Development of the SIKRIBO Mobile Health Application for Active Tuberculosis Case Detection in Semarang, Indonesia.

OBJECTIVES: This study was conducted to document the development and usability testing of SIKRIBO, a tuberculosis screening application. METHODS: The SIKRIBO application was developed using design science research methodology, which has six steps: problem identification and motivation, definition of objectives for a solution, product design and development, demonstration, evaluation, and communication. A system usability scale (SUS) questionnaire was used to assess application usability. A total of 20 health cadres (trained community members) and health workers participated in the usability tests. RESULTS: Two versions of the application were developed: Android-based for users and web-based for administrators. The Android-based version has four main menus: Find Tuberculosis, Tuberculosis Education, Latest Info, and Profile. The web version is accessible to health workers, as well as the research team and application developers who monitor and manage the user-conducted screenings. The average SUS score was 76 (standard deviation, 8.00). CONCLUSIONS: This application was developed to help detect active tuberculosis cases in the community. The SUS results indicate that the application is highly usable. Thus, SIKRIBO is expected to be broadly implemented to increase tuberculosis case detection through active community participation.

Prevalence and Determinants of Opportunistic Infections in HIV Patients: A Cross-Sectional Study in the City of Semarang.

Background: Opportunistic infection (OI) is the most significant complication of the human immunodeficiency virus (HIV). Differences in the characteristics of HIV patients make the prevalence of Opportunistic infection different between regions. The study aimed to identify variables associated with OI incidence among HIV-infected patients in Semarang City, Indonesia. Methods: This study uses secondary data sourced from special HIV surveillance for 2019-2021 with a cross-sectional method. 1362 HIV patients with variables health care facilities; year of diagnosis; area of residence; age; sex; pregnancy status; occupation; risk factors; risk group determined based on purposive sampling were included in the chi-square analysis and logistic regression. Results: This study showed 12.3% (n=167) of HIV patients experienced OI, where OI was more common in HIV patients with risk groups of sex workers (28.70%), high-risk partners (18.60%), and Male Sex with Men (MSM) (15.40). The most common types of OI were tuberculosis infection (43%), candidiasis (21%), and diarrhea (9%). Age was the variable most associated with the incidence of OI (p-value 0.001). Conclusions: Age groups 45-54 years and 55-64 years have the most influential association with Opportunistic infection incidence in HIV patients, so planning an appropriate intervention program for this subpopulation is necessary.

The National Health Insurance System of Indonesia and primary care physicians' job satisfaction: a prospective qualitative study.

BACKGROUND: The implementation of the National Health Insurance System (NHIS) in Indonesia has been changing the primary care physician (PCP) work condition and their job satisfaction. OBJECTIVE: This research aimed to explore the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. METHODS: We conducted an exploratory qualitative study within two areas in Central Java, Indonesia, using semi-structured in-depth interviews with 34 PCPs and 19 triangulation sources. We conducted both inductive and deductive analyses by the NVivo 11. RESULTS: Most PCPs felt dissatisfied with the following aspects of the NHIS: referral system, NHIS health services standard, NHIS programmes, performance evaluation and pay-for-performance, relationship with patient and workloads. PCPs felt constrained with the referral regulation and non-specialist diagnoses, which led to dissatisfaction with performance evaluation and the pay-for-performance implementation. Furthermore, an increase in workload and conflict with patients resulted from patients' misunderstanding the NHIS health service procedures. However, PCPs felt satisfied with the chronic disease management programme and patients' appreciation. CONCLUSIONS: This study presents the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. There is a need for additional discussion among all stakeholders (Ministry of Health, Social Security Agency for Health/SSAH, primary health care and physician's professional organizations about the non-specialist diagnoses list, performance evaluation and pay-for-performance). The government and SSAH need to improve the communication and socialization of the NHIS procedures/regulations.

In 2014, Indonesia implemented a National Health Insurance System (NHIS). The reform affected the primary care physicians' (PCPs') work conditions and job satisfaction. This qualitative study explored the reasons behind PCPs' satisfaction and dissatisfaction with the job satisfactions' aspect in the NHIS. We interviewed 34 PCPs and 19 triangulation sources in Semarang City and Demak Regency (Central Java). Findings showed that most physicians felt dissatisfied with the NHIS referral system, health services standard, some NHIS programmes, performance evaluation and pay-for-performance, relationship with patients and workload. Mostly, the patients­PCPs' conflicts were due to the misunderstanding of the NHIS health service procedures. However, the PCPs also received patients' appreciation. For improving the reform implementation and PCPs' job satisfaction, the physicians' concerned, leading to dissatisfaction, must be addressed.

