Public Acceptance and Willingness-to-Pay for a Future Dengue Vaccine: A Community-Based Survey in Bandung, Indonesia

Background: All four serotypes of dengue virus are endemic in Indonesia, where the population at risk for infection exceeds 200 million people. Despite continuous control efforts that were initiated more than four decades ago, Indonesia still suffers from multi-annual cycles of dengue outbreak and dengue remains as a major public health problem. Dengue vaccines have been viewed as a promising solution for controlling dengue in Indonesia, but thus far its potential acceptability has not been assessed. Methodology/Principal Findings We conducted a household survey in the city of Bandung, Indonesia by administering a questionnaire to examine (i) acceptance of a hypothetical pediatric dengue vaccine; (ii) participant's willingness-to-pay (WTP) for the vaccine, had it not been provided for free; and (iii) whether people think vector control would be unnecessary if the vaccine was available. A proportional odds model and an interval regression model were employed to identify determinants of acceptance and WTP, respectively. We demonstrated that out of 500 heads of household being interviewed, 94.2% would agree to vaccinate their children with the vaccine. Of all participants, 94.6% were willing to pay for the vaccine with a median WTP of US$1.94. In addition, 7.2% stated that vector control would not be necessary had there been a dengue vaccination program. Conclusions/Significance: Our results suggest that future dengue vaccines can have a very high uptake even when delivered through the private market. This, however, can be influenced by vaccine characteristics and price. In addition, reduction in community vector control efforts may be observed following vaccine introduction but its potential impact in the transmission of dengue and other vector-borne diseases requires further study

An Analysis of Covid-19 Transmission in Indonesia and Saudi Arabia

An outbreak of novel coronavirus has been happening in more than 200 countries and has shocked society. Several measures have been implemented to slowing down the epidemics while waiting for vaccine and pharmaceutical intervention. Using a deterministic and stochastic model, we assess the effectiveness of current strategies: reducing the transmission rate and speeding up the time to detect infected individuals. The reproductive ratio and the probability of extinction are determined. We found that the combination of both strategies is effective to slow down the epidemics. We also find that speeding up the time to detect infected individuals without reducing the transmission rate is not sufficient to slow down the epidemics

Introduction of pentavalent vaccine in Indonesia: a policy analysis

The introduction of pentavalent vaccine containing Haemophilus influenzae type b antigen in Indonesia’s National Immunization Program occurred nearly three decades after the vaccine was first available in the United States and 16 years after Indonesia added hepatitis B vaccine into the program. In this study, we analyzed the process that led to the decision to introduce pentavalent vaccine in Indonesia. Using process tracing and case comparison, we used qualitative data gathered through interviews with key informants and data extracted from written sources to identify four distinct but interrelated processes that were involved in the decision making: (a) pentavalent vaccine use policy process, (b) financing process, (c) domestic vaccine development process and (d) political process. We hypothesized that each process is associated with four necessary conditions that are jointly sufficient for the successful introduction of pentavalent vaccine in Indonesia, namely (a) an evidence-based vaccine use recommendation, (b) sufficient domestic financing capacity, (c) sufficient domestic vaccine manufacturing capacity and (d) political support for introduction. This analysis of four processes that led to the decision to introduce a new vaccine in Indonesia may help policy makers and other stakeholders understand and manage activities that can accelerate vaccine introduction in the future

Hubungan Persepsi tentang Penularan HIV/AIDS dari Ibu ke Anak terhadap Praktik Penggunaan Kontrasepsi pada Wanita Usia Subur Penerima Obat Antiretroviral di Kota Bandung

