BackgroundDengue is associated with significant economic expenditure and it is estimated that the Asia Pacific region accounts for >50% of the global cost. Indonesia has one of the world’s highest dengue burdens; Aedes aegypti and Aedes albopictus are the primary and secondary vectors. In the absence of local data on disease cost, this study estimated the annual economic burden during 2015 of both hospitalized and ambulatory dengue cases in Indonesia.MethodsTotal 2015 dengue costs were calculated using both prospective and retrospective methods using data from public and private hospitals and health centres in three provinces: Yogyakarta, Bali and Jakarta. Direct costs were extracted from billing systems and claims; a patient survey captured indirect and out-of-pocket costs at discharge and 2 weeks later. Adjustments across sites based on similar clinical practices and healthcare landscapes were performed to fill gaps in cost estimates. The national burden of dengue was extrapolated from provincial data using data from the three sites and applying an empirically-derived epidemiological expansion factor.ResultsTotal direct and indirect costs per dengue case assessed at Yogyakarta, Bali and Jakarta were US$791, US$1,241 and US$1,250, respectively. Total 2015 economic burden of dengue in Indonesia was estimated at US$381.15 million which comprised US$355.2 million for hospitalized and US$26.2 million for ambulatory care cases.ConclusionDengue imposes a substantial economic burden for Indonesian public payers and society. Complemented with an appropriate weighting method and by accounting for local specificities and practices, these data may support national level public health decision making for prevention/control of dengue in public health priority lists.
Background and purpose: Electronic cigarettes have been available globally since 2003 and first became for sale in Indonesia in 2010. Users tend to be predominately young people. The purpose of this study is to determine the proportion, characteristics and factors that influence the use of electronic cigarette among university students.Method: This research used a cross sectional survey with 351 undergraduate students from a variety of disciplines at Udayana University chosen by multistage sampling. In the first phase, 10 study programs were chosen randomly from 47 courses at Udayana University. The selection of respondents was influenced by the convenience of data collection, that is, questionnaire via the Survey Monkey application. Analysis with logistic regression was used to determine the factors influencing electronic cigarette usage based on several variables.Results: The proportion of students who used tobacco cigarettes was 14.53%. Respondents who reported using electronic cigarettes numbered 61 (17.38%, 95%CI: 13.46%-21.3%), and 40.98% of them were still current smokers. As many as 88.52% of respondents who had ever used electronic cigarette are male students, and 11.48% female students. Students who had ever used electronic cigarettes in the campus area totaled 22 people (36.07%). The reasons provided for using electronic cigarettes included a desire to stop using tobacco cigarettes (29.51%), the fact that electronic cigarettes are considered safer (26.23%), are considered “cool” (22.95%), experimental reasons, and other (26.23%). Multivariate analysis showed that the variables found to be associated with the use of electronic cigarettes were gender (AOR=14.72; 95%CI: 4.34-49.87), a history of smoking tobacco cigarettes (AOR=42.16; 95%CI: 13.56-131.08), had a history of consuming alcoholic beverages (AOR=5.72; 95%CI: 2.04-16.04) as well as coming from a smoking household (AOR=3.87; 95%CI: 1.33 - 11.21).Conclusion: The proportion of students who have ever used electronic cigarettes was found to be higher than cigarette tobacco users. In addition, use was found to be greater among male students than in female students. Influencing factors associated with the use of electronic cigarettes are gender, a history of tobacco smoking, a history of consuming alcoholic beverages as well as coming from a smoking household. There is a need for prevention efforts including education and regulations to reduce the use of electronic cigarettes among students and the general public.
Background and objectives: The World Health Organization has set a target of 90% reduction in new Hepatitis B infections by 2030. The program includes prevention of new infections, and increases testing uptake and treatment. In order to effectively foster prevention, it is necessary to understand the risk factors for transmission. This study aims to determine the risk factors of Hepatitis B infection in pregnant women.Method: A case control study was carried out among 52 pregnant women with HBsAg (+) as cases and 104 pregnant women with HBsAg (-) as controls. The source of cases and controls was the register of pregnant women at the Pringgasela Public Health Center from January 2016 to October 2017. Cases were selected using systematic random sampling from 67 HBsAg (+) pregnant women and controls were selected in the same way from 1644 pregnant women with HBsAg (-). Cases and controls were matched by domicile. The data collected were age, age of first marriage, education, family income, parity, history of miscarriage, maternal or husband’s history of working abroad, frequency of marriage, history of injection, surgery, blood transfusion and dental care. Data collection was carried out with a pre-tested questionnaire in April-May 2018 through interviews at the home of each respondent. Multivariate analysis with logistic regression was carried out to determine the adjusted odds ratio of each risk factor.Results: Case and control characteristics were found to be similar in terms of age, domicile, education and income. Significant risk factors were the history of husband working abroad (AOR=4,115; 95%CI: 1,657-11,075), age of first marriage <20 years (AOR=2,420; 95%CI: 1,157-5,481) and frequency of husband's marriage more than one time (AOR=3,081; 95%CI: 1,345-7,080).Conclusion: Husbands with history of working abroad, age of first marriage <20 years and frequency of husband's marriage more than one time were found to be the risk factors for Hepatitis B infection in pregnant women. These factors require public health attention in order to reduce the transmission of Hepatitis B.
