Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

BACKGROUND

Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers.

METHODS

The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage.

RESULTS

The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight.

CONCLUSION

The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.

Soil-transmitted helminth infections and anemia in children attending government run schools on Samosir Island, Indonesia

Background

Worldwide, >654 million children live in regions where soil-transmitted helminth (STH) infections are endemic. These parasites cause a variety of symptoms, including anemia.

Methods

In May 2023, fecal and blood samples were collected from children aged 6 to 11 years attending government run (public) elementary schools in the Simanindo and Ronggur Nihuta sub-districts of Samosir Island, Indonesia where a twice a year mass drug administration (MDA) program is currently in place. A questionnaire was administered to students' parents or adult family members on possible risk factors for STH infections. Qualitative data were collected through in-depth interviews and focus group discussions.

Results

In total, 187 and 221 children in Simanindo and Ronggur Nihuta provided samples, respectively. The STH infection prevalence in Simanindo was 4.8% (9/187) and the infection prevalence in Ronggur Nihuta was 5.9% (13/221). In Simanindo, all infections were caused by Trichuris trichiura (n = 9), and in Ronggur Nihuta infections were caused by Ascaris lumbricoides (n = 6), Trichuris trichiura (n = 5), and A. lumbricoides + T. trichiura (n = 2). Three children had anemia but were negative for STH infections. While the results of the parent/adult questionnaires indicated access to a generally safe water supply and septic system, information from the in-depth interviews and focus groups revealed that the local water supply becomes greatly diminished during the dry season.

Conclusions

While MDA has been shown to effectively control roundworms and hookworms, additional measures to control trichuriasis are needed. There is also a need for the government to invest in improving the public water supply infrastructure.

Factors Associated with the Place of Delivery among Urban Poor Societies in Indonesia

Background

Pregnant women in urban poor societies are vulnerable groups. Due to low financial capacity, there are obstacles to accessing delivery in an institution for poor women in urban areas. The study analyses factors associated with the delivery place among pregnant women in urban poor society in Indonesia.

Materials and Methods

The study analyzed secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 1,562 samples were childbearing-age women (15-49 years) who gave birth in an urban poor society in Indonesia in the last 5 years. The study examined some variables, such as delivery place, age, education, employment, marital status, parity, insurance, knowledge of pregnancy danger, antenatal care (ANC), the autonomy of health, and family finance autonomy. The study employed binary logistic regression in the final stage.

Results

The results show that age is associated with the place of delivery. The higher the education, the higher the possibility for delivery in an institution. Being employed and having partners are protective factors for women in institution delivery. The likelihood of giving birth in a medical facility decreases as more children are born alive. In addition, having health insurance, thorough ANC visits, knowledge of pregnancy danger symptoms, and health autonomy are protective factors for pregnant women having deliveries in medical facilities. On the contrary, pregnant women who rely solely on family financing have a higher chance of delivering in a medical facility.

Conclusion

The study concluded that 10 variables were associated with pregnant women's delivery in Indonesia's urban poor society: age, education, employment, marital, parity, insurance, pregnancy danger knowledge, ANC, health autonomy, and family finance autonomy.

The Role of Travel Time on Hospital Utilization in the Islands Area: A Cross-Sectional Study in the Maluku Region, Indonesia, in 2018

Background

Maluku region is one of the vulnerable areas in Indonesia, and this region has extreme geographical conditions with thousands of islands. The study aims to analyze the role of travel time to a hospital in the Maluku region in Indonesia.

Material and Methods

This cross-sectional study analyzed the 2018 Indonesian Basic Health Survey data. The research included 14,625 respondents by stratification and multistage random sampling. The study used hospital utilization as an outcome variable and the travel time to the hospital as an exposure variable. Moreover, the study employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and health insurance. The study performed binary logistic regression to interpret the data in the final analysis.

Results

The result shows a relationship between travel time and hospital utilization. Someone with a travel time of 30 min or less to the hospital has a 1.792 (95% CI 1.756-1.828) higher probability than those with a travel time of more than 30 min. The results of this analysis find that shorter travel time to the hospital has a better possibility of hospital utilization. In addition, the study also found eight control variables to have a significant relationship with hospital utilization.

Conclusion

Shorter travel time to the hospital is more likely to be utilized in the Maluku region.

Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective?

