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BackgroundOptimising mental health literacy (MHL) at the individual and population level can be an effective mental health improvement and prevention tool. However, concepts of MHL are largely based on evidence from high-income countries. Little is known about the manifestation and role of MHL in countries where collectivist health and social cultures are dominant.AimThis study aimed to examine the MHL of Indonesian children and young people (CYP) with experience of common mental health problems and their parents.MethodsSemi-structured interviews with 40 participants (19 CYP aged 11–15 with experience of common mental health problems and 21 parents) from three areas of Java, Indonesia. Data were analysed using framework analysis, informed by Jorm's 1997 Mental Health Literacy Framework.ResultsParents and CYP demonstrated relatively low levels of MHL defined from a conventional perspective. Religiosity and spirituality were salient in participants' accounts, particularly parents, as were narratives about personal responsibility. These beliefs appeared to contribute to a high level of self-blame for mental illness, self-reliance for symptom management, the foregrounding of support from spiritual/traditional healers and a reduced propensity to access professional help. CYP were heavily reliant on family support, but parents often felt they were not best placed to communicate with their children about mental health. Providing trusted, technology-based sources of mental health information were advocated by CYP.ConclusionRobust efforts are needed to improve MHL in low- and middle-income countries drawing on culturally appropriate approaches to reduce stigma and optimise timely, effective help-seeking for CYP. Enhancing parental and family level literacy may be efficacious, especially when combined with mechanisms to facilitate open communication, as may the development of standalone interventions directly developed to reach younger generations. Future research may usefully establish the comparative efficacy and acceptability of these different approaches.

Background Many mental health problems emerge in late childhood and contribute significantly to the global burden of disease. Adverse outcomes can extend into adulthood if left untreated. This impact is exacerbated in low- and middle-income countries where significant treatment gaps persist. Improving mental health literacy may offer an effective strategy for early intervention but remains underexplored in these contexts. Methods An intervention was co-developed with children and young people (CYP) by undertaking a needs analysis combined with stakeholder consensus activities. A systematic review of mental health literacy interventions in South-East Asia was undertaken in addition to semi-structured interviews with 43 children and young people (19 with and 24 without experience of anxiety and depression), 19 parents of children with experience of mental health problems and 25 education and health professionals. A focus group was also held with 8 key stakeholders immersed nationally in policy and practice. Interview schedules explored participants’ experiences of mental health, unmet needs and priorities for intervention. Data were synthesised and presented at a 3-day co-production workshop. Attendees included 13 CYP, 6 parents/guardians, 2 teachers, 8 health professionals, 2 academics and 3 game designers. Consensus exercises were utilised to identify the preferred format, content and delivery of the intervention. A smaller group of patient and public involvement contributors worked with designers to further iterate the intervention. Results An immersive storyline digital application was co-developed for young people aged 11–15 with the primary aim of improving mental health literacy and self-management. The intervention comprises two chapters; one depression focussed, and the other anxiety focussed. The storyline format is interspersed with interactive games and exercises to promote engagement and encourage self-management. CYP also take part in group sessions delivered by trained facilitators before and after intervention use to discuss outcomes of and issues raised during the game. Conclusion The IMPeTUs intervention has been co-designed for CYP aged 11–15 to improve mental health literacy and enhance self-management abilities. To the best of our knowledge, this is the first Indonesian digital intervention to improve mental health literacy and self-management for this population. Implementation, acceptability, and impact are currently being explored in a multi-site case study evaluation.

Introduction: Potentially toxigenic Corynebacteria (Corynebacterium diphtheriae, Corynebacterium ulcerans, and Corynebacterium pseudotuberculosis) can produce diphtheria toxin and stated as diphtheria causative agent. The bacteria causing diphtheria could be identified by Cystinase test on the Tinsdale medium, while its toxigenicity determined by Elek test on the Elek medium. This study aims to develop a new modified medium for both Cystinase and Elek tests simultaneously.Methods: There were ten reference strains of bacteria used for the modified medium optimization. Moreover, 15 clinical isolates were used as samples in the modified medium testing. The result of Cystinase and Elek tests on the modified medium was compared with the standardized tests on the Tinsdale and Elek mediums.Results: Twelve of 25 isolates tested on the modified medium were identified as toxigenic strain, corresponding with the result from standardized Elek test on the Elek medium. Moreover, 16 of 25 isolates tested on the modified medium were identified as positive for Cystinase test. The similar result was obtained using the standardized Cystinase test on the Tinsdale medium. This result was visible 24 hours after incubation. The modified medium was in excellent condition with the consistent result after stored in half-finished condition for 32 days at 2-8 oC.Conclusion: The modified medium developed in this study was a new good medium that could be used for Cystinase and toxigenicity tests simultaneously.

