Community Health Posts Research Articles

Stop stunting-A misguided campaign by well-meaning nutritionists.

"Stop stunting" is the central focus of the national Indonesian campaign to improve child health. We provide an autoethnographic statement on the currently practiced strategy that commits 23 ministries and an estimated $3.9 billion per year to coordinating nutrition interventions that are supposed to address the underlying causes of stunting. We visited six community health posts (posyandus) in West Timor and in Java and participated in routine child health examinations. We documented our impressions and discussed them with Indonesian colleagues, health officials, and local physicians. Routine health checks for children include anthropometry (height, weight, head, and mid-upper arm circumference), immunizations, and documentation in the children's health records. The examinations do not include a physical examination, vision and hearing tests of the child, health questionnaires, or information on nutrition. No specific information or recommendations are given to the mothers. Stunting is highly prevalent in Indonesia and "Stop-stunting" campaigns have become a national issue. Yet, their impact is disillusioning. Stunting is associated with a way of life that differs from that in developed Western countries today and was prevalent in feudal and other nondemocratic societies. We do not want to throw away policies that try to improve growth in children, but instead of spending money for dubious interventions as we have encountered in Indonesia, we rather suggest spending thoughts on the political and emotional causes of poor growth in otherwise healthy Indonesian children.

Prevalence of urinary tract infections in pregnancy in rural Andean communities of Peru.

Urinary tract infections (UTIs) can adversely affect pregnancy, yet their prevalence in rural communities remains poorly understood. For an initial evaluation of the UTI burden among pregnant women in the San Marcos province of rural Andean Peru, we aimed to determine the UTI prevalence in the region. A cross-sectional study was conducted in a subsample of 250 pregnant women enrolled in the Peruvian Andes Multigenerational High Altitude Cohort (ALTO) from 2021 to 2022. Structured questionnaires were administered to collect demographic, socioeconomic, maternal health and behavioural data. Urine samples were obtained for dipstick analyses. Descriptive and logistic regression analyses were performed to investigate the association between risk factors and UTI. The study participants had a median age of 28 years (IQR: 22-33). A UTI prevalence of 27.6% (CI: 22.4%-33.5%) was observed, surpassing estimates from other regions of Peru. Notably, nearly all pregnant women (96%) utilised antenatal care (ANC) services at least once, primarily visiting health centres and community health posts where doctors and obstetricians were the main care providers. In this population, none of the risk factors exhibited statistically significant associations with UTIs. Our study highlights the prevalence of UTIs among Andean pregnant women in San Marcos and underscores the critical need for routine UTI screening and treatment during ANC visits as recommended by national guidelines. While accessibility to ANC services is not a barrier in this region, enhancing the availability and quality of UTI screening services is crucial.

Potensi Kader Posyandu sebagai Tenaga Skrining Early Childhood Caries (ECC) Tidak Terawat

Background: Early Childhood Caries (ECC) is a significant health problem. Untreated ECC can have substantial impacts on individuals and communities, causing pain, disrupting functions, hindering the child's growth process, affecting the child's weight, and influencing the child's developmental progress, ultimately reducing the quality of life for the child. Preventive efforts for untreated ECC include activities such as ECC screening, allowing for prompt intervention in cases of untreated ECC. Non-dental health personnel, such as community health workers, are alternative resources that can be empowered to participate in screening for untreated ECC using pufa Index. Purpose: to analyze the level of validity and reliability of community health workers in conducting screening for untreated ECC using the pufa index. Methods: The research design involves diagnostic testing with a cross-sectional approach, and samples are taken from children in community health posts using simple random sampling. The study is conducted in the working area of the Sijunjung Health Center, Sijunjung District, West Sumatra. Results: The reliability of cumulative PUFA examinations by Community health workers with a Kappa value of 0.88 is considered a very strong level of agreement. The sensitivity and specificity values of cumulative PUFA are 96% and 94%, respectively, which indicate excellent diagnostic values. This means that Community health workers demonstrate a very strong level of agreement and excellent accuracy in diagnosing untreated ECC using the PUFA index in young children. Conclusion: Community health workers have great potential to be empowered as personnel for screening untreated ECC using pufa index.

Medication Use and Associated Factors Among Indonesian Pregnant Women: A Cross-Sectional Study.

