Bagoes Widjanarko

Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia

There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme.There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme.

The path to impact of operational research on tuberculosis control policies and practices in Indonesia

Background Operational 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. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using 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. Results Operational 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. Conclusions Operational 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.Background Operational 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. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using 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. Results Operational 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. Conclusions Operational 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.

Profile of glycated-hemoglobin, antioxidant vitamin and cytokine levels in pulmonary tuberculosis patients: A cross sectional study at Pulmonary Diseases Center Semarang City, Indonesia

Background Uncontrolled blood glucose, which marked by high level of HbA1c, increases risk of pulmonary TB because of cellular immunity dysfunction. This study aimed to analyze profile of glycated hemoglobin, antioxidant vitamins status and cytokines levels in active pulmonary TB patients. Methods This was a cross sectional study, conducted at Pulmonary Diseases Center Semarang City, Indonesia. Study subject consisted of 62 pulmonary TB patients, diagnosed with positive acid fast bacilli and chest X-ray. ELISA was used to measure IFN-γ and IL-12. Status of antioxidant vitamins was determined by concentration of vitamin A and E using HPLC. Blood glucose control was determined by HbA1c concentration (HbA1c ≥7% is considered as uncontrolled). Results A significant difference of age between pulmonary tuberculosis patients with normal and uncontrolled blood glucose (p = 0.000) was showed, while all other characteristics (sex, education, occupation) did not differ with p = 0.050, 0.280, 0.380 respectively. Mean HbA1c was 7.25 ± 2.70%. Prevalence of uncontrolled glucose among pulmonary TB patients was 29%. Levels of IFN-γ and IL-12 did not differ according to HbA1c concentration (p = 0.159 and p = 0.965 respectively). Pulmonary tuberculosis patients with uncontrolled blood glucose has higher vitamin E (p = 0.006), while vitamin A did not differ significantly (p = 0.478). Conclusions This study supports the importance of performing diabetes screening among pulmonary TB patients. Further study needs to be done to determine the feasibility of TB-DM co-management.

The need of adequate information to achieve total compliance of mass drug administration in Pekalongan

World Health Organization (WHO) initiated The Global Program to Eliminate Lymphatic Filariasis (LF) through mass drug administration (MDA). PEkalongan started MDA in 2011. Yet the LF prevalence in 2015 remained exceed the threshold (1%). This study aimed to describe the inhibiting factors related to the compliance of MDA in community level. This was a rapid survey with cross sectional approach. A two-stages random sampling was used in this study. In the first stage, 25 clusters were randomly selected from 27 villages with proportionate to population size (PPS) methods (C-Survey). In the second stage, 10 subjects were randomly selected from each cluster. Subjects consisted of 250 respondents from 25 selected clusters. Variables consisted of MDA coverage, practice of taking medication during MDA, enabling and inhibiting factors to MDA in community level. The results showed most respondents had poor knowledge on filariasis, which influence awareness of the disease. Health-illness perception, did not receive the drugs, lactation, side effect, and size of the drugs were dominant factors of non-compliance to MDA. MDA information and community empowerment were needed to improve MDA coverage. Further study to explore the appropriate model of socialization will support the success of MDA program

Social multiplier effects: academics’ and practitioners’ perspective on the benefits of a tuberculosis operational research capacity-building program in Indonesia

ABSTRACT Background: The Tuberculosis Operational Research Group (TORG) implemented a capacity-building model involving academics and practitioners (i.e. clinicians or program staff) in an operational research (OR) team in Indonesia. Objective: This study explored academics’ and practitioners’ perspectives regarding the benefits of participating in a tuberculosis (TB) OR capacity-building program in Indonesia. Methods: We conducted a qualitative study involving in-depth interviews with 36 academics and 23 practitioners undertaking the TORG capacity-building program. We asked open-ended questions about their experience of the program. Data were analyzed via content analysis. Results: The findings demonstrated the social multiplier effects of the OR capacity-building program. Both academics and practitioners reported perceived improvements in research knowledge, skills, and experience, and described additional individual- and institutional-level benefits. The individual-level benefits level included improvements in understanding of the TB program, motivation for research and self-satisfaction, the development/enhancement of individual networking, receipt of recognition, and new opportunities. The additional benefits reported at an institutional level included improvement in research curricula, in-house training, and program management and the development/enhancement of institutional partnerships. Conclusions: The program improved not only individuals’ capacity for conducting OR but also the quality of the TB program management and public health education. OR should be included in research methodology curricula for postgraduate public health/disease control programs. The capacity-building model, in which academics and program staff collaborated within an OR team, should be promoted.

How do laboratory technicians perceive their role in tuberculosis diagnostic process: a cross-sectional study among laboratory technicians in health centers of Central Java Province, Indonesia

Purpose Detection of acid-fast bacilli in respiratory specimens serves as an initial pulmonary tuberculosis (TB) diagnosis. Laboratories are the essential and fundamental part of all health systems. This study aimed to describe how laboratory technicians perceived their own self and work. This included perceived self-efficacy, perceived role, perceived equipment availability, perceived procedures, perceived reward and job, and perceived benefit of health education, as well as level of knowledge and attitudes related to work performance of laboratory technicians. Methods This was a cross-sectional quantitative study involving 120 laboratory technicians conducted in Central Java. Interviews and observation were conducted to measure performance and work-related variables. Results Among 120 laboratory technicians, 43.3% showed fairly good performance. They complied with 50%–75% of all procedures, including sputum collection, laboratory tools utilization, sputum smearing, staining, smear examination, grading of results, and universal precaution practice. Perceived role, perceived self-efficacy, and knowledge of laboratory procedures were significantly correlated to performance, besides education and years of working as a laboratory technician. Perceived equipment availability was also significantly correlated to performance after the education variable was controlled. Conclusion Most of the laboratory technicians believed that they have an important role in TB patients’ treatment and should display proper self-efficacy in performing laboratory activities. The result may serve as a basic consideration to develop a policy for enhancing motivation of laboratory technicians in order to improve the TB control program.

