BackgroundOperational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices.ObjectiveWe aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014.DesignUsing a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis.ResultsOperational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process.ConclusionsOperational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.
BackgroundThe contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners.MethodsWe conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time.ResultsThe following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1 – 3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0 – 4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0).ConclusionsEducation and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.
Background and purpose: Hypertension was a significant public health problem. This study aims to determine risk factors of hypertension. Methods: The study used a case-control design, involving 77 cases and 77 controls aged 18-65 years old, who were selected consecutively. Cases and controls were matched on age and sex. Cases were defined as patients who were diagnosed with hypertension by clinician at the primary health center (PHC), and controls were patients at PHC who were not diagnosed as hypertension. Data were collected through interview regarding sosiodemographic status and risk factors of hipertension. Direct measurement was performed for weight, height and abdominal circumference. Multivariate analysis was conducted using logistic regression.Results: Cases and controls were comparable in term of sex, age and education level. Variables that associated with hypertension were family history (AOR=9.20; 95%CI: 3.47-24.41), moderate stress (AOR=13.01; 95%CI: 3.70-45.79), severe stress (AOR=16,75; 95%CI: 3,32-84,38), less physical activity (AOR=3.53 (95%CI: 1.38-9.01), obesity (AOR=5.72; 95%CI: 2.09-15.68) and excessive salty food consumption (AOR=3.08; 95%CI: 1.17-8.09). Eating fatty foods may also indirectly cause hypertension. Income, mild stress, smoking habits, being passive smokers, coffee consumption habits, frequency of fruits and vegetables consumption were not found to be risk factors. Conclusion: Family history, moderate and severe stress, less physical activity, obesity and excessive salty food consumption were risk factors of hypertension. ABSTRAKLatar belakang dan tujuan: Hipertensi merupakan masalah kesehatan masyarakat. Penelitian bertujuan untuk mengetahui faktor risiko kejadian hipertensi. Metode: Penelitian case control dilakukan dengan sampel sebanyak 77 kasus dan 77 kontrol berusia 18-65 tahun, dan dipilih secara consecutive. Kasus dan kontrol dilakukan matching berdasarkan umur dan jenis kelamin. Kasus adalah pasien yang terdiagnosis hipertensi oleh dokter puskesmas, kontrol adalah pasien yang berkunjung ke puskesmas dan tidak menderita hipertensi. Data tentang status sosiodemografi dan faktor risiko dilakukan dengan wawancara. Tinggi dan berat badan serta lingkar perut diukur secara langsung. Analisis multivariat dilakukan dengan regresi logistik. Hasil: Kasus dan kontrol sudah komparabel menurut jenis kelamin, umur dan tingkat pendidikan. Variabel yang berhubungan dengan
The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.
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