Medication use during pregnancy should be considered carefully due to its potential harm to the fetus. Data on prescribed medication and self-medication among Indonesian pregnant women is lacking. This study aimed to assess the prevalence and factors related to medication use among pregnant women attending antenatal care services at community health posts in Soreang, a suburban area in Indonesia. A cross-sectional community-based study was conducted. Data on medication use, excluding supplements, were collected. Medication was categorized using the former United States Food and Drug Administration (US FDA) pregnancy risk classification system. Proportions of pregnant women using prescribed medication and self-medication during pregnancy and associated factors were calculated. A total of 439 pregnant women were enrolled. There were 155 (35.5%) subjects who used at least one medication during pregnancy. These subjects had medical problems as the reasons for medication use. Among medication users, prescribed medication and self-medication were demonstrated in 138 (89.0%) and 17 (11.0%) pregnant women, respectively. There was a pregnant woman who was exposed to category D medication. Self-medication among pregnant women was less likely when health insurance was available (adjusted OR = 0.11, 95% CI: 0.027-0.413, P = 0.001). The prevalence of medication use among Indonesian pregnant women is high. The presence of health insurance was protective against self-medication among pregnant women. Safe and effective practices in prescribing have to be ensured for pregnant women.

Google Form Training for Healthcare Professionals to Enhance Services at Belimbing Health Center, Padang City

Google Form is one of Google's free applications that serves various purposes. This application assists in managing registrations, creating opinion surveys, gathering social data, crafting short quizzes, and performing various other functions. Google Form also enables users to create and analyze surveys directly through a web browser. Another advantage is its capability for collaborative work with multiple individuals simultaneously, and all changes are automatically saved. To enhance services in healthcare facilities, medical professionals and healthcare staff can utilize Google Form to create health service surveys, record data for patients requiring special care, monitor infants at community health posts, and similar activities. However, many medical professionals and healthcare staff at Belimbing Health Center are not yet familiar with the free and instant Google Form application provided by Google. Hence, a socialization activity on the use of Google Form is needed for them. The purpose of this activity is to provide training to medical professionals and healthcare staff at Belimbing Health Center to enable them to effectively utilize Google Form, thus enhancing their performance in patient care at the health center. This Google Form usage training was conducted as a form of community service at Belimbing Health Center, Padang City, on September 23, 2023. The training began with the delivery of Google Form materials, followed by practical exercises in creating Google Forms. The expected outcome of this activity is that medical professionals and healthcare staff can use Google Form effectively and implement it according to their needs to support their work seamlessly.

Penggunaan buklet dalam meningkatkan literasi perilaku hidup bersih dan sehat kader posyandu

This study was conducted to determine the effective booklet design and its use in enhancing the literacy of PHBS cadres at Posyandu in Jatinangor Sub-district. The method used is qualitative with an action research approach. The booklet creation followed four stages based on the action research theory: planning, implementing, observing, and reflecting. The informants in this study consisted of eight cadres from two community health posts in Jatinangor Sub-district. These eight cadres are from Posyandu Nuri 3 (Cikeruh Village, RW 03) and Posyandu Nuri 4 (Cikeruh Village, RW 04). Data were collected through interviews, observations, FGDs, and literature studies. The results of this study indicated that the criteria for an effective booklet include being user-oriented, credible, easily understandable, and visually appealing. The information sources used in the booklet come from trusted sources such as the Jatinangor Health Center, the Indonesian Ministry of Health, and health journals. The language used in the booklet is clear, straightforward, and simple in Indonesian, making it easily understandable for the cadres. The booklet has a colorful design and supporting images to make it more appealing. The booklet aims to enhance the cadres' knowledge of self-care, caring for others, preventing diseases, and persuading the community to apply these principles in daily activities. In conclusion, the booklet can be used to improve the PHBS literacy of Posyandu cadres.

