Publications
93 results found
Puspikawati SI, Dewi DMSK, Astutik E, et al., 2021, Density of outdoor food and beverage advertising around gathering place for children and adolescent in East Java, Indonesia, Public Health Nutrition, Vol: 24, Pages: 1066-1078, ISSN: 1368-9800
OBJECTIVE: To survey outdoor food and beverage advertisements ('F&B adverts') for products that may be a risk factor for obesity, diabetes and CVD located in the vicinity of gathering places for children and adolescents. DESIGN: We recorded the GPS coordinates of all F&B adverts visible from the streets at distances of 0-100, 100-300 and 300-500 m from facilities often used by children and adolescents. Those for unhealthy foods and beverages were identified. The density (number per square kilometre) of such advertisements was calculated and evaluated using hotspot analysis. SETTING: The sub-districts Mulyorejo and Sukolilo in Surabaya city and the sub-districts Banyuwangi and Giri in Banyuwangi District, Indonesia. PARTICIPANTS: None. RESULTS: The proportion of all outdoor advertisements that were F&B adverts was slightly higher in Banyuwangi than in Surabaya. Of the 570 F&B adverts recorded in Banyuwangi, 227 (39·8 %) and 273 (47·9 %) were for unhealthy foods and beverages, respectively. Of 960 F&B adverts in Surabaya, 271 (28·2 %) and 445 (46·3 %) were for unhealthy foods and beverages. In both regions, F&B advert density increased near gathering places for children and adolescents; all recreational areas had at least one set of advertisements for unhealthy beverages and food at 100-300 and 300-500 m. Both regions had one hotspot with significantly high numbers of unhealthy advertisements; Banyuwangi had one cold spot with a significantly low number of healthy advertisements. CONCLUSION: Regulations to control advertisements for unhealthy foods and beverages in areas frequented by children and adolescents are urgently needed.
Handayani S, Rachmani E, Saptorini KK, et al., 2021, Is youth smoking related to the density and proximity of outdoor tobacco advertising near schools? Evidence from Indonesia, International Journal of Environmental Research and Public Health, Vol: 18, ISSN: 1660-4601
Abstract: Background: Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. Objective: To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. Methods: We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. Results: We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. Conclusion: There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.
Kusuma D, Pradeepa R, Khawaja KI, et al., 2021, Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: evidence from a large-scale multi-country surveillance programme, SSM - Population Health, Vol: 13, ISSN: 2352-8273
Background. South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods. We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results. Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P<0.001), and household income fell by 52% (P<0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P<0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P<0.001), during the lockdown.Conclusions. Our results identified important knowledge, access and uptake barriers to the prevention of COV
Dhani R, Artini A, Pannindriya ST, et al., 2021, Effects of pictorial health warnings on cognitive, affective, and smoking behavior: a mixed methods study in four cities in Indonesia, Asian Pacific Journal of Cancer Prevention (APJCP), Vol: 22, Pages: 397-405, ISSN: 1513-7368
While studies have shown the importance of pictorial health warnings (PHW) as a tobacco control strategy, empirical evidence on the efficacy of PHW in prompting smoking behavior remains inconclusive. The study aimed to examine the association between PHW and cognitive reactions, emotional/affective reactions, and smoking behavior. We conducted a mixed-methods study, which included a cross-sectional face-to-face survey of 401 smokers in four cities (Jakarta, Bandung, Semarang, and Yogyakarta) and three focus group discussions among 24 participants in Jakarta. We applied multiple logit regression in STATA for quantitative data analysis and explanatory sequential design for qualitative data analysis. Quantitatively, we found high (63-84% of respondents) understanding about PHW objectives (cognitive reactions), including to remind health risks and encourage smoking cessation. With only 40% PHW, we found relatively low (32%-39%) negative emotional reactions, including feeling scared, annoyed and disgusted and relatively low proportions (33-40%) of respondents that reported quit attempt. Consistent with the quantitative findings, qualitative data provided contexts, including in explaining that the professional worker group was the least affected by PHW, while the student and non-professional groups were the most vulnerable. All this is supportive of governments in Indonesia and other countries to increase the PHW size.
