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A framework for estimating causes of death in Indonesia [causes of death in Indonesia].

A number of demographic techniques for the indirect estimation of trends in causes of death in Indonesia are proposed. These involve "the use of rates and proportions derived from other nations experiencing similar levels of mortality to that prevailing in Indonesia. Four sets of estimates were produced, the first based on a regression developed by Preston, the other three derived from national patterns of Mexico, the Philippines, and a composite group of countries. These were compared with available epidemiologic and clinical data from Indonesia to produce a final set of estimates which accord both with known Indonesian patterns and medical findings from other nations."

Asia↗

Study on hepatitis B virus (HBV) infection and hepatitis B virus carrier state in children at two Mobil Oil Indonesia locations in Indonesia.

Between May and July 1985, a cross-sectional study on hepatitis B virus (HBV) infection and hepatitis B virus carrier state was conducted in children at two locations of Mobil Oil Indonesia i.e. Jakarta and Medan. Two main groups of Mobil Oil Indonesia population namely "employees" and "dependents" were also included in this study. From each subject, 10 ml of venous blood was taken and the sera separated and kept in a freezer at the temperature of -20 degrees C before sending them to the laboratories and tested with reagents produced by the Abbott Laboratory for HBsAg, anti-HBs and anti-HBc by radioimmunoassay (AUSRIA II-125, AVSAB and CORAB respectively). The test of blood samples from Jakarta population was done by the "the PRODIA LABORATORY" in Jakarta, while the test of blood samples from Medan was conducted by "the PATH LABORATORY" in Singapore which is nearer from Medan than Jakarta. The result of HBV markers test from 197 children were as follows: Incubation period of carrier state (HBsAg+) 1%; acute hepatitis B or persistent carrier state (HBsAg + and anti-HBc +) 0.5%; recovery/immune (anti-HBs + and anti-HBc +) 3.5%; immunization without infection or recovery with loss of detectable anti-HBc (anti-HBs +) 2% and acute hepatitis B (Window period) or recovery with loss of detectable antiHBs (anti-HBc +) 5%. The conclusion is that hepatitis B virus infection in a low percentage was found in children of Mobil Oil Indonesia population.

Adolescent↗

Stroke in Indonesia: a first large prospective hospital-based study of acute stroke in 28 hospitals in Indonesia.

Stroke is an increasing cause of morbidity and mortality in Indonesia. Data on clinical patterns of hospitalized Indonesian stroke patients are still not available. This study is a part of ASNA (ASEAN Neurological Association) Stroke Epidemiological Stu dy aimed to investigate clinical profile of stroke in seven ASEAN countries with the same protocol. From 2065 acute stroke patients admitted to 28 hospitals all over Indonesia, the mean age was 58.8 (Standard Deviation [SD] 13.3) years (range: 18-95 year s). 12.9% were younger than 45 years, and 35.8% were older than 65 years. There were more men than women. Mean admission post-stroke time was 48.5 h (SD 98.8) (range: 1-968 h). Most of them arrived at hospital more than 6 h from stroke onset. The reasons for delayed admission were unawareness of stroke symptoms and long distance transportation. The most frequent stroke symptoms were motor disability. The most common risk factors were hypertension, heart disease, cigarette smoking and diabetes mellitus. Recurrent stroke was found in nearly 20% of patients. Ischemic stroke was the most frequent and the majority of the study subjects were discharged alive and improved.

Acute Disease↗

Salmonellosis in Indonesia: phage-type of Salmonella oranienburg obtained from hospitalized patients in Jakarta, Indonesia.

During a survey in Jakarta, Indonesia, 158 cultures of Salmonella oranienburg, consisting of two phage types, were obtained from 150 hospitalized patients with diarrhoea. Phage type I, though found notably in young children, was found in all age groups while phage type II was found almost exclusively in young children aged 0-7 years. Phage type I may produce a more severe clinical picture affecting all age groups alike, while phage type II may result in hospitalization of only the very young, who are more susceptible to dehydration. Phage type I was significantly more resistant than phage type II to the individual antibiotics: tetracycline, chloramphenicol, kanamycin and neomycin. However, there was no difference in their respective antibiotic resistance patterns as measured by disk and MIC assay. All cultures were sensitive to gentamicin and trimethoprim-sulphamethoxazole 1:19.

