Soewarta Kosen

Mortality in Central Java: results from the indonesian mortality registration system strengthening project

BackgroundMortality statistics from death registration systems are essential for health policy and development. Indonesia has recently mandated compulsory death registration across the entire country in December 2006. This article describes the methods and results from activities to ascertain causes of registered deaths in two pilot registration areas in Central Java during 2006-2007. The methods involved several steps, starting with adaptation of international standards for reporting causes of registered deaths for implementation in two sites, Surakarta (urban) and Pekalongan (rural). Causes for hospital deaths were certified by attending physicians. Verbal autopsies were used for home deaths. Underlying causes were coded using ICD-10. Completeness of registration was assessed in a sample of villages and urban wards by triangulating data from the health sector, the civil registration system, and an independent household survey. Finally, summary mortality indicators and cause of death rankings were developed for each site.FindingsA total of 10,038 deaths were registered in the two sites during 2006-2007; yielding annual crude death rates of 5.9 to 6.8 per 1000. Data completeness was higher in rural areas (72.5%) as compared to urban areas (52%). Adjusted life expectancies at birth were higher for both males and females in the urban population as compared to the rural population. Stroke, ischaemic heart disease and chronic respiratory disease are prominent causes in both populations. Other important causes are diabetes and cancer in urban areas; and tuberculosis and diarrhoeal diseases in rural areas.ConclusionsNon-communicable diseases cause a significant proportion of premature mortality in Central Java. Implementing cause of death reporting in conjunction with death registration appears feasible in Indonesia. Better collaboration between health and registration sectors is required to improve data quality. These are the first local mortality measures for health policy and monitoring in Indonesia. Strong demand for data from different stakeholders can stimulate further strengthening of mortality registration systems.

Measuring Subnational Under-5 Mortality: Lessons From a Survey in the Eastern Indonesian District of Ende

There is an urgent need for measurements of the magnitude and determinants of under-5 mortality at the district level in Indonesia. This article describes a sample household survey conducted in Ende District, East Nusa Tenggara province. Complete birth histories were recorded from all women residing in a sample of 32 villages (7454 households) of Ende. The survey was conducted in early 2010, deriving measures for the period 2000-2009. The survey instrument also included key variables required to measure determinants of under-5 mortality. The results showed that there are significant differentials in under-5 mortality risk within Ende, ranging from 27 to 85 per 1000. This information will assist the district health office to implement maternal and child health programs to meet national targets for United Nations Millennium Development Goal 4. The findings provide robust mortality measures at the district level and demonstrate the feasibility of conducting such a study using local resources, in a short time, and with low costs.

Development of an Indonesian sample registration system: a longitudinal study

Abstract Background Accurate basic demographic statistics are the basis for formulation of health policies and management of effective programmes. Mortality statistics from hospitals are incomplete due to limited utilisation of hospital services (only 8% of total cases). The benefits of a well-developed vital registration system include the ability to monitor and evaluate the impact of health programmes, better quality information, and more efficient delivery of health-care services. Methods Based on the Population Administration Law (Law No. 23/2006), the mortality registration system in Indonesia has been developed and implemented systematically in 128 randomly selected subdistricts located in 103 districts and 25 cities, covering Indonesias population of 8 million since April 2012. The efforts get financial support from the Global Fund Round 10: cross-cutting health-systems strengthening interventions to evaluate achievement of Millennium Development Goals (MDGs) 4, 5, and 6 by 2015. Findings The previous pilot registration system in Solo City and Pekalongan District showed that the data collection, compilation, and verbal autopsy procedures could be carried out in a timely and reliable way to generate annual mortality statistics. The results show stroke as a leading cause of death among adults, the continued burden from tuberculosis, diarrhoeal diseases, and pneumonia, and the growing concern of diabetes, heart disease, chronic obstructive pulmonary disease, and neoplasm. Verifications were carried out using several criteria, namely completeness of birth and death registration (using capture–recapture method), validity of reported multiple causes of death (based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), and consistency of local data over time. Other improvement efforts include strengthening of the voluntary reporting of neonatal, infant, and maternal deaths based on cohort data of pregnant mothers. Furthermore, better coordination between the population administration and health personnel at village and subdistrict levels has improved the completeness of registered births and deaths data. The condition is also facilitated by a joint decree between the Minister of Home Affairs and Minister of Health from 2010 regarding sharing of birth and death data. Development of a similar system has been carried out in the Islands of Sumatra, Jawa, Bali, Sulawesi, Maluku, and Papua, and will cover 128 subdistricts by the end of 2013. Interpretation Hopefully, these efforts will successfully produce outcome indicators as real-time tracers of achievement of MDGs in Indonesia by the end of 2014. Funding Global Fund Round 10 for cross-cutting health-systems strengthening interventions.

On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Summary Background As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care. Methods We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results. Findings In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3–8·8) to 71·7 years (71·0–72·3): the increase was 7·4 years (6·4–8·6) for males and 8·7 years (7·8–9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6–61·6), from 43·8 million (95% UI 41·4–46·5) to 18·1 million (16·8–19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8–15·4) of DALYs in 2016. Interpretation Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity. Funding The Bill & Melinda Gates Foundation.