Graetz N, Woyczynski L, Wilson KF, et al., 2021, Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems, BMC Medicine, Vol: 19, Pages: 1-25, ISSN: 1741-7015
BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variati
Roth GA, Mensah GA, Johnson CO, et al., 2020, Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study., Journal of the American College of Cardiology, Vol: 76, Pages: 2982-3021, ISSN: 0735-1097
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost al
Lozano R, Fullman N, Mumford JE, et al., 2020, Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1250-1284, ISSN: 0140-6736
BackgroundAchieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.MethodsBased on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified
Murray CJL, Abbafati C, Abbas KM, et al., 2020, Five insights from the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1135-1159, ISSN: 0140-6736
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
Wang H, Abbas KM, Abbasifard M, et al., 2020, Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1160-1203, ISSN: 0140-6736
BackgroundAccurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019.Methods8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated usin
Murray CJL, Aravkin AY, Zheng P, et al., 2020, Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1223-1249, ISSN: 0140-6736
BackgroundRigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.MethodsGBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quant
Vos T, Lim SS, Abbafati C, et al., 2020, Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1204-1222, ISSN: 0140-6736
BackgroundIn an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.MethodsGBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of
Yunarman S, Zarkani A, Walid A, et al., 2020, Compliance with smoke-free policy and challenges in implementation: evidence from Bengkulu, Indonesia., Asian Pacific Journal of Cancer Prevention (APJCP), Vol: 21, Pages: 2647-2651, ISSN: 1513-7368
BACKGROUND: Smoking is among the top contributors to deaths and disability-adjusted life years in Indonesia, particularly among males. In 2012, a presidential decree encouraged provinces and districts to implement a smoke-free policy (SFP). This study aims to evaluate compliance and explore the challenges in the implementation. METHODS: Through a mixed-methods design, we used quantitative methods to examine the compliance with six criteria including signage, no active smoking, no selling, no advertisement, no smoke, and no ashtray at SFP facilities in Bengkulu city. We observed SFP compliance at 105 facilities, including health/educational facilities, places of worship, workplaces, and indoor/outdoor public facilities. We also used a qualitative method to explore challenges in the implementation through interviews with the government and legislators. RESULTS: The compliance rate to all six criteria was 38% overall, ranging from 17% at outdoor public facilities to 67% at health facilities. We found no spatial patterning, as shown by non-significant differences in compliance rates between SFP facilities inside and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included lack of sensitization, lack of coordination, and limited budget. CONCLUSION: The compliance was relatively low due to several challenges, which could serve as a tobacco control policy lesson in a lower-middle-income country.
Micah AE, Su Y, Global Burden of Disease Health Financing Collaborator Network, et al., 2020, Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3, The Lancet, Vol: 396, Pages: 693-724, ISSN: 0140-6736
Background Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available.Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH)from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated.Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was $5·1 billion (
Local Burden of Disease WaSH Collaborators, 2020, Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17., The Lancet Global Health, Vol: 8, Pages: e1162-e1185, ISSN: 2214-109X
BACKGROUND: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. METHODS: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. FINDINGS: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-
Local Burden of Disease 2019 Neglected Tropical Diseases Collaborators, 2020, The global distribution of lymphatic filariasis, 2000-18: a geospatial analysis., The Lancet Global Health, Vol: 8, Pages: e1186-e1194, ISSN: 2214-109X
BACKGROUND: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. METHODS: A global dataset of georeferenced surveyed locations was used to model annual 2000-18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000-18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. FINDINGS: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174-234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6-5·7 million) in the region of the Americas to 107 million (91-134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43-63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. INTERPRETATION: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thre
Sivasampu S, Teh XR, Lim YMF, et al., 2020, Study protocol on Enhanced Primary Healthcare (EnPHC) interventions: a quasi-experimental controlled study on diabetes and hypertension management in primary healthcare clinics, Primary Health Care Research and Development, Vol: 21, Pages: 1-12, ISSN: 1463-4236
Aim:This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called ‘Enhanced Primary Healthcare’ (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients’ experience and healthcare providers’ job satisfaction.Background:In 2014, almost two-thirds of Malaysia’s adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients.Methods:This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to ‘intervention’ and ‘control’ arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.
