Yusuf Ari Mashuri

Introduction: This study explored the experiences of medical students and lecturers with e-learning online resources on tropical medicine in Indonesia to find opportunities to enhance medical education. Methods: This was a mixed-methods study conducted between July and September 2022. The study involved academic staff and students from 13 universities in Indonesia. The universities were selected using stratified random sampling with consideration of accreditation level and geographical location. A survey with a structured self-reported questionnaire was conducted among 888 undergraduate and clinical medical students. For the qualitative study, 19 students and 12 academic staff participated in focus group discussions until data saturation was reached. Quantitative data were analysed descriptively, while thematic analysis was used to analyse the qualitative data. Results/discussion: Our study found that most of pre-clinical students never accessed a specific e-learning platform for tropical medicine (68.2%, n = 345), meanwhile, the majority of clinical students had ever accessed e-learning platforms (51.6%, n = 197) for tropical medicine, thus showing a statistically significant difference (p-value of <0.001) between both groups. The most used resources to learn tropical medicine consisted of online journals by both pre-clinical (58.7%, n = 297) and clinical students (74.1%, n = 283). Online journals were said to help students a lot to understand tropical medicine concepts because of the quality information they provide. Google Scholar was the most common search engine used to seek information. While there was not yet a specific e-learning platform for tropical medicine, both pre-clinical (88.8%, n = 409) and clinical students (73.0%, n = 279) hoped for the improvement of e-learning platform quality (p-value of 0.006) that had existed. Students have the perception that e-learning has a role as a learning tool that can support them, especially clinical students, to reach their competence in tropical medicine, even though there are barriers related to infrastructural aspects, including internet access and limited user-friendly and local platforms on tropical medicine. Conclusion: Preclinical and clinical students have the advantages of using e-learning on tropical medicine, even though there are some barriers related to access. However, specific e-learning platforms for tropical medicine are still very limited. Due to the importance of digital skills for the students as a medical professional in the future, there is an interest in developing a user-friendly e-learning platform specific for tropical medicine to facilitate medical students’ learning.

COVID-19 pandemic known to affect health service deliveries including for HIV care support and treatment. In this retrospective study involving 2,780 people living with HIV (PLHIV), we evaluated impact of COVID-19 pandemic by comparing the proportion of PLHIV linked to care, started antiretroviral therapy (ART), retained in care (within the first 3 months of treatment), and adhered to ART (within the first 3 months of treatment) between the pre-pandemic period (2018–2019) and pandemic period (2020–2021) in Yogyakarta and Bandung, Indonesia. Our study showed that during the pandemic period the number of PLHIV linked to care was 18% lower (1,529 vs 1,251) and those retained in care was significantly lower (59.6% vs 53.3%, p = 0.0009) than the pre-pandemic period. Whereas, proportion in ART initiation (79.6% vs 78.3%, p = 0.3892) and ART adherence (50.0% vs 46.8%, p = 0.1010) were not statistically different. Multivariate analysis showed that ART initiation (aOR = 1.00, p = 0.996) nor retention in care (aOR = 0.90, p = 0.344) were not significantly different between two period cohorts. Adherence for the first three months of treatment, however, was significantly higher in the pandemic cohort (aOR = 1.53, p = 0.009). In the subgroup analysis, older PLHIV and those attending hospitals (tertiary versus primary care clinics) were significantly less likely to initiate ART, be retained in care, or adhere to ART. This study provides evidence of the impact of the COVID-19 pandemic on several characteristics of the HIV treatment cascade such as lower number of linkage to- and retention in care, lower number of older PLHIV, and attendance to tertiary care (hospital). General and HIV-specific mitigation strategies should be designed to minimise pandemic related disruptions and to support the continuity of HIV care to face possible future health crises.