BACKGROUND

An urban poor is a vulnerable group that needs government financing support to access health services. Once they are sick, they will fall deeper into poverty. The study aims to analyze the effectiveness of government-run insurance in hospital utilization in urban poor in Indonesia.

METHODS

The research analyzed the 2018 Indonesian Basic Health Survey data. This cross-sectional survey collected 75,970 participants through stratification and multistage random sampling. Meanwhile, the study employed hospital utilization as an outcome variable and health insurance ownership as an exposure variable. Moreover, the study looked at age, gender, marital status, education, and occupation as control factors. The research employed a binary logistic regression to evaluate the data in the final step.

RESULTS

The results show that someone with government-run insurance is 4.261 times more likely than the uninsured to utilize the hospital (95% CI 4.238-4.285). Someone with private-run insurance is 4.866 times more likely than the uninsured to use the hospital (95% CI 4.802-4.931). Moreover, someone with government-run and private-run insurance has 11.974 times more likely than the uninsured to utilize the hospital (95% CI 11.752-12.200).

CONCLUSION

The study concluded that government-run insurance is more effective than the uninsured in improving hospital utilization among the urban poor in Indonesia. Meanwhile, private-run is more effective than government-run and uninsured in improving hospital utilization among the urban poor in Indonesia. Moreover, the most effective is to combine the kind of health insurance ownership (government-run and private-run).

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018

Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026-3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109-0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393-1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

The Activities on Prevention of Malaria and Filariasis Vector Bites among Indonesian Society: A Nationwide Disease Prevention Survey

Vector Borne Diseases are diseases that cause many problems. These diseases are spread by mosquitoes as the vectors. They transmit parasites to humans through their bites. The people who live in Indonesia have several characteristics that make them vulnerable to these diseases. Therefore, it is necessary to explore these characteristics in order to gain better prevention promotional targeting strategy. This study aims to determine the factors that can influence mosquito bite prevention behaviour in Indonesian society.  The data from a nationwide survey research were used with a cross sectional design conducted once in every five years.  The Riskesdas was conducted from April to May 2018 in all districts in Indonesia. The influencing factors observed were including experience of exposure to vector borne diseases (malaria or filariasis), gender, age group, education level and area of residence. This study conducted a multivariate test using logistic regression analysis to determine the factors that influence mosquito bite prevention behaviour. The results demonstrated that the factors of experience of exposure to vector borne diseases, gender, age group, education level and area of residence could determine the mosquitoes bite prevention behaviour in Indonesian society. Respondents who have experience of being exposed to malaria or filaria, under 60 years old, women, college graduates, and rural communities are more likely to prevent mosquito bites, therefore they could be empowered in promoting public awareness towards mosquito bites prevention.

Swallowing Ability in Stroke Patients: A Case Study in Tasikmalaya Hospital, Indonesia

BACKGROUND: Dysphagia is one of the problems that stroke patients often experience. Stroke patients who experience dysphagia often do not get attention because of the lack of early screening, which will cause delays in treatment. To overcome this, nurses have an essential role from the initial screening phase to independent nursing interventions. In screening for dysphagia, nurses can use various methods: Gugging Swallowing Screen (GUSS). AIM: The purpose of the study was to identify and explain association between respondent characteristics and the GUSS method of swallowing ability scores in stroke patients. METHODS: This research was a descriptive study, with a total sample of 20 people. The sampling technique used was consecutive sampling. RESULTS: The results showed that based on the results of the screening test for swallowing ability using the GUSS method, it was found that most of the respondents (75%) belonged to the category of severe dysphagia. Dysphagia was associated with age (p < 0.001), gender (p = 0.000), type of stroke (p < 0.001), comorbidities (p < 0.001), and the frequency of stroke attacks (p < 0.001). CONCLUSION: This study concludes that there is association between respondent characteristics: Age, gender, type of stroke, comorbidities, and frequency of attacks with the score of swallowing ability of stroke patients.

Sub-national disparities in accessing anti-malarial drug treatment in eastern Indonesia

BACKGROUND

Poor access to health care providers was among the contributing factors to less prompt and ineffective malaria treatment. This limitation could cause severe diseases in remote areas. This study examined the sub-national disparities and predictors in accessing anti-malarial drug treatment among adults in Eastern Indonesia.

METHODS

The study analyzed a subset of the 2018 National Basic Health Survey conducted in all 34 provinces in Indonesia. We extracted socio-demographic data of 4655 adult respondents diagnosed with malaria in the past 12 months in five provinces in Eastern Indonesia. The association between socio-demographic factors and the access to anti-malarial drug treatment was assessed using logistic regression.