Abstract    More than 90% of cases of Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrom (AIDS) in children, occur due to transmission from mother to child. Prevention of unwanted pregnancies with contraception in HIV positive women is important strategy to reduce the rate of mother to child HIV/AIDS transmission. The practice of contraceptive use in HIV positive women is strongly influenced by individual beliefs regarding the benefits and effectiveness of contraception for the prevention of mother to child HIV/AIDS transmission. This study aims to determine the relationship of perceptions based on the construct of the Health Belief Model (HBM) wich consists of perceived susceptibility, perceived severity, perceived benefit, perceived barrier, self efficacy, and cues to action and based on pluralistic ignorance on the practice of contraceptive use among woman of childbearing age recipients of antiretroviral in Bandung. The design of this study was quantitative non-experimental with survey methods. Data were collected for one month, using questionnaire from 188 women of childbearing age  receiving  antiretroviral drughs taken by consecutive sampling (non-probability) technique. Data were analyzed by logistic regression. The results revealed perceived susceptibility is an HBM construct that affects contraceptive use (Adjusted Odds Ratio (AOR):4.5). While knowledge (AOR:7.3) and age (AOR:0.801), emerged as other factors that influence contraceptive use among WUS recipients of antiretroviral in Bandung. The HBM is used to predict contraceptive behavior in women. HIV positive women who believe themselves to be at high risk of infecting HIV/AIDS from mother to child will tend to use contraception, besides that knowledge is the basis for HIV positive women taking action to use contraception. Abstrak Lebih dari 90% kasus Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrom (AIDS) pada anak, terjadi akibat penularan dari ibu ke anak. Pencegahan kehamilan yang tidak direncanakan dengan kontrasepsi pada wanita HIV positif merupakan strategi penting untuk menurunkan angka penularan HIV/AIDS dari ibu ke anak. Praktik penggunaan kontrasepsi oleh wanita HIV positif sangat dipengaruhi oleh keyakinan individu terkait manfaat dan efektivitas kontrasepsi terhadap pencegahan penularan HIV/AIDS dari ibu ke anak. Penelitian ini bertujuan untuk mengetahui hubungan persepsi berdasarkan konstruk Health Belief Model (HBM) yang terdiri dari perceived susceptibility, perceived severity, perceived benefit, perceived barrier, self efficacy, dan cues to action serta berdasarkan ketidaktahuan majemuk terhadap praktik penggunaan kontrasepsi pada Wanita Usia Subur (WUS) penerima obat antiretroviral di Kota Bandung. Desain penelitian ini adalah kuantitatif non-experimental dengan metode survei. Data dikumpulkan selama satu bulan, menggunakan kuesioner dari 188 WUS penerima obat antiretroviral yang diambil dengan teknik consecutive sampling (non-probability). Data dianalisis dengan regresi logistik. Hasil penelitian mengungkapkan perceived susceptibility adalah konstruk HBM yang berpengaruh terhadap penggunaan kontrasepsi (Adjusted Odds Ratio (AOR):4,5). Sementara pengetahuan (AOR:7,3) dan usia (AOR:0,801) muncul sebagai faktor-faktor lain yang berpengaruh terhadap praktik penggunaan kontrasepsi pada WUS penerima obat antiretroviral di Kota Bandung. HBM digunakan untuk memprediksi perilaku kontrasepsi pada wanita. Wanita HIV positif yang meyakini dirinya berisiko tinggi dapat menularkan HIV/AIDS ke anak, akan cenderung menggunakan kontrasepsi, disamping itu pengetahuan menjadi dasar bagi wanita HIV positif dalam mengambil tindakan untuk menggunakan kontrasepsi

Tuberculosis care provided by private practitioners in an urban setting in Indonesia: Findings from a standardized patient study

In Indonesia, government-owned Community Health Centers (CHCs) spearhead tuberculosis (TB) care at the primary level, but a substantial proportion of individuals with pulmonary TB also seek care from Private Practitioners (PPs). However, little is known about PPs’ practice in managing patients with TB-associated symptoms. To avoid bias associated with self-administered surveys, we used standardized patients (SPs) to evaluate PPs’ adherence to the national TB guidelines. Four clinical scenarios of individuals presenting complaints suggestive of TB, accompanied by different sputum smear results or TB treatment histories were developed. We assigned 12 trained SPs to PPs practicing in 30 CHC catchment areas in Bandung city, Indonesia. For comparison, two scenarios were also presented to the CHCs. A total of 341 successful SP visits were made to 225 private general practitioners (GPs), 29 private specialists, and 30 CHCs. When laboratory results were not available, adherence to the recommended course of action, i.e., sputum examination, was low among private GPs (31%) and private specialists (20%), while it was requested in 87% of visits to the CHCs. PPs preferred chest X-ray (CXR) in all scenarios, with requests made in 66% of visits to private GPs and 84% of visits to private specialists (vs. 8% CHCs). Prescriptions of incorrect TB drug regimens were reported from 7% and 13% of visits to private GPs and specialists, respectively, versus none of the CHCs. Indonesian PPs have a clear preference for CXR over microbiological testing for triaging presumptive TB patients, and inappropriate prescription of TB drugs is not uncommon. These findings warrant actions to increase awareness among PPs about the importance of microbiological testing and of administering appropriate TB drug regimens. SP studies can be used to assess the impact of these interventions on providers’ adherence to guidelines

Willingness-to-pay for a COVID-19 vaccine and its associated determinants in Indonesia