Impact Evaluation of National Health Insurance toward Access Hospital Inpatient Care in Indonesia

Indonesian government launched officially the National Health Insurance (JKN Program) on January 14, 2014. JKN program constructed with participation is mandatory and there is no selection, the spirit of cross subsidy (rich-poor, healthy-ill, young-old), non-profit and fees calculated as a percentage of wages or income. One of the main objectives of JKN is to improve equity in access to health services. This study aims to evaluate the impact of National Health Insurance program that has been running more than one year over the access to inpatient care at the hospital. This study used Indonesian Family Life Survey IFLS-4 (2007) and IFLS-5 (2014/2015). The analysis used a combination of propensity score matching methods and difference in difference. This analysis enables the research resembles the experiment considering the access changes to the inpatient care on the same individuals were evaluated before and one year after the National Health Insurance starts. The results showed that the National Health Insurance program have impact 2.4% on access to health care of inpatient at the government hospital and or private hospital. The resulting effect of National Health Insurance is not final because the data is just collected in 2014 until mid-2015, about half a year of the commencement of National Health Insurance.

Measuring the effective coverage of the immunisation programme in Indonesia: using community-based surveys

Abstract Background Effective coverage of obligatory public health functions, including immunisation, are important in contributing to the achievement of health-system goals. Since the enactment of decentralisation of the health sector to districts and cities in Indonesia in 2001, the coverage of complete immunisation among children aged 12–23 months has been decreasing. Findings of the recent Health Facility Survey 2010 also showed deterioration of the immunisation programme, such as poor quality of cold chain. Complete immunisation includes one BCG vaccination, three diphtheria-tetanus-pertussis (DPT)–hepatitis B vaccinations, four polio vaccinations, and one measles vaccination. Methods The population of the study was all households in Indonesia, including all districts and cities. A multistage sampling method was used. Information was obtained from one of the following: information from the mother or other household members, records from the maternal and child health handbook, road to health card, or immunisation card. Analysis includes only immunisation among children aged 12–23 months to avoid missed opportunity in children younger than than 12 months. Findings Findings from Baseline Health Research 2007 show that many areas have low complete immunisation coverage, ranging from 17·3% (88/509) in West Sulawesi to 73·9% (319/432) in Bali, with a national average of 46·2% (14 111/30 543). Results of Baseline Health Research 2010 ranged from 28·1% (68/242) in Papua to 91·1% (42/46) in Yogyakarta, with a national average of 53·8% (3608/6706). Records of the immunisation programme showed consistently higher coverage than survey results (85·2%) because of differences of sample characteristics. The records of the immunisation programme did not randomly cover children aged 12–23 months in the area, and did not cover children living in underserved areas where services are usually poor. At the same time, there were reports of outbreaks of immunisable disease in several areas of Indonesia that supported the survey findings. Interpretation It can be concluded that a cross-sectional survey of randomly selected samples can produce representative results with better validity than programme-based records. Funding National Institute of Health Research and Development, Jakarta, Indonesia.

TRIAL OF MEDICAL CERTIFICATE OF CAUSE OF DEATH (SMPK) TO IMPROVE THE QUALITY OF RECORDING AND REPORTING HOSPITALS MORTALITY DATA IN JAKARTA, YEAR 2007

Household insecticide was widely and repeatedly used in a closed room in the community, despite of the potential accumulation of its hazard to human health and the environment. The control of all pesticides (household, as well as agricultural pesticides), i.e. registration for licensed certificate, licensed renewal, and evaluation of the safety was conducted and supervised by the Ministry of Agriculture. On the other hand, the Ministry of Health is also conducted the same activities on household pesticides, so there are a doubling-up in the regulation systems which might be inefficient. However. since was catagorized as a household health hazard, household pesticides should be exactly the subject to be controlled by the Ministry of Health through the Directorate General of Pharmaceutical Services and Medical Devices, particularly for its safety and product license for marketing, while other pesticide used in agriculture was remained to be under control ofthe Ministry of Agriculure. This article describes discourses and alternative inputs on household insecticide policy for the optimum control of the household pesticides. Key words: household pesticide, registration, control, policyIndonesia is the 5th largest country that consumes tobacco in the world. Eighty five percent smokers, smokes local brand cigarette names Clove Cigarette. Clove cigarette is cigarette mixed with clove for around 30% per stick, the combination of clove (eugenol) and nicotine creates double addictives effect. According to Health legislation No. 23/1992 to protect the public from dangerous substances, article No 44 provision 1,2,3 all the addictive substances have to limited and stipulate in Government Regulation (Peraturan Pemerintah) No. 81/1999, the nicotine as a addictive substance content may not exceed 1.5 mg/stick and tar maximum 20 mg/stict. Due to pressure from tobacco manufacturer caused amendment Peraturan Pemerintah No. 38/2000, to pospone the regulation (from 5 to 7 years). A new Peraturan Pemerintah No. 19/2003 was made without limitation of addictive substances, its mean completely different with Health legtslation No. 23/1992. The draft of tobacco control legislation has been prepared by parliament and the role of Ministry of Health is needed to give input the contents of tobacco control legislation. The limitation the two addictive substances (nicotine & eugenol) may not exceed 1.5 mg/stick and tar maximum 20 mg/stick and pinalty is given to those who violate legislation should be autority of Ministry of Health. Key words: clove cigarette, eugenol, legislation

SURVEI KEMATIAN NEONATAL (STUDI AUTOPSI VERBAL) DI KABUPATEN CIREBON, 2004

In western countries with good nutrition BCG status were given during perinatal age with pretuberculin test show on 80% but in developing countries with variation nutrition status BCG have protection level on 0%-80%. The objective of this study is to determine TB event in children after BCG immunization. Design of study was cohort historical, total samples were 222. consisted of 148 with BCG immunization and 74 BCG non immunization. The result showed that there was no significant association between BCG immunization with TB cases in children after it has been adjusted by sex OR= 0,952 (95%CI: 0.541-1.676)