Pengembangan Jaringan Virologi dan Epidemiologi Influenza di Indonesia

Tulisan ini diturunkan untuk menyokong program pengendalian penyakit flu burung, sekaligus untuk menjelaskan riwayat terbentuknya program surveilans penyakit yang menyerupai influenza (Influenza Like Illness=ILI). Tulisan ini disadur dari laporan akhir "pengembangan jaringan surveilans virologim influenza di Indonesia Juni 2007" yang merupakan pertanggungjawaban pelaksanaan proyek surveilans ILI

Studi Evaluasi Pelatihan Penatalaksanaan Pms dengan Pendekatan Sindrom di Beberapa Kabupaten di Jawa Timur

Sexually Transmitted Diseases (STD continue to become major public health problems. Most of STD patients present with urethral or vaginal discharge, even though the causes may be of different micro-organisms. The Syndromic Approach (SA) is an algorithm for STD management currently recommended by the WHO. Diagnosis are made based on clinical signs and symptoms using a certain flowchard-without laboratory confirmation, and all possible causes will be treated. IEC are also given and the patients' partners are notified. The East Java Provincial health office has trained Puskesmas' and hospitals' doctors and paramedics on this new STD management approach.The objecttive of this study is to evaluate the implementation of SA in some Puskesmas and private clinics which personnels have been trained before. Using direct observation, document research, interviews and focus group discussions, data and information on the benefit of SA, the obstacles in implementing SA, and recommendations to improve the health providers' performance in STD management are collected. Results are hopefully used as inpc;ts in improving the STD control program, provincially as well as nationally

STUDI EVALUASI PELATIHAN PENATALAKSANAAN PMS DENGAN PENDEKATAN SINDROM DI BEBERAPA KABUPATEN DI JAWA TIMUR

Sexually Transmitted Diseases (STD continue to become major public health problems. Most of STD patients present with urethral or vaginal discharge, even though the causes may be of different micro-organisms. The Syndromic Approach (SA) is an algorithm for STD management currently recommended by the WHO. Diagnosis are made based on clinical signs and symptoms using a certain flowchard-without laboratory confirmation, and all possible causes will be treated. IEC are also given and the patients' partners are notified. The East Java Provincial health office has trained Puskesmas' and hospitals' doctors and paramedics on this new STD management approach.The objecttive of this  study is to evaluate the implementation of SA in some Puskesmas and  private clinics which personnels have been trained before. Using direct observation, document research, interviews and focus group discussions, data and information on the benefit of SA, the obstacles in implementing SA, and recommendations to improve the health providers' performance in STD management are collected. Results are hopefully used as inpc;ts in improving the STD control program, provincially as well as nationally

Prevalensi Infeksi Menular Seksual, Faktor Risiko Dan Perilaku Di Kalangan Anak Jalanan Yang Dibina Lembaga Swadaya Masyarakat Di Jakarta, Tahun 2000

A rough estimate of 4 to 20 thousand children work and/or live in the streets of Jakarta. These children are at the ages where sexual awareness and activities are rising. Living in an environment where regulations and socio-spiritual norms are more lax gives them more freedom to be sexually active. Previous study showed that many of them were forced to start sexual lives at early age by older peers, some were forced to enter prostitution. All of these put the street children at high risk to get sexually transmitted infections (STI), including HIV. So far, there had not been any STI survey study conducted among this community in Indonesia. The objectives of this study were to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV infection among male street children in Jakarta, and to investigate their risky behaviours. In the year 2000, male street children aged 10 to 20 years in Jakarta who were reached-out by NGOs were interviewed using a short questionnaire. Specimens of venous blood, urethral, anal and throat swabs were taken for laboratory tests. As the results, among the 274 children who participated, more than half (58.4%) were children "on" the street (had somewhat regular contact with their family), and the rest were children "of" the street (little or no contact with the family). Knowledge of STI was low, while 22.3%) admitted to be sexually active (one out of 3 children "of" the street). Condom use was very low: 85.2% among the sexually active never used condoms and only 5% used it continuously. The prevalence of gonorrhoea was 7.7%, chlamydia 7.4%, syphilis 0%, and HIV 0%. Self-treatment was practiced by 31.4% of the participants

Vaccine-preventable haemophilus influenza type B disease burden and cost-effectiveness of infant vaccination in Indonesia.

