collected on a geographically isolated island highly endemic for leprosy, to explain the distribution of leprosy per se, leprosy type and persons harbouring Mycobacterium leprae-specific antibodies. Heritability estimates and risk ratios for siblings were calculated to quantify the genetic effect. Leprosy was clinically diagnosed and specific anti-M. leprae antibodies were measured using ELISA. RESULTS: For leprosy per se in the total population the genetic correlation structure fitted best. In the population with relative stable household status (persons under 21 years and above 39 years) all structures were significant. For multibacillary leprosy (MB) genetic factors seemed more important than for paucibacillary leprosy. Seropositivity could be explained best by the spatial model, but the genetic model was also significant. Heritability was 57% for leprosy per se and 31% for seropositivity. CONCLUSION: Genetic factors seem to play an important role in the clustering of patients with a more advanced form of leprosy, and they could explain more than half of the total phenotypic variance.

Adolescent↗