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Background: Nurses constitute a significant portion of the health care workforce, playing a crucial role in enhancing the quality of hospital services, particularly in the context of nursing documentation to ensure the precise recording of patient information in accordance with established standards. This study examines the factors associated with implementing nursing documentation in a psychiatric hospital. Methods: This cross-sectional study was conducted in June 2023 in a psychiatric hospital in Indonesia. A convenience sampling method was employed to recruit 144 nurses working in the hospital. Data collection methods encompassed supervision questionnaires, Unified Motive Scales (UMS), and observation sheets used for recording nursing care activities. Data analysis involved the chi-square test and multiple logistic regression. Data analysis was performed with a significance level set at 0.05 and a CI of 95%, utilizing STATA 13. Results: We found significant associations between nursing documentation and supervision techniques (p = 0.01), need for power (p = 0.001), and need for affiliation (p = 0.002). Notably, the need for power emerged as the most influential factor in nursing documentation (odds ratio [OR] = 8.46; 95% CI, 3.53-20.28). Conclusion: These findings underscore the importance of supervision techniques, power needs, and affiliated needs in the context of nursing documentation. The statistically significant associations between these factors emphasize their role in ensuring accurate and comprehensive record-keeping within health care settings. Particularly noteworthy is the substantial influence of the need for power, with a high OR, suggesting that addressing power dynamics may be an essential strategy for improving nursing care documentation practices.

Fusobacterium nucleatum is a Gram-negative anaerobic bacteria that is commonly found in oral cavities and is associated with connective tissue destruction in periodontitis. UDP-N-acetylglucosamine 1-carboxyltransferase with enzyme commission number 2.5.1.7 is a transferases enzyme that plays a role in bacterial pathogenesis. Inhibiting binding sites of UDP-N-acetylglucosamine 1-carboxyltransferase is needed to find potential antibiotic candidates for periodontitis treatment. Hence, the research aimed to present potential UDP-N-acetylglucosamine 1-carboxyltransferase inhibiting compounds through molecular docking simulation by in silico analysis. DrugBank database was used to obtain the antibacterial candidates, which were further screened computationally using the AutoDock Vina program on Google Colab Pro. The top nine compounds yielded binding affinity ranging from −12.1 to -12.8 kcal/mol, with conivaptan as one of the three compounds having the highest binding affinity. Molecular dynamic study revealed that the ligand–protein complex for conivaptan had root-mean-square deviation values of 0.05–1.1 nm, indicating likeliness for stable interaction. Our findings suggest that conivaptan is the potent UDP-N-acetylglucosamine 1-carboxyltransferase inhibitor, hence its efficacy against periodontitis-causing bacteria.

Willingness to pay (WTP) for booster doses of coronavirus disease 2019 (COVID-19) vaccines is an under studied research topic. Therefore, the current study aimed to investigate the WTP for the booster doses of COVID-19 vaccines and its predictors in Indonesia using an online survey distributed all over the provinces of this low-middle-income country. The WTP was evaluated using a basic dichotomous contingent valuation approach, and its associated determinants were evaluated using a linear regression model. Out of 2935 responders, 66.2% (1942/2935) were willing to pay for a booster dose of the COVID-19 vaccine. The majority of respondents (63.5%) were willing to pay within a price range of 100,000–500,000 Indonesian rupiah (IDR), i.e., USD 6.71–33.57. Being older than 40 years, having a higher educational level, having a higher income, knowing and understanding that booster doses were important, and having a vaccine status that is certified halal (permissible in Islamic law), were all associated with a higher WTP for the booster dose of COVID-19 vaccines. The study findings imply that the WTP for a booster dose of COVID-19 vaccination in Indonesia is lower compared to acceptance of vaccines provided free of charge. This WTP data can be utilized to develop a pricing scheme for the booster doses of COVID-19 vaccination in the country with potential benefits in other low-income countries. The government may be required to provide subsidies for the herd immunity vaccination process to proceed as anticipated. Furthermore, the public community must be educated on the importance of vaccination as well as the fact that the COVID-19 epidemic is far from being over.

