Retna Siwi Padmawati

Physician assessment of patient smoking in Indonesia: a public health priority

Objective: To explore Indonesian physician’s smoking behaviours, their attitudes and clinical practices towards smoking cessation. Design: Cross-sectional survey. Setting: Physicians working in Jogjakarta Province, Indonesia, between October and December 2003. Subjects: 447 of 690 (65%) physicians with clinical responsibilities responded to the survey (236 men, 211 women), of which 15% were medical faculty, 35% residents and 50% community physicians. Results: 22% of male (n = 50) and 1% of female (n = 2) physicians were current smokers. Approximately 72% of physicians did not routinely ask about their patient’s smoking status. A majority of physicians (80%) believed that smoking up to 10 cigarettes a day was not harmful for health. The predictors for asking patients about smoking were being male, a non-smoker and a medical resident. The odds of advising patients to quit were significantly greater among physicians who perceived themselves as sufficiently trained in smoking cessation. Conclusions: Lack of training in smoking cessation seems to be a major obstacle to physicians actively engaging in smoking cessation activities. Indonesian physicians need to be educated on the importance of routinely asking their patients about their tobacco use and offering practical advice on how to quit smoking.

Bringing smoking cessation to diabetes clinics in Indonesia

Objectives: To assess the feasibility of delivering brief and disease-centred smoking cessation interventions to patients with diabetes mellitus in clinical settings. Methods: We conducted a feasibility study involving two interactive smoking cessation interventions: doctor’s advice and visual representation of how tobacco affects diabetes (DA) and DA plus direct referral to a cessation clinic (CC). Follow-up was at 3 and 6 months post intervention. Primary outcome was 7-day-point prevalence abstinence. The study involved male patients recruited from two referral diabetes clinics in Yogyakarta Province, Indonesia during January 2008 to May 2009. Of the 71 patients who smoked during the last month, 33 were randomized to the DA group and 38 to the CC group. Results: At 6 months follow-up, DA and CC groups had abstinence rates of 30% and 37%, respectively. Of those continuing to smoke, most reported an attempt to quit or reduce smoking (70% in DA and 88% in CC groups). Patients in both groups had increased understanding of smoking-related harm and increased motivation to quit smoking. Conclusions: This study demonstrates the feasibility of disease-centred doctors’ messages about smoking cessation for patients with diabetes, supported by the presence of a CC motivating clinicians to routinely give patients cessation messages.

Smoking among diabetes patients in Yogyakarta, Indonesia: cessation efforts are urgently needed

Objectives  To document the prevalence of tobacco use among male diabetes patients in a clinic based population of Yogyakarta Province, Indonesia; to examine patient’s perceptions of smoking as a risk factor for diabetes complications; and to investigate whether patients had received cessation messages from their doctors.

Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand

This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.

Medical syncretism in Yogyakarta: what do the practitioners get?

Background Medical syncretism involves activities conducted by healers who are mixing or blending different treatment strategy and explanatory models, is prevalent in the modern world. In medical pluralism, the pattern demonstrates that biomedicine exerts dominance over alternative medical system. The rigid clinical practice guidelines derived from the current best evidence of systematic reviews and meta-analyses involving many randomised-controlled trials (RCTs), have strictly guided physicians in managing patients’ diseases. In poor neighbourhood of Yogyakarta, it is not only the health seekers who combine biomedicine and traditional medicines, but some biomedical practitioners combined their techniques with alternative or traditional system. This paper aimed to describe why biomedical practitioners practicing medical syncretism; to explore what are their underlying practices; and what are their roles in medical pluralism.

Impacts of stigma on HIV risk for women who inject drugs in Java: A qualitative study

BACKGROUND People who inject drugs have experienced stigma around the world. Stigma has been found to have negative consequences for individuals in relation to health-service use, psychological wellbeing and physical health; and for populations in terms of health inequalities. Indonesia has experienced a rapid growth in injecting drug use and HIV and little is known about drivers of HIV risk among Indonesian women who inject drugs. The purpose of this paper is to describe and consider the multiple impacts of stigmatization of injecting drug use on injecting behaviors among women who inject drugs in Java. METHODS In-depth interviews were conducted with 19 women who inject drugs in Java. Mean age was 25 years, all but one was employed or at college. The interviewers were Indonesian women. RESULTS Significant stigma around womens drug use was reported from multiple sources in Java including family, friends and health services, resulting in feelings of shame. To avoid this stigma, most of the study participants hid their drug use. They lived away from family and had few friends outside their drug-injecting circle, resulting in isolation from mainstream society and harm-reduction services. Sharing of injecting equipment was restricted to a small, closed circle of trusted friends, thus limiting possible HIV transmission to a small number of injectors. CONCLUSIONS The stigmatization of drug use, particularly of drug use by women, in Indonesia appears to have contributed to significant shame, isolation from mainstream society and high rates of sharing injecting equipment with a small group of trusted friends (particularly the partner).