Community Health Posts Impact on Adult Male Access to HIV Services in Lusaka, Zambia

Achieving HIV epidemic control is an ultimate goal for Zambia. To achieve this goal there is need to close services access gaps. Adult men are less likely to utilize existing health facility-based HIV services and they account for a significant proportion of new HIV infections with risk to onward HIV transmission in the community. Almost two-thirds of males (65.1%) and 79.2% of females aged 15-59 years reported ever having been tested for HIV and having received their results. Over two-thirds (67.1%) of HIV-positive males 25-29 years of age reported being unaware of their HIV status. Twenty-five percent of the national pandemic is in Lusaka. This non-experimental, descriptive mixed-methods study shows increase in number of adult males accessing services at community health posts and the impact of community health posts on improving adult male access to HIV services, including improved retention to HIV services and viral load suppression. The attitude or customer care of health care workers and the location of the community health posts played a bigger role in improving adult male access to HIV services, by creating a better, trusted environment and by bringing the services closer to where these males work or live. The community health post improved also the inequality in accessing HIV services for adult males, as this is one of the key factors to achieving the end of HIV pandemic. Keywords: Community Health Post, Control, Epidemic, HIV, Impact, and Inequality, Male Adult.

Choline, DHA, and Diarrheal Disease Associated with Growth Faltering in a Case-Control Study

ABSTRACTBackgroundChildren with recurrent infectious diarrhea are susceptible to growth faltering. DHA and choline may play a role in this relationship due to their involvement in lipid metabolism, gut immunity, and inflammatory pathways.ObjectivesThis study aimed to characterize the contributions made by DHA and choline status and enteric damage in young children in the association between diarrheal illness and child growth.MethodsA longitudinal case-control study was conducted among children aged 6–36 mo (N = 195) in Cap-Haitien, Haiti. Mother-child dyads were recruited from community health posts and outpatient clinics. Cases were defined as children experiencing acute diarrhea within the last 3 d and matched to healthy controls. Child anthropometry, dietary intake, and blood and stool samples were collected at baseline and follow-up. Plasma DHA, choline, and betaine were determined by LC-MS/MS methods (n = 49) and intestinal fatty acid–binding protein (I-FABP) by ELISA (n = 183). Multivariate regression models were applied with mediation analyses to examine associations and adjust for confounding factors.ResultsAt baseline, mean plasma DHA concentrations (1.03 µg/mL; 95% CI: 0.91, 1.15) were not significantly different between cases and controls, nor was there a difference in mean plasma choline concentrations (4.5 µg/mL; 95% CI: 3.8, 5.1). Mean plasma I-FABP concentrations were significantly higher at follow-up in cases (3.34; 95% CI: 3.28, 3.40) than controls (3.20; 95% CI: 3.13, 3.27; P = 0.002). In adjusted multilinear regression models, higher plasma DHA concentrations at follow-up were associated with a negative change in weight-age z score (P = 0.016), and follow-up I-FABP was inversely associated with height-age z score (P = 0.035). No interaction or mediation effects were found.ConclusionsI-FABP concentrations were significantly higher in cases as compared with controls at follow-up, suggesting ongoing enteric damage and increased risk for malnutrition. Plasma DHA and I-FABP may have a role in childhood growth outcomes.

The Aging Study of Pyeongchang Rural Area (ASPRA): Findings and Perspectives for Human Aging, Frailty, and Disability.

The Aging Study of Pyeongchang Rural Area (ASPRA) is a population-based, prospective cohort study of older adults in Pyeongchang, South Korea. Since the initial enrollment of 382 participants, the ASPRA has been maintained and has conducted comprehensive geriatric assessments annually, gradually expanding its population and coverage area. As a cohort study of aging-related conditions and their functional consequences, the ASPRA leveraged Pyeongchang’s relatively low annual population movement rate and its healthcare delivery system, which was largely maintained by community health posts. Since its establishment, the ASPRA has reported numerous observational and multicomponent intervention studies on functional decline, geriatric syndrome, and frailty. Here, we discuss the findings and perspectives of ASPRA studies. We hope that the ASPRA enables the further implementation of a longitudinal study design on geriatric parameters and the development of public health strategies targeting aging-related conditions, especially in resource-limited community settings.

Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger

BackgroundLittle is known about the contribution of community health posts and community health workers (CHWs) to geographical accessibility of primary healthcare (PHC) services at community level and strategies for optimising...

Gaps in Infection Prevention and Control in Public Health Facilities of Sierra Leone after the 2014-2015 Ebola Outbreak.

