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Background: The unmet need for family planning in Indonesia has been stagnant since the early 2000s in the 10%-12% range with substantial socioeconomic and geographic disparities. This study sought to better understand the factors underlying the nonuse of contraceptives among women with an apparent need for family planning so that evidence-based corrective actions can be taken. Methods: Three sources of quantitative data were used in the study--the 2017 Indonesia Demographic Health Survey, the 2018 Village Potential Survey, and the National Population and Family Planning Board service statistics. Further insights were obtained from online focus group discussions and in-depth interviews with participants in 12 districts/cities in seven provinces. Results: The analyses indicated that health concerns, service delivery-related factors, and opposition to family planning all contribute to the unmet need for family planning in Indonesia. Importantly, the salience of these factors varied significantly across different subgroups of women and geographic areas. Conclusions: Successful efforts to reduce the unmet need for family planning are complex in that they must contend with the interplay between local sociocultural contexts, individual beliefs/aspirations/preferences, and the supply environment of family planning services. Differentiated interventions for different population subgroups and geographic areas will be needed. [ABSTRACT FROM AUTHOR]

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents' abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration. Methods: We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS). Results: A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% confidence interval [CI], 2.90--6.37] vs. 2.55 [95% CI, 2.19--2.90] vs. 3.82 [95% CI, 2.41--5.22], P=0.047; GRS: 10.00 [95% CI, 7.01--12.99] vs. 5.18 [95% CI, 3.99--6.38] vs. 7.18 [95% CI, 6.11--8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88--8.46]; GRS: 12.83 [95% CI, 8.61--17.05] vs. OSATS: 3.40 [95% CI, 0.83--5.97]; GRS: 5.67 [95% CI, 2.80--8.54]). Conclusion: Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Abstract Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.

Indonesia is seeking to expand its cocoa production to meet the increased international demand. However, this effort faces economies of scale and ecological challenges. This research aims at evaluating environmental performance of cocoa production from cocoa monoculture and cocoa-agroforestry by life cycle assessment based on ISO 14040 and 14044, with adaptation for local impact indicators. This study defined cocoa-agroforestry as raw and sequential of cocoa–coconut and cocoa–rubber agroforestry, combined with shading trees Leucaena sp. and Gliricidia sepium . The analysis considered cocoa production at farm level, from cradle to on-farm gate boundary for 1 metric tonne of cocoa pod. The results showed that cocoa–coconut agroforestry had the least contribution to global impact categories of global warming, acidification and eutrophication, accounting for 3.67E+01 kgCO 2 -eq, 4.31E-02 kgSO 2 -eq, and 2.25E-05 kgPO 4 -eq respectively. Cocoa–coconut agroforestry also had the highest organic carbon and soil organic matter, conditions supporting the growth and activity of beneficial soil microbeds ( Pseudomonas sp. and Trichoderma sp.). In addition, total land equivalent ratio of cocoa–coconut agroforestry had the highest value at 1.36, indicating a highest yield advantage was gained. Therefore, cocoa–coconut agroforestry could be a wise option to promote environmental sustainability of cocoa cultivation. [ABSTRACT FROM AUTHOR]

Abstract: This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The sample consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client''s belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses. [Copyright &y& Elsevier]