Adolescent↗

The approach to the leprosy problem in the past in Indonesia. A historical review of leprosy control activities in Indonesia during the last centuries.

Due to the severe disabilities leprosy has always been a disease which appealed to the imagination. In bygone centuries cause and treatment were unknown and the fear to be infected was enormous. In Indonesia medical officers struggled with the problem. As early as the 17th century the disease was described in detail by Ten Rhijne. In the 19th century leprosy was considered hereditary. After the discovery of the leprosy bacillus by Hansen in 1873, confusion continued as the bacillus could not be cultivated. Many therapies were tried, but with no result. At first patients were isolated in leprosaria, later on a more humane system of house-isolation was introduced. Since 1932 Indonesian medical officers have played a prominent part in research and the determination of the future approach to the problem. Seen against the background of our present knowledge about the disease, it is interesting to follow the struggle against leprosy in the past.

History, 17th Century↗

Some hematological problems in Indonesia.

Indonesia consist of many island inhabited by many ethnic groups with different social economic condition. As in other parts of the world, anemia is still one of the major health problem in Indonesia. The reported anemia prevalence differs in each area and age groups, ranging from 5.4% in well nourished preschool children to 56.3% in primary school children; and 19% to 62.5% in pregnant women. The causes of anemia mostly reported were nutritional like iron deficiency, abnormal hemoglobin besides other conditions. In Cipto Mangunkusumo Hospital as the national referral hospital in Indonesia, in the adults groups, the cause of anemia reported were 14% with iron deficiency, 54% aplastic, 16% hemolytic and 16% other causes. Whereas in the child health department the cause were 29% nutritional deficiency, 31% thalassemia, 10% aplastic, 4% hemolytic and 26% other causes. Thalassemia is quite often reported in Indonesia. In 1955 Lie-Injo first reported the HbE as the most frequently found abnormality among many ethnic groups in Indonesia, ranging from 2.5% to 13.2%. In later studies the prevalence reported varies very much. It was reported as 9.5% in newborns, 22% in pregnant women, and 15.95% to 60% in athletes. The carrier frequency in some areas was between 6-10%, while the pattern of mutation varied widely within each region. Hemophilia cases in Indonesia is still not diagnosed adequately, only 530 cases were reported. The problems were lack of diagnostic laboratories and awareness. As many as 56.9% of the hemophilia patients who received cryoprecipitate were reported positive with HCV antibody. Hematological malignancy is now also became an increasing problem in Indonesia, in child health department the prevalence of leukemia was 57%, and lymphoma 13% among other malignancies. In National Cancer hospital, the prevalence leukemia as diagnosed using morphology and flowcytometry, were 51.4% AML, 19.7% B-ALL, 14.6% T-ALL, 4.5% preB-ALL, with 9.8% cases with co expression, and 30% other malignancies. Due to geographical situation, economic condition and lack of diagnostic laboratory facility many abnormalities were unable to be diagnosed properly.

Adult↗

The ThyroMobil model for standardized evaluation of iodine deficiency disorder control in Indonesia.