Background: High compliance to infection prevention and control (IPC) is vital to prevent health care-associated infections. In the worst 2014–2015 Ebola-affected district in Sierra Leone (Kenema), we assessed (a) average yearly IPC compliance (2016–2018) using a National IPC assessment tool in the district hospital and peripheral health units (PHUs), and (b) gaps in IPC activities, infrastructure and consumables in 2018. Methods: This was a cross-sectional study using secondary program data. Results: At the district hospital, compliance increased from 69% in 2016 to 73% in 2018 (expected minimal threshold = 70%; desired threshold ≥ 85%). Compliance for screening/isolation facilities and decontamination of medical equipment reached 100% in 2018. The two thematic areas with the lowest compliance were sanitation (44%) and sharps safety (56%). In PHUs (2018), the minimal 70% compliance threshold was not achieved in two (of 10 thematic areas) for Community Health Centers, four for Community Health Posts, and five for Maternal and Child Health Units. The lowest compliance was for screening and isolation facilities (range: 33–53%). Conclusion: This baseline assessment is an eye opener of what is working and what is not, and can be used to galvanize political, financial, and material resources to bridge the existing gaps.

Oral health knowledge and practices in the Kaski District of Nepal.

Oral disease is a widespread problem in Nepal. However, up-to-date information on oral health is limited and oral health initiatives may be shaped by assumptions about insufficient oral health knowledge. Furthermore, the influence of socio-demographic factors on oral health in Nepal remains unclear. This study aims to explore the relationship between demographic background and oral health knowledge, attitudes and behaviors in rural Nepal. Secondary analysis of data from a community-based survey on oral health knowledge, beliefs, practices, and access to care among residents ages 12 and above across 4 rural villages in Nepal's Kaski District (Total number = 3,243). Chi-square tests were performed to examine associations among oral health knowledge, attitudes and behaviors and demographic characteristics. Participants reported a baseline knowledge of oral health; 92.4% knew about the recommended tooth-brushing regimen. Participants with higher education and younger age demonstrated better oral health knowledge. Misconceptions about dental treatment causing blindness (23.1%), deafness (11.6%), and mental health problems (14.9%) were reported across all groups. Numerous factors besides knowledge likely determine individual oral health behavior. Future interventions should consider community-based outreach programs and dental care delivery through community Health Posts to build trust in dental care, build on existing knowledge and community experiences, and improve access to preventative care. Up-to-date understanding of oral health knowledge and practices and sociocultural influences on oral health behavior will better focus interventions and policy decisions.

Evaluation of the Interaction Model of Client Health Behavior-based multifaceted intervention on patient activation and osteoarthritis symptoms.

This study evaluated a multifaceted intervention for osteoarthritis symptoms. A cluster randomized controlled trial was conducted with a convenience sample of 90 patients aged between 45 and 82 years, who were recruited from three Community Health Posts (CHPs). The CHPs were randomized into two experimental groups (E1 and E2) and one control group (C). The intervention included health education and counseling combined with exercise classes based on the Interaction Model of Client Health Behavior. Trained community health nurse practitioners led the intervention. Stretching exercise (E1) and walking (E2) combined with muscle strengthening exercise were provided. The instruments included the Patient Activation Measure (PAM), Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index (K-WOMAC), Stanford Health Assessment Questionnaire Disability Scale (HAQDS), and Center for Epidemiologic Studies Depression Scale (CES-D). The HAQDS was measured using an ordinal scale, and Likert scales were used for the other instruments. Chi-square test and analysis of covariance were used; P values <.05 were considered significant. The study was conducted in 2014. The groups were similar at the baseline (P > .05) except for joint pain and patient activation (P < .05). At post-test, the changes in the mean scores were significant for joint pain and stiffness, and physical functioning. E2 with walking exercise showed better improvements in joint pain and physical functioning than the other groups (P < .01). Eight sessions of multifaceted intervention improved the osteoarthritis symptoms. Follow-up studies will be needed to determine the intermediate and long-term effects of the multifaceted intervention.

