Risk factors for delayed sputum conversion: A qualitative case study from the person-in-charge of TB program's perspectives.

Background: One of the indicators to determine the success of TB treatment is the conversion of sputum from smear positive to negative. However, several factors can lead to this failure of sputum conversion. Objectives: To investigate the risk factors for delayed sputum conversion from the person-in-charge (PIC) of the TB program's perspective. Design and methods: This qualitative case study was conducted on September 7th, 2022. Thirty-one PICs of the TB program from 31 public health centers (Puskesmas) in Bandar Lampung, Indonesia, were recruited purposively. All participants were grouped into three FGDs. Developed semi-structured interview questions were used for data collection. Thematic analysis was used to synthesize and cross-reference emerging topics. Results: Three themes emerged in our study: (1) individual factors with the sub-themes of medication adherence, education, initial laboratory examination, comorbid disease, nutrition, and lifestyle; (2) environmental factors with the sub-themes of types of support, sources of support, environmental conditions and stigma; and (3) health service factors with the sub-theme of access to health service facilities. Conclusions: Problems related to TB management are not only the individual's responsibility but need to strengthen support from the environment and health services.

Facilitators and barriers of preventive behaviors against COVID-19 during Ramadan: A phenomenology of Indonesian adults.

Introduction: Intercity mobility restriction, physical distancing, and mask-wearing are preventive behaviors to reduce the transmission of COVID-19. However, strong cultural and religious traditions become particular challenges in Indonesia. This study uses the Behavior Change Wheel to explore barriers and facilitators for intercity mobility restriction, physical distancing, and mask-wearing during Ramadan. Methods: Semi-structured in-depth interviews with 50 Indonesian adults were conducted between 10 April and 4 June 2020. Having mapped codes into the Capacity, Opportunity, Motivation - Behavior (COM-B), and Theoretical Domain Framework (TDF) model, we conducted summative content analysis to analyze the most identified factors to preventive behaviors and proposed interventions to address those factors. Results: Belief about the consequence of preventive behaviors was the most mentioned facilitator to all preventive behaviors among compliers. However, optimism as a TDF factor was commonly mentioned as a barrier to preventive behaviors among non-compliers, while environmental context and resources were the most commonly mentioned factors for intercity mobility restriction. Conclusions: Public health intervention should be implemented considering the persuasion and involvement of religious and local leaders. Concerning job and economic context, policy related to the intercity mobility restriction should be reconsidered to prevent a counterproductive effect.

Decentralized recommender system for ambient intelligence of tourism destinations serious game using known and unknown rating approach.

Tourism destinations serious game (TDSG) requires the ability to respond to players through recommendations for selecting appropriate tourist destinations for them as potential tourists. This research utilizes ambient intelligence technology to regulate the response visualized through a choice of serious game scenarios. This research uses the Multi-Criteria Recommender System (MCRS) to produce recommendations for selecting tourist destinations as a reference for selecting scenario visualizations. Recommender systems require a decentralized, distributed, and secure data-sharing concept to distribute data and assignments between nodes. We propose using the Ethereum blockchain platform to handle data circulation between parts of the system and implement decentralized technology. We also use the known and unknown rating (KUR) approach to improve the system's ability to generate recommendations for players who can provide rating values or those who cannot. This study uses the tourism theme of Batu City, Indonesia, so we use personal characteristics (PC) and rating of destinations attribute (RDA) data for tourists in that city. The test results show that the blockchain can handle decentralized data-sharing well to ensure PC and RDA data circulation between nodes. MCRS has produced recommendations for players based on the KUR approach, indicating that the known rating has better accuracy than the unknown rating. Furthermore, the player can choose and run the tour visualization through game scenarios that appear based on the recommendation ranking results.

Spatio-Temporal Dynamics of Tuberculosis Clusters in Indonesia.

CONTEXT: Stratification of social determinants leads to clustering of low socioeconomic communities, which then leads to spatio-temporal tuberculosis (TB) clusters. While previous studies have investigated spatio-temporal TB clusters, few have reported on the dynamics of them and the characteristics of social determinants. AIMS: To investigate the spatio-temporal dynamics of TB clusters in Bandar Lampung, Indonesia, from 2015 to 2016, and to identify the characteristics of population density and percentage of poverty of the clusters. SETTINGS AND DESIGN: A cross-sectional study was performed to analyze the spatio-temporal dynamics of TB clusters. The sample consisted of 705 TB patients (2015) and 1134 TB patients (2016), registered in 30 community health centers in Bandar Lampung, Indonesia. SUBJECTS AND METHODS: Geographical coordinates of the TB patients' residence were collected using Geographical Positioning System. Secondary data, consisting of population density and the percentage of poverty, were obtained from the subdistrict office in the region under investigation. STATISTICAL ANALYSIS: Data were analyzed with space-time permutation model using SaTScan software. RESULTS: Spatio-temporal dynamics of TB clusters were found in 2015 and 2016, including the number of significant clusters, TB cases within the clusters, as well as locations and sizes of the clusters. All the clusters were found to have similar social determinant characteristics: medium-high population density and low-medium percentage of poverty. CONCLUSIONS: TB control programs in countries with a high TB burden and low social determinants should consider the spatio-temporal dynamics of the TB cluster and its social determinant characteristics for a better TB's intervention.

