Dwi Agustian

The Epidemiology of Respiratory Syncytial Virus Lower Respiratory Tract Infections in Children Less than 5 Years of Age in Indonesia

Background: Although the epidemiology of respiratory syncytial virus (RSV) lower respiratory tract infections (LRI) is well known in industrialized countries, the burden in developing Asian countries is not well studied. Methods: To define the burden of RSV disease in children <5 years of age in rural and urban Indonesia, infants and children were enrolled from peri-urban and rural subdistricts, in the following 2 cohorts: (a) a cross-sectional cohort of approximately 100 children from each of 2 subdistricts in the following 5 age groups: 3 to 5, 6 to 8, 9 to 11, 12 to 23, and 24 to 48 months; (b) a birth cohort of all newborns in both subdistricts during the 28 months of the study. All subjects were visited weekly at home. Children with World Health Organization-defined LRI or wheezing had a nasal wash for detection of RSV using an enzyme immunoassay and polymerase chain reaction. Results: Of the 2014 children studied, 1074 were in the cross-sectional and 940 in the newborn cohorts. Of the 802 episodes of LRI, 163 were caused by RSV. The RSV LRI incidence per 1000 child-years (C-Y) was higher in rural areas (57.25 vs. 38.54), P < 0.05. No RSV LRI occurred in the first 2 months of life and the peak incidence was in the 6- to 8-month-old infants (103/1000 C-Y). The rates were lowest in those <6 months, 16.5 per 1000 C-Y, compared with 83.1 per 1000 C-Y in those 6 to 11 months of age (P < 0.001), 66.99 in those 12 to 23 months of age, and 28.1 in 2- to 5-year-olds. Conclusions: In Indonesia, the incidence of RSV LRI in the first 6 months of life is relatively low with most disease occurring in older children.

Biopsychosocial model of illnesses in primary care: A hermeneutic literature review

Biopsychosocial model is a useful worldview for primary care or family doctors. However, it is often considered as impractical or too complicated. The objective of this study is to review the implementation of the biopsychosocial model in clinical practice, and its contributions to clinical outcomes. Hermeneutic circle literature review was conducted to provide experiential learning in an attempt to understand biopscyhosocial model, first developed by George Engel. Literature search started with review articles in Medline and Scopus as search engines. Citations from previous articles, editorials, and research articles were identified and interpreted in the context of the knowledge derived from all identified relevant articles. The progress of biopsychosocial model has been slow, and primary care doctors do not implement biopsychosocial medicine in their practice, while biomedical thinking and approach are still the dominant model. Biopsychosocial research addressed chronic illnesses and functional disorders as conditions in need for biopsychosocial model implementation. As payment scheme, clinical guidelines and clinical performance indicators are biomedically oriented, there is no incentive for primary care doctors to adopt biopsychosocial model in their practice. Workload and lack of competence in primary care may hinder the implementation of biopsychosocial model. Biopsychosocial model helps primary care doctors to understand interactions among biological and psychosocial components of illnesses to improve the dyadic relationship between clinicians and their patients and multidisciplinary approaches in patient care. Biopsychosocial model potentially improves clinical outcomes for chronic diseases and functional illnesses seen in primary care.

Hubungan Fungsi Keluarga dengan Status Gizi Anak di Kecamatan Soreang Kabupaten Bandung pada Tahun 2016