Abstract Aim: Residents are concerned about the presence of flies, especially in areas near landfills, so it is important to study the distribution patterns of fly communities and community responses to the presence of flies. This study focuses on two main topics: fly distribution in various zones and people’s perspectives on fly prevention initiatives. Materials and Methods: Data were collected by dividing the sampling location into four clusters and collecting data three times per day (morning, noon, and afternoon). Flypaper was used to collect the insects, which were then separated based on their morphology. The data were tabulated and analyzed using the Shannon-Wiener equation for the diversity index, and the Morisita index equation for the distribution pattern. The observation was then continued by asking people about the existence of the fly community. Results: Cluster 4 has the strongest dynamics with varying absolute density. The morning has the highest absolute density, with an average of 26.56. The findings of the relative density analysis suggest that Musca domestica has the highest percentage, with an average percentage of 74.36%. Only 45% of respondents took actions to combat the presence of flies. The study’s findings also revealed that 97% of the population had never been socialized about sanitary management and attempts to control fly communities. Conclusions: Community sanitation, the prevalence of trash, and the presence of insects are not successfully regulated. The residential sector of the Gampong Jawa Community, which has the most direct access to the landfill, is at a higher risk of getting affected by hazardous diseases conveyed by flies.

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients’ family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Background and Objectives: The ineffective combination of corticosteroids and antibiotics in treating some atopic dermatitis (AD) cases has been concerning. The skin barrier defects in AD ease the colonization of Staphylococcus aureus (S. aureus), which results in a rise in interleukin-31 (IL-31). Lumbricus rubellus (L. rubellus) has shown antimicrobial and antiallergic effects but has not been studied yet to decrease the growth of S. aureus and IL-31 levels in AD patients. This study aimed to analyze the effect of L. rubellus extract in reducing S. aureus colonization, the IL-31 level, and the severity of AD. Materials and Methods: A randomized controlled trial (RCT) (international registration number TCTR20231025004) was conducted on 40 AD patients attending Dermatology and Venereology Polyclinic, Mother and Child Hospital (RSIA), Aceh, Indonesia, from October 2021 to March 2022. AD patients aged 8–16 who had a Scoring Atopic Dermatitis (SCORAD) index > 25, with total IgE serum level > 100 IU/mL, and had healthy weight were randomly assigned into two groups: one received fluocinolone acetonide 0.025% and placebo (control group) and one received fluocinolone acetonide 0.025% combined with L. rubellus extract (Vermint®) (intervention group). The S. aureus colony was identified using a catalase test, coagulase test, and MSA media. The serum IL-31 levels were measured using ELISA assay, while the SCORAD index was used to assess the severity of and improvement in AD. Mean scores for measured variables were compared between the two groups using an unpaired t-test and Mann–Whitney U test. Results: A significant decline in S. aureus colonization (p = 0.001) and IL-31 (p = 0.013) in patients receiving L. rubellus extract was found in this study. Moreover, fourteen AD patients in the intervention group showed an improvement in the SCORAD index of more than 35% (p = 0.057). Conclusions: L. rubellus extract significantly decreases S. aureus colonization and the IL-31 level in AD patients, suggesting its potential as an adjuvant therapy for children with AD.

Background: The decrease of immunity acquired from COVID-19 vaccines is a potential cause of breakthrough infection. Understanding the dynamics of immune responses of vaccine-induced antibodies post-vaccination is important. This study aimed to measure the level of anti-SARS-CoV-2 receptor-binding domain (RBD) total antibody in individuals at different time points upon the receipt of the second dose of CoronaVac vaccine, as well as evaluate the plausible associated factors. Methods: A cross-sectional study was conducted among CoronaVac-vaccinated residents in Banda Aceh, Indonesia. The level of anti-SARS-CoV-2 RBD total antibody was measured using Elecsys immunoassay. A set of standardized and validated questionnaires were used to assess the demographics and other associated factors. Results: Our results showed waning anti-SARS-CoV-2 RBD total antibody titres over time post-vaccination. Compared to samples of the first month post-vaccination, the antibody titres were significantly lower than those of five-months (mean 184.6 vs. 101.8 U/mL, p = 0.009) and six-months post-vaccination (mean 184.6 vs. 95.59 U/mL, p = 0.001). This suggests that the length of time post-vaccination was negatively correlated with titre of antibody. A protective level of antibody titres (threshold of 15 U/mL) was observed from all the samples vaccinated within one to three months; however, only 73.7% and 78.9% of the sera from five- and six-months possessed the protective titres, respectively. The titre of antibody was found significantly higher in sera of individuals having a regular healthy meal intake compared to those who did not (mean 136.7 vs. 110.4 U/mL, p = 0.044), including in subgroup analysis that included those five to six months post-vaccination only (mean 79.0 vs. 134.5 U/mL, p = 0.009). Conclusions: This study provides insights on the efficacy of CoronaVac vaccine in protecting individuals against SARS-CoV-2 infection over time, which may contribute to future vaccination policy management to improve and prolong protective strategy.