Predominant Determinants of Delayed Tuberculosis Sputum Conversion in Indonesia.

CONTEXT: Sputum conversion in the first 2 months of tuberculosis (TB) treatment is closely related to successful treatment and a decrease in the likelihood of relapse. In 2015, there were 76% high TB burden countries with low rate of TB successful treatment. AIMS: This study aims to evaluate the correlation between delayed sputum conversion and several determinants including social determinants, smoking, malnutrition, and type II diabetes mellitus (DM). SETTINGS AND DESIGN: A case-control approach was used to study the potential determinants. A case sample group consisted of smear-positive TB patients with delayed sputum conversion (31 patients) at community health centers in Bandar Lampung, Indonesia. Meanwhile, a control sample group consisted of smear-positive TB patients with sputum conversion (62 patients). SUBJECTS AND METHODS: Primary data consisted of social determinants and smoking, were collected through in-depth interviews. Meanwhile, secondary data consisted of malnutrition, DM, and sputum conversion were obtained from the medical record. STATISTICAL ANALYSIS USED: Data were analyzed using Chi-square and multivariate logistic regression. RESULTS: Low education (odds ratio [OR]: 5.313; 95% (confidence interval [CI]: 1.711-16.503), low social class (OR: 4.993; 95% CI: 1.430-17.430), smoking (OR: 7.457; 95% CI: 1.757-31.640), and DM (OR: 7.168; 95% CI: 1.746-29.431) influenced delayed sputum conversion. CONCLUSIONS: TB control programs in high TB burden countries with low rate of TB successful treatment, should be integrate TB treatment education, smoking cessation programs and follow-up treatments for TB patients with DM to improve the probability of sputum conversion and successful treatment.

Prediction Model of Tuberculosis Transmission Based on Its Risk Factors and Socioeconomic Position in Indonesia.

CONTEXT: The current evidence shows that people in low-socioeconomic positions tend to be at high risk for tuberculosis (TB) transmission. AIMS: The aim of this study is to identify the significance of socioeconomic position and TB risk factors to TB transmission, particularly in Bandar Lampung, Indonesia. SETTINGS AND DESIGN: This cross-sectional study, conducting in January-November 2017, included 166 samples of smear-positive TB patients collected from 30 community health centers across the city that had implemented DOTS strategy. SUBJECTS AND METHODS: The latent variables consisted of the following: socioeconomic position, housing, nutritional, healthcare access, and TB transmission, which was measured through corresponding indicators. The data were collected through in-depth interviews. STATISTICAL ANALYSIS USED: Data analyzed using the partial least square method. RESULTS: Determinants of socioeconomic position through housing determinants significantly influence TB transmission with R 2 of 42.3%. They also show that education, housing density index, and internal house transmission are the strongest indicators in explaining their associated latent variables. CONCLUSIONS: TB control program should be integrated with education improvement, a reduction of housing density index, and strengthened examinations of internal house contacts. These programs should be supported by health institutions and other related institutions. The findings will improve TB control programs, especially in low- and middle-income countries with high-socioeconomic disparity.

Clustered tuberculosis incidence in Bandar Lampung, Indonesia.

BACKGROUND: The incidence of tuberculosis (TB) in the city of Bandar Lampung, Indonesia, increased during the period 2009-2011, although the cure rate for TB cases treated under the directly observed treatment, short course (DOTS) strategy in the city has been maintained at more than 85%. Cluster analysis is recognized as an interactive tool that can be used to identify the significance of spatially grouping sites of TB incidence. This study aimed to identify space-time clusters of TB during January to July 2012 in Bandar Lampung, and assess whether clustering co-occurred with locations of high population density and poverty. METHODS: Medical records were obtained of smear-positive TB patients who were receiving treatment at DOTS facilities, located at 27 primary health centres and one hospital, during the period January to July 2012. Data on home addresses from all cases were geocoded into latitude and longitude coordinates, using global positioning system (GPS) tools. The coordinate data were then analysed using SaTScan. RESULTS: Two significant clusters were identified with P value of 0.05 for the primary cluster and 0.1 for the secondary cluster. Clusters occurred in areas with high population density and a high proportion of poor families and poor housing conditions. The short radius of the clusters also indicated the possibility of local transmission of TB. CONCLUSIONS: The incidence of TB in Bandar Lampung was not randomly distributed, but significantly concentrated in two clusters. Identification of clusters of TB, together with its etiological factors such as social determinants, and risk factors, can be used to support TB control programmes, particularly those aiming to reach vulnerable populations, and intensified case-finding.