Browsing by Subject "Indonesia"

Introduction: Globally, acute respiratory infections (ARIs) are the leading cause of mortality and death among children below 5 years of age and adults of all ages. The disease burden due to ARIs is particularly high in low-to-middle income countries (LMICs) like Indonesia where the tropical climate, poverty-associated malnutrition, overcrowding, and air pollution increase the risk of infections from airborne pathogens. Although, the global burden of respiratory viruses such as respiratory syncytial virus, influenza, and enteroviruses has been broadly studied, there remains a lack of effective and continuous surveillance data to understand the full impact of respiratory viruses in Indonesia and other LMICs. Additionally, due to crowded conditions, inadequate ventilation, and poor sanitation, health care centers in LMICs may be hot spots for rapid transmission and exchange of respiratory viruses. In such settings, bioaerosol sampling, which is a low cost, rapid and noninvasive method for surveillance of respiratory pathogens, has been shown to be an effective tool for surveillance of respiratory viruses. Therefore, in this study, we conducted surveillance for influenza A virus and enterovirus using bioaerosol and surface swab sampling in a clinical setting located in Jakarta, Indonesia.

Methods: In this study, we performed bioaerosol sampling and surface swab sampling for 8 days during August 2019, inside a tertiary care hospital located in Eastern Jakarta, Indonesia. The sampling sites included a common waiting room, a triage room, and a physician’s room with clinical staff and patients present during sample collection. We used a SKC BioSampler with a BioLite Air Sampling Pump (run for 60 min at 5 L/min) with polytetrafluoroethylene Teflon filter cassettes and sterile nylon-flocked swabs to take surface swab samples. Temperature and humidity data were also collected at each sampling site concurrently. Viral RNA was extracted from bioaerosol samples and surface swabs using the QIAamp Viral RNA Mini Kit. Extracted Viral RNA was assessed with real-time RT-PCR (qRT-PCR) assays using the SuperScript® III Platinum One-Step qRT-PCR System with Platinum® Taq DNA Polymerase for the detection of influenza A and human enterovirus.

Results: Overall, 5 (7.8%) of the 64 specimens indicated evidence of Influenza A, with 4 (12.5%) positive for influenza A virus among 32 bioaerosol samples, and 1 (3.12%) positive for influenza A virus, among 32 surface swab samples. We repot no enteorvirus positive from our samples.

Conclusions: The gaps in surveillance of respiratory viruses from LMICs countries like Indonesia can be fulfilled by adopting bioaerosol sampling method, which is noninvasive, effective, cost friendly and rapid surveillance method. Combined with molecular assays, aerosol sampling has potential to detect respiratory viruses in health care settings. These surveillance techniques using bioaerosol samplings in one way, will help to generate evidence based scientific studies to identify prevalence of respiratory viruses in different settings, while in another way might facilitates to improve global and national polices for surveillance and early detection of respiratory viruses.

Background: Indonesia has one of the highest TB burdens in the world and is one of ten countries that accounted for 77% of the global gap between treatment enrollment and the estimated number of new cases of MDR/RR-TB in 2019. However, there are knowledge gaps about how the delay of MDR-TB treatment initiation might affect this situation. Therefore, this study aimed to examine challenges of implementing MDR-TB treatment initiation in a Programmatic Management of Drug-Resistant Tuberculosis (PMDT) national referral hospital in Indonesia. Method: This study used mixed methods to collect both quantitative data through hospital records of MDR-TB patients and qualitative data through interviews with patients and health workers. Result: The median time between diagnosis and treatment initiation was 26 days, and was associated with co-morbidities, MDR-TB knowledge, and support assessment. This study also revealed the complex situation of people affected with MDR-TB with lack of social support and health system challenges during the MDR-TB treatment initiation process. Conclusion: The results of this study revealed the challenges of the treatment initiation process from the complex perspectives of the patients, the aspects of the health system that need to be improved, and the importance of social support starting from diagnosis.

How can we understand patterns of upward mobility, and the forces that may shape these patterns, in places undergoing rapid social and economic change? Many of the places where today’s young people are growing up are “developing” countries. The realities and choices young people are navigating in these places can be quite different than those their parent’s faced. Both the measures used to describe these young people’s place in their social worlds and policy supports must adapt, and continue adapting, through this change. In the first chapter, I consider the socio-economic composition of one elite destination: engineering bachelor’s degrees in India. This national context is one of many where rapid expansion in higher education has taken places in the last decade. Yet it remains unclear whether all young people from across the socio-economic spectrum are present in higher education, a question complicated by gaps in data, unfit measures, and the unknown influence of rapid change itself on definitions of socio-economic origins. This paper addresses these bigger questions by focusing on one potential pathway to socio-economic advantage: engineering undergraduate degrees in India. I find five distinct socio-economic origin subgroups within the student body, using Latent Class Analysis, a model-based technique for identifying hidden populations. A significant proportion of India’s engineering students come from backgrounds of mixed advantage and disadvantage, with socio-economic disadvantages cooccurring alongside rural and/or low caste backgrounds. This complexity is less apparent using traditional one-dimensional measures of socio-economic status. Additionally, I find that the process of gaining access likely differs between institutional quality tiers. A higher proportion of groups eligible for affirmative action, and a lower proportion of women, regardless of socio-economic origins, attend top tier institutions. This divergent pattern suggests different attainment processes, and that enrollment policies may provide some narrow support for expanding opportunity. More broadly, these findings suggest that context specific, multidimensional approaches to social stratification in places experiencing significant change can both improve our understanding of status attainment and more directly inform opportunity enhancing policy. In a second paper, I zoom out from the specific destination approach in the first paper, instead considering the population level trajectories of the 1980’s birth cohort in Indonesia, using panel data from the Indonesia Family Life Survey. I again consider multiple dimensions of status, examining changes in the distribution of educational attainment, occupations, and household consumption over 20 years. I find that education, the most common way of measuring upward mobility in developing countries, suggests lower rates of upward mobility than occupation or consumption, but urge caution in making these comparisons given the unique nature of each hierarchy. Significant upward shifts in the education distribution between parents and children, unaccompanied by commensurate shifts in occupation make comparison difficult. Secondly, I measure the occupation, salary, and consumption distributions for those who reach the “top” of the education distribution, finding significant heterogeneity. Taken together, I suggest that untangling these complexities for one cohort is a useful complement to the extant literature on cross-national comparisons of educational mobility. The final paper represents a departure from the preceding two. This paper is co-authored with Carolyn Barnes who served as lead author. In this paper, we investigate a gap in the literatures on social support, social ties, and childcare. This qualitative study applies concepts from social capital theory to examines 1) how social ties between parents and staff members develop and vary and 2) how parents mobilize these ties for resources. In doing so, we analyze 23 in-depth staff interviews and 48 parent interviews across three after-school programs. We find that a select group of parents develop and activate strong social ties with staff for social support. Strong tie development reflects a distinct social process of rapport building, time, shared experiences, and pivotal moments in which staff members demonstrate trustworthiness. While distinct, I argue this paper contributes to a broader research agenda on measurement of processes and outcomes within a specific context, illuminating insights missed by large scale comparisons.