Physics is a science that discusses every result of studying the answers to the question of causes, as well as natural phenomena that can occur. The most complex problem experienced by students is the lack of skills in solving physics problems for students. The low problem solving ability of students resulted in the ability to master the basic concepts of students. This study aimed to observe the escalation of problem solving skills after the implementation of the PIL learning model in physics at MAN 6 Aceh Besar. This research is included in the type of quasi-experimental research by designing a nonequivalent control group using 2 class samples as the experimental class and the control class. The population of this study was 64 students with 43 students participating in the study. Purposive sampling method was used in order to select the study sample. The collected data was analyzed using an independent-t test technique. This study observed that PIL learning models gave a positive impact to student autonomous learning and problem solving skills. The escalation of both variables was observed from the N-Gain score. On the problem solving skills, the control group reached 0.50 N-Gain score and the eksperimen group reached 0.79.

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic.

Background: Outbreaks of hand foot mouth disease (HFMD) is endemic in Malaysia and causes outbreaks and deaths amongst young children. The aim of this study was to assess the knowledge and awareness towards HFMD and their associated determinants among parents in Malaysia. Methods: A community-based cross-sectional study was conducted between January and March 2020 in Selangor state of Malaysia using a self-administered survey. The validated questionnaires were distributed to parents with children attending kindergartens in the nine districts of Selangor through multistage sampling. Logistic regression was used to estimate the differences in knowledge and awareness between groups and to identify their associated variables. Results: We received 690 participant responses of which 485 were included in the final analysis. We found that only 34.4% of parents had good knowledge and 78.1% had good awareness of HFMD. The multivariate analysis found that those who were working in the private sectors had lower odds of having good knowledge compared to those who were working in the public sectors, adjusted odds ratio (aOR): 0.59; 95%CI: 0.36–0.97. Compared to Malay, Malaysian Chinese and Malaysian Indian had lower odds of having good awareness with aOR: 0.48; 95%CI: 0.29–0.81 and aOR: 0.44; 95%CI: 0.23–0.83, respectively. Conclusion: Although parents' awareness was relatively high, they have poor knowledge on HFMD in particular to identify the symptoms of severe cases, basic treatment and preventive measures of HFMD. HFMD information needs to be communicated in a simplified language including in online communications to improve parents’ knowledge and awareness of HFMD.

Background: The aim of this study was to summarize the antiviral activities of remdesivir against SARS-CoV-2, the causative agent of COVID-19. Methods: Available publications were systematically explored on some databases and gray literature was examined. Publications were discussed narratively. Results: Remdesivir inhibits SARS-CoV-2 replication, reduces viral load, and exerts protective effects in SARS-CoV-2 infected animals. Remdesivir also reduces the pathological process, alleviates mild symptoms, and improves pulmonary lesions in SARS-CoV-2-infecetd animals. Remdesivir has been used as a compassionate drug for treating COVID-19 patients. Conclusion: Although remdesivir has shown potent antiviral activities, more efficacy assessments are urgently warranted in clinical trials.

How countries, particularly low- and middle-income economies, should pay the coronavirus disease 2019 (COVID-19) vaccine is an important and understudied issue. We undertook an online survey to measure the willingness-to-pay (WTP) for a COVID-19 vaccine and its determinants in Indonesia. The WTP was assessed using a simple dichotomous contingent valuation approach and a linear regression model was used to assess its associated determinants. There were 1,359 respondents who completed the survey. In total, 78.3% (1,065) were willing to pay for the COVID-19 vaccine with a mean and median WTP of US$ 57.20 (95%CI: US$ 54.56, US$ 59.85) and US$ 30.94 (95%CI: US$ 30.94, US$ 30.94), respectively. Being a health-care worker, having a high income, and having high perceived risk were associated with higher WTP. These findings suggest that the WTP for a COVID-19 vaccine is relatively high in Indonesia. This WTP information can be used to construct a payment model for a COVID-19 vaccine in the country. Nevertheless, to attain higher vaccine coverage, it may be necessary to partially subsidize the vaccine for those who are less wealthy and to design health promotion materials to increase the perceived risk for COVID-19 in the country.