Adisasmito W, Amir V, Atin A, et al., 2020, Density of cigarette retailers around formal and informal educational facilities: Geospatial analysis in Indonesia, International Journal of Tuberculosis and Lung Disease, Vol: 24, Pages: 770-775, ISSN: 1027-3719
Background: With 61.4 million current smokers in 2018, Indonesia has contributed significantly to the number of smokers globally. The latest data showed an increasing smoking prevalence among youth. Objective: We examined the density of cigarette retailers around formal and informal educational facilities in Indonesia. Methods: We employed geospatial and quantitative analyses using data on cigarette retailers (from survey during July-August 2019) and educational facilities in Depok city. Data analyses, in ArcMap 10.6 and Stata 15, compared the density within 100 meters and 100-200 meters from the facility. Results: We found a 40%-higher density of cigarette retailers in areas closer to educational facilities. The higher density is similar between formal (i.e., primary, junior high, and senior high schools) and informal educational facilities (i.e., early years education centers and mosques). Moreover, the density is higher near primary schools and senior high schools, compared to the average. Conclusion: There is a higher density of cigarette retailers around formal and informal educational facilities for youth in Indonesia. This evidence confirms the need to regulate cigarette retailers near educational facilities, to enforce the ban on sale to minors, and to ban product displays at retailers.
Wiens KE, Lindstedt PA, Blacker BF, et al., 2020, Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17, The Lancet Global Health, Vol: 8, Pages: e1038-e1060, ISSN: 2214-109X
BackgroundOral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs.MethodsWe used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws.FindingsWhile ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively co
Hapsari D, Nainggolan O, Kusuma D, 2020, Hotspots and regional variation in smoking prevalence among 514 districts in Indonesia: analysis of basic health research 2018, Global Journal of Health Science, Vol: 12, Pages: 32-44, ISSN: 1916-9736
BACKGROUND: The prevalence among adult men in Indonesia is among the highest in the world. Objective: Our study examines the hotspots and regional variation in smoking prevalence among 514 districts in Indonesia.METHODS: Taking advantage of the latest national health survey (Basic Health Research, Riskesdas 2018), which included smoking prevalence representative at the district level. We assessed the smoking prevalence among male and female adults (15+ years) and youth (13-14 years). We conducted geospatial analyses, using ArcMap 10.6, including quintile analysis (mapping the smoking prevalence by quintile for each district) and hotspot analysis (using Getis-Ord Gi* statistics to produce the hotspots, areas with a significantly higher density of advertisements). We also conducted quantitative analyses, using Stata 15.1, on geographic disparity, including region and urbanicity.RESULTS: We found huge disparity in smoking prevalence between districts, ranging from 9 to 81% for men, 0 to 50% for, 0 to 41% for women, and 0 to 50% for girls. We found up to 62 and 47 smoking hotspots among males and females, respectively. The poorest districts had significantly higher smoking prevalence among men but lower smoking prevalence among boys, and less educated districts had higher smoking prevalence among women.CONCLUSION: There were significant hotspots and regional variations among 514 districts in Indonesia.