Malnutrisi merupakan salah satu masalah kesehatan yang dialami oleh kebanyakan negara berkembang yang dapat disebabkan oleh faktor langsung maupun tidak langsung salah satunya faktor keluarga. Setiap keluarga memiliki fungsi keluarga yang dapat memberi pengaruh terhadap aspek kehidupan setiap anggotanya. Penelitian ini bertujuan mencari hubungan antara fungsi internal dan eksternal keluarga terhadap status gizi anak di Kecamatan Soreang, Kabupaten Bandung Tahun 2016. Penelitian ini merupakan penelitian dengan metode potong lintang yang melibatkan 251 pasangan ibu dan anak balita di Kecamatan Soreang, Kabupaten Bandung Tahun 2016. Data penelitian diambil pada bulan September- November 2016 dengan pengisian kuesioner APGAR serta SCREEM oleh responden untuk menilai fungsi keluarga dan melakukan pengukuran berat serta tinggi badan balita untuk menentukan nilai Z score (berat terhadap tinggi) sebagai status gizi balita. Selanjutnya hubungan keduanya dianalisis menggunakan perhitungan koefisien korelasi spearman . Tidak terdapat hubungan yang signifikan pada fungsi internal keluarga (p = 0,304; r = -0,065) dan fungsi ekternal keluarga (p = 0,116; r = -0,100) terhadap status gizi anak. Dapat disimpulkan bahwa dalam penelitian ini, fungsi keluarga tidak memberikan pengaruh pada status gizi anak di Kecamatan Soreang, Kabupaten Bandung. Penelitian mengenai fungsi keluarga dengan menggunakan instrumen kuesioner APGAR Keluarga dan SCREEM dibutuhkan proses analisis yang lebih lanjut. Kata kunci: APGAR keluarga, Fungsi Keluarga, SCREEM, Status Gizi Anak

Demographic and ecological risk factors for human influenza A virus infections in rural Indonesia

Indonesia has the worlds highest reported mortality for human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus. Indonesia is an agriculturally driven country where human‐animal mixing is common and provides a unique environment for zoonotic influenza A virus transmission.

