14 results on '"Utarini, Adi"'
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2. “I would do something if I could!”: experiences and reflections from ethics teachers on how to respond when hearing alarming cases from medical students
- Author
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Muhaimin, Amalia, Hoogsteyns, Maartje, Wicaksono, Raditya Bagas, Utarini, Adi, and Willems, Derk Ludolf
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- 2021
- Full Text
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3. A protocol study of participatory action research: integrated care pathway for pregnant women with heart disease in Indonesia
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Yuliyanti, Suryani, Utarini, Adi, and Trisnantoro, Laksono
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- 2020
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4. Update to the AWED (Applying Wolbachia to Eliminate Dengue) trial study protocol: a cluster randomised controlled trial in Yogyakarta, Indonesia
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Anders, Katherine L., Indriani, Citra, Ahmad, Riris Andono, Tantowijoyo, Warsito, Arguni, Eggi, Andari, Bekti, Jewell, Nicholas P., Dufault, Suzanne M., Ryan, Peter A., Tanamas, Stephanie K., Rancès, Edwige, O’Neill, Scott L., Simmons, Cameron P., and Utarini, Adi
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- 2020
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5. Hospitals accreditation status in Indonesia: associated with hospital characteristics, market competition intensity, and hospital performance?
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Wardhani, Viera, van Dijk, Jitse Pieter, and Utarini, Adi
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- 2019
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6. Acceptability of the dengue vaccination among parents in urban poor communities of Quezon City, Philippines before and after vaccine suspension
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Valido, Ezra M., Laksanawati, Ida Safitri, and Utarini, Adi
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- 2018
- Full Text
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7. Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study.
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Mawarti, Yuli, Utarini, Adi, and Hakimi, Mohammad
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MATERNAL health services , *MATERNAL mortality , *POSTNATAL care , *LABOR (Obstetrics) , *MEDICAL triage , *DELIVERY (Obstetrics) , *PREVENTION , *ACADEMIC medical centers , *MEDICAL quality control , *PREGNANCY complications , *PUBLIC hospitals , *SPECIALTY hospitals , *RETROSPECTIVE studies - Abstract
Background: Reducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon.Methods: A retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality.Results: The mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02-0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03-1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06-1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04-0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1.05-11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01-0.91).Conclusions: The near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death. [ABSTRACT FROM AUTHOR]- Published
- 2017
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8. How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia.
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Mahendradhata, Yodi, Lestari, Trisasi, Probandari, Ari, Indriarini, Lucia Evi, Burhan, Erlina, Mustikawati, Dyah, and Utarini, Adi
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TUBERCULOSIS case studies ,MEDICAL practice ,TUBERCULOSIS treatment ,PREVENTIVE medicine ,PUBLIC health - Abstract
Background: Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia. Methods: A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented. Results: Of 608 eligible GPs invited to participate during the study period, 547 (89.9 %) consented and completed the interview. A low proportion of GPs (24.6-74.3 %) had heard of the International Standards for TB care (ISTC) and only 41.2-68.9 % of these GPs had participated in ISTC training. As few as 47.3 % (90 % CI: 37.6-57.0 %) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0-5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6 %. In all cities, a substantial proportion of GPs (12.0-45.5 %) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8-52.0 %). Conclusions: The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions. [ABSTRACT FROM AUTHOR]
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- 2015
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9. Missed opportunity for standardized diagnosis and treatment among adult Tuberculosis patients in hospitals involved in Public-Private Mix for Directly Observed Treatment Short-Course strategy in Indonesia: a cross-sectional study.