BACKGROUND: Most of Asia, including Indonesia, does not use Haemophilus influenzae type b (Hib) conjugate vaccines. We estimated total vaccine-preventable disease burden and the cost-effectiveness of Hib conjugate vaccine in Indonesia. METHODS: Hib pneumonia and meningitis incidences for children with access to health care were derived from a randomized vaccine probe study on Lombok Island, Indonesia during 1998-2002. Incidences were adjusted for limited access to care. Health system and patient out-of-pocket treatment cost data were collected concurrent with the probe study. For Hib vaccine in monovalent and combined (with DTP-HepB) presentations, we used 2007 UNICEF vaccine prices of US$3.30 and$3.75 per dose. RESULTS: For the 2007 Indonesian birth cohort, Hib vaccine would prevent meningitis in 1 of every 179 children, pneumonia in 1 of every 18 children, and 4.9% of mortality among those younger than 5 years. The total incremental societal costs of introducing Hib vaccine in monovalent and pentavalent presentations were, respectively, US$11.74 and$8.93 per child vaccinated. Annual discounted treatment costs averted amounted to 20% of pentavalent vaccine costs. For the pentavalent vaccine, the incremental costs per discounted death and disability adjusted life-year averted amounted to US$3102 and$74, respectively, versus $4438 and$102 for monovalent vaccine. CONCLUSIONS: Routine infant Hib vaccination would prevent a large burden of pediatric illness and death in Indonesia. Even without external funding support, Hib vaccine will be a highly cost-effective intervention in either a monovalent or pentavalent presentation based on commonly used benchmarks

Validasi Pemeriksaan Infeksi Menular Seksual Secara Pendekatan Sindrom Pada Kelompok Wanita Berperilaku Risiko Tinggi

Accurate and adequate treatment of STIs is a critical component of STI-control activities to reduce transmission and sequelaes. On the other hand, chronic shortage in skilled staff and laboratory equipment in many countries necessitate the use of clinical skills more in order to diagnose and differentiate STIs. For these places, the WHO has recommended and produced a protocol of it syndromic approach management of STIs in place of treatment by -etiology. Since 1997 the Indonesia Ministry of Health has been conducting national training on this method. However, the syndromic approach for vaginal discharge is known to be problematic since differentiation among cervicitis, vaginitis, and even normal condition is difficult. The main objective of this study is to determine the sensitivity, specificity and positive predictive value of the syndromic approach management of women with signs and/or symptoms of abnormal vaginal discharge. The sample population were women with high risk sexual behaviors in East Java and North Sulawesi provinces. The laboratory tests using DNA hybridization probe technique (the PACE 2 test, Gen-Probe, San Diego, Calif.) for Neisseria gonorrhoeae and Chlamydia trachomatis were used as gold standard. In addition, we also compared the clinical approach widely used by clinicians (mainly at hospitals) with laboratory results. A total of 439 participants was recruited purposively (230 from E. Java and 209 from N.Sulawesi). In E.Java, the sensitivity, specificity, and predictive value of the syndromic management for vaginal discharge are 31%, 83%, and 59%, respectively, and in N.Sulawesi 49%, 56%, and 40%,respectively. The clinical approach did not show better results. In E.Java the sensitivity, specificity, and positive predictive value are 13%, 89%, and 50%, res­pectively, while in N.Sulawesi they are 42%, 61%, and 39%, respectively. As a conclusion, the current form of syndromic management has little use for STI screening among high risk women. Further studies by adding more criteria to the syndromes are needed to improve this method

Statistical analyses in disease surveillance systems

The performance of disease surveillance systems is evaluated and monitored using a diverse set of statistical analyses throughout each stage of surveillance implementation. An overview of their main elements is presented, with a specific emphasis on syndromic surveillance directed to outbreak detection in resource-limited settings. Statistical analyses are proposed for three implementation stages: planning, early implementation, and consolidation. Data sources and collection procedures are described for each analysis

Epidemiological Study of Influenza in Jakarta and Surrounding Areas

EPIDEMIOLOGICAL STUDY OF INFLUENZA IN JAKARTA AND SURROUNDING AREA