Background Improperly disposed medicines could adversely affect the environment and increase the risk of drug misuse or accidental poisoning. Objective To evaluate the disposal practices of unused and expired medicines among the general population in Bandung, Indonesia. Method This was a descriptive cross-sectional survey conducted among 497 respondents in Bandung, Indonesia. Data were collected through interviews using a prevalidated structured questionnaire. Descriptive statistics were calculated using the Statistical Package for Social Science (SPSS) version 23. Ethics approval was obtained. Main outcome measure General public knowledge and attitude regarding unused and expired medication disposal practice. Results Approximately 95% of the respondents had unused medicines stored in their homes, with nonsteroidal anti-inflammatory drugs (NSAIDs), vitamins/nutritional supplements, and antibiotics were the most common types of medicines left unused. The majority of the respondents checked the expiration date of the drugs before purchasing (72.8%). The most common disposal method of unwanted medicines was throwing away in household garbage (82.1%). A significant percentage of them never received information about proper medication disposal practice (79.5%). Furthermore, more than half of the respondents were unaware that unsafe medication disposal practices could harm the environment and population health (53.1%). Conclusion Disposal of unwanted pharmaceutical products through environmentally unsafe route was prevalent among the respondents. There is also a lack of awareness of the impact of improperly disposed of medicines for the ecosystem. These findings call upon the strategies to strengthen the pharmaceutical waste management program.

Objectives: To review the literature on the cost-effectiveness of dengue vaccination in Southeast Asian countries and possibly to provide recommendations on promoting dengue vaccination in this region. Methods: A systematic search was conducted to identify relevant articles in 3 major databases (ProQuest, American Society of Tropical Medicine and Hygiene, and PubMed). Complete economic evaluation studies, including willingness-to-pay (WTP) studies, that were conducted in any Southeast Asian country were included in this study. Systematic review, nonefull-text, and non-English studies were specifically excluded. Results: Nine selected studies highlighted the economic evaluation of dengue vaccination in Southeast Asian countries by considering many parameters (eg, vaccine cost, vaccine efficacy, cost-effectiveness threshold, economic assessment, public acceptance, and WTP). All studies confirmed that dengue vaccine can be used as a prevention strategy to reduce the incidence rate of dengue cases by providing a variance of high cost-effectiveness values. In addition, communities provided a good assessment, acceptance, and WTP value for the vaccine. Conclusions: The use of dengue vaccine could reduce the burden of disease and economic burden due to dengue infection in Southeast Asian countries. The efficacy of dengue vaccine was estimated to be 50-95% for those <9 years, 9 years, and >9 years. In particular, several studies reported that dengue vaccine could be categorized as a cost-effective intervention in Southeast Asian countries within certain conditions.

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995, $4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.

Objective:The exposure of organophosphate could be caused by the absorption in some parts of the body like skin and breath. Toxicity may cause nausea, vomiting and dizziness which are not too specific related with the pesticide toxicity. The purpose of this study is to understand the association between organophosphate exposure and farmers’ health in Kulon Progo County from the perspectives of physical, emotional and social health.Methods:This study was conducted using descriptive observational design. The blood sample was collected during harvesting periods in 2016. The inclusion criterion of farmers was using organophosphate-contained pesticide during the planting period of red onion. The farmers who had renal disease, liver disease and cancer were excluded. The organophosphate exposure parameters were the duration and frequency of pesticide application, width of the area, serum cholinesterase activity and the completeness of personal protective equipment.Results:Among 84 farmers, most of them were male (85.7%), and the mean age was 49.1 (standard deviation: 12.5) years; 71.4% of the subjects experienced tremor, 17.86% experienced dizziness and 8.33% subjects experienced nausea–vomiting after pesticide application. According to the pesticide application, in average, subjects used pesticide 1.4 h/day with the area of 1.285 m2. The frequency of pesticide used is three times per week. Around 97.6% subjects used incomplete personal protective equipment. The average of serum cholinesterase activity in subjects with tremor is higher than subjects without tremor (p > 0.05). There is a significant association between serum cholinesterase activity and creatinine content (p < 0.05). The farmers’ quality-of-life domain scores are lower than the scores of the normal population in Yogyakarta.Conclusion:Organophosphate exposure may affect the farmers’ physical health and quality of life.