Challenges and Assets for Promoting Early Childhood Development in Indonesia: A Health Statistics Review from a Community Health Perspective

Background: Although early childhood development is important, there are limited health statistics reviews related to the early childhood development in Indonesia. This study organized statistical health information across 33 Indonesian provinces to assess ongoing challenges and existing assets for improving early childhood development. Information about early childhood development in Indonesia between 2007 and 2013 was obtained through data supplied by the Indonesian Ministry of Health and the Indonesian Central Bureau of Statistics. Methods: The information collected was organized into five domains of early childhood development: health, nutrition, responsive care giving, early learning, and security and safety. Challenges and assets in Indonesia were assessed in terms of early childhood development. Results: Our results indicated that although the child mortality rate decreased between 2007 and 2013, it remained higher than the global average, with large disparities between provinces. Background factors influencing child mortality rates included the limited availability of health services, large catchment areas for puskesmas (community health centers), parents' limited caregiving responsiveness, and limited opportunities for parents to achieve advanced education. However, our results also revealed several important assets, including the existence of community health posts, alert village programs, community volunteers, and a large number of nurses and midwives; Conclusions: To improve early childhood development in Indonesia, it is important to empower parents to utilize these community health-related assets. Nurses and kaders (community health volunteers) should promote parents' enhanced awareness of child health and development.

Logistic Regression Analysis on the Determinants of Stunting among Children Aged 6-24 Months in Purworejo Regency, Central Java

Background: Stunting is a representation of the state of chronic malnutrition in the first 1000 days of life that occurred in the world at an incidence of 22.2% in 2017. Stunting in children has impact on morbidity and mortality, resulting in a long-term decline socio-economic productivity of the community. The purpose of this study was to analyze the determinants of stunting in children aged 6-24 months in Purworejo, Central Java. Sub j e cts an d Method: This was an analytic observational study with a case control design. It was conducted in 25 integrated community health posts (posyandu) in Purworejo, from October to December 2018. A sample 200 children under five was selected using by simple random sampling. The dependent variable was stunting. The independent variables were maternal mid-upper arm circumference (MUAC) at pregnancy, maternal education, paternal education, family income, family food allocation, infant birth weight, exclusive breastfeeding, complementary feeding (CF), posyandu strata, stunting monitoring at posyandu, and posyandu stunting intervention. The data was collected by questionnaire and analyzed by a multiple logistic regression. Results: Maternal MUAC at pregnancy ≥23.5 cm (b= -1.56; 95% CI= 0.06 to 0.67; p = 0.009), high maternal education (b= -1.70; CI95% = 0.06 to 0.57; p = 0.003), high paternal education (b= -1.90; 95% CI= 0.05 to 0.51; p= 0.002), high family income (b= -1.85; 95% CI= 0.05 to 0.50; p = 0.002), family food allocation (b= -2.26; 95% CI= 0.03 to 0.37; p<0.001), birth weight ≥2,500 g (b= -1.39; 95% CI= 0.08 to 0.83; p= 0.024), exclusive breastfeeding (b = -2.04; 95% CI= 0.04 to 0.48; p= 0.002), and adequate complementary feeding (b= -1.61; 95% CI= 0.06 to 0.65; p= 0.007) reduced the risk of stunting in children aged 6-24 months. Conclusions: Maternal MUAC at pregnancy ≥23.5 cm, high maternal education, high paternal education, high family income, family food allocation, birth weight ≥2,500 g, exclusive breastfeeding, and adequate complementary feeding reduce the risk of stunting in children aged 6-24 months. Keywords: stunting, determinants, children aged 6-24 months Correspondence: Atika Rakhmahayu. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta, Indonesia. Email: tikarakhmahayu@gmail.com. Mobile: 083124386960. Journal of Maternal and Child Health 4(3): 158-169 https://doi.org/10.26911/thejmch.2019.04.03.03

Multilevel Analysis on Factors Affecting Measles Rubella Immunization Uptake among Toddlers in Pekanbaru, Indonesia