Background and objectives: Reported microbial resistance to antibiotics is increasing. One of the main factors is patient non-compliance in use of antibiotics. Pharmacist counseling has been shown to be effective in increasing compliance with the use of several types of medications, but its effectiveness of on compliance with antibiotic use has not been widely published. The purpose of this study was to determine the effectiveness of pharmaceutical counseling in a pharmacy setting to increase compliance with antibiotic use.Method: A randomized controlled trial was conducted on 104 adult patients aged 18 years and over who purchased antibiotics by prescription at a pharmacy in Denpasar City, Bali Province. The number of subjects was determined with a confidence level of 95% and a power of 90% with the effect size of 20%. Subjects were divided into two groups using the block randomization method, namely 52 subjects in the intervention group and 52 subjects in the control group. The intervention group was provided with pharmaceutical counseling by a pharmacist at the time of delivery of the drug at the pharmacy, while the control group was provided drug information according to the pharmacy service standard. Subject compliance was measured by telephone interview using the Morisky Medication Adherence Scale-8 questionnaire within 3-5 days after purchasing the medication. Statistical analysis with the Mann Whitney U Test was performed to determine the difference in mean rank of compliance scores between the intervention group and the control group. The proportion of compliance among the intervention group was divided by proportion of compliance in the control group to get the compliance ratio. Logistic regression analysis was conducted to determine the adjusted compliance ratio.Results: The number of subjects analyzed was 98, as 5 subjects could not be contacted by telephone and 1 subject was hospitalized. The mean rank of compliance scores in the intervention group (61.05) was significantly higher (p<0.001) than the comparison group (37.95). The proportion of compliance in the intervention group was 65.3% and the control group was 18.4%, with the proportion ratio (PR) of 3.56 (95%CI=1.90-6.64). Logistic regression analysis showed that variables which significantly increased compliance with antibiotic use were pharmacist counseling (APR=9.33; 95%CI: 3.24-26.87), frequency of taking medication (APR=6.94; 95%CI: 2.01-23.92) and method of payment (APR=4.30; 95%CI: 1.18-15.66).Conclusion: Pharmaceutical counseling at a pharmacy setting was found to increase compliance of antibiotic use. Compliance of antibiotic use is also influenced by the frequency of taking medication and the method of payment. Pharmacist counseling when accessing medication at a pharmacy is crucial for improving patient compliance of antibiotic use.
Abstrak: Provinsi Bali merupakan daerah endemis Demam Berdarah Dengue (DBD). Kota Denpasar menyumbang kasus DBD terbesar dengan angka insiden 143,2 per 100.000 penduduk tahun 2011. Hingga saat ini belum tersedia vaksin untuk mencegah infeksi DBD, sementara upaya pengendalian yang dilaksanakan belum optimal. Penelitian ini bertujuan untuk mengetahui faktor risiko terhadap kejadian DBD di Denpasar. Disain penelitian adalah kasus-kontrol dengan jumlah kasus 80 dan kontrol 160 orang. Kasus adalah penderita yang dikonfirmasi sebagai DBD di RS ataupun puskesmas, sedangkan kontrol adalah tetangga terdekat kasus yang tidak DBD menurut gejala klinis. Faktor risiko kejadian DBD yang digali adalah karakteristik responden, lingkungan dalam dan luar rumah, mobilitas responden, riwayat kontak dengan penderita dan keberadaan jentik pada tempat-tempat umum dengan radius maksimal 100 m dari tempat tinggal responden. Pengumpulan data melalui penelusuran dokumen, wawancara dengan kuesioner dan observasi dengan memakai check list. Analisis data dilakukan menggunakan analisa univariat, bivariat (chi square) dan multivariat (logistik regresi). Berdasarkan analisis bivariat, variabel jenis kelamin OR=1,88 [95%CI 1,09-3,23], lingkungan dalam rumah OR=8,27 [95%CI 2,63-26,07], mobilitas OR=2,78 [95%CI 1,57-4,92) dan riwayat kontak OR=2,85 [95%CI 1,62-5,03] memiliki peran dalam penularan DBD. Setelah dilakukan analisis multivariat, variabel yang terbukti sebagai faktor risiko kejadian DBD di Denpasar adalah umur OR=1,09 [95%CI 1,06-1,11], lingkungan dalam rumah OR=10,74 [95%CI 2,94-39,32], mobilitas responden OR=3,12 [95%CI 1,55-6,28] dan riwayat kontak OR=2,4 [95%CI 1,21-4,79]. Perlu dilakukan promosi kesehatan untuk mencegah dan mengendalikan penyakit DBD melalui perbaikan kualitas lingkungan dalam rumah antara lain pada tempat penampungan air dibelakang kulkas dan dispenser.
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