Redistributing vulnerabilities: house reconstruction following the 2006 Central Java earthquake

Vulnerability in the face of disaster varies across individuals, households, neighbourhoods and social class. It is this social distribution of vulnerability in a given society that may turn hazardous events into disasters for some people and not for others. This distributional approach draws attention to continuities that explain catastrophes as an outcome of the workings of society prior to the event. Expanding on and partially deviating from this approach, in this paper, we draw attention to the social processes whereby vulnerability is modified and renegotiated in the period after the event of natural disaster where resources for disaster alleviation and reconstruction reach local communities. Specifically, we explore the social dynamics of house damage classification in the wake of the 2006 Central Java earthquake, and we explore relations between citizens and the state during post-disaster house reconstruction. We argue that disastrous outcomes of catastrophic events do not follow pre-existing fault lines of vulnerability in a simple or predictable manner, and that the social process of redistribution of vulnerability continues in the post-disaster scenario.

Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia

BackgroundRotavirus has been identified as the most common pathogen associated with severe diarrhoea. Two effective vaccines against the pathogen have been licensed. However, many countries including Indonesia have yet to introduce the vaccine into their national immunisation programs. This study aimed to examine the attitudes of healthcare providers (HCPs) and other health stakeholders towards the pathogen and the vaccine.MethodsSemi-structured in-depth interviews were undertaken in two districts of Yogyakarta Province, Indonesia with nurses, midwives, primary care providers, pediatricians and other health stakeholders. Thematic analysis was undertaken.ResultsFourteen interviews were conducted between August and October 2013. We identified that while participants do not consider diarrhea to be an important problem in Indonesia, they do acknowledge that it can be serious if not properly treated. While the majority had some level of knowledge about rotavirus, not all participants knew that a vaccine was available. There were mixed feelings towards the need for the vaccine. Some felt that the vaccine is not ranked as a priority as it is not listed on the national program. However, others agreed there is a rationale for its use in Indonesia. The cost of the vaccine (when sold in the private sector) was perceived to be the primary barrier impacting on its use.ConclusionsThe high cost and the low priority given to this vaccine by the public health authorities are the biggest obstacles impacting on the acceptance of this vaccine in Indonesia. HCPs need to be reminded of the burden of disease associated with rotavirus. In addition, reminding providers about the costs associated with treating severe cases versus the costs associated with prevention may assist with improving the acceptance of HCPs towards the vaccine. Promotion campaigns need to target the range of HCPs involved in the provision of care to infants and pregnant women.

Peran Ayah dalam Praktik Menyusui

Background: In Indonesia the prevalence of exclusive breastfeeding in 2007 was 32%. Although breastfeeding is a common practice, exclusive breastfeeding remains unpracticed optimally due to some influential factors. One factor to be considered here is father’s role. However, until recently studies regarding father’s role in breastfeeding practice have not been fully explored in Indonesia. In Bukittinggi exclusive breastfeeding rate was 63,5% in 2008. Objective: To investigate the relationship between the father’s role and breastfeeding practices in Bukittinggi Municipality. Method: This was an observational study with cross-sectional study design. Subjects were families with babies aged 0 – 6 months using non probability sampling. The independent variable was the father’s role and the dependent variable was breastfeeding practices. Meanwhile, the extraneous variables included knowledge, attitude, mother’s occupation; father’s working hours in a day, and income. The data were analyzed using univariable analysis, bivariable analysis with chi-square test, and multivariable analysis with logistic regression. Results: The result of multivariable analysis showed that there was a significant relationship between the father’s role and breastfeeding practice, by including father’s knowledge, mother’s knowledge, father’s attitude and mother’s attitude that could predict by 12% (RP= 1.93; 95% CI= 1.36 – 2.74). Conclusion: The prevalence of exclusive breastfeeding practices in the supporting father group was greater than in the group that non-supporting father. The recommendations are that fathers should be targeted audience in the breastfeeding promotion. Keywords: father’s role, breastfeeding practices