1
|
Sutrisni IA, Kekalih A, Friska D, Timoria D, Limato R, Dien R, Bogh C, Chambers M, Lewycka S, Van Nuil JI, Hamers RL. Indonesian healthcare professionals' experiences in rural and urban settings during the first wave of COVID-19: A qualitative study. PLoS One 2023; 18:e0288256. [PMID: 37432956 DOI: 10.1371/journal.pone.0288256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/22/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, healthcare workers (HCWs) faced unprecedented challenges, increased workload, and often struggled to provide healthcare services. We explored the experiences faced by HCWs working at primary healthcare centers (PHCs) and hospitals across urban and rural settings in Indonesia. METHODS As part of a larger multi-country study, we conducted semi-structured in-depth interviews with a purposive sample of Indonesian HCWs. We used thematic analysis to identify the main challenges described by the participants. RESULTS We interviewed 40 HCWs between December 2020 and March 2021. We identified that challenges varied depending on their role. i) For those in clinical roles, challenges included maintaining trust with communities, and patient referral issues; ii) for those in non-clinical roles, sub-optimal laboratory capacity and logistics, and lack of training were the main challenges; iii) for managerial roles, challenges included access to budget and supplies, and staff shortages due to isolation and overwork. There were also several cross-cutting challenges across all the roles including limited or rapidly changing information (in urban settings), and culture and communication (in rural settings). All of these challenges contributed to mental health issues among all HCW cadres. CONCLUSIONS HCWs across roles and settings were confronted with unprecedented challenges. Understanding the various challenges across different healthcare cadres and within different settings is crucial for supporting HCWs during pandemic times. In rural areas, in particular, HCWs should be more sensitive to cultural and linguistic differences to enhance the effectiveness and awareness of public health messages.
Collapse
Affiliation(s)
- Ida Ayu Sutrisni
- Faculty of Medicine Universitas Indonesia, Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Aria Kekalih
- Faculty of Medicine Universitas Indonesia, Department of Community Medicine, Jakarta, Indonesia
| | - Dewi Friska
- Faculty of Medicine Universitas Indonesia, Department of Community Medicine, Jakarta, Indonesia
| | | | - Ralalicia Limato
- Faculty of Medicine Universitas Indonesia, Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Ragil Dien
- Faculty of Medicine Universitas Indonesia, Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
| | - Claus Bogh
- Faculty of Medicine Universitas Indonesia, Department of Community Medicine, Jakarta, Indonesia
| | - Mary Chambers
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Jennifer Ilo Van Nuil
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Raph L Hamers
- Faculty of Medicine Universitas Indonesia, Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Suwarti S, Zanjabila S, Bonifacius, Da Costa Y, Bogh C, Subekti D, Jeny J, Dewi AM, Nuraeni N, Rahardjani M, Elyazar I, Nelwan EJ, Shankar AH, Baird JK, Hamers RL. Evaluating Saliva Sampling with Reverse Transcription Loop-mediated Isothermal Amplification to Improve Access to SARS-CoV-2 Diagnosis in Low-Resource Settings. Am J Trop Med Hyg 2022; 107:284-290. [PMID: 35895405 PMCID: PMC9393441 DOI: 10.4269/ajtmh.22-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 11/07/2022] Open
Abstract
Standard diagnosis of SARS-CoV-2 by nasopharyngeal swab (NPS) and real-time reverse transcriptase-polymerase chain reaction (PCR) requires a sophisticated laboratory, skilled staff, and expensive reagents that are difficult to establish and maintain in isolated, low-resource settings. In the remote setting of tropical Sumba Island, eastern Indonesia, we evaluated alternative sampling with fresh saliva (FS) and testing with colorimetric loop-medicated isothermal amplification (LAMP). Between August 2020 and May 2021, we enrolled 159 patients with suspected SARS-CoV-2 infection, of whom 75 (47%) had a positive PCR on NPS (median cycle threshold [Ct] value: 27.6, interquartile range: 12.5-37.6). PCR on FS had a sensitivity of 72.5% (50/69, 95% confidence interval [CI]: 60.4-82.5) and a specificity of 85.7% (66/77, 95% CI: 75.9-92.6), and positive (PPV) and negative (NPV) predictive values of 82.0% (95% CI: 0.0-90.6) and 77.6% (95% CI: 67.3-86.0), respectively. LAMP on NPS had a sensitivity of 68.0% (51/75, 95% CI: 56.2-78.3) and a specificity of 70.8% (63/84, 95% CI: 58.9-81.0), with PPV 70.8% (95% CI: 58.9-81.0) and NPV 72.4% (95% CI: 61.8-81.5%). LAMP on FS had a sensitivity of 62.3% (43/69, 95% CI: 49.8-73.7%) and a specificity of 72.7% (56/77, 95% CI: 61.4-82.3%), with PPV 67.2% (95% CI: 54.3-78.4) and NPV 68.3% (95% CI: 57.1-78.1%). LAMP sensitivity was higher for NPS and FS specimens with high viral loads (87.1% and 75.0% for Ct value < 26, respectively). Dried saliva on filter paper was stable for 4 days at room temperature. LAMP on either NPS or FS could offer an accessible alternative for SARS-CoV-2 diagnosis in low-resource settings, with potential for optimizing sample collection and processing, and selection of gene targets.