Indonesia used to be affected by varying degrees of iodine deficiency. Salt iodization has been the adopted strategy on a national basis since 1979. The prevalence of goiter in school-age children (SAC) determined by palpation subsequently markedly decreased within the next 15 years. The objective of the present work was to perform an updated evaluation of the status of iodine nutrition in Indonesia by using standardized methods for the measurement of thyroid volume by ultrasounds and the concentration of urinary iodine in SAC. The survey included 7,447 SAC ages 6 to 12 years from 129 sites selected by multistage and stratified sampling in five provinces (4 in Java plus Sumatra and the Province of Bali). A mobile unit (ThyroMobil van) equipped with a sonographic device and facilities for the collection of urine samples visited all sites. In Java plus Sumatra, the median urinary iodine was 195 microg/L. Thirty-four percent of the values were within normal limits (between 100 and 200 microg/L); 17.2% were below 100 microg/L and 48.8% were above 200 microg/L, including 18.2% above 300 microg/L and 0.7% above 1000 microg/L. In Bali, the median was 81 microg/L with 58.3% of the values below 100 microg/L and only 14.7% of the values above 200 microg/L. The prevalence of goiter determined by ultrasounds and using the World Health Organization/International Council for Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values for gender and age was 3.0% in Java plus Sumatra and 1.9% in Bali. The values were 8.0% and 12.5%, respectively, when using reference values for Indonesia established during the present survey in an iodine replete area in central Java. In conclusion, (1) iodine deficiency has been eliminated in large parts of Indonesia; (2) Bali is still affected by mild iodine deficiency; (3) in many places, iodine deficiency has been replaced by iodine excess, occasionally potentially toxic; (4) the WHO/ICCIDD normative values for thyroid volume measured by ultrasound in SAC are not valid for Indonesia; (5) in Indonesia, the level of salt iodization could be decreased and the biological monitoring of urinary iodine at the population level should be reinforced and maintained; (6) the ThyroMobil model has, as in other parts of the world, demonstrated its efficiency in the organization of partnership evaluation and monitoring of iodine nutrition, as well as in social mobilization.

Adolescent↗

Japan, Indonesia to investigate condom plant feasibility.

The Japanese government has begun investigations on the possibility of constructing a condom manufacturing plant in Indonesia in response to a request by the Indonesian government. Indonesia, which hopes to reduce its birthrate as of 1971 by 1/2 by 1990, asked for Japanese assistance in building a condom plant based on the expectation that demand for this contraceptive method, although quite low at present, will increase rapidly in the near future with stepped-up motivation campaigns. As a 1st step in the investigation, the Japan International Cooperation Agency (JICA) sent a study team of family planning experts headed by Family Planning Federation of Japan Chairman Dr. Hidebumi Kubo and including JOICFP International Division Director MR. Tameyoshi Katagiri to Indonesia from March 15-24. During its visit, the JICA team held discussions with representatives of BKKBN (the National Family Planning Coordinating Board) including its Chairman and Minister of Health Dr. Suwardjono and reached agreement on the scope and schedule of work toward determining the feasibility of building and operating a condom plant in Indonesia. In defining the scope of work and the schedule, the JICA team and the BKKBN representatives decided on specific issues to be investigated in the feasibility study to be carried out by JICA and scheduled to be completed by the end of October of this year. To be included in the feasibility study are: estimation of future domestic demand for condoms, examination of the domestic supply of latex capacity, chemicals and packaging materials, and collection of information on infrastructure relating to water, energy, transportation, etc. Actual data collection for the study is expected to begin in late May or early June. Dr. Kubo and Mr. Katagiri, upon returning to Japan, reported great enthusiasm for the project in Indonesia and expressed the hope that the plant construction will be feasible so that the country's family planning program can be given a boost and the cooperative relationship between Indonesia and Japan deepened.

Asia↗

Review of air pollution and its health impact in Indonesia.

Air quality monitoring is part of the initial strategy in the pollution prevention program in Indonesia. Since 1978, the government of Indonesia has had a commitment to the World Health Organization (WHO) to provide air quality data for the Global Environmental Monitoring System (GEMS Programme)--The WHO/UNEP Project, in which certain cities from all over the world have been selected. Air quality as part of the WHO/UNEP project is monitored with respect to pollutants like SPM, SO2 and NOx. The result of the monitoring indicates that SPM and NOx are the predominant pollutants. Other pollutants such as O(x), H2S, NH3, and CO are also monitored in several big cities in Indonesia. The air pollution mainly comes from land transportation, industrial emissions, and a densely populated residential area where most people perform their activities. Review of the air pollution in Indonesia was based on the reports of the air quality monitoring in several large cities in Indonesia which covered air pollutants such as SPM, SO2, NOx, CO, O(x), and NH3 from 1978 until the latest available data in 1989. This review also discusses health impact investigations conducted in the community, especially from the exposure to SPM, CO, and lead from motor vehicle exhaust.

Air Pollution↗

Environmental and occupational lung diseases in Indonesia.