Perilaku Seksual Remaja di Lingkungan Lokalisasi Kabupaten Sidoarjo

ABSTRACT Sexual behavior as every conducts driven by sexual desire, either for other sex or even same sex. The purpose of this research to recognize Adolescent Sexual behavior in localization area of Sidoarjo regency. It is done a research due to still high adolescent sexual behavior happened in localization. This research as quantitave research with cross-sectional sampling with minimally sample size. This research performed in localization of Sidoarjo regency done by assessing adolescent in questionnaire sheet. Population of the research is teenager who lived at localization area of Sidoarjo regency as 221 respondents with sample of 140 respondets. Become inclusive criteria that is teenage who lived around localization area, age 12-18 years old, unmarried, not prostitute and ready to be respondent. Which become dependent variable and independent variable are sexual behavior. Data collected then processed by using chi square test indicating that p value > 0,05. Conclusion of this research show there is adolescent sexual behavior in localization area of Sidoarjo regency. Keywords: sexual behavior

FACTORS INFLUENCING CONDOM USE BEHAVIOUR AMONG INJECTING DRUG USERS (IDUS) IN SEMARANG, CENTRAL JAVA

Latar Belakang: Hubungan seks telah diidentifikasi sebagai sumber utama penularan HIV dari pengguna narkoba suntik (penasun) untuk pasangan seksual mereka. Studi sebelumnya menunjukkan bahwa penggunaan kondom di kalangan IDU masih rendah. Tujuan: Penggunaan kondom telah diidentifikasi sebagai salah satu metode paling efektif untuk mencegah HIV dan AIDS melalui kontak seksual. Metode: Penelitian ini bertujuan untuk menganalisis faktor yang mempengaruhi penggunaan kondom di kalangan IDU penelitian explenalory dan 64 IDU dipilih menggunakan teknik accidental sampling. Hasil: menunjukkan bahwa hanya 40,6% dari penasun sering tidak menggunakan kondom selama hubungan seks pasangan mereka dalam periode enam bulan terakhir. Kesimpulan: Beberapa variabel seperti melihat hambatan dan isyarat eksternal untuk bertindak secara signifikan terkait dengan penggunaan kondom di kalangan IDU Analisis regresi logistik menunjukkan bahwa persepsi yang baik pada isyarat eksternal untuk tindakan adalah prediktor penggunaan kondom di kalangan IDU. Kata kunci: penasun, penggunaan kondom, HIV dan AIDS

SEKS PRANIKAH SEBAGAI PEMENUHAN HAK REPRODUKSI MAHASISWA DI KOTA SEMARANG

Latar Belakang: Hubungan seks telah diidentifikasi sebagai sumber utama penularan HIV dari pengguna narkoba suntik (penasun) untuk pasangan seksual mereka. Studi sebelumnya menunjukkan bahwa penggunaan kondom di kalangan IDU masih rendah. Tujuan: Penggunaan kondom telah diidentifikasi sebagai salah satu metode paling efektif untuk mencegah HIV dan AIDS melalui kontak seksual. Metode: Penelitian ini bertujuan untuk menganalisis faktor yang mempengaruhi penggunaan kondom di kalangan IDU penelitian explenalory dan 64 IDU dipilih menggunakan teknik accidental sampling. Hasil: menunjukkan bahwa hanya 40,6% dari penasun sering tidak menggunakan kondom selama hubungan seks pasangan mereka dalam periode enam bulan terakhir. Kesimpulan: Beberapa variabel seperti melihat hambatan dan isyarat eksternal untuk bertindak secara signifikan terkait dengan penggunaan kondom di kalangan IDU Analisis regresi logistik menunjukkan bahwa persepsi yang baik pada isyarat eksternal untuk tindakan adalah prediktor penggunaan kondom di kalangan IDU. Kata kunci: penasun, penggunaan kondom, HIV dan AIDS

Urinating after Sexual Intercourse Prevents Pregnancy: Adolescents' Misconceptions of Reproductive Health Knowledge

Background: Although ANC coverage tends to be high, the pregnant women will not always giving birth by health provider. Jati Sampurna subdistrict, where most of the pregnant women prefer deliver their baby in Bekasi city and about 14.30% giving birth by traditional birth attendant. Objective: Analyze the maternal cohort data to prove correlation between compliance of ANC with selection of birth attendant in those area, which consisted of obedience of ANC, age, parity, birth spacing, pregnancy history, with selection of birth attendant. Methode: The retrospective cohort design study was used. After deciding several criteria: inclusion and exclusion criteria, and by simple random sampling, we achieved 372 subjects which consisted of 186 subjects in exposed group, and 186 subjects in unexposed group. Data analyzed by univariate, bivariate and multivariate. Result: The study showed that two out of five variables were statistically significant correlation, those are compliance of ANC [RR=2,41(95% CI 1,45-4,01)] and pregnancy history [RR=0,22 (95% CI 0,10-0,47)] or on the other result that [RR=4,55 (95% CI 2,13 -10,00)]. Conclusion: Promotion to pregnant women about the importance obedience of ANC and the selection of safe childbirth helper were in need of improvement. The measurement of history of pregnancy should be carried out consistently in ANC package as well. Keywords: Antenatal Care (ANC), birth attendant