Kusuma D, 2020, Comparison of tobacco import and tobacco control in five countries: lessons learned for Indonesia, Globalization and Health, Vol: 16, Pages: 1-8, ISSN: 1744-8603
BackgroundWith a 264 million population and the second highest male smoking prevalence in the world, Indonesia hosted over 60 million smokers in 2018. However, the government still has not ratified the Framework Convention on Tobacco Control. In the meantime, tobacco import increases rapidly in Indonesia. These create a double, public health and economic burden for Indonesia’s welfare.ObjectiveOur study analyzed the trend of tobacco import in five countries: Indonesia, Pakistan, Bangladesh, Zimbabwe, and Mozambique. Also, we analyze the tobacco control policies implemented in these countries and determine some lessons learn for Indonesia.MethodsWe conducted quantitative analyses on tobacco production, consumption, export, and import during 1990–2016 in the five countries. Data were analyzed using simple ordinary least square regressions, correcting for time series autocorrelation. We also conducted a desk review on the tobacco control policies implemented in the five countries.ResultsWhile local production decreased by almost 20% during 1990–2016, the proportion of tobacco imports out of domestic production quadrupled from 17 to 65%. Similarly, the ratio of tobacco imports to exports reversed from 0.7 (i.e., exports were higher) to 2.9 (i.e., import were 2.9 times higher than export) in 1990 and 2016, respectively. This condition is quite different from the other four respective countries in the observation where their tobacco export is higher than the import. From the tobacco control point of view, the four other countries have ratified the Framework Convention on Tobacco Control (FCTC).ConclusionThe situation is unlikely for Indonesia to either reduce tobacco consumption or improve the local tobacco farmer’s welfare, considering that the number of imports continued to increase. Emulating from the four countries, Indonesia must ratify the FCTC and implement stricter tobacco control policies to decrease tobacco consumption and import.
Nurjanah N, Manglapy YM, Handayani S, et al., 2020, Density and hotspots of outdoor tobacco advertising around schools in Semarang, Indonesia: geospatial analysis, International Journal of Tuberculosis and Lung Disease, Vol: 24, Pages: 674-680, ISSN: 1027-3719
Background: Indonesia has the second-highest smoking prevalence among adult males in the world, with over 61.4 million current smokers. However, there is no national regulation on outdoor tobacco advertising. Objective: The study aims to assess the density and hotspots of outdoor tobacco advertisements around schools in Indonesia with Semarang city as an example. Methods: We conducted geospatial analyses using buffer and hotspot analyses using advertisement and school data in ArcMap 10.6. We statistically test the significance of different densities, including between area 100 meter and 100-300-meter buffers from schools using Stata 15.1. Results: We found a total of 3,453 advertisements, of which 3,026 (87%) were at least medium in size (1.3×l.9 meters), and 2,556 (74%) were within 300 meters from schools. We also found a 45% higher density of advertisements within 100-meter around schools (compared to within 100-300 meters). There were 378 schools (39%) were in the advertisement hotspots. Conclusion: There were high density and significant hotspots of outdoor tobacco advertising around schools in Semarang city. Policy implications were discussed.
Adisasmito W, Amir V, Atin A, et al., 2020, Geographic and socioeconomic disparity in cardiovascular risk factors in Indonesia: analysis of the Basic Health Research 2018, BMC Public Health, Vol: 20, Pages: 1-13, ISSN: 1471-2458
BackgroundCardiovascular diseases (CVDs) accounted for over 17 million deaths and 353 million disability-adjusted life years lost in 2016. The risk factors are also high and increasing with high blood pressure, smoking, and high body mass index contributed to up to 212 million disability-adjusted life years in 2016. To help reduce the burden, it is crucial to understand the geographic and socioeconomic disparities in CVD risk factors.MethodsEmploying both geospatial and quantitative analyses, we analyzed the disparities in the prevalence of smoking, physical inactivity, obesity, hypertension, and diabetes in Indonesia. CVD data was from Riskesdas 2018, and socioeconomic data was from the World Bank.ResultsOur findings show a very high prevalence of CVD risk factors with the prevalence of smoking, physical activity, obesity, hypertension ranged from 28 to 33%. Results also show the geographic disparity in CVD risk factors in all five Indonesian regions. Moreover, results show socioeconomic disparity with the prevalence of obesity, hypertension, and diabetes are higher among urban and the richest and most educated districts while that physical inactivity and smoking is higher among rural and the least educated districts.ConclusionThe CVD burden is high and increasing in particularly among urban areas and districts with higher income and education levels. While the government needs to continue tackling the persistent burden from maternal mortality and infectious diseases, they need to put more effort into the prevention and control of CVDs and their risk factors.
