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The Post-Pandemic Plateau: A Provincial-Level Longitudinal Analysis of Tuberculosis Stagnation in Indonesia (2021–2023) Adhika Rahman; Punik Mumpuni Wijayanti; Vita Widyasari
Community Medicine and Education Journal Vol. 6 No. 2 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i2.858

Abstract

The COVID-19 pandemic caused profound disruptions to global tuberculosis (TB) control, particularly in high-burden nations. Indonesia, ranking second globally in TB burden, faces a critical recovery period. This study aims to characterize the epidemiological trajectory of TB in Indonesia during the post-pandemic phase (2021–2023), testing the hypothesis of stagnation versus recovery. We conducted a longitudinal ecological study utilizing Global Burden of Disease (GBD) estimates and national registry data. The dataset comprised 102 observations, representing a balanced panel of Indonesia’s 34 provinces across three years (2021, 2022, 2023). Variables included age-standardized prevalence per 100,000 population, mortality rates, and Human Development Index (HDI). Normality was assessed via the Shapiro-Wilk test. Correlations were analyzed using Spearman’s rank test for non-normal distributions. To account for unobserved spatial heterogeneity and provincial clustering, we employed a Fixed Effects Within-Group Panel Regression model to determine the independent effect of time on disease burden. The mean TB prevalence across the 34 provinces was 645.2 per 100,000 population (Standard Deviation 120.5), with a mean mortality rate of 38.4 per 100,000. Regional disparities were pronounced; Papua reported prevalence rates exceeding 1,000 per 100,000, while Bali remained below 350. The Fixed Effects regression model revealed that, after controlling for provincial heterogeneity, the passage of time from 2021 to 2023 was not significantly associated with a reduction in prevalence (beta = -1.24; p = 0.68) or mortality (beta = -0.05; p = 0.81). The model confirmed a Post-Pandemic Plateau, where metrics remained statistically unchanged despite the resumption of health services. In conclusion, TB control in Indonesia has entered a critical period of stagnation. The lack of a significant downward trend in the fixed-effects model suggests that post-pandemic recovery efforts have yet to neutralize the accumulated burden of missed diagnoses. Structural interventions targeting high-incidence provinces are urgently required to restart the decline.
Sustaining Infection Prevention and Control Post-Accreditation: A Systematic Review and Meta-Analysis of Global Longitudinal Outcomes Adhika Rahman; Siswanto Pabidang
Community Medicine and Education Journal Vol. 7 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.v7i1.872

Abstract

Hospital accreditation is globally recognized as a strategic framework for standardizing healthcare quality. However, the long-term efficacy of accreditation in sustaining Infection Prevention and Control (IPC) practices and reducing Healthcare-Associated Infections (HAIs) remains fiercely debated. Most existing literature relies on cross-sectional data, failing to capture the temporal stability of post-accreditation outcomes. A systematic review and meta-analysis were conducted following PRISMA guidelines. We analyzed longitudinal, interrupted time-series, and pre-and-post research articles evaluating IPC compliance and HAI incidence before, during, and after accreditation cycles. Data extraction focused on sample sizes, means, and standard deviations to calculate the Standardized Mean Difference (SMD) using a DerSimonian-Laird random-effects model. Heterogeneity was assessed via the I-squared statistic. Eight longitudinal studies encompassing varying international healthcare contexts were included. The pooled meta-analysis demonstrated a statistically significant, moderate improvement in IPC outcomes post-accreditation, with an overall SMD of 0.52 (95 percent Confidence Interval: 0.38 to 0.66, p < 0.001). Subgroup analyses revealed that structural IPC compliance measures showed higher effect sizes (SMD = 0.58) compared to direct clinical outcomes like HAI incidence density reductions (SMD = 0.42). Moderate heterogeneity was observed (I-squared = 54 percent). In conclusion, hospital accreditation acts as a significant catalyst for improving IPC metrics over time. The moderate effect size on direct clinical outcomes suggests that accreditation provides a structural foundation that must be coupled with continuous quality improvement and strong institutional leadership to prevent post-survey decay.