Berbagai Faktor yang Memengaruhi Kejadian Demam Berdarah Dengue di Kota Bandung

Abstract. Dengue haemorrhagic fever (DHF) incidence rate in Aceh Province for the past three years 2012-2014 were fluctuated from 51‰, 29 ‰ and 45 ‰. The most widely used larvacide to control larvae Ae. aegypti is temefos, in Indonesia 1% temefos (abate 1SG) started used in 1976, and since 1980 has been used for the eradication program of Ae. aegypti larvae. The intensive use of temefos will be not a problem until population were dominated by resistant individuals. The purpose of this study was to determine the status of susceptibility of Ae. aegypti larvae against temefos in three dengue fever endemic areas in Aceh. We conducted an observational study to examine the susceptibility of Ae. aegypti population in 3 districts of Aceh Province: Banda Aceh, Lhokseumawe and Aceh Besar. Entomological survey and larval collection was assigned. Larvae then reared in laboratory until third generation. Third and early fourth instars stage of Ae. aegypti larvae were used as test samples. Susceptibility test was undergo based on World Health Organization guidelines. Results shows that larva Ae. aegypti from Banda Aceh (100%) and Lhokseumawe (99%) districts was still susceptible, while Aceh Besar (97%) indicates tolerance to temefos 0,02%. In conclusion, temefos still effective to be used as larvicide for vector control in those three endemic of dengue fever in Aceh Province. The priority vector control program that can be suggested is put mosquito breeding place eradication called PSN as a proactive movement in community. Keywords : Aedes aegypti, temefos, susceptibility, insecticide, Aceh Abstrak. Angka insidensi demam berdarah dengue (DBD) di Provinsi Aceh tahun 2012-2014 berturut turut 51‰ menurun 29 ‰ dan meningkat kembali 45 ‰. Penggunaan larvasida temefos 1% (abate ISG) untuk mengendalikan larva Aedes aegypti sudah digunakan oleh program sejak 1976. Penggunaan larvasida tidak akan menjadi masalah sampai suatu populasi didominasi oleh individu-individu yang resisten. Tujuan dari penelitian ini adalah menentukan status kerentanan larva Ae. aegypti terhadap temefos di tiga kabupaten/kota endemis DBD di Provinsi Aceh. Penelitian observasional ini menggunakan desain potong lintang. Pengumpulan data dilakukan selama bulan Mei-Juni 2015 dengan lokasi penelitian di tiga Kabupaten/Kota yang tersebar di Provinsi Aceh, yaitu Kota Lhokseumawe, Banda Aceh dan Kabupaten Aceh Besar. Survei larva Ae. aegypti dilakukan pada 100 rumah terpilih di setiap kab/kota dengan pengamatan pada kontainer yang dapat menampung air di dalam dan luar rumah. Larva Ae. aegypti yang diperoleh kemudian dipelihara sehingga didapatkan nyamuk generasi ketiga. Spesimen uji yang digunakan adalah larva instar III dan atau IV awal berdasarkan metodologi WHO. Hasil uji terhadap temefos 0,02 ppm menunjukkan bahwa larva Ae. aegypti dari semua wilayah yang diteliti Kota Lhokseumawe (100%) dan Banda Aceh (99%) masih rentan kecuali di Kabupaten Aceh Besar (97%) sudah toleran terhadap insektisida tersebut. Kesimpulan penelitian adalah temefos masih layak digunakan sebagai larvasida dalam pengendalian vektor di tiga kabupaten/kota endemis DBD di Provinsi Aceh. Upaya pengendalian yang lebih utama diterapkan adalah Gerakan Pemberantasan Sarang Nyamuk (PSN) sebagai gerakan proaktif di masyarakat. Kata Kunci : Aedes aegypti, kerentanan, insektisida, temefos, AcehAbstract . Dengue Hemorrhagic Fever (DHF) reemerged as a significant public health problem, which reflects the difficulty in sustaining DHF control program. Community-based strategy to control Aedes aegypti breeding sites needs to be understood. The objective of this study is to understand contributed factors to DHF based on characteristics, the availability of basic sanitation, knowledge, perception, and attitude towards DHF prevention program. A survey conducted to 2035 households in 12 districts and 16 villages in Kota Bandung in April to June 2015 using stratified random sampling method. A questionnaire was administered to collect information on variables related to economic status, knowledge on DBD, risk perception and practices associated with Aedes aegypti breeding sites, also basic sanitation facilities. The analysis used was correlation and generalized estimating equation (GEE). Results showed that gender, basic sanitation availability, knowledge about dengue in general, knowledge about DHF symptoms, and perception about the disease contribute to dengue cases (p ≤ 0.05). The conclusion of this study is factors contributed to dengue cases were sex, education, basic sanitation, knowledge about dengue in general, knowledge about DHF symptoms and perception about the disease. Program planning should also include factors and the need for the local community. Keywords : knowledge, attitude, risk perception, basic sanitation, dengue Abstrak . Munculnya kembali Demam Berdarah Dengue (DBD) sebagai masalah kesehatan masyarakat yang utama menunjukkan sulitnya mempertahankan kelangsungan program pencegahan dan pemberantasan penyakit ini. Pengetahuan yang memadai mengenai DBD dan metode untuk mencegahnya harus dapat dimengerti oleh masyarakat sebelum mereka mau berpartisipasi aktif. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi kejadian DBD di Kota Bandung. Penelitian ini merupakan survei pada 2035 rumah tangga di 12 kecamatan dan 16 desa di Kota Bandung pada Bulan Mei – Juni 2015 yang dilakukan dengan metode stratified random sampling. Kuesioner dipergunakan untuk mengetahui faktor-faktor karakteristik, pengetahuan mengenai DBD, persepsi risiko dan sikap dalam pemberantasan sarang nyamuk serta fasilitas sanitasi dasar. Analisis data menggunakan analisis korelasi serta Generalized Estimating Equation (GEE). Hasil menunjukkan jenis kelamin, pendidikan, ketersediaan sanitasi, pengetahuan umum mengenai DBD, pengetahuan mengenai gejala DBD, dan persepsi mengenai DBD menjadi faktor yang memberikan pengaruh terhadap kejadian DBD (p<0,005). Simpulan penelitian adalah faktor yang memengaruhi kejadian DBD di Kota Bandung adalah jenis kelamin, pendidikan tinggi, sanitasi, pengetahuan umum mengenai DBD, pengetahuan mengenai gejala DBD dan persepsi mengenai DBD. Perencanaan program sebaiknya mengikut sertakan faktor karakteristik lokal masyarakat. Kata Kunci : DBD, sanitasi dasar, persepsi, pengetahuan, pencegahanAbstrak. Penelitian ini bertujuan untuk menentukan tingkat risiko penularan DBD di wilayah endemis DBD di Kabupaten Bone, Kota Palopo dan Kota Makassar Provinsi Sulawesi Selatan. Penelitian dilaksanakan Bulan Mei-Juni 2015 pada rumah tangga secara sistematik sampling sebanyak 100 rumah pada setiap wilayah kerja puskesmas endemis DBD tertinggi di Kab. Bone (Watampone), Kota Palopo (Wara) dan Kota Makassar (Mangasa) Provinsi Sulawesi Selatan. Data dianalisis untuk menunjukkan indikator surveilans larva (HI, CI, dan BI) dan density figure. Data disajikan dengan jumlah larva berdasarkan jenis kontainer, persentase dan distribusi kontainer. Nilai ABJ ketiga puskesmas termasuk rendah Watampone: 53%, Wara: 54%, Mangasa: 68%. Persentase CI (angka container) larva tertinggi adalah Puskesmas Watampone (17, 78%), selanjutnya Wara (17,71%) dan Mangasa (15,47%). Berdasarkan perhitungan HI, CI dan BI, density figure dari ketiga kabupaten pada kategori sedang hingga tinggi dan Maya index menunjukkan tingkat risiko penularan DBD sedang. Hasil menunjukkan bahwa Density figure pada kontainer rumah tangga yang diperiksa sedang hingga tinggi. Kampanye pencegahan DBD yang kuat, deteksi kasus dari rumah ke rumah dan upaya persuasif yang mengedukasi mengenai hal ini penting dilakukan untuk meningkatkan kesadaran masyarakat agar ikut berpartisipasi dan lebih waspada terhadap DBD. Kata Kunci : DBD, larva, Aedes aegypti, kontainer, Maya Indeks Abstract. The aim of this research is to determine of transmission risk level of Dengue Hemorrhagic Fever (DHF) endemic area in District of Bone, Municipal of Palopo, and Municipal of Makassar, South Sulawesi province. Study held in May-June 2015 to 100 households by systematically sampling method in three highest local healthcare center work area in each endemic in District of Bone (Watampone), Municipal of Palopo (Wara), and Municipal of Makassar (Mangasa), South Sulawesi Province. Data analyzed to show the indicators of DHF surveillance (House Index, Container Index, and Breteau Index) and density figure. Data served with the number of larva in each inspected container, percentage and distribution of containers. Larval free house indices values of three local healthcare center were Watampone: 53%, Wara: 54%, and Mangasa: 68%. The highest container indices values were local healthcare center of Watampone (17.78%), Wara (17.71%) and Mangasa (15.47%) respectively. According to HI, CI and BI, density figure calculation, the study areas were categorized as moderate to high risk to DHF and the Maya index indicate the moderate risk to DHF transmission. Density figure of household water containers were moderate to high. Stronger campaign, door to door case detection and educating persuasive efforts concerning DHF case is important to be done in order to awaken the community awareness including stake holder to contribute to solve on DHF problem. Keywords : Dengue Hemorrhagic Fever, larva, Aedes aegypti, container, Maya index.