Indonesia as a developing country has air pollution which is mainly caused by motor vehicle emissions and industrial smoke. The most important indoor air pollution is cigarette smoke. The prevalence of smoking among Indonesian men is 45.7%. Of the population, 10.8% are ex-smokers and 43.5% are non-smokers. Among the female population, only 1.8% smoke. There are some important factors that influence the air pollution in Indonesia; this paper identifies the real problems and their impact. The paper reviews various studies that have been carried out in Indonesia which were related to ambient air quality, industrial air pollutants levels (SO2, NOx, Ox, Pb, CO, HC) in large cities in Indonesia have exceeded the acceptable level, especially in industrial trade and heavy traffic areas. The more cigarettes inhaled and the deeper the inhalation, especially the kretek cigarettes, the risk of ling function abnormality becomes greater. Smoking high dose kretek cigarettes, that is > or = 116 cigarettes/day x years, the risk of abnormal lung function is 13-fold that of a non-smoker; if added with the deep inhalation of smoke, the risk becomes 20-fold. Smoking increases the risk of occupational lung disease. The level of dust in some industrial areas exceeded the standard level and correlated with respiratory problems. The existence of industry caused by air pollution in the environment increased the incidence of obstructive airway diseases. We conclude that the main cause of air pollution in Indonesia is motor vehicle emissions, followed by industrial smoke. Cigarette smoke is also related to abnormal lung function.

Air Pollutants↗

[The state of vector-borne diseases in Indonesia].

From epidemiological point of view, Indonesia is an extremely interesting area owing its insular structure and ecological, anthropological, cultural and economical diversity. As everywhere, vector-borne diseases are the result of complex and variable epidemiological systems, subject both to biogeographical rules and human activity. Two main arboviroses are present in Indonesia: dengue and Japanese encephalitis. Dengue appears as an endemoepidemic disease and is mostly circumscribed to urban areas. Haemorrhagic cases were first observed in 1968; since then, the incidence has been constantly increasing and the disease is now one of the principal causes of child lethality. Japanese encephalitis is a rural endemic disease transmitted by rice-field mosquitoes; its incidence remains relatively low since pigs, which are usual link-hosts for the virus, are uncommon in this mainly Muslem country. Human clinical cases are recorded from non-Muslem islands such as Bali or Irian Jaya which raises the question of immunisation for travellers. Recently, Japanese encephalitis was observed on east of the Wallace line which had been considered as the eastern cut-off line. Malaria is common throughout the country, Plasmodium vivax being the most frequent species. Some of the Anopheline vectors are related to brackish water as are coastal species; others have been favoured by rice growing. Several species bite and rest outdoors, rendering control measures complex. Moreover, chloroquine resistance is increasing in both P. falciparum and P. vivax. All three filaria species responsible for human lymphatic filariasis exist in Indonesia. Bancroft filariasis is present in rather limited foci on most of the islands; malayan filariasis is very prevalent on many islands, mostly in coastal areas, and Timor filariasis exist only on a few small islands. These parasitic diseases are cumulative and do not practically endanger the health of travellers. In the past, plague was common on Java island, but today, human cases are very rare. Scrub typhus is prevalent everywhere, as is murine typhus, being very frequent in harbour cities and one of the main causes of hospitalisation for febrile syndromes.. On the whole, the situation of several of these diseases has been worsening in Indonesia for about thirty years. Although epidemiological situations constantly evolve, two recent occurrences should be paid particular attention: -transmigration which is now a national priority and greatly facilitates the spread of many pathogens, arboviroses or chloroquine-resistant plasmodia, but also of rats, mosquitoes, etc. -deforestation due either to land-farming by Javanese transmigrants or to sudden climatic changes such as El Niño in 1997. Such deep ecological transformations may have considerable and unforeseeable consequences on the epidemiology of vector-borne diseases in Indonesia.

Animals↗

Gastro-intestinal cancer in Indonesia.