RESULTS

Over 20% of respondents diagnosed with malaria within last 12 months admitted that they did not receive anti-malarial drug treatment (range 12-29.9%). The proportion of untreated cases was 12.0% in East Nusa Tenggara, 29.9% in Maluku, 23.1% in North Maluku, 12.7% in West Papua, and 15.6% in Papua. The likelihood of receiving anti-malarial drug treatment was statistically lower in Maluku (adjusted OR = 0.258; 95% CI 0.161-0.143) and North Maluku (adjusted OR = 0.473; 95% CI 0.266-0.840) than those in Eastern Nusa Tenggara (reference). Urban respondents were less likely to receive malaria treatment than rural (adjusted OR = 0.545; 95% CI 0.431-0.689).

CONCLUSIONS

This study found that there were sub-national disparities in accessing anti-malarial drug treatment in Eastern Indonesia, with a high proportion of untreated malaria cases across the areas. Findings from this study could be used as baseline information to improve access to anti-malarial drug treatment and better target malaria intervention in Eastern Indonesia.

Geographical heterogeneity and socio-ecological risk profiles of dengue in Jakarta, Indonesia

The aim of this study was to assess the role of climate variability on the incidence of dengue fever (DF), an endemic arboviral infection existing in Jakarta, Indonesia. The work carried out included analysis of the spatial distribution of confirmed DF cases from January 2007 to December 2018 characterising the sociodemographical and ecological factors in DF high-risk areas. Spearman's rank correlation was used to examine the relationship between DF incidence and climatic factors. Spatial clustering and hotspots of DF were examined using global Moran's I statistic and the local indicator for spatial association analysis. Classification and regression tree (CART) analysis was performed to compare and identify demographical and socio-ecological characteristics of the identified hotspots and low-risk clusters. The seasonality of DF incidence was correlated with precipitation (r=0.254, P<0.01), humidity (r=0.340, P<0.01), dipole mode index (r= -0.459, P<0.01) and Tmin (r= -0.181, P<0.05). DF incidence was spatially clustered at the village level (I=0.294, P<0.001) and 22 hotspots were identified with a concentration in the central and eastern parts of Jakarta. CART analysis showed that age and occupation were the most important factors explaining DF clustering. Areaspecific and population-targeted interventions are needed to improve the situation among those living in the identified DF high-risk areas in Jakarta.

Persepsi Kader Terhadap Program Gerakan 1 Rumah 1 Jumantik (G1R1J) Dalam Pengendalian Demam Berdarah Dengue Di Kelurahan Pondok Betung Kota Tangerang Selatan

Program of One House One Larvae Monitoring Specialist (or G1R1J) is a community empowerment endeavor to eradicate mosquito nest of Dengue Hemorrhagic Fever. Program involves one of the family members to be a Larvae Monitoring Specialist at home. Factors influencing community behavior to implement a program are driving factors such as attitudes, and community leader's behavior, health staff, and other health staff that is a community reference group. The study's objective is to know the cadres' perception of the G1R1J Program as an agent of change to control DHF and their roles in a community. A qualitative study with Health Believe Model Approach. Data Collection conducted in the year 2019 using Focus Group Discussion and In-Depth Interview methods. Informants are cadres in Pondok Betung Sub-District Pondok Aren District, which a DBD endemic area in South Tangerang City. Data obtained were then processed according to thematic analysis. The study results showed cadre as a frontline implementation of G1R1J Program, who have a good understanding concerning program technical in Community. Risk perception related to disease and benefit from G1R1J Program is one of cadre motivation to run roles. Lack of response and dependency of the community about cadre are obstacles to conduct G1R1J Program. Efforts can do socialization of the G1R1J Program at the family level, which involves across sectors. Abstrak Program Gerakan 1 Rumah 1 Jumantik (G1R1J) adalah satu upaya pemberdayaan masyarakat dalam pelaksanakan pemberantasan sarang nyamuk Demam Berdarah Dengue (DBD). Program tersebut melibatkan salah satu anggota keluarga menjadi jumantik rumah. Salah satu faktor yang memengaruhi perilaku masyarakat dalam pelaksanaan suatu program adalah adanya faktor pendorong berupa sikap dan perilaku tokoh, petugas kesehatan atau petugas lain yang merupakan kelompok referensi masyarakat. Tujuan penelitian ini adalah mengetahui persepsi kader terhadap Program G1R1J; sebagai agen perubahan dalam pengendalian DBD dan perannya di masyarakat. Penelitian ini merupakan penelitian kualitatif dengan pendekatan Health Belief Model (HBM). Pengumpulan data dilakukan pada tahun 2019 melalui Diskusi Kelompok Terarah (DKT) dan wawancara mendalam (In-Depth Interview/IDI). Informan penelitian ini adalah kader yang berada di Kelurahan Pondok Betung Kecamatan Pondok Aren yang merupakan wilayah endemis DBD di Kota Tangerang Selatan. Data yang diperoleh kemudian diolah berdasar analisis tematik. Hasil penelitian menunjukkan bahwa kader sebagai ujung tombak implementasi program G1R1J sudah memiliki pemahaman yang baik tentang teknis program di masyarakat. Persepsi risiko terkait penyakit dan manfaat dari program G1R1J menjadi salah satu motivasi kader dalam menjalankan perannya. Kurangnya respon dan ketergantungan masyarakat terhadap kader menjadi hambatan dalam pelaksanaan program G1R1J. Upaya yang dapat dilakukan adalah sosialisasi program GIRIJ di tingkat keluarga dengan melibatkan lintas sektor.  

Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey

Background

Geographical variation may likely influence the effectiveness of prevention efforts for malaria across Indonesia, in addition to factors at the individual level, household level, and contextual factors. This study aimed to describe preventive practices at individual and a household levels applied by rural communities in five provinces in eastern Indonesia and its association with the incidence of malaria among adult (≥15 years) populations.

Methods

This study analyzed a subset of data of nationally representative community-based survey 2018 Riset Kesehatan Dasar (Riskesdas). Data for socio-demographic (age, gender, education and occupation) and preventive behaviors (use of mosquito bed nets while slept, insecticide-treated mosquito nets (ITNs), mosquito repellent, mosquito electric rackets, mosquito coil/electric anti-mosquito mats, and mosquito window screen) were collected. Data were analyzed using bivariate and multivariable logistic regression model.

Results

Total of 56,159 respondents (n = 23,070 households) living in rural areas in Maluku (n = 8044), North Maluku (n = 7356), East Nusa Tenggara (n = 23,254), West Papua (n = 5759) and Papua (n = 11,746) were included in the study. In the multivariable models, using a bed net while slept likely reduced the odds of self-reported malaria among Maluku participants. Reduced odds ratios of self-reported malaria were identified in those participants who used ITNs (North Maluku, ENT, Papua), repellent (Maluku, West Papua, Papua), anti-mosquito racket (ENT), coil (Maluku, North Maluku, Papua) and window screen (West Papua, Papua).

Conclusion

Our study concluded that the protective effects of preventive practices were varied among localities, suggesting the need for specific intervention programs.

Upaya Pengendalian Malaria Dalam Rangka Pre-Eliminasi di Kabupaten Garut: Sebuah studi kualitatif

Indonesia is one of the malaria-endemic countries commits to eliminate malaria in 2030. The implementation of malaria control program policy is a determinant to achieve the goal. This research was qualitative that described the implementation of malaria control program policy in Garut Regency, West Java Province. The data collected through in-depth interviews and documents’ review. The implementation of malaria control had referred to guidelines from the Ministry of Health, Republic of Indonesia. This control was also technically adjusted to regional conditions. Case detection of malaria was conducted such as a mass blood survey, rapid diagnostic tests and a microscopic laboratory test both passive and active. The malaria case surveillance has already accomplished. However, the vector was left. The malaria vector control focused on the distribution of insecticide-treated nets and the insecticide spray by the Indoor Residual Spraying (IRS) technique. The analysis indicated that the cross-program cooperation at the central government was well coordinated. However, at the level of the district, this cooperation has to be tightened. Moreover, malaria control budget was still the under district level, so that controlling malaria program did not cover all aspects of the implementation. Abstrak Indonesia sebagai salah satu negara endemis malaria, berkomitmen melakukan eliminasi di tahun 2030. Implementasi kebijakan program pengendalian malaria menjadi determinan keberhasilan eliminasi. Tujuan penelitian ini memberikan gambaran pelaksanaan program pengendalian malaria di Kabupaten Garut, Provinsi Jawa Barat. Pengumpulan data dilakukan dengan wawancara mendalam pada pengelola Program Penanggulangan Malaria serta telaah dokumen dan data dianalisis secara kualitatif. Hasil penelitian menunjukkan bahwa kebijakan pelaksanaan program pengendalian malaria di Kabupaten Garut, Provinsi Jawa Barat sudah merujuk pada pedoman Kementerian Kesehatan RI, secara teknisnya disesuaikan dengan kondisi wilayah. Penemuan penderita dilakukan secara pasif maupun aktif melalui Mass Blood Survey (MBS), dengan pemeriksaan menggunakan Rapid Diagnostic Test (RDT) dan laboratorium secara mikroskopis, Surveilans yang dilakukan oleh Puskesmas hanya terfokus pada surveilans kasus dan belum dilakukan surveilans vektor malaria. Pengendalian vektor malaria yang dilakukan berupa pembagian kelambu dan penyemprotan insektisida dengan metode Indoor Residual Spraying (IRS).  Kerjasama lintas program berjalan dengan baik, namun kerjasama lintas sektor terutama pada tingkat kabupaten masih perlu dilakukan dan ditingkatkan. Pembiayaan program pengendalian malaria hanya dari pemerintah daerah dan belum dapat mengakomodir kegiatan pengendalian secara keseluruhan.    