One of the government’s efforts to reduce MMR, which is still high, is the implementation of the Antenatal Care (ANC) program at the primary health center (PHC). Besides, the government also accredits PHC to improve the quality of health services starting in 2015, so it is hoped that ANC achievements will increase. This study aims to determine the relationship between accreditation status and ANC achievements in PHC. The study design was cross-sectional with a sample of 103 accredited PHC. The distribution of PHC samples is seen based on the 2013 Public Health Development Index (IPKM) categorized as low, medium, and high. Analysis of the relationship between accreditation status and the K4 achievement program used the chi-square test. The results of this study indicate that the majority of the PHC in the sample are distributed in areas with a high and medium IPKM areas. The relationship between accreditation status and K4 achievement showed a value of p = 0.034. The logistic regression results showed that when compared with primary - complete accredited PHC, basic PHC had OR = 0.224 (95% CI: 0.064 - 0.786) with p = 0.020 to the proportion of K4 achievements. Meanwhile, the middle PHC had OR = 0.517 (95% CI: 0.146 - 1.828) with a p-value = 0.306. This study concludes that the accreditation status of PHC is related to the proportion of K4 achievements. The proportion of K4 achievements increases with the increase in the level of PHC accreditation. A basic accredited PHC has a chance to achieve K4 by 0.224, lower than a primary – complete accredited PHC. There was no significant difference between middle accredited PHC with primary - complete PHC for the proportion of K4 achievement Abstrak Salah satu upaya pemerintah menurunkan AKI yang masih tinggi adalah dengan pelaksanaan program Antenatal Care (ANC) di puskesmas. Selain itu, pemerintah juga melakukan akreditasi puskesmas untuk meningkatkan mutu pelayanan kesehatan yang dimulai tahun 2015, sehingga diharapkan capaian ANC meningkat. Penelitian ini bertujuan untuk mengetahui hubungan status akreditasi terhadap capaian ANC di puskesmas. Desain penelitian ini adalah crosssectional dengan sampel penelitian sebanyak 103 puskesmas terakreditasi. Sebaran sampel puskesmas dilihat berdasarkan Indeks Pembangunan Kesehatan Masyarakat (IPKM) tahun 2013 dengan dikategorikan sebagai IPKM rendah, sedang, dan tinggi. Analisis hubungan status akreditasi dengan program capaian K4 digunakan uji chi-square. Hasil dari penelitian ini menunjukkan mayoritas puskesmas yang menjadi sampel terdistribusi pada wilayah dengan IPKM tinggi dan sedang. Hasil analisis chi-square hubungan antara status akreditasi dengan ketercapaian K4 menunjukkan nilai p=0,034. Hasil regresi logistik menunjukkan bahwa jika dibandingkan dengan puskesmas terakreditasi utama-paripurna, puskesmas terkareditasi dasar mempunyai OR = 0,224 (95%CI: 0,064 - 0,786) dengan nilai p = 0,020 terhadap proporsi capaian K4. Sedangkan puskesmas terkareditasi madya mempunyai OR = 0,517 (95% CI: 0,146 - 1,828) dengan nilai p = 0,306. Kesimpulan penelitian ini adalah status akreditasi puskesmas berhubungan dengan proporsi capaian K4. Proporsi capaian K4 meningkat seiring meningkatnya satus akreditasi puskesmas. Puskesmas terakreditasi dasar mempunyai peluang untuk tercapaianya K4 sebesar 0,224 lebih rendah dibandingkan puskesmas terakreditasi utama - paripurna. Tidak ada perbedaan yang signifikan antara puskesmas terakreditasi madya dengan puskesmas terakreditasi utama-paripurna terhadap proporsi capaian K4.

Diabetes mellitus (DM) may complicate tuberculosis (TB) treatment and control. The National Institute of Health Research and Development in collaboration with seven referral public hospitals in Java and Bali established a disease registry system for tuberculosis (TB) and diabetes mellitus (DM). Medical records containing data of ≥15 years old patients, diagnosed with TB (ICD-10 code A15-A19) in 2014, with or without DM (ICD-10 code E10-E14) were recorded into case report form (CRF). From January 1st 2014 to January 12th 2016, the registry recorded 1975 TB cases, 15% of cases were TB-DM. 73.6% TB-DM were ≥45 years old and 70,8% TB-non DM were 2 weeks (76.4%), weight loss (72.6%), loss of appetite (65.9%), and night sweats (65.2%). In TB-non DM, predominant symptoms were weight loss (59.4%), loss of appetite (57.8%), cough >2 weeks (57.6%), and fever (56.9%). Higher chest X-rays abnormality in TB-DM (OR 7.249; 95%CI 3.2-16.5) and higher positive AFB smears (OR 2.568; 95%CI 1.8-3.8). TB treatment failure (death, defaulted, failure, or transferred out) were three times higher in TB-DM (aOR 3.042; 95%CI 1.7-5.4). TB-DM Registry showed negative effects of DM on clinical condition and the treatment success of TB. Abstrak Diabetes melitus (DM) menyulitkan pengobatan dan kontrol tuberkulosis (TB). Badan Penelitian dan Pengembangan Kesehatan bersama tujuh rumah sakit (RS) umum kelas A dan B di Pulau Jawa dan Bali mengembangkan Sistem Registri Penyakit TB-DM. Data pasien berusia ≥15 tahun, didiagnosis TB (kode A15-A19 ICD-10) mulai tahun 2014, dengan atau tanpa DM (kode E10-E14 ICD-10) diabstraksi ke dalam case report form (CRF). Mulai 1 Januari 2014 – 2 Januari 2016, terdapat 1975 kasus TB, 15% adalah TB dengan DM. 73,6% pasien TB-DM berusia ≥45 tahun dan 70,8% TB-non DM berusia