In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed. Keywords: 2019-nCoV, COVID-19, Outbreak, SARS-CoV-2, Novel coronavirus

During the COVID-19 pandemic, health workers are at the highest risk of infection so appropriate coping strategies are needed to survive the situation. This study aims to examine the role of coping strategies ((problem focused coping, emotion focused coping, and avoidance coping) on the resilience of health workers in hospitals. Using the Brief COPE questionnaire for coping strategy variables with α 0.888 and the Connor-Davidson Resilience Scale (CD-RISC) for resilience with α 0.89. The sampling technique used proportional random sampling with 86 respondents. Data analysis using multiple regression shows that there is a significant effect between coping strategy variables on resilience with a value of p = 0.008 (p

Obtaining a booster dose of coronavirus disease 2019 (COVID-19) vaccine is required to maintain the protective level of neutralizing antibodies and therefore herd immunity in the community, and the success of booster dose programs depends on public acceptance. The aim of this study was to determine the acceptance of a booster dose of COVID-19 vaccine and its drivers and barriers in Indonesia. A cross-sectional survey was conducted in the provinces of Indonesia between 1 and 15 August 2022. Individuals who completed the primary series of the COVID-19 vaccine were asked about their acceptance of a booster dose. Those who refused the booster dose were questioned about their reasons. A logistic regression was used to determine the determinants associated with rejection of a booster dose of COVID-19 vaccine. A total of 2935 respondents were included in the final analysis. With no information on the efficacy and safety of the COVID-19 vaccine, 95% of respondents agreed to receive a booster dose if it were provided for free by the government. This acceptance was reduced to only 50.3% if the vaccine had a 75% efficacy with a 20% chance of side effects. The adjusted logistic regression analysis indicated that there were eight factors associated with the rejection of the booster dose: age, marital status, religion, occupation, type of the first two vaccines received, knowledge regarding the importance of the booster dose, belief that natural immunity is sufficient to prevent COVID-19 and disbelief in the effectiveness of the booster dose. In conclusion, the hesitancy toward booster doses in Indonesia is influenced by some intrinsic factors such as lack of knowledge on the benefits of the booster dose, worries regarding the unexpected side effects and concerns about the halal status of the provided vaccines and extrinsic determinants such as the effectiveness and safety of the vaccine. These findings suggest the need for more campaigns and promotions regarding the booster dose benefits to increase its acceptance.

Objective: To assess healthcare workers’ knowledge of novel coronavirus disease 2019 (COVID-19) in the early phase of the outbreak in Indonesia. Methods: A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25, 2020. Healthcare workers’ knowledge on COVID-19 was assessed, and demographic data, workplace characteristics, and medical professional characteristics as well as the current local situation of COVID-19 were collected. To characterize determinants associated with knowledge, a logistic regression analysis was employed. Results: Out of 288 healthcare workers who completed the interview-assisted questionnaire, 149 (51.7%) respondents had a good knowledge. Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors: adjusted odds ratio (aOR): 0.38; 95% CI: 0.20-0.72 and aOR: 0.31; 95% CI: 0.13-0.73, respectively. Compared to healthcare workers who had medical practice experience less than 5 years, those who had worked for more than 10 years had lower knowledge (aOR: 0.43; 95% CI: 0.20-0.90). Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room (aOR: 14.33; 95% CI: 3.67-55.88). Conclusions: The knowledge of COVID-19 among surveyed healthcare workers was relatively low. The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.