Individual and contextual factors predicting self-reported malaria among adults in eastern Indonesia: findings from Indonesian community-based survey

BACKGROUND

Malaria is still an important parasitic infectious disease that affecting poor and vulnerable communities in many developing countries, including Indonesia. During the period of 2010-2017, there have been approximately 2.2 million confirmed malaria cases reported across Indonesia. This study aimed to identify individual, household and village-level factors associated with self-reported malaria among adults more than 15 years of age in Maluku, West Papua and Papua province.

METHODS

This study analysed a subset of the data from nationally representative population-based Indonesian National Basic Health Research (Riset Kesehatan Dasar) (N = 1,027,763 in 294,959 households in 33 provinces) in 2013. Total of 41,079 individuals (20,326 males and 20,753 females) aged ≥ 15 years in 19,269 households in Maluku, West Papua and Papua provinces were included. Participants were interviewed if they ever had been diagnosed and laboratory confirmed of having malaria by physician in the past 12 months. A mixed effects multilevel logistic regression models were developed to assess the associations between socio-demographical variables at individual, household and village level and self-reported malaria.

RESULTS

Individuals aged ≥ 15 years in 701 villages in Maluku (n = 11,919), West Papua (n = 8003) and Papua (n = 21,157) were analysed. In all provinces, gender distribution was equally-represented. The prevalence of self-reported malaria was 4.1% (Maluku), 12.4% (West Papua) and 18.8% (Papua). At the individual level, primary industry workers (OR 1.29, 95% CI 1.15-1.46 [Maluku]; OR 1.17, 95% CI 1.09-1.25 [Papua]) and having higher education were associated with self-reporting malaria (OR 0.67, 95% CI 0.53-0.83 [Maluku]; OR 1.27, 95% CI 1.15-1.40 [Papua]). Household level factors include having bed net and better off wealth index were associated with increased self-reporting malaria among West Papua (OR 1.21; 95% CI 1.09-1.34 and OR 1.38; 95% CI 1.17-1.65, respectively) and Papuan (OR 1.12; 95% CI 1.02-1.23 and OR 1.33; 95% CI 1.11-1.57, respectively) adults. Increased odds of self-reporting malaria was associated with time required to reach healthcare facility (OR 1.30, 95% CI 1.01-1.67 [Maluku]). Contextual village-level characteristics such as living in rural (OR 1.31, 95% CI 1.12-1.54 [Maluku]; OR 1.56, 95% CI 1.17-2.07 [West Papua]), higher community education level (OR 1.28, 95% CI 1.02-1.63 [West Papua]; OR 1.45, 95% CI 1.23-1.72 [Papua]), higher community bed net ownerships (OR 0.59 95% CI 0.45-0.77 [West Papua]) were associated with self-reported malaria.

CONCLUSIONS

Factors associated with self-reported malaria were varied between provinces suggesting locally-specific determinants were exist at individual, household and community-level. This study highlights the need for specific interventions by taking into consideration the contextual factors within the region and involving multi-sectoral collaboration between health authorities and related stakeholders (e.g., bureau of education, bureau of public works and infrastructure) to improve designs in planning and intervention strategies to succesfully eliminate malaria in Maluku and Papua.