Microbiological Quality, Hygiene, and Sanitation of the Production Processes of a Traditional Beverage at Tourism Areas in Bali.

Loloh Cemcem, a traditional beverage containing Cemcem leaves of (Spondias pinnata (L.f.) Kurz) from the tourism area of Penglipuran, has been widely distributed across Bali. This study aims to examine the microbiological quality of Loloh Cemcem and its association with hygiene and the sanitation of its production processes. A cross-sectional study was conducted, involving all home industries that produce Loloh Cemcem and its handlers, four water depots, and three samples of water source in Penglipuran, Bali. Observations and interviews were conducted to obtain data on hygiene and sanitation. Samples were tested for microbiological qualities, including total plate count (TPC), most probable number (MPN) method for coliform, and Escherichia coli (E. coli) contamination. A polymerase chain reaction (PCR) examination was conducted to identify virulent genes. The water source was contaminated with enterotoxigenic E. coli (ETEC), and about 25% of water depots and 43.3% of Loloh Cemcem samples were also contaminated with E. coli. This indicates E. coli viability under an acidic medium (average pH of 2.8). Of the 30 home industries, 76.7% of sanitation facilities met the safety standards, while the conditions were considerably lower for instrument sanitation (60.0%), personal hygiene of the handlers (50.0%), and production site sanitation (43.3%). Poor personal hygiene of the handlers was associated with the microbiological quality of Loloh Cemcem with an adjusted odds ratio (AOR) of 15.02 (95%CI: 1.32-171.56, P = 0.029). Ongoing monitoring is warranted to improve personal hygiene and sanitation of the production processes. Microbiological research is essential to understand the nature of E. coli, including its viability in acidic environments.

Evaluation of Community-Based Dog Welfare and Rabies Project in Sanur, a Sub-district of the Indonesian Island Province of Bali.

The Indonesian island province of Bali experienced its first rabies incursion in 2008. Mass vaccination of the dog population has proven effective and rabies cases in dogs and people have decreased, however the virus is still circulating among the dog population. Vaccination coverage must be maintained until rabies elimination. Increasing efficiency and effectiveness of vaccination campaigns is therefore desired. Community engagement leading to preventative health actions by community members can reduce disease incidence and costs of control. Here we evaluate 2 years of a novel community-based dog welfare and rabies control project (Program Dharma) in the Sanur sub-district. The project engaged the services of people living in the project area with an interest or experience in dogs or community health services. These people spoke with owners within their own community about dog welfare and health, monitored owned and unowned dogs and increased owner and carer efforts to access vaccination and further veterinary services. The evaluation focused on a sample of dogs whose owners had been regularly engaged with project. Vaccination coverage was increased and there were no dog or human rabies cases reported in the project area; the percentage of the dogs that had never been vaccinated was reduced by an average 28.3% (baseline unvaccinated 41-49%, post-project unvaccinated 11-19%). The welfare of dogs improved from an average of 20.7% of dogs with visible welfare problems at baseline to 2.7% after project implementation. Roaming dog density observed on street surveys also decreased in all project areas (24-47% reduction dependent on desa). A participatory evaluation event with a sample of Program Dharma community-based agents highlighted several additional successes, including that the community appeared to welcome and value their services and were beginning to support the cost of project activities. Conversely, challenges included identifying dogs in the database during revisits, sustaining the costs of community member time spent working on Program Dharma activities and the costs of veterinary care, whilst avoiding dependency of owners on free veterinary services. The benefits revealed by the evaluation were judged to be sufficient to extend Program Dharma to new areas, whilst evolving activities to resolve challenges.

Dog Ecology and Rabies Knowledge of Owners and Non-Owners in Sanur, A Sub-District of the Indonesian Island Province of Bali.

