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ahmad musyafa
Universitas Gadjah Mada Yogyakarta
Nursing Public Health

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Investigation of Measles Outbreak in a School, Blora District, Central Java, Indonesia 2016 ahmad musyafa
Berita Kedokteran Masyarakat (BKM) Vol 33, No 5 (2017): Proceedings of the 1st UGM Public Health Symposium
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (888.141 KB) | DOI: 10.22146/bkm.37570

Abstract

Background: On December 6, 2016 Blora District Health Office (DHO) received a reports of four suspected measles cases from Jiken Public Health Centers (PHC). All cases were from a Public High School.  Field investigation was conducted to characterize the outbreak. Methods: We conducted active case finding to find additional cases. We defined a case as students from affected high school with skin rash and influenza like syndrome and/or conjunctivitis, and/or blood test positive for IgM for measles during August 29 to December 28, 2016. Primary data were collected by interviewing patients and their parents or care giver. Secondary data were collected from Blora DHO, PHC and schools.Results: Of 270 students, 44 were matched to our case definition. We found 14 cases were from a high school. The first case was a student who had sibling with measles in his house and student of a Kindergarten. Additional 27 cases were identified during our investigation in the Kindergarten. We found that the first case in this kindergarten have had a contact with her family who had measles after returned form other province. Of 44 cases, 14 cases were from high school, 27 from kindergarten, and 3 cases from community. The highest Attack Rate (AR,56.8%) was children aged 5 – 10 years, children who attend kindergarten (39.7%).Immunization coverage data was not available at DHO or PHC, and most of the care giver were no remember the measles immunization status of their children.  Conclusion: The measles outbreak has a Public High School and a Kindergarten in from Agust-Desember 2016. The late detection of measles cases has contributed to this outbreak. Improvement of immunization and surveillance systems for prevention of future outbreak. Provision of Vitamin A and ORI was conducted to contain the outbreak
Evaluation of DHF Surveillance System in District Blora 2017 ahmad musyafa
Berita Kedokteran Masyarakat (BKM) Vol 33, No 5 (2017): Proceedings of the 1st UGM Public Health Symposium
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3871.135 KB) | DOI: 10.22146/bkm.37571

Abstract

Background: In the last 49 years, dengue has emerged as a major health problem in Indonesia. Prevention and control of endemic diseases is done by improving surveillance system. Objective: Evaluation of DHF surveillance system in District of Blora 2017 Method: Descriptive observational study in the form of evaluation. The subjects were 26 DHF surveillance officers at public health center and 2 surveillance officers of Blora District Health Office. Data were collected by interview and observation. Result: surveillance system in PHC and hospital identify cases with clinical case report so that sensitivity is needed for early detection. The case definition has high sensitivity. All health centers have followed the guidelines from the Ministry of Health and WHO but the cases are found only as a suspect due to laboratory examination only thrombocyte and hematocrit, can not be analyzed trends of events either graph (weekly, monthly, yearly) minimal and minimum time series pattern. During 2016 in Blora District 713 reported cases of dengue with CFR 1.26. Availability of DHF guidebook (65.38%), nurse 53.85%, 0% healthiness. Of the 26 PHC, 65.38% of the surveillance personnel have never had training with 100% having double duty. Ability to process and analyze data below 40%, accuracy and completeness of report below 60% (Ewars) and 42% (STP). The immediate response has been made by the health department but not yet at the puskesmas level because the DHF report is still awaiting information from the active surveillance of the health department at the hospital in Blora. Discussion: This study emphasizes the need for laboratory-based dengue surveillance systems especialli trained personnel. Education and training is a supporting factor in improving DHF surveillance system especially in processing, analyzing and presenting data for guidance in making policy in Blora Regency.
Tuberculosis: Case Finding in Public Health Center of Blora, Indonesia ahmad musyafa
Berita Kedokteran Masyarakat (BKM) Vol 33, No 11 (2017): Proceedings of the 2nd UGM Public Health Symposium
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.37572

Abstract

Background: Tuberculosis is a disease of international concern. Control measure have been implemented in the World and Indonesia. One of the indicators of TB prevention program in Indonesia is Case Notification Rate (CNR), through case finding to screen of suspected TB, physical examination, laboratory and diagnosis Objective: Implementation of TB case finding program in Blora Distric, Indonesia, 2017 Methods: A descriptive observational study of evaluation. Subjects were 12 TB programmers at Public Health Center, 12 laboratory workers and 1 supervisor of Blora District Health Office. Data were collected by in-depth interviews and observations on input, process, output and outcome aspects. Results: Input aspect, 75% of respondents have double job, with duration of >5 years (75%) and was followed TB training >5 years (66%). Aspects of process, planning, budget requirements, targeting above 90%. Increase internal lineage (58%). Implementation already uses active search (92%) and passive (67%). Involvement of health cadres is not optimal, people are more confident to health workers in the village. PPM has not gone well (17%) so many patients are not reported in PHC. Clinics, hospitals and private practice doctors have not yet applied DOTS strategy treatment. Monitoring and evaluation has been done by wasor >2 times/year 33% and <2 times/year 67%. The CNR output aspect of 2016 128/100.000 population is below the national target of 316/100.000 population. Outcome aspect consists of 91.1% cure rate and 3.5% death. Conclusions: Overall TB case finding in Blora has gone well. But there are still shortcomings in the input aspect, needs to improve the skills of TB programmers with training and refresher.  On process aspect is still necessary increasing PPM by involving the private sector, hospitals and polyclinics, involving the village midwife actively encompassing TB cases cross program and sector network. So it can increase the CNR TB in Blora. 
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