- Author
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Probandari, Ari, Lindholm, Lars, Stenlund, Hans, Utarini, Adi, and Hurtig, Anna-Karin
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TUBERCULOSIS diagnosis ,MYCOBACTERIAL diseases ,MEDICAL care ,HOSPITAL administration ,SPUTUM - Abstract
Background: The engagement of hospitals in Public-Private Mix (PPM) for Directly Observed Treatment Short-Course (DOTS) strategy has increased rapidly internationally - including in Indonesia. In view of the rapid global scaling-up of hospital engagement, we aimed to estimate the proportion of outpatient adult Tuberculosis patients who received standardized diagnosis and treatment at outpatients units of hospitals involved in the PPM-DOTS strategy. Methods: A cross-sectional study using morbidity reports for outpatients, laboratory registers and Tuberculosis patient registers from 1 January 2005 to 31 December 2005. By quota sampling, 62 hospitals were selected. Post-stratification analysis was conducted to estimate the proportion of Tuberculosis cases receiving standardized management according to the DOTS strategy. Result: Nineteen to 53% of Tuberculosis cases and 4-18% of sputum smear positive Tuberculosis cases in hospitals that participated in the PPM-DOTS strategy were not treated with standardized diagnosis and treatment as in DOTS. Conclusion: This study found that a substantial proportion of TB patients cared for at PPM-DOTS hospitals are not managed under the DOTS strategy. This represents a missed opportunity for standardized diagnoses and treatment. A combination of strong individual commitment of health professionals, organizational supports, leadership, and relevant policy in hospital and National Tuberculosis Programme may be required to strengthen DOTS implementation in hospitals. [ABSTRACT FROM AUTHOR]
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- 2010
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10. Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province, Indonesia.
- Author
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Mahendradhata, Yodi, Syahrizal, Bobby M., and Utarini, Adi
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TUBERCULOSIS patients ,LUNG diseases ,PUBLIC health ,RURAL population - Abstract
Background: In year 2000, the entire population in Indonesia was 201 million and 57.6 percent of that was living in rural areas. This paper reports analyses that address to what extent the rural structure influence the way TB patients seek care prior to diagnosis by a DOTS facility. Methods: We documented healthcare utilization pattern of smear positive TB patients prior to diagnosis and treatment by DOTS services (health centre, chest clinic, public and private hospital) in Yogyakarta province. We calculated the delay in treatment as the number of weeks between the onset of symptoms and the start of DOTS treatment. Statistical analysis was carried out with Epi Info version 3.3 (October 5, 2004). Results: The only factor which was significantly associated with total delay was urban-rural setting (p = < 0.0001). The median total delay for TB patients in urban districts was 8 (1
st Quartile = 4; 3rd Quartile = 12) weeks compared to 12 (1st Quartile = 7; 3rd Quartile = 23) weeks for patients in rural districts. Multivariate analysis suggested no confounding between individual factors and urbanrural setting remained as the main factor for total delay (p = < 0.0001). Primary health centre was the first choice provider for most (38.7%) of these TB patients. Urban-rural setting was also the only factor which was significantly associated with choice of first provider (p = 0.03). Conclusion: Improving access to DOTS services in rural areas is an area of vital importance in aiming to make progress toward achieving TB control targets in Indonesia. [ABSTRACT FROM AUTHOR]- Published
- 2008
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11. The AWED trial (Applying <italic>Wolbachia</italic> to Eliminate Dengue) to assess the efficacy of <italic>Wolbachia</italic>-infected mosquito deployments to reduce dengue incidence in Yogyakarta, Indonesia: study protocol for a cluster randomised controlled trial
- Author
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Anders, Katherine L., Indriani, Citra, Ahmad, Riris Andono, Tantowijoyo, Warsito, Arguni, Eggi, Andari, Bekti, Jewell, Nicholas P., Rances, Edwige, O'Neill, Scott L., Simmons, Cameron P., and Utarini, Adi
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DENGUE ,ARBOVIRUS diseases ,AEDES aegypti ,WOLBACHIA ,ENDEMIC diseases - Abstract
Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika and chikungunya, present an increasing public health challenge in tropical regions. Current vector control strategies have failed to curb disease transmission, but continue to be employed despite the absence of robust evidence for their effectiveness or optimal implementation. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with Wolbachia bacterium, with a significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Modelling predicts this will translate to local elimination of dengue in most epidemiological settings. This study protocol describes the first trial to measure the efficacy of Wolbachia in reducing dengue virus transmission in the field.Methods/design: The study is a parallel, two-arm, non-blinded cluster randomised controlled trial conducted in a single site in Yogyakarta, Indonesia. The aim is to determine whether large-scale deployment of Wolbachia-infected Ae. aegypti mosquitoes leads to a measurable reduction in dengue incidence in treated versus untreated areas. The primary endpoint is symptomatic, virologically confirmed dengue virus infection of any severity. The 26 km2 study area was subdivided into 24 contiguous clusters, allocated randomly 1:1 to receive Wolbachia deployments or no intervention. We use a novel epidemiological study design, the cluster-randomised test-negative design trial, in which dengue cases and arbovirus-negative controls are sampled concurrently from among febrile patients presenting to a network of primary care clinics, with case or control status classified retrospectively based on the results of laboratory diagnostic testing. Efficacy is estimated from the odds ratio of Wolbachia exposure distribution (probability of living in a Wolbachia-treated area) among virologically confirmed dengue cases compared to test-negative controls. A secondary per-protocol analysis allows for individual Wolbachia exposure levels to be assessed to account for movements outside the cluster and the heterogeneity in local Wolbachia prevalence among treated clusters.Discussion: The findings from this study will provide the first experimental evidence for the efficacy of Wolbachia in reducing dengue incidence. Together with observational evidence that is accumulating from pragmatic deployments of Wolbachia in other field sites, this will provide valuable data to estimate the effectiveness of this novel approach to arbovirus control, inform future cost-effectiveness estimates, and guide plans for large-scale deployments in other endemic settings.Trial Registration: ClinicalTrials.gov, identifier: NCT03055585 . Registered on 14 February 2017. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
12. The AWED trial (Applying Wolbachia to Eliminate Dengue) to assess the efficacy of Wolbachia-infected mosquito deployments to reduce dengue incidence in Yogyakarta, Indonesia: study protocol for a cluster randomised controlled trial.
- Author
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Anders KL, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Andari B, Jewell NP, Rances E, O'Neill SL, Simmons CP, and Utarini A
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- Adolescent, Adult, Animals, Child, Child, Preschool, Dengue epidemiology, Dengue transmission, Dengue virology, Female, Humans, Incidence, Indonesia epidemiology, Male, Middle Aged, Time Factors, Young Adult, Culicidae microbiology, Dengue prevention & control, Dengue Virus pathogenicity, Mosquito Vectors microbiology, Pest Control, Biological methods, Wolbachia physiology
- Abstract
Background: Dengue and other arboviruses transmitted by Aedes aegypti mosquitoes, including Zika and chikungunya, present an increasing public health challenge in tropical regions. Current vector control strategies have failed to curb disease transmission, but continue to be employed despite the absence of robust evidence for their effectiveness or optimal implementation. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with Wolbachia bacterium, with a significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Modelling predicts this will translate to local elimination of dengue in most epidemiological settings. This study protocol describes the first trial to measure the efficacy of Wolbachia in reducing dengue virus transmission in the field., Methods/design: The study is a parallel, two-arm, non-blinded cluster randomised controlled trial conducted in a single site in Yogyakarta, Indonesia. The aim is to determine whether large-scale deployment of Wolbachia-infected Ae. aegypti mosquitoes leads to a measurable reduction in dengue incidence in treated versus untreated areas. The primary endpoint is symptomatic, virologically confirmed dengue virus infection of any severity. The 26 km
2 study area was subdivided into 24 contiguous clusters, allocated randomly 1:1 to receive Wolbachia deployments or no intervention. We use a novel epidemiological study design, the cluster-randomised test-negative design trial, in which dengue cases and arbovirus-negative controls are sampled concurrently from among febrile patients presenting to a network of primary care clinics, with case or control status classified retrospectively based on the results of laboratory diagnostic testing. Efficacy is estimated from the odds ratio of Wolbachia exposure distribution (probability of living in a Wolbachia-treated area) among virologically confirmed dengue cases compared to test-negative controls. A secondary per-protocol analysis allows for individual Wolbachia exposure levels to be assessed to account for movements outside the cluster and the heterogeneity in local Wolbachia prevalence among treated clusters., Discussion: The findings from this study will provide the first experimental evidence for the efficacy of Wolbachia in reducing dengue incidence. Together with observational evidence that is accumulating from pragmatic deployments of Wolbachia in other field sites, this will provide valuable data to estimate the effectiveness of this novel approach to arbovirus control, inform future cost-effectiveness estimates, and guide plans for large-scale deployments in other endemic settings., Trial Registration: ClinicalTrials.gov, identifier: NCT03055585 . Registered on 14 February 2017.- Published