Background : Measles-Rubella (MR) immunization is a way to prevent measles and rubella, because the disease cannot be treated and the treatment given to patients is only supportive. Measles and rubella are spread in almost all provinces in Indonesia, so it needs a high and evenly coverage of at least 95% to break the chain of transmission. This study aimed to analyze the determinants of MR immunization uptake in infants. Subjects an d Met h od: This was a cross-sectional study conducted in 25 community health posts (posyandu) in Pekanbaru, Indonesia, from April to May 2019. A sample of 200 mothers who had children aged 9-59 months was selected by stratified random sampling. The dependent variable was Rubella-Measles immunization. The independent variables were maternal education, maternal knowledge, family support, perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, and self-efficacy. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression. Results: Measles-Rubella immunization uptake increased with high maternal education (b= 0.66; 95% CI= -0.07 to 1.41; p= 0.080), high maternal knowledge (b= 0.90; 95% CI= 0.14 to 1.65; p= 0.020), strong family support (b= 0.71; 95% CI= -0.05 to 1.48; p= 0.068), high perceived susceptibility (b= 1.24; 95% CI= 0.33 to 2.14; p= 0.007), high perceived severity (b= 1.19; 95% CI= 0.36 to 2.03; p= 0.005), strong perceived benefit (b= 0.93; 95% CI= 0.19 to 1.66; p= 0.013), high cues to action (b= 0.96; 95% CI= 0.19 to 1.73; p= 0.014), and high self efficacy (b= 1.45; 95% CI= 0.59 to 2.31; p= 0.001). It decreased with strong perceived barrier (b= -1.05; 95% CI= -1.81 to -0.29; p= 0.007). Posyandu had a contextual effect on Rubella-Measles immunization with ICC= 10.53%. Conclusion : Measles-Rubella immunization uptake increases with high maternal education, high maternal knowledge, strong family support, high perceived susceptibility, high perceived severity, strong perceived benefit, high cues to action, and high self efficacy. It decreases with strong perceived barrier. Posyandu has a contextual effect on Rubella-Measles immunization. Keywords : Measles, Rubella, immunization, health belief model, multilevel analysis Cor r esponden ce : Wahyuni Rosadi. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: wahyuni.rosadi08@gmail.com. Mobile: 085271819193. Journal of Maternal and Child Health (2019), 4(6): 448-460 https://doi.org/10.26911/thejmch.2019.04.06.06

Evaluation of the national policy of single screening and treatment for the prevention of malaria in pregnancy in two districts in Eastern Indonesia: health provider perceptions

BackgroundMalaria in pregnancy has devastating consequences for both the expectant mother and baby. Annually, 88.2 (70%) of the 125.2 million pregnancies in malaria endemic regions occur in the Asia–Pacific region. The control of malaria in pregnancy in most of Asia relies on passive case detection and prevention with long-lasting insecticide-treated nets. Indonesia was the first country in the region to introduce, in 2012, malaria screening at pregnant women’s first antenatal care visit to reduce the burden of malaria in pregnancy. The study assessed health providers’ acceptability and perceptions on the feasibility of implementing the single screening and treatment (SST) strategy in the context of the national programme in two endemic provinces of Indonesia.MethodsQualitative data were collected through in-depth interviews with 86 health providers working in provision of antenatal care (midwives, doctors, laboratory staff, pharmacists, and heads of drug stores), heads of health facilities and District Health Office staff in West Sumba and Mimika districts in East Nusa Tenggara and Papua provinces, respectively.ResultsHealth providers of all cadres were accepting of SST as a preventive strategy, showing a strong preference for microscopy over rapid diagnostic tests (RDTs) as the method of screening. Implementation of the policy was inconsistent in both sites, with least extensive implementation reported in West Sumba compared to Mimika. SST was predominantly implemented at health centre level using microscopy, whereas implementation at community health posts was said to occur in less than half the selected health facilities. Lack of availability of RDTs was cited as the major factor that prevented provision of SST at health posts, however as village midwives cannot prescribe medicines women who test positive are referred to health centres for anti-malarials. Few midwives had received formal training on SST or related topics.ConclusionsThe study findings indicate that SST was an acceptable strategy among health providers, however implementation was inconsistent with variation across different localities within the same district, across levels of facility, and across different cadres within the same health facility. Implementation should be re-invigorated through reorientation and training of health providers, stable supplies of more sensitive RDTs, and improved data capture and reporting.

Tuberculosis prevalence survey reveals the high proportion of asymptomatic disease, and points to high-burden households as a site for potential intervention in peri-urban slums of Callao, Peru

