Characteristic tetanus infection in disaster-affected areas: case study of the Yogyakarta earthquakes in Indonesia

<p>Abstract</p> <p>Background</p> <p>Tetanus is an infectious disease caused by the contamination of wounds from bacteria that live in soil. The tetanus mortality rate remains high in developing countries affected by natural disasters. Whether the socio-demography and geographical conditions may influence the tetanus treatment outcome on the earthquake situation in Yogyakarta, Indonesia has not been investigated.</p> <p>Findings</p> <p>We present 26 tetanus patients who were admitted to eight hospitals following the earthquakes that occurred on May, 27, 2006, in Yogyakarta, Indonesia. The independent variables were age, gender, distance, admission, hospitalization, and type of hospital with the dependent variable surviving or perishing. Data were analyzed by logistic regression methods on SPSS 17.0. The distance from the patient's place of residence to the hospital were obtained and analyzed by using geospatial tools MapInfo 7.8 SCP and Global Mapper 7. Eight of the 26 patients were dead (30.8%) and statistical results showed that the distance (OR = 1.740, 95% CI = 1.068–2.835) and type of hospital (OR = 0.067, 95% CI = 0.001–3.520) were significant predictors of death.</p> <p>Conclusion</p> <p>Our findings show that in order to reduce the mortality rates, performing triage systems based on the distance and type of hospital priority for internally displaced persons could be proposed as well as making provisions for the generally old population in order to prevent an outbreak of tetanus following earthquakes in Yogyakarta, Indonesia.</p

Characteristics and risk factors for typhoid fever after the tsunami, earthquake and under normal conditions in Indonesia

<p>Abstract</p> <p>Background</p> <p>Although typhoid transmitted by food and water is a common problem in daily life, its characteristics and risk factors may differ in disaster-affected areas, which reinforces the need for rapid public health intervention. Surveys were carried out post-tsunami in Banda Aceh, post-earthquake in Yogyakarta, and under normal conditions in Bandung, Indonesia. Logistic regression analysis was used to assess the risk factors with the dependent variable of typhoid fever, with or without complications.</p> <p>Findings</p> <p>Characteristic typhoid fever with complications was found in 5 patients (11.9%) affected by the tsunami in Aceh, 8 (20.5%) after the earthquake in Yogyakarta, and 13 (18.6%) in Bandung. After the tsunami in Aceh, clean water (OR = 0.05; 95%CI: 0.01-0.47) and drug availability (OR = 0.23; 95%CI: 0.02-2.43) are significant independent risk factors, while for the earthquake in Yogyakarta, contact with other typhoid patients (OR = 20.30; 95%CI: 1.93-213.02) and education (OR = 0.08; 95%CI: 0.01-0.98) were significant risk factors. Under normal conditions in Bandung, hand washing (OR = 0.07; 95%CI: 0.01-0.50) and education (OR = 0.08; 95%CI: 0.01-0.64) emerged as significant risk factors.</p> <p>Conclusion</p> <p>The change in risk factors for typhoid complication after the tsunami in Aceh and the earthquake in Yogyakarta emphasizes the need for rapid public health intervention in natural disasters in Indonesia.</p

Risk Factors of Typhoid Infection in the Indonesian Archipelago.

BACKGROUND: Knowledge of risk factors and their relative importance in different settings is essential to develop effective health education material for the prevention of typhoid. In this study, we examine the effect of household level and individual behavioural risk factors on the risk of typhoid in three Indonesian islands (Sulawesi, Kalimantan and Papua) in the Eastern Indonesian archipelago encompassing rural, peri-urban and urban areas. METHODS: We enrolled 933 patients above 10 years of age in a health facility-based case-control study between June 2010 and June 2011. Individuals suspected of typhoid were tested using the typhoid IgM lateral flow assay for the serodiagnosis of typhoid fever followed by blood culture testing. Cases and controls were defined post-recruitment: cases were individuals with a culture or serology positive result (n = 449); controls were individuals negative to both serology and culture, with or without a diagnosis other than typhoid (n = 484). Logistic regression was used to examine the effect of household level and individual level behavioural risk factors and we calculated the population attributable fraction (PAF) of removing each risk significant independent behavioural risk factor. RESULTS: Washing hands at critical moments of the day and washing hands with soap were strong independent protective factors for typhoid (OR = 0.38 95% CI 0.25 to 0.58 for each unit increase in hand washing frequency score with values between 0 = Never and 3 = Always; OR = 3.16 95% CI = 2.09 to 4.79 comparing washing hands with soap sometimes/never vs. often). These effects were independent of levels of access to water and sanitation. Up to two thirds of cases could be prevented by compliance to these practices (hand washing PAF = 66.8 95% CI 61.4 to 71.5; use of soap PAF = 61.9 95%CI 56.7 to 66.5). Eating food out in food stalls or restaurant was an important risk factor (OR = 6.9 95%CI 4.41 to 10.8 for every unit increase in frequency score). CONCLUSIONS: Major gains could potentially be achieved in reducing the incidence of typhoid by ensuring adherence to adequate hand-washing practices alone. This confirms that there is a pivotal role for 'software' related interventions to encourage behavior change and create demand for goods and services, alongside development of water and sanitation infrastructure