Background: Measles is a highly contagious and a vaccine-preventable disease. On 14 August 2015, a measles outbreak was reported in Langkat District, North Sumatra province of Indonesia. To investigate the risk factors of the outbreak and to recommend control measures, an epidemiological investigation was undertaken. Method: A 1:1 matched case-control study was conducted. All suspect and confirmed cases were recruited and included. Controls were healthy neighbors of cases, matched for age and gender. House-to-house search for cases was carried out. Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. A two-step logistic regression was employed to assess the potential risk factors associated with the infection. Results: During 20 July to 25 September 2015, a total of 28 measles cases were identified with no death. All tested blood samples were positive for measles-specific IgM antibodies confirming the outbreak. All cases presented with fever and rash; cough (80%), coryza (65%), and conjunctivitis (25%). The attack rate (AR) was 14.1% (age ranged between 1 and 14 years old), the highest AR (50.0%) occurred among those aged 1-4 years. In multivariate model, those who have not received measless vaccication and those who had contact with a measles case had higher odds of having infection, with adjusted odds ratio (aOR): 2.31 (95%CI: 1.22-4.27) and aOR: 1.15 (95%CI: 1.12-3.70), respectively. Conclusions: Being unvaccinated and having a contact history increased the risk of measles are two risk factors of measles infection. A mass measles immunization to the school children was undertaken and a strict measles surveillance and notification system were recommended to control the transmission in the future.
BACKGROUND: Our world is now facing the public health emergency situation. Since early December 2019, COVID-19 emerged the Wuhan City, Hubei Province, China. The disease is still continuing spread to more than 200 countries and territories globally. AIM: This study aimed to assess the knowledge of COVID-19 among the surveillance officers and outbreak investigation team in North Sumatera, Indonesia. METHODS: A cross-sectional study was performed between March 5, 2020 and April 20, 2020, among the surveillance officers and outbreak investigation team in North Sumatera province, Indonesia. A set of validated, pre-tested questionnaire was used to measure knowledge regarding COVID-19 infection and to collect a range of explanatory variables. Data were collected through a self-administered questionnaire. A two-step logistic regression analysis was employed to assess the association of participants’ demographic data, level of education, surveillance training, length of work, and location of workplace with the knowledge. RESULTS: A total of 246 participants were collected. We found that 109 out of 246 (44.3%) participants were good knowledge of COVID-19. Multivariate model revealed that surveillance training was the most associated variable with knowledge of COVID-19 (OR = 2.15, 95% CI = 1.09–4.27). In addition, as much as 27 participants (79.4%) have good knowledge and also have received surveillance training expressed a willingness to conduct surveillance (OR = 4.75, 95% CI = 1.98–11.39). CONCLUSIONS: The knowledge of surveillance officers and outbreak investigation team in North Sumatera regarding COVID-19 is relatively low. Participants who have good knowledge and have received surveillance training expressed a willingness to conduct surveillance of COVID-19 in the community. Therefore, training for surveillance and outbreak investigation team to improve the understanding and skill is a must.
Rabies merupakan masalah kesehatan masyarakat di Sumatera Utara. Tujuan dari program pencegahan dan pengendalian rabies adalah untuk mencapai Sumatera Utara bebas rabies tahun 2020. Penelitian ini merupakan penelitian observasional dengan desain cross sectional dengan mengumpulkan dan menganalisis laporan bulanan dan tahunan kasus rabies di Sumatera Utara sejak tahun 2007-2017. Evaluasi dilakukan terhadap seluruh proses program pencegahan dan pengendalian rabies. Hasil didapatkan bahwa pelaksanaan program pencegahan dan pengendalian rabies di Sumatera Utara belum berjalan optimal, seperti pelaksanaan surveilans epidemiologi, pelacakan kasus, tata laksana kasus di fasilitas pelayanan kesehatan, masih kurangnya partisipasi masyrakat, kurangnya rabies center di kabupaten/kota, serta kurangnya kerja sama antara dinas kesehatan dan dinas peternakan kabupaten/kota. Program pencegahan dan pengendalian rabies di Sumatera Utara belum berhasil dalam menurunkan kasus lyssa, masih terdapat 9 kabupaten/kota yang selama 2 tahun terakhir memiliki kasus lyssa. Disarankan lebih meningkatkan kerja sama lintas sektor dan program untuk mencapai Sumatera Utara bebas rabies 2020.