Background: Skin disorders are symptoms and signs that appear on the skin, such as redness, itching, bumps, cracked skin, and dry scaly skin caused by bacteria, viruses, fungi, parasitic infections, allergic reactions, and personal hygiene factors. Workers, including waste pickers and scavengers, often neglect their personal hygiene habits. The risk of skin disorders is also due to their activities that are always in contact with waste that accumulates in landfills. Purpose: This study aimed to determine the relationship between personal hygiene and skin disorders in workers at Putri Cempo landfill, Surakarta. Methods: An analytic observational study with a cross-sectional design using convenience sampling was conducted. The study included a total of 51 waste haulers and 22 scavengers. Personal hygiene data collection was carried out by filling out a questionnaire; kin disorder data was collected by analyzation of symptoms and direct observation of signs of skin disorders in workers. The Chi-Square test and Cramer's V test were used to assess the association. Result: The prevalence of skin disorders among workers at Putri Cempo landfill, Surakarta, was 46.6%. The predilections of skin disorders were on the hands, feet, and nails, with 31.5% itchy complaints and 17.8% dry and scaly skin. There was a significant relationship (p <0.001) with a moderately strong correlation (v = 0.431) between personal hygiene and skin disorders. Conclusion: Personal hygiene is significantly associated and moderately correlated with skin disorders in workers at Putri Cempo landfill, Surakarta. A comprehensive approach to tackle the problems are urgently needed.

Objectives In Indonesia, antibiotics are often purchased without a prescription at community pharmacies, contrary to current regulations. This practice may increase the risk of out-of-specification (OOS) medicines being dispensed, potentially contributing to treatment failure and antibiotic resistance. To address this concern, we assessed the quality of antibiotics purchased without a prescription at private drug retail outlets (PDROs) in Indonesia. Design and setting We conducted a cross-sectional study in Tabalong and Bekasi, Indonesia, using standardised patients (SPs) who purchased antibiotics without a prescription for three clinical scenarios: upper respiratory tract infection (URTI), tuberculosis (TB) and child diarrhoea. The pharmacies and drug stores were randomly selected from each subdistrict based on the probability proportional method. We measured the active pharmaceutical ingredient (API) content of the antibiotic samples using high-performance liquid chromatography (HPLC). Samples and analysis The quality of 183 antibiotics including amoxicillin tablets (148/183, 80.9%, 95% CI 74.7% to 86.1%), amoxicillin dry syrup (12/183, 6.6%, 95% CI 3.6% to 10.8%), ampicillin tablets (5/183, 2.7%, 95% CI 1.1% to 5.9%) and ciprofloxacin tablets (18/183, 9.8%, 95% CI 6.2% to 14.8%) obtained from 117/166 (70.5%, 95% CI 62.8 to 77.2) PDROs were tested. Descriptive statistics were used to describe the characteristics of the purchased antibiotics, and the API content of each antibiotic was compared against the United States Pharmacopeia 43-National Formulary 38 (USP 43-NF 38) standards in absolute values and percentages. Results Almost all samples produced in Indonesia (182/183, 99.5%, 95% CI 97.5% to 99.9%) were unbranded (123/183, 67.2%, 95% CI 60.2% to 73.7%) or branded generic (60/183, 32.8%, 95% CI 26.3% to 39.8%) and packaged in strips (165/183, 90.2%, 95% CI 85.2% to 93.8%). Around 12/183 (6.6%, 95% CI 3.6% to 10.8%) antibiotics were found to be OOS; these were mostly amoxicillin 125 mg dry syrup (6/12, 50%, 95% CI 24.3% to 75.7%) and ciprofloxacin 500 mg tablet (5/18, 27.8%, 95% CI 11.5% to 50.6%). Around 33% (4/12, 95% CI 12.5% to 61.2%) of amoxicillin 125 mg dry syrup samples had an API content above the label claim, the highest being 187%, whereas 16.7% (2/12, 95% CI 3.6% to 43.6%) were below the label claim, the lowest being 64%. About 27.8% (5/18, 95% CI 11.5% to 50.6%) of ciprofloxacin samples tested had an API content above the label claim; the highest was 120%. Conclusion While the proportion of OOS antibiotics identified was relatively small, at a population level, it represents a significant proportion of sub-optimally treated infections.

Introduction: Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia. Methods: A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ² tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics. Findings: Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9% (76.3%–55.4%) compared with 2.3% (84.6%–82.3%) in the non-participating group (p value <0.001). Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95% CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95% CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present. Interpretation: Multifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed.