Reiner RC, Wiens KE, Deshpande A, et al., 2020, Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 395, Pages: 1779-1801, ISSN: 0140-6736
BackgroundAcross low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.MethodsWe used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.FindingsThe greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration
Priyono B, Hafidhah B, Wihardini W, et al., 2020, Removal of point of sale tobacco displays in Bogor city, Indonesia A spatial analysis, Tobacco Prevention and Cessation, Vol: 6, Pages: 1-9, ISSN: 2459-3087
Introduction:Indonesia contributes over 61 million smokers to global tobacco users, and the smoking prevalence is increasing among young people. In October 2017, Bogor city started the ban on tobacco displays at point-of-sale (POS), starting with modern cigarette retailers. This study aims to assess compliance with the ban and the visibility of POS with tobacco displays around educational facilities.Methods:We included 266 modern retailers surveyed throughout the city during November and December 2017. Compliance indicators included no tobacco product displays, advertisements, promotions, and sponsorship. We conducted spatial and quantitative analyses in ArcMap 10.6 and Stata 15.1, respectively.Results:Immediately following the ban, the compliance with all four criteria was high (83%). However, POS in areas with higher population density and poverty rates had significantly lower compliance. We also found that the ban reduced the visibility of tobacco displays around schools and universities.Conclusions:Compliance with the ban was high, which helped to reduce the visibility of tobacco displays around educational facilities.
Wahidin M, Hidayat MS, Arasy RA, et al., 2020, Geographic distribution, socioeconomic disparity, and policy determinant of smoke-free policy adoption in Indonesia, International Journal of Tuberculosis and Lung Disease, Vol: 24, Pages: 383-389, ISSN: 1027-3719
Background: Indonesia has the second highest smoking prevalence among adult male in the world and smoking prevalence is increasing among youth. Objective: We evaluated the smoke-free policy (SFP), a flagship national tobacco control, by providing evidence on geographic distribution, socioeconomic disparity, and policy determinants of SFP adoption by districts in Indonesia. Methods: We employed spatial and quantitative methods. The former provided evidence on geographic distribution of the adoption and the latter provided evidence on the disparity and associations between the national and provincial SFP regulations and adoption by districts. Results: Twenty one of 34 provinces adopted SFP and 345 of 514 districts did. We found significant geographic disparity: all districts outside of Papua were up to 6.3 times more likely to adopt and up to 3 years longer in duration. We also found significant socioeconomic disparity: urban, richest, and most educated districts were 3.9 times, 9.1 times, and 2.8 times more likely to adopt, respectively. Moreover, districts within provinces that had SFP regulation were 3.2 times more likely to adopt. Lastly, the national regulations were associated with district adoption. Conclusion: In addition to geographic and socioeconomic disparity, the national and provincial regulations and policy were determinants of adoption.
Trisnowati H, Kusuma D, Ahsan A, et al., 2019, Smoke-free home initiative in Bantul, Indonesia: Development and preliminary evaluation, Tobacco Prevention and Cessation, Vol: 5, Pages: 1-5, ISSN: 2459-3087
Introduction:Tobacco control policies in Indonesia are still limited. This study aims to describe the process of the implementation of the smokefree home (SFH) program in rural areas in Indonesia and to conduct a preliminary evaluation of its implementation.Methods:The development of SFH (or Rumah Bebas Asap Rokok) applies the theory of diffusion of innovation with the following stages: innovation, dissemination, adoption, implementation, and evaluation. The preliminary evaluation of the SFH program used an observational method combined with a cross-sectional survey. The population of this study was all houses in Karet hamlet, in Bantul district, Yogyakarta province with 378 houses as population, from which 196 houses were selected as sample using the proportional random sampling technique. Quantitative data analysis used multiple linear regression in Stata 15.1.Results:SFH is a community-based tobacco control innovation program that began with a community declaration. Preliminary evaluation after one-year implementation showed that 55% and 45% of respondents were smokers and non-smokers, respectively. Among smokers, 95%, 78% and 56% reported not smoking near pregnant women, children, and nonsmokers, respectively. Moreover, 52% of respondents reported having a front-door ashtray, and 46% reported guests not smoking; among nonsmokers, the corresponding values were 56% and 60%.Conclusions:SFH implementation has an impact on the community’s smoking pattern. Awareness of smokers to protect women and children from secondhand smoke is very high. While the results are promising, more political and resource support is needed from the local and national policymakers to support SFH initiatives.