Background: To improve the reach of tuberculosis elimination, we must understand the population that does not seek medical contact. Prevalence surveys are widely used to measure undiagnosed TB disease, but rarely characterize the clinical and social risk factors and barriers to care that obstruct diagnosis, notification, and treatment. Methods & Materials: A cross-sectional prevalence survey of pulmonary TB disease was undertaken with sputum culture on Middlebrook 7H11 thin-layer agar in a cohort of 1668 households known to have been affected by TB in the past 10 years. Symptoms, co-morbidities, and health-seeking behaviour were assessed for all household members, and treatment records from community health posts were used to identify all courses of antitubercular therapy prescribed to household members. Results: Sputum was obtained from 6380 residents over 8 years old (1744 former patients; 4636 other residents). 101 participants were taking antitubercular therapy and no longer sputum-culture-positive. 51 culture-positive cases of prevalent TB disease were detected, of whom only 13 met the national clinical criteria for sputum testing (>2 weeks of productive or bloody cough). 11 had been tested for TB, 10 diagnosed, and 4 had been initiated on treatment at the time of the survey. Multiple treatment episodes within the household (whether due to repeated infection, re-initiation of uncompleted therapy, or change of treatment scheme) were associated with increased odds of prevalent disease in the survey. Participants who had undergone two or more treatment episodes had 8.6 times the odds of prevalent TB of those with none (95%CI:3.9-18.7;P < 0.001). Members of households with more that two treatment episodes had 3.2 times the odds of TB of those without—2.9 after adjustment for age, sex, poverty, HIV status, and drug and alcohol misuse (95%CI:1.6-5.3;P < 0.001). Conclusion: Accelerating currently recommended case management strategies could achieve a four-fold increase in treatment coverage for this population, but 75% of potentially infectious cases would still remain undetected. New strategies are needed to identify and engage populations at risk of undetected, minimally symptomatic disease. Meanwhile, follow-up of households affected by TB to provide preventative therapy for latent TB and active surveillance for new illness episodes will aid control and elimination of TB.

Stunting-Related Knowledge: Exploring Sources of and Factors Associated with Accessing Stunting-Related Knowledge among Mothers in Rural Indonesia

Background: Stunting in young children continues to be a major concern in developing country settings, including middle income countries like Indonesia. Early intervention is critical to prevent increased morbidity and mortality, lower cognitive functioning, and diminished productivity in adulthood. Mothers may benefit from knowledge and information related to stunting causes and effects. Indonesia has readily adopted a variety of platforms, which are now being used to disseminate health information. The purpose of this study was to address two related research questions: 1) What are the primary sources of Indonesian mothers’ stunting-related knowledge? 2) What factors are associated with using these various platforms to access stunting-related information? Method: Mothers (n = 745) responded to questions about demographics and the source of stunting knowledge, which included hospitals, the Internet, midwives, posyandu (community health posts), and puskesmas (public health centers). Multivariate logistic regression was used to identify factors associated with mothers’ reported use of the three most common sources to acquire information about stunting, including posyandu, puskesmas and the Internet. Results: Eighty percent of mothers in this study sample used posyandu, 31.7% puskesmas, and 16.9% used the Internet as a source for stunting-related knowledge. For the three most common sources, factors associated with each included not accessing the other sources. Conclusions: Indonesian mothers are using a variety of platforms and services to acquire information about stunting. These sources are different one from another and each may be an important resource for disseminating health information, especially outside of urban centers. Results from this study may help to identify characteristics of Indonesian mothers who could benefit from acquiring stunting-related information in these formats. Each of these sources of information appears to be utilized by different groups of mothers. This is an important finding as it suggests that each may continue to be a resource for mothers that might not otherwise access stunting information. The Indonesian health system in rural settings has a history of support for posyandu and puskesmas. Moving forward, the Internet may also be used to improve outcomes for children of mothers that do not access information through these more traditional means.

Qualitative Analysis of Tele-healthcare Systems based on the Diffusion of Innovation Model

The purpose of this study is to explore factors which influence adoption, implementation and continued use of tele-healthcare systems. Methods: Qualitative research was conducted by in-depth interviews with 17 professionals from various fields of organizations involved in developing and implementing tele-healthcare systems. Data were analysed thematically, using a conceptual model of diffusion of innovations. Results: The system users were reacted positively to the 3 attributes out of 9 which decided the adoption of innovation. In addition, it is required to redesign the tele-health care system simpler and easier so that the system users can access to the system much more easily regardless of space and time limitations. From the design stage on an individual level, it is necessary to conduct detailed needs analysis and listen to users who are at the center of innovation diffusion. On an organizational level, it is necessary to actively prepare for possible problems during system implementation, educate the users and build communication channels continuously. Conclusion: This study has identified the factors affecting the innovation of tele-health care systems and contributed to the understanding of the operation of tele-health care systems by the diffusion of innovation theory in community health posts.