How countries, particularly low- and middle-income economies, should pay the coronavirus disease 2019 (COVID-19) vaccine is an important and understudied issue. We undertook an online survey to measure the willingness-to-pay (WTP) for a COVID-19 vaccine and its determinants in Indonesia. The WTP was assessed using a simple dichotomous contingent valuation approach and a linear regression model was used to assess its associated determinants. There were 1,359 respondents who completed the survey. In total, 78.3% (1,065) were willing to pay for the COVID-19 vaccine with a mean and median WTP of US$57.20 (95$ 54.56, US$59.85) and US$ 30.94 (95%CI: US$30.94, US$ 30.94), respectively. Being a health-care worker, having a high income, and having high perceived risk were associated with higher WTP. These findings suggest that the WTP for a COVID-19 vaccine is relatively high in Indonesia. This WTP information can be used to construct a payment model for a COVID-19 vaccine in the country. Nevertheless, to attain higher vaccine coverage, it may be necessary to partially subsidize the vaccine for those who are less wealthy and to design health promotion materials to increase the perceived risk for COVID-19 in the country

Knowledge, attitude, and practice regarding dengue virus infection among inhabitants of Aceh, Indonesia: A cross-sectional study

Background: The Indonesian region of Aceh was the area most severely affected by the earthquake and tsunami of 26 December 2004. Department of Health data reveal an upward trend of dengue cases in Aceh since the events of the tsunami. Despite the increasing incidence of dengue in the region, there is limited understanding of dengue among the general population of Aceh. The aim of this study was to assess the knowledge, attitude, and practice (KAP) regarding dengue among the people of Aceh, Indonesia in order to design intervention strategies for an effective dengue prevention program. Methods: A community-based cross-sectional study was conducted in Aceh between November 2014 and March 2015 with a total of 609 participants living in seven regencies and two municipalities. Information on the socio-demographic characteristics of participants and their KAP regarding dengue was collected using a pre-tested structured questionnaire. The KAP status (good vs. poor) of participants with different socio-demographic characteristics was compared using Chi Square-test, ANOVA or Fisher's exact test as appropriate. Logistic regression analysis was used to determine the predictors of each KAP domain. Results: We found that 45% of participants had good knowledge regarding dengue and only 32% had good attitudes and good dengue preventive practices. There was a significant positive correlation between knowledge and attitudes, knowledge and practice, and attitudes and practice. In addition, people who had good knowledge were 2.7 times more likely to have good attitudes, and people who had good attitudes were 2.2 times more likely to have good practices regarding dengue. The level of education, occupation, marital status, monthly income, socioeconomic status (SES) and living in the city were associated with the knowledge level. Occupation, SES, and having experienced dengue fever were associated with attitudes. Education, occupation, SES and type of residence were associated with preventive practices. Conclusion: Our study suggests that dengue prevention programs are required to increase KAP levels regarding dengue in the communities of Aceh

Utilization of PRECEDE Model to Identify Risk Factors of Sexual Initiation and Engagement in Unprotected Sex among Adolescents

In the United States, the rates of unplanned pregnancies and sexually transmitted diseases, including HIV infection, caused by unprotected sex is alarmingly high. Adverse outcomes of unprotected sexual intercourse continue to be a burden, not only for affected adolescents but for the community at large. Using data from the National Longitudinal Study of Adolescent Health, this study applied the PRECEDE model as a means to identify those salient risk factors and risk conditions of sex initiation and engagement in unprotected sex among adolescent students. Results showed that 52.6% of the students have had sexual intercourse and 54.5% of sexually experienced students reported inconsistent condom use during sexual intercourse. Logistic regression analysis showed that risks factors for having had sexual intercourse differ from those for having engaged in unprotected sex in sexually experienced students. Furthermore, these factors also differed between male and female students. Only students’ age and perceived hardships related to pregnancy were found to be common risk factors for both outcomes in both sex groups. Results suggest that the PRECEDE is a practical tool to aid program planners identify the intervention priorities most relevant to their target populations

Faktor yang Memengaruhi Dukungan Suami terhadap Pemberian ASI Eksklusif Berdasarkan Theory of Planned Behavior (TPB)