Wahyuti W, Hasairin SK, Mamoribo SN, et al., 2019, Monitoring compliance and examining challenges of a smoke-free policy in Jayapura, Indonesia, Journal of Preventive Medicine and Public Health, Vol: 52, Pages: 427-432, ISSN: 1975-8375
Objectives: In Indonesia, 61 million adults smoked in 2018, and 59 million were exposed to secondhand smoke at offices or restau- rants in 2011. The Presidential Decree 109/2012 encouraged local governments to implement a smoke-free policy (SFP), and the city of Jayapura enacted a local bill (1/2015) to that effect in 2015. This study aimed to evaluate compliance with this bill and to explore challenges in implementing it.Methods: We conducted a mixed-methods study. Quantitatively, we assessed compliance of facilities with 6 criteria (per the bill): the presence of signage, the lack of smoking activity, the lack of sale of tobacco, the lack of tobacco advertisements, the lack of cigarette smoke, and the lack of ashtrays. We surveyed 192 facilities, including health facilities, educational facilities, places of worship, govern- ment offices, and indoor and outdoor public facilities. Qualitatively, we explored challenges in implementation by interviewing 19 in- formants (government officers, students, and community members).Results: The rate of compliance with all 6 criteria was 17% overall, ranging from 0% at outdoor public facilities to 50% at health facili- ties. Spatial patterning was absent, as shown by similar compliance rates for SFP facilities within a 1-km boundary around the provin- cial and city health offices compared to those outside the boundary. Implementation challenges included (1) a limited budget for en- forcement, (2) a lack of support from local non-governmental organizations and universities, (3) a lack of public awareness at the facil- ities themselves, and (4) a lack of examples set by local leaders.Conclusions: Overall compliance was low in Jayapura due to many challenges. This information provides lessons regarding tobacco control policy in underdeveloped areas far from the central government.
Megatsari H, Ridlo IA, Amir V, et al., 2019, Visibility and hotspots of outdoor tobacco advertisement around educational facilities without an advertising ban: Geospatial analysis in Surabaya City, Indonesia, Tobacco Prevention and Cessation, Vol: 5, ISSN: 2459-3087
Introduction:Despite having over 60 million smokers in 2018, Indonesia still lacks tobacco control measures, including an outdoor tobacco advertising ban. This study aimed to provide evidence on the visibility and hotspots of advertisements around educational facilities in a city without a ban.Methods:We collected data on the locations of outdoor tobacco advertisements and schools and universities in Surabaya city. We conducted buffer and hotspots analyses using ArcMap. Using Getis-Ord Gi* statistics, hotspot analysis identifies significant clusters with a high number of advertisements.Results:We found 307 large and medium-sized outdoor tobacco advertisements and 1287 educational facilities (1199 schools, 88 universities). Almost 80% of those advertisements (237 units) were just 300 m away (10-minute walk) from primary schools and high schools in the city. More than half of all schools (652) and two-thirds of all universities (59) were inside hotspots where there were statistically significant clusters with a high number of advertisements. These hotspots were more densely populated and more-deprived areas.Conclusions:There was high visibility of large and medium-sized outdoor tobacco advertisements around educational facilities in the city without the ban.
Kusuma D, Kusumawardani N, Ahsan A, et al., 2019, On the verge of a chronic disease epidemic: comprehensive policies and actions are needed in Indonesia., International Health, ISSN: 1876-3405
In the midst of tackling the persistent burden of maternal mortality and infectious diseases, Indonesia is facing an increasing burden of non-communicable diseases (NCDs). Although there are increasing national efforts in NCD prevention and control, the worsening trend of NCD risk factors and morbidity is alarming. We provided assessment and discussion on the policies and actions needed in the country including comprehensive efforts to reduce tobacco use and unhealthy diet, the need to reorient the health systems for better NCD prevention and control, and the promotion of NCD-related research that are still lacking.
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