Background: Indonesia has a population of over 69 million women of reproductive age and struggles to reduce national maternal mortality rates. The transitioning health system must contend with improving the quality of maternity care. This study aimed to investigate the provision of maternity care from the perspective of two key stakeholders: providers and clients. Methods: We conducted individual, in-depth qualitative interviews with 31 pregnant and postpartum mothers and held two focus group discussions with 10 midwives in a community health center to examine attitudes and perceptions of quality maternity care. We then analyzed data through mapping emergent themes to the WHO QMNC framework. Results: Participants across both groups most frequently referenced interpersonal relationships, more than physical or human resources, as the main determinate to perceptions of quality care. Additionally, socioeconomic, religious and cultural factors also played a significant role in the provision of care; yet, was not fully captured in the definition of quality care. Conclusions: Interpersonal relationships are critical components to the provision of quality care. Investments in further fostering these relationships are important in strengthening the capability of the health system to provide safe, effective and high quality maternity care.

This research evaluates the potential for regulatory measures governing oil palm plantation expansion, and corporate voluntary sustainability commitments in the oil palm industry, to contribute to forest protection and greenhouse gas emissions reduction goals at regional and national scales, using case studies from Indonesia and Gabon. Globally, agricultural production will need to increase by 60–110% by 2050, to meet anticipated demand for food, fiber and biofuels (Alexandratos and Bruinsma, 2012; Tilman et al., 2011). Achieving this increase without negative consequences for forests, biodiversity, and climate will require innovative solutions including increasing productivity, minimizing waste and inefficiencies, improving food distribution and access, shifting diet preferences, and optimizing land use (Foley et al., 2011; Godfray et al., 2010; Newton et al., 2013). Palm oil, which comprises 35% of global vegetable oil consumption, is emblematic of this challenge (Sayer et al., 2012). The production of palm oil is increasing more rapidly than any other oil crop, and an increasingly urban and wealthy global population is anticipated to drive further demand (Hertel, 2011). In Southeast Asia, where 87% of global palm oil production is currently concentrated, industrial-scale plantations nearly quadrupled in extent from 1990–2010 (Gunarso et al., 2013), and drove the conversion of millions of hectares of forest and peat lands (Carlson et al., 2013; Koh et al., 2011). There is therefore growing concern among environmental advocates that, if appropriate safeguards are not put in place, future expansion of oil palm cultivation will reflect historical patterns, leading to the continued destruction of biodiversity- and carbon-rich forest landscapes (Linder, 2013; Wich et al., 2014). In response to these concerns, government and private sector stakeholders have proposed or established policies aimed at minimizing the negative environmental consequences of oil palm production. Here, I investigate the potential impacts of these programs and policies by examining historical trends in industrial-scale oil palm plantation expansion patterns, predicting business-as-usual trajectories of future plantation expansion, and estimating the potential impacts of alternative policy scenarios on future plantation development, and on forests, peatlands, and carbon stocks. In Chapter 1, I provide background information on palm oil and its uses, cultivation requirements, production patterns, and documented environmental impacts. I additionally discuss actual or proposed government regulations and private sector sustainability initiatives that are relevant in the contexts of Indonesia and/or Gabon. In Chapter 2, I present an analysis of patterns of oil palm expansion, and impacts on forest and peat lands, in Indonesia from 1995–2015. In Chapter 3, I develop predictions of future Indonesian oil palm expansion under a range of policy scenarios, and provide estimates of the extent to which these scenarios will contribute to forest protection and concomitant CO2 emissions reductions. In Chapter 4, I evaluate the extent to which greenhouse gas emissions reductions in the oil palm sector will contribute to Indonesia’s national mitigation goals, given uncertainties in the current national greenhouse gas inventory system. In Chapter 5, I develop national suitability maps for oil palm cultivation in Gabon, a new frontier of oil palm expansion, and identify priority areas which have the potential to support production goals while protecting forest landscapes. Finally, I summarize findings across these studies, present next steps, and provide concluding remarks in Chapter 6.