- 2018
- Full Text
- View/download PDF
13. High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study.
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Lestari T, Probandari A, Hurtig AK, and Utarini A
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- Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Directly Observed Therapy statistics & numerical data, Disease Notification statistics & numerical data, Humans, Indonesia epidemiology, Infant, Infant, Newborn, Inpatients statistics & numerical data, Outpatients statistics & numerical data, Registries, Tuberculosis classification, Hospitals statistics & numerical data, Tuberculosis epidemiology
- Abstract
Background: Childhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in DOTS hospitals on Java Island, Indonesia., Methods: Cross-sectional study of TB cases recorded in inpatient and outpatient registers of 32 hospitals. Cases were analyzed by hospital characteristics, age groups, and types of TB. The number of cases reported in the outpatient unit was compared with that recorded in the TB register., Results: Of 5,877 TB cases in the inpatient unit and 15,694 in the outpatient unit, 11% (648) and 27% (4,173) respectively were children. Most of the childhood TB cases were under five years old (56% and 53% in the inpatient and outpatient clinics respectively). The proportion of smear positive TB was twice as high in the inpatient compared to the outpatient units (15.6% vs 8.1%). Extra-pulmonary TB accounted for 15% and 6% of TB cases in inpatient and outpatient clinics respectively. Among children recorded in hospitals only 1.6% were reported to the National TB Program., Conclusion: In response to the high caseload and gross under-reporting of childhood TB cases, the National TB Program should give higher priority for childhood TB case management in designated DOTS hospitals. In addition, an international guidance on childhood TB recording and reporting and improved diagnostics and standardized classification is required.
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- 2011
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14. How to optimize tuberculosis case finding: explorations for Indonesia with a health system model.
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Ahmad RA, Mahendradhata Y, Cunningham J, Utarini A, and de Vlas SJ
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- Computer Simulation, Delphi Technique, Humans, Indonesia epidemiology, Patient Acceptance of Health Care, Tuberculosis prevention & control, Models, Theoretical, Outcome Assessment, Health Care, Tuberculosis epidemiology
- Abstract
Background: A mathematical model was designed to explore the impact of three strategies for better tuberculosis case finding. Strategies included: (1) reducing the number of tuberculosis patients who do not seek care; (2) reducing diagnostic delay; and (3) engaging non-DOTS providers in the referral of tuberculosis suspects to DOTS services in the Indonesian health system context. The impact of these strategies on tuberculosis mortality and treatment outcome was estimated using a mathematical model of the Indonesian health system., Methods: The model consists of multiple compartments representing logical movement of a respiratory symptomatic (tuberculosis suspect) through the health system, including patient- and health system delays. Main outputs of the model are tuberculosis death rate and treatment outcome (i.e. full or partial cure). We quantified the model parameters for the Jogjakarta province context, using a two round Delphi survey with five Indonesian tuberculosis experts., Results: The model validation shows that four critical model outputs (average duration of symptom onset to treatment, detection rate, cure rate, and death rate) were reasonably close to existing available data, erring towards more optimistic outcomes than are actually reported. The model predicted that an intervention to reduce the proportion of tuberculosis patients who never seek care would have the biggest impact on tuberculosis death prevention, while an intervention resulting in more referrals of tuberculosis suspects to DOTS facilities would yield higher cure rates. This finding is similar for situations where the alternative sector is a more important health resource, such as in most other parts of Indonesia., Conclusion: We used mathematical modeling to explore the impact of Indonesian health system interventions on tuberculosis treatment outcome and deaths. Because detailed data were not available regarding the current Indonesian population, we relied on expert opinion to quantify the parameters. The fact that the model output showed similar results to epidemiological data suggests that the experts had an accurate understanding of this subject, thereby reassuring the quality of our predictions. The model highlighted the potential effectiveness of active case finding of tuberculosis patients with limited access to DOTS facilities in the developing country setting.
- Published
- 2009
- Full Text
- View/download PDF
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