BACKGROUND: Report on cancer incidence in Indonesia was presented in relative frequency. To lower the bias, the report has been presented in age standardized cancer ratio (ASCAR). The report was a department of pathology based cancer registration. The ASCAR of gastro intestinal cancer in Indonesia has some variation between pathologic centres. The incidence of rectal cancer in Jogjakarta was higher than colon cancer, and stomach cancer is very low. The risk factors of stomach cancer are H. Pylori infection and food consumption especially salt and the risk factor of colorectal cancer is food consumption. PURPOSE: The article will discuss the ASCAR of stomach and colorectal cancer in Indonesia. The histopathologic of stomach and colorectal cancer in Jogjakarta will be presented from the view point of pathology. METHODS: Stomach and colorectal cancer data from 13 pathologic diagnostic centres in Indonesia were collected. The pathogenesis of stomach and colorectal cancer will be discussed in correlation with the cancer prevention. RESULTS: The incidence of stomach cancer in many centres in the year of 1996 are very low from 0,00% - 0,24 % for the most lowest incidence and 2.22 % - 5.60 % for the highest incidence. The higher incidence of stomach cancer was in Medan 19 males (5.6%); 10 females (2.22%); Palembang 7 males (4.75%), 1 female (0.11%); Surabaya 18 males (1.38%), 7 females (0.35%); Denpasar 12 males (2.97%), 1 female (0.24%), and Jakarta 55 males (4%), 28 females (1.39%). The incidence of colorectal cancer is almost equal in every pathologic diagnostic centres. It is interesting that the incidence of rectal cancer was higher than colon cancer. In Jogjakarta the histopathological feature of stomach cancer was predominated by poorly differentiated adenocarcinoma, while colorectal cancer was predominated by well differentiated adenocarcinoma. CONCLUSIONS: The low incidence of gastric cancer in Indonesia in relation with H. Pylori and food consumption and the high ratio between rectal and colon cancer in correlation with the food consumption and it pathogenesis need further investigation.

Adenocarcinoma↗

Identification of Campylobacter jejuni in Macaca fascicularis imported from Indonesia.

Campylobacter jejuni was selectively cultured in 33 (66%) of 50 Macaca fascicularis that had been imported from Indonesia. As there was no published information on the incidence of Campylobacter infection in nonhuman primates from Indonesia, a survey was conducted to determine the presence and incidence of Campylobacter jejuni in 50 macaques before they were exported from Indonesia. The organism was positively identified in 18 (36%) of the specimens examined. Repeat cultures after importation and during the quarantine period produced 37 of 48 (77%) positive results. Stool cultures from 57 other Macaca fascicularis and Macaca nemestrina in more preliminary stages of captivity in Indonesia produced only two positive identifications. These findings suggest that Campylobacter jejuni is not a natural pathogen of macaques in Indonesia, but it infects them after capture.

Animals↗

Breastfeeding practices in Indonesia.

UNLABELLED: Breastfeeding promotion program was started by the paediatricians and others in 1977, and is becoming a strong activity since 1990 it was declared by the President of the Republic of Indonesia as a National Movement. One year later the First Lady stated the importance of every Indonesian mother to breast-feed her baby, and thereafter many hospitals created the so called "Baby Friendly Hospital". In this occasion we only limit with eminent topics, i.e., "Exclusive Breast-feeding" in Indonesia, and "Breastfeeding amongst Working Mothers." In fact, until now the percentage of mothers who breastfeed exclusively is very low. Although the ever breastfed babies in Indonesia is 97% (Kodyat, 1996) but the data of the "Exclusive Breastfeeding" of Indonesia is just like Pakistan and Thailand, i.e. nearly 2 months, whereas the Philippines and Ceylon showed a figure of 4 months, and India 5 months. The Home Health Survey (SKRT) data in 1992 showed that 63.7% of the babies were exclusively breast-fed until 3 months. Three quarter of the quality of the exclusive breastmilk is quite good, enough or excellent, whereas the other one quarter is poor and this should be interfered by increasing the quality of the breastmilk and/or adding other formula, to prevent the baby of getting "failure to thrive" (Suharyono, 1996). Working mothers use to do "Early Weaning Practices" with very high mixed feeding practices (Matulessy et al, 1996). Mothers have to go to work because they have to support their family income, but unfortunately most of them ignore their main task of care their children. IN CONCLUSION: the experience in Indonesia proves that a very hard work should still be continued on the effort of promoting breastfeeding, especially regarding the two issues, i.e. "Exclusive breastfeeding" (we do hope at least until 4 months) and the other issue is regarding the "Working Mothers".

Breast Feeding↗