The coverage of exclusive breastfeeding has not yet reached the target both in Indonesia and other countries. One of the factors that influence husband’s support. Husband’s support for exclusive breastfeeding will be influenced by his intention. A person’s planned behavior or intentions can be predicted through their attitudes as described in Theory of Planned Behavior (TPB), which states that a person’s intention is influenced by behavior belief, outcome evaluation and perceived power. The research aims was to analyze which factors most influenced husband’s support for exclusive breastfeeding based on TPB. The study is a quantitative research using survey method. The sampling technique used multistage sampling to get respondents as many as 90 husbands who have babies aged 0-6 months in Bandung. The instrument used the Partner Breastfeeding Influence Scale (PBIS) and the TPB questionnaire, while the statistical analysis used the Multiple Linear Regression Test. The results of the analysis showed that the husband’s support for exclusive breastfeeding can be categorized as sufficient. Whereas the factors that most influenced the husband’s support for exclusive breastfeeding based on TPB were behavior beliefs (β = 1.8; p = 0.01). These results provide information that a health promotion program design is needed to improve attitudes and support for husband in exclusive breastfeeding. Abstrak Cakupan pemberian Air Susu Ibu (ASI) eksklusif masih belum mencapai target baik di Indonesia maupun di negara lain. Salah satu faktor yang memengaruhinya adalah dukungan suami. Dukungan suami terhadap pemberian ASI eksklusif akan dipengaruhi oleh intensinya. Perilaku terencana atau intensi seseorang dapat diprediksi melalui sikap yang dimilikinya seperti yang dijelaskan dalam Theory of Planned Behavior (TPB) bahwa intensi seseorang dipengaruhi oleh behavior belief, outcome evaluation dan perceive power. Tujuan penelitian yaitu untuk menganalisis faktor mana yang paling memengaruhi dukungan suami terhadap pemberian ASI eksklusif berdasarkan TPB. Penelitian ini merupakan penelitian kuantitatif dengan metode survei. Teknis pengambilan sampel menggunakan multistage sampling untuk mendapatkan responden sebanyak 90 orang suami yang memiliki bayi usia 0-6 bulan di Kota Bandung. Instrumen penelitian menggunakan Partner Breastfeeding Influence Scale (PBIS) dan kuesioner TPB sedangkan analisis statistik menggunakan uji regresi linear berganda. Hasil analisis diperoleh besar dukungan suami terhadap pemberian ASI eksklusif dapat dikategorikan cukup, sedangkan faktor yang paling memengaruhi dukungan suami terhadap pemberian ASI eksklusif berdasarkan TPB adalah behavior beliefs (β=1,8; p=0,01). Hasil ini memberikan informasi bahwa diperlukan suatu rancangan program promosi kesehatan untuk meningkatkan sikap serta dukungan suami dalam pemberian ASI eksklusif. &nbsp

Model CIPP dalam Pelayanan Kesehatan Peduli Remaja di Kota BAndung

Evaluasi Program Pelayanan Kesehatan Peduli Remaja (PKPR) diharapkan menyajikan hasil yang dapat digunakan sebagai masukan bagi pengambil keputusan dalam menentukan alternatif kebijakan dalam keberlanjutan kegiatan program. Dengan menggunakan model CIPP (Context, Input, Process, Product) evaluasi yang dihasilkan akan lebih komprehensif. Penelitian ini bertujuan untuk menganalisis dan mengevaluasi terhadap pelaksanaan program. Metode penelitian yang digunakan adalah kualitatif dengan pendekatan studi kasus. Terdapat tiga kelompok narasumber yang terdiri dari setiap perwakilan puskesmas mampu PKPR. Kelompok pertama merupakan petugas pemegang program PKPR, kelompok kedua merupakan kepala puskesmas dan kelompok ketiga adalah remaja sebagai penerima pelayanan PKPR. Hasil evaluasi context didapatkan beberapa tema penting diantaranya awal pembentukan program ditiap puskesmas berbeda-beda, hal ini dikarenakan kesiapan tiap masing-masing puskesmas berbeda, tujuan pembentukan program karena permasalahan pada remaja semakin meningkat terutama di wilayah kerja Puskesmas. Evaluasi Input yang didapatkan adalah keterbatasan SDM, sarana prasarana yang tidak memadai dan keterbatasan sumber pendanaan dari biaya operasional kesehatan. Evaluasi process yang didapatkan adalah pelaksanaan program PKPR di lapangan sudah sesuai, partisipasi masyarakat mendukung, dan belum adanya kunjungan oleh Dinas Kesehatan sebagai upaya pemantauan pencapaian Standar Nasional PKPR. Evaluasi product yang didapatkan adalah jumlah kunjungan yang meningkat, dampak bagi remaja baik perubahan perilaku dan pengendalian penyakit. Saran dalam penelitian ini diharapkan adanya peningkatan kualitas pelayanan baik dari sumber daya manusia, media kesehatan dan sistem supervisi yang dilaksanakan oleh dinas kesehatan agar dapat memaksimalkan pelayanan pada remaja