Pitch and Flat Roof Factors' Association with Spatiotemporal Patterns of Dengue Disease Analysed Using Pan-Sharpened Worldview 2 Imagery

Dengue disease incidence is related with the construction of a house roof, which is an Aedes mosquito habitat. This study was conducted to classify pitch roof (PR) and flat roof (FR) surfaces using pan-sharpened Worldview 2 to identify dengue disease patterns (DDPs) and their association with DDP. A Supervised Minimum Distance classifier was applied to 653 training data from image object segmentations: PR (81 polygons), FR (50), and non-roof (NR) class (522). Ground validation of 272 pixels (52 for PR, 51 for FR, and 169 for NR) was done using a global positioning system (GPS) tool. Getis-Ord score pattern analysis was applied to 1154 dengue disease incidence with address-approach-based data with weighted temporal value of 28 days within a 1194 m spatial radius. We used ordinary least squares (OLS) and geographically weighted regression (GWR) to assess spatial association. Our findings showed 70.59% overall accuracy with a 0.51 Kappa coefficient of the roof classification images. Results show that DDPs were found in hotspot, random, and dispersed patterns. Smaller PR size and larger FR size showed some association with increasing DDP into more clusters (OLS: PR value = −0.27; FR = 0.04; R2 = 0.076; GWR: R2 = 0.76). The associations in hotspot patterns are stronger than in other patterns (GWR: R2 in hotspot = 0.39, random = 0.37, dispersed = 0.23).