Introduction: Recent evidence shows that there is an increase in the incidence of pulmonary mycosis globally. In clinical settings, pulmonary mycosis is commonly misdiagnosed as pulmonary tuberculosis (PTB). Identifying risk factors can ease the diagnosis of pulmonary mycosis. This study aimed to determine the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta.Methods: This was an analytic observational study with a retrospective cohort study method. This study used purposive sampling technique on 218 medical records of immunocompromised patients during January 2019–September 2022 at a referral hospital in Surakarta. The correlation of sociodemographic, health status, health behavior, history of diseases, medications, and transplantations with the incidence of pulmonary mycosis was analyzed using Chi-Square test or Fisher’s exact test as its alternative.Results: There was a significant correlation between educational level (p=0.018), nutritional status (p=0.001), smoking habit (p=0.000), history of corticosteroid use (p=0.031), history of antibiotic use (p=0.006), history of chemotherapy (p=0.003), history of PTB (p=0.047), and history of chronic obstructive pulmonary disease (COPD) (p=0.001) with the incidence of pulmonary mycosis. Meanwhile, there was no significant correlation between occupation (p=0.057), neutrophil level (p=1.000), history of human immunodeficiency virus (HIV) infection (p=1.000), history of diabetes mellitus (DM) (p=0.070), and history of organ transplantation (p=1.000) with the incidence of pulmonary mycosis.Conclusion: Low educational level, malnutrition, smoking habit, history of pulmonary diseases, and medications are the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta. It is important to identify these risk factors when examining patients with respiratory disorder symptoms.

Introduction In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care. Methods We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018–19); and during COVID-19 (2020–21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic. Results There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers. Conclusion The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.

Background: A high prevalence of hypertension is found in Low- and Middle-income Countries (LMICs) including in Indonesia. However, hypertension awareness, treatment, and control are relativity poor. A community-based program to screen and educate people on non-communicable disease prevention (POSBINDU) was launched by the Indonesian government. However, the association between participation in the POSBINDU program with increasing knowledge, attitude, and practice of hypertension has not been widely assessed. In this study, we compared the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU program. Subsequently, factors associated with the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU were explored.Methods: This was an observational study with a cross-sectional design measuring the knowledge, attitudes, and practices for hypertension control in four districts in Indonesia from October 2019 to January 2020. A total of 1,988 respondents were included in this study. A questionnaire was used to assess the knowledge, attitudes, and practices of hypertension. Simple logistic regression was used to investigate the correlation between the characteristics of respondents and knowledge, attitudes, and practice status. Multiple logistic regression tests were conducted to investigate factors associated with knowledge, attitudes, and practice status.Results: We found that people who accessed POSBINDU had higher odds of having better knowledge (aOR:1.4; 95%CI:1.2–1.8), however, accessed to POSBINDU was associated with lower attitudes (aOR:0.6; 85%CI: 0.5–0.7) and had no association with hypertension-related practice.Conclusion: People who accessed POSBINDU have an association with good knowledge, but the association with good attitude and practice was less clear. Therefore, an improvement in the POSBINDU program is needed to increase the attitudes and practices of hypertension.

Human sparganosis, a parasitic infection prevalent in Asia, can progress to cerebral sparganosis, a severe condition with significant neurological symptoms. Diagnosis and treatment are challenging due to its clinical similarity to other infections, highlighting the need for improved detection and management strategies. The aim of this study was to observe research trends, key contributors, gaps in the existing knowledge, diagnosis challenges, effective treatment options, and prevention strategies, providing recommendations for future research directions and clinical practice improvements on cerebral sparganosis. A bibliometric analysis was conducted by extracting 139 documents from the Scopus database in June 2024. The retrieved data were analyzed using the R package's Bibliometrix (Biblioshiny) and VOSviewer. Spanning 97 different sources, the research exhibited an annual growth rate of 2.5%. Annual scientific production revealed fluctuating research activity with peaks in 2010 and 2011 and notable citation peaks in 1996 and 2005, indicating pivotal studies that significantly influenced subsequent research. Early studies focused on diagnosis and specific parasites, while recent studies (2010–2024) have increasingly addressed clinical outcomes, treatment strategies, and advanced diagnostic techniques. Trends revealed a shift towards clinical and diagnostic advancements, with recent emphasis on diagnostic imaging, immunoassays, and the relationship between cerebral sparganosis and brain tumors. In conclusion, the studies on cerebral sparganosis underscore the potential for enhancing clinical practice by improving diagnostic accuracy, informing treatment decisions, and implementing targeted screening efforts based on epidemiology and risk factors. Recommendation to further study needs to notify the cerebral sparganosis in high-risk countries with similar socioeconomic and cultural characteristics to endemic regions, including Indonesia.