The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study

BACKGROUND

The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30-59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer).

METHODS

This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression.

RESULTS

Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481-9.928; p<0.001).

CONCLUSION

The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.

Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia

BACKGROUND

Tuberculosis (TB) is the world's major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia.

METHODS

This national coverage cross-sectional survey was conducted from 2013 to 2014 with stratified multi-stage cluster sampling. Based on the region and rural-urban location. The 156 clusters were distributed in 136 districts/cities throughout 33 provinces, divided into three areas. An eligible population of age ≥15 was interviewed to find TB symptoms and screened with a thorax x-ray. Those whose filtered result detected positive followed an assessment of Sputum microscopy, LJ culture, and Xpert MTB/RIF. Census officers asked all participants about their history of TB and their treatment-defined Nonadherence as discontinuation of anti-tuberculosis treatment for <6 months. Data were analyzed using STATA 14.0 (College Station, TX, USA).

RESULTS

Nonadherence to anti-TB treatment proportion was 27.24%. Multivariate analysis identified behavioral factors significantly associated with anti-TB treatment nonadherence, such as smoking (OR = 1.78, 95% CI (1.47-2.16)); place of first treatment received: government hospital (OR = 1.45, 95% CI:1.06-1.99); private hospital (OR = 1.93, 95% CI: 1.38-2.72); private practitioner (OR = 2.24, 95% CI: 1.56-3.23); socio-demographic and TB status included region: Sumatera (OR = 1.44, 95% CI: 1.05-1.98); other areas (OR = 1.84, 95% CI: 1.30-2.61); low level of education (OR = 1.60, 95% CI: 1.27-2.03); and current TB positive status (OR = 2.17, 95% CI: 1.26-3.73).

CONCLUSIONS

Nonadherence to anti-TB drugs was highly related to the personal perception of the respondents, despite smoking, current TB status, a place for the first treatment, education, and region. The position of the first TB treatment at the private practitioner was significantly associated with the risk of Nonadherence to treatment.

Factors associated with measles antibody titers in children aged 12-36 months in Indonesia: an analysis of National Health Research 2013

Background: The immunization program in Indonesia has been implemented since 1956 started to eradicate smallpox and expanded until 1980, including Measles. The timely and complete implementation of basic immunization is the main strategy to protect the population, including outbreak prevention. The purpose of this study is to determine the level immunity of Measles antibody as the outcome of completed basic immunization and its contributors in children aged 12-36 months. Methods: This study is a secondary data analysis of the Indonesia Basic Health Survey (RISKESDAS) 2013. The analysis was carried out on a serological sample of the antibody titer of children aged 12-36 months, totaling 229 samples. The sample inclusion criteria were children who had complete sociodemographics data, basic immunization records and Measles antibody titer data. Measles examination was carried out using the Enzyme-Linked Immunosorbent Assay (ELISA) method.   Results: Incomplete immunization, being a boy, and lack of cleanliness in the family room were significantly associated with lower measles antibody levels in children. Having each variable controlled, completeness of immunization (OR=1,99; p=0.018; 95% CI=1.124-3.544) and gender of boy (OR=2.0; p=0.016; 95% CI=1.137-3.515) remain as significant variables for antibody’s titer. Conclusion: The completeness of immunization has a significant association towards titer antibody of Measles in children. Immunization completeness is an actual effort to reach herd immunity in children and to prevent measles outbreak in the community. Adequate health promotion is needed to change people's behavior to believe in the safety and importance of implementing complete basic immunization for children even in pandemic conditions. Keywords: antibody titer, immunization, children aged 12-36 months, Indonesia, measles   Abstrak Latar belakang: Program imunisasi di Indonesia telah dilaksanakan sejak tahun 1956 yang dimulai dengan pemberantasan cacar yang diperluas hingga tahun 1980, termasuk campak. Pelaksanaan imunisasi dasar yang tepat waktu dan lengkap merupakan strategi utama untuk perlindungan penduduk, termasuk pencegahan Kejadian Luar Biasa (KLB). Tujuan dari penelitian ini untuk mengetahui tingkatan kekebalan antibodi Campak sebagai hasil dari kelengkapan imunisasi dasar dan faktor yang berkontribusi pada anak usia 12-36 bulan. Metode: Penelitian ini merupakan analisis data sekunder Riset Kesehatan Dasar Indonesia (RISKESDAS) 2013. Analisis dilakukan pada sampel serologi titer antibodi anak usia 12-36 bulan yang berjumlah 229 sampel. Kriteria inklusi sampel adalah anak yang memiliki data sosiodemografi lengkap, catatan imunisasi dasar dan data titer antibodi Campak. Pemeriksaan campak dilakukan dengan metode Enzyme-Linked Immunosorbent Assay (ELISA). Hasil: Imunisasi yang tidak lengkap, berjenis kelamin laki-laki, dan kurangnya kebersihan di ruang keluarga berhubungan bermakna dengan rendahnya tingkat antibodi campak pada anak. Setelah masing-masing variabel terkontrol, kelengkapan imunisasi (OR=1,99; p=0,018; 95% CI=1.124-3.544) dan jenis kelamin laki-laki (OR=2.0; p=0.016; 95% CI=1.137-3.515) merupakan variabel yang tetap berhubungan dengan titer antibodi secara signifikan. Kesimpulan: Kelengkapan imunisasi memiliki hubungan yang bermakna terhadap titer antibodi Campak pada anak. Kelengkapan imunisasi merupakan upaya nyata untuk mencapai herd immunity pada anak dan mencegah wabah campak di masyarakat. Promosi kesehatan yang memadai diperlukan untuk mengubah perilaku masyarakat agar percaya akan keamanan dan pentingnya pelaksanaan imunisasi dasar lengkap bagi anak meskipun dalam kondisi pandemi. Kata kunci: titer antibodi, imunisasi, anak usia 12-36 bulan, Indonesia, campak