This study gained an understanding of dog demographics, owner behaviour, and knowledge, attitudes and practices relating to rabies in three villages in Sanur, Bali, providing insights for an intervention to improve responsible dog ownership. A combination of a census of all dogs, street surveys of roaming dogs, and a Knowledge, Attitude and Practices (KAP) survey was used to study both dogs and people. A total of 6009 dogs were recorded, of which only 3.3% appeared to be unowned; unowned dogs had poorer welfare and were more likely to be wary of attempted approaches by people. The source of dogs, method of confinement used by owners, and whether dogs were sterilised differed between three breed types; purebred dogs, mixed breed, and Bali dogs (native breed). Three variables were found to have significant effects on the chances of not being vaccinated: age, dog type, and confinement. A mean of 3.81 roaming dogs per km of street surveyed was recorded along 28 sub-village routes. Responses to attitude statements showed that most people had a positive attitude towards dogs and vaccination and did not agree with culling. Knowledge of appropriate bite treatment and symptoms of rabies in dogs was good.

Factors associated to referral of tuberculosis suspects by private practitioners to community health centres in Bali Province, Indonesia.

BACKGROUND: The contrast between the low proportion of tuberculosis (TB) suspects referred from private practitioners in Bali province and the high volume of TB suspects seeking care at private practices suggests problems with TB suspect referral from private practitioners to the public health sector. We aimed to identify key factors associated with the referral of TB suspects by private practitioners. METHODS: We conducted a case-control study conducted in Bali province, Indonesia. The cases were private practitioners who had referred at least one TB suspect to a community health centre between 1 January 2007 and the start of data collection, while the controls were private practitioners who had not referred a single TB suspect in the same time. RESULTS: The following factors were independently associated with referral of TB suspects by private practitioners: having received information about the directly observed treatment short-course (DOTS) strategy (OR 2.0; 95% CI 1.1-3.8), ever having been visited by a district TB program officer (OR 2.1; 95% CI 1.0-4.5), availability of TB suspect referral forms in the practice (OR 2.8; 95% CI 1.5-5.2), and less than 5 km distance between the private practice and the laboratory for smear examination (OR 2.2; 95% CI 1.2-4.0). CONCLUSIONS: Education and exposure of private practitioners to the TB program improves referral of TB suspects from private practitioners to the national TB program. We recommend that the TB program provides all private practitioners with information about the DOTS strategy and TB suspect referral forms, and organizes regular visits to private practitioners.

Comparison of Yacon (Smallanthus sonchifolius) Tuber with Commercialized Fructo-oligosaccharides (FOS) in Terms of Physiology, Fermentation Products and Intestinal Microbial Communities in Rats.

The yacon (Smallanthus sonchifolius) tuber was examined with regard to its prebiotic effects compared with commercialized fructo-oligosaccharides (FOS). A feed containing 10% yacon tuber, which is equivalent to 5% commercialized FOS in terms of the amount of fructo-oligosaccharides (GF2, GF3 and GF4), was administrated to rats for 28 days. The yacon diet changed the intestinal microbial communities beginning in the first week, resulting in a twofold greater concentration of cecal short-chain fatty acids (SCFAs). The SCFA composition differed, but the cecal pH in rats fed yacon tuber was equal to that in rats fed FOS. Serum triglycerides were lower in rats fed yacon compared with rats fed FOS and the control diet. Cecal size was greater with the yacon tuber diet compared with the control diet. The abundant fermentation in the intestines created a selective environment for the intestinal microbiota, which included Lactobacillus acidophilus, Bifidobacterium pseudolongum, Bifidobacterium animalis and Barnesiella spp. according to identification with culture-independent analysis, 16S rRNA gene PCR-DGGE combined with cloning and sequencing. Barnesiella spp. and B. pseudolongum were only found in the rats fed the yacon diet, while L. acidophilus and B. animalis were found in abundance in rats fed both the yacon and FOS diets. The genus Barnesiella has not previously been reported to be associated with yacon or FOS fermentation. We concluded that the physiological and microbiological effects of the yacon tuber were different from those of FOS. Differences in cecal size, blood triglycerides and microbial community profiles including their metabolites (SCFAs) between the yacon tuber and FOS were shown to be more greatly affected by the yacon tuber rather than FOS.