Background: Chikungunya is a serious emerging arbovirus in Indonesia. On 12 October 2013, an outbreak of chikungunya was reported in Serdang Bedagai District, North Sumatera, Indonesia. Objective: An epidemiological investigation was conducted to identify the risk factors for the outbreak and recommend control measures. Methods: A 1:1 matched case-control study was conducted. A case of chikungunya was defined as a previously well resident of Sei Suka Subdistrict who had clinical symptoms of chikungunya fever such as fever, arthralgia, myalgia, rash and headache of at least two days duration between 8 August and 17 November 2013. Cases were identified by active case finding through the affected area; a control was defined as a neighbor of a case that did not have clinical signs and symptoms of chikungunya, matched for age and gender. Blood samples were tested using ELISA assay to confirm the presence of anti-CHIKV specific IgM antibody. Results: Total of 94 cases and 94 controls were included in the case control study. Age ranged from 1 year to 76 years (median 35 years) and 57% were female. In multivariate analyses, being a household contact of a chikungunya case (adjusted OR=11.4, 95%CI=4.69-27.55) and lack of routinely eliminating mosquito breeding sites were risk factors (adjusted OR=3.3, 95%CI=1.50-7.05). Six out of ten cases were positive for CHIKV IgM antibody. Conclusions: In this confirmed outbreak of chikungunya, using anti mosquito measures were protective, reinforcing the need for routine elimination of mosquito breeding sites as well as control measures in affected households and communities.
Dengue fever (DF) infection continues to present as a serious public health problem in Medan municipality, North Sumatera, Indonesia. The number of DF cases continuously increasing recently. However, space time clusters of DF have not been investigated yet. A study was undertaken to detect clusters of DF incidence during 2015-2018 in Medan. Spatial geo-reference was conducted to 151 village coordinates by geocoding each village’s offices. A retrospective space-time scan statistic analysis based on population data and monthly DF incidence was performed using SaTScan TM v9.4.4. Data of DF during 1 January 2015-31 December 2018 were analyzed using Poisson model to identify the villages at high risk of DF. The test of significance of the identified clusters of DF was based on comparing the likelihood ratio (LLR) against the null distribution obtained from Monte Carlo hypothesis testing. Total number of permutation was set to 999 and the significance level was set as 0.05. The highest LLR number was determined as the most likely cluster, while the rests were as the secondary clusters. This analysis identified 13 significant clusters. These DF clusters were initially spatially concentrated in the southwest and center of Medan and the last two years of study moved towards the northern part and identified in the last four months (September-December) of each year, which were the rainy seasons in the area. Most likely clusters were most frequently detected in the last three-year period of study in Anggrung village. Thirteen statistically significant DF clusters were identified in the 2015-2018 period. This may assist health authorities to improve the DF preventive strategies and develop public health interventions especially in the cluster’s area.
Tuberculosis (TB) is one of the leading causes of morbidity and mortality. It is carrying a heavy public health problem burden in Indonesia. This study aimed to determine the risk of poor knowledge of TB, socioeconomic status, malnutrition and contact history with TB cases with the incidence of TB in Medan. This was a cross sectional study conducted between May – August 2019 in Medan municipality, in the three highest TB cases incidence public health centers (puskesmas). Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. Logistic regression was conducted to assess the potential risk factors associated with the infection. We enrolled 260 clinically suspected cases of TB, comprising 135 (51.9%) cases positive for TB and 125 (48.1%) cases negative for TB. In multivariate model, those who had contact history with active TB cases and those who malnourished had higher odds of having TB infection, with adjusted odds ratio (aOR): 5.58 (95%CI:3.13–9.93) and aOR: 3.36 (95%CI: 1.87–6.02), respectively. Having contact history with TB active case and malnutrition were the most significant risk factors of TB incidence in Medan municipality, North Sumatera, Indonesia. Therefore, educating patients on the importance of cough or sneezes etiquette procedures including use of face masks to minimize the risk of infection.
Dengue infection continues to present as a serious public health problem in North Sumatera, Indonesia. A dengue fever outbreak was reported in Teluk Dalam Subdistrict, South Nias District, North Sumatera during February 2016. An epidemiological investigation was conducted to identify the risk factors and recommend control measures. An observational study with a matched case-control design was conducted. A case was defined as a resident of Teluk Dalam District who had suffered two or more clinical symptoms of fever, headache, pain behind eyes, muscle and joint pain, and rash from 14 Feb to 16 Mar 2016. Blood samples were tested to confirm the diagnosis and serotype identification. Total 68 cases and 68 controls were included in the matched case-control study. The case fatality rate was 2.9%, age ranged from six months to 51 years (median 25 years). Three out of six cases were tested positive for DEN-3 serotype. In multivariate analyses, not eliminating mosquito breeding sites routinely (adjusted odds ratio = 3.7, 95% CI = 1.48-9.46) and having habit of hanging worn clothes (adjusted odds ratio = 2.9, 95% CI = 1.21-6.96) were risk factors. Elimination of mosquito breeding sites routinely, proper management of worn clothes, and conducting strict surveillance for dengue infection were recommended.
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