Viral Factors Associated With the High Mortality Related to Human Infections With Clade 2.1 Influenza A/H5N1 Virus in Indonesia

Background

Since their emergence in Indonesia in 2005, 200 human infections with clade 2.1 highly pathogenic avian influenza A/H5N1 virus have been reported, associated with exceptionally high mortality (84%) compared to regions affected by other genetic clades of this virus. To provide potential clues towards understanding this high mortality, detailed clinical virological analyses were performed in specimens from 180 H5N1 patients, representing 90% of all Indonesian patients and 20% of reported H5N1-infected patients globally.

Methods

H5N1 RNA was quantified in available upper- and lower-respiratory tract specimens as well as fecal and blood samples from 180 patients with confirmed infection between 2005 and 2017. Mutations in the neuraminidase and M2 genes that confer resistance to oseltamivir and adamantanes were assessed. Fatal and nonfatal cases were compared.

Results

High viral RNA loads in nasal and pharyngeal specimens were associated with fatal outcome. Mortality increased over time during the study period, which correlated with increasing viral RNA loads on admission. Furthermore, the prevalence of amantadine resistance–conferring M2 mutations increased over time, and viral loads were higher in patients infected with viruses that harbored these mutations. Compared to observations from other regions, viral RNA was detected more frequently in feces (80%) and particularly in blood (85%), and antiviral responses to oseltamivir appeared less pronounced.

Conclusions

These observations confirm the association of viral load with outcome of human H5N1 infections and suggest potential differences in virulence and antiviral responses to oseltamivir that may explain the exceptionally high mortality related to clade 2.1 H5N1 infections in Indonesia.

Non Communicable Disease (NCD) as Risk for Disability: Recommendation for Indonesian UHC Program

BACKGROUND: Disability is health condition drives people seek treatment. Information on magnitude of disability and its contributors is important in Indonesian universal health coverage (UHC) era. It is useful for cost estimation, as well as to design type of service needed at the time being and in the future. This research intends to assess magnitude of disability and its non-communicable diseases (NCD) as risk. Disability obtained from WHODAS 2 score. METHOD: data obtained from 2018 National Health Survey (Riskesdas 2018) sample age 18 &ndash; 59, consisted of 528762 respondents. Dependent variable is disability measured using WHODAS2. Independent variables are NCD consist of statements ever diagnosed asthma, cancer, diabetes, heart, stroke, chronic renal failure, and joint disease by healthcare personnel and emotional distress which is score obtained from self-report questionnaire (SRQ) instrument. STATISTIC ANALYSIS: Validation between disability and 2 diseases was performed using Chi Square analysis. Logistic regression analysis was applied to identify contribution of NCD on disability. RESULTS: Results show risk of NCD on disability in the working age group of 18&ndash;59 years. Stroke and emotional distress are the highest contributors with OR more than 3. Results can serve as input for UHC program to estimate costs of working age health service, including rehabilitation. The Ministry of Health can develop or improve current health system with comprehensive services provision including psychological intervention in rehabilitation.

