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Building Community Resilience to Climate Change in Jakarta: A Public Health Approach Integrating Policy, Practice, and Education Jonah Abraham; Andi Fatihah Syahrir; Neva Dian Permana; Matilda Munoz; Sarah Armalia
Community Medicine and Education Journal Vol. 6 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i1.700

Abstract

Climate change poses significant and escalating threats to public health in Jakarta, Indonesia, including increased risks of vector-borne diseases, heat-related illnesses, and mental health impacts exacerbated by flooding and displacement. This study examined the current state of community resilience to these climate-related health threats and evaluated the effectiveness of existing policies and educational interventions. A mixed-methods approach was employed, combining a cross-sectional survey of Jakarta residents (n= 850), semi-structured interviews with key stakeholders (n= 25) from government agencies, NGOs, and community organizations, and a policy review of relevant Indonesian and Jakarta-specific regulations and strategic plans. The survey assessed climate change awareness, perceived health risks, adaptive capacity, and access to resources. Interviews explored policy implementation challenges, inter-sectoral collaboration, and community engagement strategies. The policy review analyzed alignment with international best practices and identified gaps. The survey revealed moderate levels of climate change awareness but significant gaps in understanding of specific health risks (62% aware of general climate change, but only 38% aware of the link to dengue fever increase). Perceived adaptive capacity was low, particularly among vulnerable populations (low-income households, those living in flood-prone areas). 75% of respondents in flood-prone areas reported lacking adequate resources to cope with flooding events. Interviews highlighted challenges in inter-sectoral coordination, limited funding for community-based programs, and a lack of culturally appropriate health education materials. The policy review found that while national-level policies exist, Jakarta-specific implementation lags, particularly in integrating health considerations into urban planning and disaster preparedness. In conclusion, building community resilience to climate change in Jakarta requires a multi-pronged approach. This includes strengthening health system preparedness, developing targeted and culturally appropriate health education programs, improving inter-sectoral collaboration, enhancing community engagement, and integrating health considerations into all relevant policies. Specific recommendations include strengthening early warning systems for heat waves and floods, expanding access to clean water and sanitation, promoting climate-resilient housing, and investing in community-based adaptation projects.
Comparative Effectiveness of KDIGO 2021 versus Previous Blood Pressure Targets on Renal Outcomes in Chronic Kidney Disease Patients in Palembang, Indonesia Jonah Abraham; Andhika Kurnianta Kusuma
Sriwijaya Journal of Internal Medicine Vol. 2 No. 1 (2024): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v1i2.78

Abstract

Introduction: The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend lower blood pressure (BP) targets for chronic kidney disease (CKD) patients compared to previous guidelines. This study aimed to evaluate the comparative effectiveness of achieving KDIGO 2021 BP targets versus previous targets on renal outcomes in CKD patients in Palembang, Indonesia. Methods: A retrospective cohort study was conducted involving CKD patients (stages 1-5, not on dialysis) attending a tertiary hospital in Palembang from January 2018 to December 2023. Patients were categorized into two groups: those achieving KDIGO 2021 BP targets (<120/80 mmHg) and those achieving previous targets (<130/80 mmHg). The primary outcome was a composite of renal events including a 50% decline in estimated glomerular filtration rate (eGFR), end-stage renal disease (ESRD), or renal death. Secondary outcomes included individual components of the composite outcome and all-cause mortality. Data were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression. Results: A total of 860 CKD patients were included (mean age 58.2 ± 12.5 years, 52% male). 345 patients achieved KDIGO 2021 BP targets, while 515 achieved previous targets. Over a median follow-up of 3.8 years, the primary composite outcome occurred in 187 patients (21.7%). The incidence rate of the primary outcome was significantly lower in the KDIGO 2021 group (15.6 per 1000 person-years) compared to the previous targets group (27.2 per 1000 person-years) (p=0.003). After adjusting for potential confounders, achieving KDIGO 2021 BP targets was independently associated with a lower risk of the primary outcome (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.38-0.83, p=0.004). Similar findings were observed for individual components of the composite outcome and all-cause mortality. Conclusion: Achieving KDIGO 2021 BP targets was associated with a significant reduction in the risk of adverse renal outcomes and all-cause mortality in CKD patients in Palembang. These findings support the implementation of the updated KDIGO guidelines in this population.