Collapse
Affiliation(s)
- Suwarti Suwarti
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | | | - Bonifacius
- Karitas Hospital, Sumba Barat Daya, Nusa Tenggara Timur, Indonesia
| | - Yacobus Da Costa
- Pratama Reda Bolo Hospital, Sumba Barat Daya, Sumba, East Nusa Tenggara, Indonesia
| | - Claus Bogh
- Sumba Foundation, Sumba Barat, Nusa Tenggara Timur, Indonesia
| | - Decy Subekti
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Jeny Jeny
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Ayu Madri Dewi
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Nunung Nuraeni
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Mutia Rahardjani
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
| | - Erni J. Nelwan
- Tropical Infection Division, Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anuraj H Shankar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Raph L. Hamers
- Eijkman-Oxford Clinical Research Unit, Jakarta, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
3
|
Van Nuil JI, Friska D, Kekalih A, Bhandari AR, Bogh C, Brindle H, Bui THN, Deokota D, Ragil Dien SW, Doan PN, Fisher J, Gautum A, Kurniawan LN, Limato R, Nguyen HY, Nguyen TH, Nguyen TP, Nguyen TT, Nguyen THY, Nguyen TKN, Nguyen TKT, Nguyen Le TM, Pandey A, Rijal S, Roberts C, Shakya R, Shakya SU, Sharma P, Sutrisni IA, Thapa P, Timoria D, Tran MH, Tran PT, Tran TH, Vu BH, Vu TVD, Karkey A, Hamers RL, Chambers M, Lewycka S. COVID-19 Social Science and Public Engagement Action Research in Vietnam, Indonesia and Nepal (SPEAR): Protocol for a mixed methods study exploring the experiences and impacts of COVID-19 for healthcare workers and vulnerable communities. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17314.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: When the novel coronavirus – SARS-CoV-2 – started to spread globally, there was a call for social and behavioral scientists to conduct research to explore the wider socio-cultural contexts of coronavirus disease 2019 (COVID-19), to understand vulnerabilities, as well as to increase engagement within communities to facilitate adoption of public health measures. In this manuscript, we describe the protocol for a study conducted in Indonesia, Nepal, and Vietnam. In the study, we explore how the COVID-19 pandemic is affecting individuals and their communities. We focus on the wider health and economic impacts of COVID-19, in particular emerging and increased burden on mental health, as well as new or deepened vulnerabilities in the communities. The introduction of vaccines has added another layer of complexity and highlights differences in acceptance and inequalities around access. Methods: We use mixed methods, combining survey methods and social media surveillance to gain a picture of the general situation within each country, with in-depth qualitative methods to gain a deeper understanding of issues, coupled with a synergistic engagement component. We also include an exploration of the role of social media in revealing or driving perceptions of the pandemic more broadly. Participants include health workers and members of communities from 13 sites across the three countries. Data collection is spread across two phases. Phase 1 is concerned with exploring lived experiences, impacts on working lives and livelihoods, mental health and coping strategies. Phase 2 is concerned with acceptance of COVID-19 vaccines, factors that increase and reduce acceptance, and factors that influence access. Conclusions: We will disseminate findings in multiple ways including short reports and policy briefs, articles in peer-reviewed journals, and digital diaries will be edited into short films and uploaded onto social media sites.
Collapse
|
4
|
Jawara M, Pinder M, Drakeley CJ, Nwakanma DC, Jallow E, Bogh C, Lindsay SW, Conway DJ. Dry season ecology of Anopheles gambiae complex mosquitoes in The Gambia. Malar J 2008; 7:156. [PMID: 18710559 PMCID: PMC2533673 DOI: 10.1186/1475-2875-7-156] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 08/18/2008] [Indexed: 11/10/2022] Open
Abstract
Background Malaria in The Gambia is highly seasonal, with transmission occurring as Anopheles gambiae s.l. populations expand during and immediately after a single annual rainy season that lasts from June to October. There has been very limited investigation of the ecology of vectors during the dry season, when numbers are very limited and distributions may be restricted. Methods Weekly adult mosquito collections (pyrethrum spray, light trap, and search collections from rooms, as well as light trap collections from animal shelters, abandoned wells and grain stores), and artificial sentinel breeding site surveys were performed in four villages near the upper tidal and partially saline part of the Gambia River in the last four months of an annual dry season (March to June). Mosquito species were identified by morphological and DNA analysis, and ELISA assays were performed to test for Plasmodium falciparum sporozoites and human blood meal components. Results Adults of An. gambiae s.l. were collected throughout the period, numbers increasing towards the end of the dry season when humidity was increasing. Adult collections were dominated by An. melas (86%), with An. gambiae s.s. (10%) and An. arabiensis (3%) also present throughout. Most females collected in room search and spray collections contained blood meals, but most from light traps were unfed. None of the females tested (n = 1709) contained sporozoites. Larvae (mostly An. gambiae s.s.) were recovered from artificial sentinel breeding sites in the two villages that had freshwater pools. These two villages had the highest proportions of An. gambiae s.s. adults, and experienced the most substantial increase in proportions of An. gambiae s.s. after the onset of rains. Conclusion During the dry season population minimum, An. melas was the predominant vector species, but differences among villages in availability of fresh-water breeding sites correlate with egg laying activity and relative numbers of An. gambiae s.s. adults, and with the increase in this species immediately after the beginning of the rains. Local variation in dry season vector persistence is thus likely to influence spatial heterogeneity of transmission intensity in the early part of the rainy season.
Collapse
Affiliation(s)
- Musa Jawara
- Medical Research Council Laboratories, Fajara, PO Box 273, Banjul, The Gambia.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Lukwa N, Molgaard P, Furu P, Bogh C, Gundidza M. Ineffectiveness of essential oils from Artemisia afra (Asteraceae), Lantana angiolensis (Verbenaceae) and Syzygium hiullense (Myrtaceae) in inhibiting mosquito biting. Cent Afr J Med 2000; 46:232-3. [PMID: 11317598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
|