ANALISIS SITUASI HAK KEKAYAAN INTELEKTUAL BIDANG KESEHATAN DI INDONESIA

The information about intellectual property rights (IPR) related to health products in Indonesia is limited. This manuscript aims to describes the situation of health innovative researches including their products (patented and copyrights) in the last 5 years (2009-2013). This is a cross-sectional exploratory qualitative research, followed by the identifi cation of data and information related to health IPR documents retrospectively from 2009 till 2013. In-depth interviews conducted on IPR managers in 5 (fi ve) government research institutions, Indonesia Institute of Science, Agency for the Assessment and Application of Technology and 7 (seven) universities in Java island. The results showed that the IPR policy is strong, because it is written in the Act, majority of institutions state that IPR is their main indicators, however, the priority of health innovative researches is low. Generally, patented products were not planned to be patented from the beginning. Not all institutions have IPR management structured and incubation unit for development and “scaling up” of  researches results, so that, patented health products were potentially not to be commercialised. This shows that there is still a gap between policy and its implementation in terms of research innovation. Governments should actively promote and utilize the patented health products of Indonesia. Abstrak Informasi tentang Hak Kekayaan Intelektual (HKI) di Indonesia yang terkait dengan produk kesehatan masih sangat kurang. Tulisan ini bertujuan memaparkan situasi penelitian inovatif dan produk hasil penelitian kesehatan terkait HKI (paten dan hak cipta) dalam 5 tahun terakhir (2009-2013). Studi ini merupakan penelitian kualitatif eksplorasi potong lintang disertai identifi kasi data dan informasi pada dokumen HKI bidang kesehatan secara retrospektif dari tahun 2009 sd 2013. Wawancara mendalam dilakukan terhadap pengelola HKI di 5 (lima) lembaga litbang kementerian, Lembaga Ilmiah Pengetahuan Indonesia, Badan Pengkajian dan Penerapan Teknologi dan 7 (tujuh) universitas di pulau Jawa. Hasil penelitian menunjukkan bahwa dasar kebijakan HKI Indonesia telah kuat karena sudah dituangkan kedalam Undangundang, hampir semua institusi yang disurvei menjadikan HKI sebagai indikator utama, hanya penelitian yang berorientasi HKI kesehatan masih kurang diprioritaskan. Pada umumnya hasil penelitian yang dipatenkan tidak direncanakan sejakawal. Belum semua institusi memiliki unit pengelola HKI secara terstruktur dan unit inkubasi untuk pengembangan dan scaling up hasil penelitian agar dimanfaatkan masyarakat luas sehingga produk paten kesehatan berpotensi menjadi yang tidak bisa dikomersialisasikan. Hal ini menunjukkan bahwa terdapat gap antara kebijakan dan implementasinya dalam hal penelitian inovasi. Pemerintah perlu secara aktif membantu mempromosikan dan memanfaatkan hasil produk kesehatan yang telah memperoleh HKI.  

Case Report: Diagnosis and Treatment of Psychosomatic Gastritis at a Primary Health Clinic in West Surabaya, Indonesia

Indonesia is highly populated of a total 238,452,952 people with 274,396 gastritis cases. However, psychosomatic gastritis was just reported by very few patients. Because of the common gastritis cases in Indonesia and with the act of Healthcare and Social Security Agency or BPJS, so primary health cares should diagnose and manage the cases. This study aimed to determine the diagnosis and management of psychosomatic gastritis at a primary health clinic in West of Surabaya. It was a case study. It was a case on a woman aged 45 years old. She was high school graduate, married and had a child. She experienced reflux gastritis and psychiatric condition of depression and anxienty disorders. She was treated by psychiatrist at the first time and self-medicated for the gastritis. After stopping visiting the psychiatrist, she had problems of gastritis in four months. Then, she was referred to internist and examined Ultra Sonography of abdominal organs with normal result. There was a conventional method to determine psychosomatic gastritis that consicting of life styles, psychologic factor, social factor, and behavior assessment. This patient was a local migrant who struggled to gain a better life in the city, had a trigger for his father's death, had a relatively low socioeconomic state and lived in a monthly boarding house, and was a part-time worker. First-line care should establish a psychosomatic diagnosis of gastritis and treat psychological disorders together with their somatic abnormalities. Thus, the first level of health services must provide holistic services consisting of physical, psychological and social aspects.

Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia

Introduction: As the country hardest hit by avian influenza, both in poultry and in human, Indonesia’s decision to withhold samples of avian influenza virus A (H5N1) has fired up a global controversy. The objective of this paper is to describe the position taken by Indonesia in the events leading to the decision and in those conducted to resolve the situation. Methods: The sources for this paper are the Indonesian human influenza A(H5N1) case reports and study results, summaries, minutes and reports of national and international meetings of virus sharing, and other related Indonesian and WHO documents. Results: The International Health Regulations 2005 have been applied in different ways based on different interpretations. While one party insists on the importance of free, non-conditional, virus sharing for risk assessment and risk response, Indonesia – as supported by most of the developing countries – stresses on the more basic principles such as sovereignty of a country over its biological materials, transparency of the global system, and equity between developed and developing nations. Conclusions: This event demonstrates the unresolved imbalance between the affluent high-tech countries and the poor agriculture-based countries. Regional, global and in-country meetings must continue to be conducted to find solutions acceptable to all. Key words: H5N1, IHR 2005, MTA, Sovereignty

Towards mutual trust, transparency and equity in virus sharing mechanism: the avian influenza case of Indonesia

INTRODUCTION

As the country hardest hit by avian influenza, both in poultry and in human, Indonesia's decision to withhold samples of avian influenza virus A (H5N1) has fired up a global controversy. The objective of this paper is to describe the position taken by Indonesia in the events leading to the decision and in those conducted to resolve the situation.

METHODS

The sources for this paper are the Indonesian human influenza A(H5N1) case reports and study results, summaries, minutes and reports of national and international meetings of virus sharing, and other related Indonesian and WHO documents.

RESULTS

The International Health Regulations 2005 have been applied in different ways based on different interpretations. While one party insists on the importance of free, non-conditional, virus sharing for risk assessment and risk response, Indonesia--as supported by most of the developing countries--stresses on the more basic principles such as sovereignty of a country over its biological materials, transparency of the global system, and equity between developed and developing nations.

CONCLUSIONS

This event demonstrates the unresolved imbalance between the affluent high-tech countries and the poor agriculture-based countries. Regional, global and in-country meetings must continue to be conducted to find solutions acceptable to all.

Epidemiology of cases of H5N1 virus infection in Indonesia, July 2005-June 2006

BACKGROUND

Highly pathogenic avian influenza A (H5N1) virus was detected in domestic poultry in Indonesia beginning in 2003 and is now widespread among backyard poultry flocks in many provinces. The first human case of H5N1 virus infection in Indonesia was identified in July 2005.

METHODS

Respiratory specimens were collected from persons with suspected H5N1 virus infection and were tested by reverse-transcriptase polymerase chain reaction and viral culture. Serum samples were tested by a modified hemagglutinin inhibition antibody and/or microneutralization assay. Epidemiological, laboratory, and clinical data were collected through interviews and medical records review. Close contacts of persons with confirmed H5N1 virus infection were investigated.

RESULTS

From July 2005 through June 2006, 54 cases of H5N1 virus infection were identified, with a case-fatality proportion of 76%. The median age was 18.5 years, and 57.4% of patients were male. More than one-third of cases occurred in 7 clusters of blood-related family members. Seventy-six percent of cases were associated with poultry contact, and the source of H5N1 virus infection was not identified in 24% of cases.

CONCLUSIONS

Sporadic and family clusters of cases of H5N1 virus infection, with a high case-fatality proportion, occurred throughout Indonesia during 2005-2006. Extensive efforts are needed to reduce human contact with sick and dead poultry to prevent additional cases of H5N1 virus infection.