Association between posttraumatic stress disorder (PTSD) severity and ego structure of the Nanai people.

BACKGROUND: A man-made chemical disaster occurred in the Amur River, leading to posttraumatic stress disorder (PTSD) in the Nanai people indigenous to the river's surrounding area. PTSD severity measured by the total scores of Impact of Event Scale-Revised (IES-R) (Total-I) and Clinician-Administered PTSD Scale (CAPS) (Total-C) were not always identical in terms of demographic and ethnocultural characters. It is possible that the results derived using the Total-I and Total-C may differ for persons with different backgrounds and/or individual characteristics. In this study, the associations between PTSD severity and personal characteristics were evaluated. METHODS: The study was a field-type survey including 187 randomly selected participants (75 males and 112 females). In addition to Total-I/Total-C, scores for each IES-R/CAPS item, Intrusion, Avoidance, and Hyperarousal, and Ego Structure Test by Ammon (ISTA) score were examined to evaluate their personal characteristics. RESULTS: No specific trends in ISTA score were obvious among four groups defined according to Total-I/Total-C. The results of principal component analysis showed that all IES-R/CAPS items contributed positively to the 1st axis but to the 2nd axis in a different manner. ISTA items did not always show correlations to each other, but principal component analysis suggested that Construct contributed positively and Destruct and Deficient (with the exception of Destruct sexuality) contributed negatively. High IES-R scores were associated with Construct Aggression and Deficient Inner demarcation, but high CAPS score was less likely to exhibit Construct Narcissism. CONCLUSION: To avoid the misdiagnosis of PTSD, usage of both IES-R/CAPS may be required. Simultaneous application of personality/ego tests may be helpful, but appropriate numbers of their questions would be important.

Factors associated with tuberculosis cases in Semarang District, Indonesia: case-control study performed in the area where case detection rate was extremely low.

OBJECTIVES: Indonesia is ranked as the 4th highest contributor to tuberculosis (TB) in the world. Semarang District in Central Java displays extremely low case detection rate (CDR), possibly contributing to the local prevalence of TB. METHODS: A case-control study was performed to explore the factors that cause such low CDR. We recruited 129 TB cases and 83 controls that visited the same centers and were not diagnosed with TB. RESULTS: The cases had 7.5 ± 2.3 symptoms/person on average, indicating the delay in diagnosis because the controls only displayed 1.0 ± 1.7. The multiple logistic regression analysis comparing the cases/controls extracted following factors as a risk to have TB: farmer, close contact with TB patients, ignorance of whether Bacillus Calmette-Guérin (BCG) was accepted or no, smoking, low income, a lot of people living in the same room, irregular hand wash before meals, not wash hands after blow, soil floor, and no sunlight and no ventilation in the house. CONCLUSIONS: Neither the cases nor the controls knew the symptoms and how to avoid TB infection, which probably caused the delay in diagnosis. It is difficult to change the current living conditions. Thus, the amendment of the community-based education program of TB seems to be required.

Posttraumatic stress disorders in the Nanai after pollution of the Amur River: ethnocultural analysis.

OBJECTIVES: Chemical pollution of the Amur River has seriously damaged traditions and caused posttraumatic stress disorder (PTSD) among the Nanai, the indigenous people living along this river. This study was performed to clarify the ethnographic characteristics of PTSD in this unique population. METHODS: The study group consisted of 75 male and 112 female randomly selected volunteers. PTSD severity measured using scores of the Impact of Event Scale--Revised (Total-I) and Clinical-Administered PTSD Scale (Total-C) was estimated according to demographic and ethnocultural backgrounds, clinical status, and ethnopsychological attitudes toward the Amur River. RESULTS: The differences in averages of Total-I and Total-C were not always the same in the groups divided by ethnographic information. Logistic regression analysis with a dependent variable, possibly without PTSD (Total-I <34 and Total-C <40)/possibly with PTSD (either Total-I ≥34 or Total-C ≥40), and categorical independent variables using ethnographic information extracted a low score when 'priority values' and 'the Amur River for me is' was "profession" and a high score when 'dominant role in spousal relationship' was "self," when 'predominant forms of response in stressful situations' was "try to organize," when 'preferred method of medical treatment' was specific for the Nanai, when "rely on something mystical" was manifested, and when the Amur River was believed to be "sacred". CONCLUSION: Those with a pragmatic attitude were less likely to have PTSD. However, those who were required to make decisions within close relationships and were intimate with the Nanai tradition and the Amur River had increased likelihood of PTSD.