Breast milk was a food source to meet all the baby's needs for nutrients. Early initiation of breastfeeding may improve survival of children, improve health status, and improve brain development and motoric. Efforts to improve the health of infants with exclusive breastfeeding can be done by involving students with the mentoring process. This studied aims to find out the level of success of mentoring by students on the provision of breastfeeding exclusive in Aceh Province. The project design was cross-sectional study with a number of subjects were 86 infant under two years. The sampling technique uses cluster sampling. Data analyses using Chi-Square test. The results of the studied found that of 43 respondents who received a breastmilk income, 76,7% gave exclusive breastfeeding and 23,3% did not give exclusive breastfeeding. Then of 43 respondents who did not get the assistance, as 53,5% gave exclusive breastfeeding, and 46,5% did not give exclusive breastfeeding. Results known to have a significant relationship between mentoring with exclusive breastfeeding (p= 0,020). Students mentoring is effective in increasing the provision of exclusive breastfeeding to infant under two years of age. ASI merupakan sumber makanan untuk memenuhi semua kebutuhan nutrisi pada bayi. Inisiasi menyusui dini dapat meningkatkan kelangsungan hidup anak-anak, meningkatkan status kesehatan, dan meningkatkan perkembangan otak dan motorik. Upaya meningkatkan kesehatan bayi dengan pemberian ASI eksklusif dapat dilakukan dengan melibatkan siswa dengan proses pendampingan. Penelitian bertujuan untuk mengetahui tingkat keberhasilan pendampingan oleh siswa tentang pemberian ASI eksklusif di Provinsi Aceh. Desain penelitian adalah studi cross-sectional dengan jumlah subjek 86 anak di bawah dua tahun. Teknik pengambilan sampel menggunakan cluster sampling. Analisis data menggunakan uji Chi-Square. Hasil penelitian menujukkan bahwa dari hasil pendampingan oleh siswa terdapat 76,7% yang telah memberikan ASI eksklusif. Sedangkan tidak mendapatkan pendampingan hanya sebesar 53,5% yang memberikan ASI eksklusif. Terdapat hubungan signifikan antara pendampingan dengan pemberian ASI eksklusif (p= 0,020). Kesimpulan, pendampingan siswa efektif dalam meningkatkan pemberian ASI eksklusif untuk bayi di bawah usia dua tahun. Saran, perlu penguatan kepada dinas pendidikan bahwa lintas sektor ini sangat bagus dalam meningkatkan kesehatan masyarakat.

This study was conducted to determine the density index of phytoplankton and Aedes albopictus larvae found in breeding sites. The object of research was phytoplankton and Aedes albopictus larvae taken at Syiah Kuala District, Banda Aceh. Data was collected in December 2014 and January 2015. This study used a descriptive exploratory design. The research parameters are the type and density of phytoplankton found in various breeding places found at the study site. Data on the density of Aedes albopictus larvae was analyzed using the House and Container Index, and Density Index. This study found 15 species of phytoplankton with the larvae density index was 203 ind/L and phytoplankton density index was 649 ind/L.

A research to investigate the improvement of student learning outcomes on Biotechnology concept with the application of SETS (Science, Environment, Technology and Society) based handout has been carried out at MAS DarulIhsan Aceh Besar on the second semester of the Academic Year 2017/2018. The research used The Pre-experimental with One Group Pretest-Posttest Design. The samples were 32 students of class XII/b MAS Darul Ihsan Aceh Besar. The data were collected by using multiple choice questions. The results showed that student learning outcomes were increased after the implementation of handout based on SETS. It can be concluded that the application of handout that is based on SETS approach can improve students learning outcomes on Biotechnology concept in MAS Darul Ihsan Aceh Besar.

Abstract Background The aim of this study was to assess the knowledge and attitudes towards pregnancy-related issues of Zika virus (ZIKV) infection among general practitioners (GPs), a frontline healthcare worker group, in Indonesia. Methods A cross-sectional, online survey assessing knowledge and attitudes towards ZIKV infection on multiple-item scales was sent to GPs in the Sumatra and Java islands of Indonesia. The associations between independent factors and either knowledge or attitude were assessed with logistic regressions. The correlation and association between knowledge and attitude were estimated. Results We included 457 (53.7%) out of 850 responses in the analysis. Among these, 304 (66.5%) and 111 (24.2%) respondents had a good knowledge and attitude, respectively. No demographic, workplace, professional development, or experiential characteristics related to ZIKV infection were associated with knowledge. In the multivariate analysis, only contact experience was associated with attitude. There was a significant, positive correlation between knowledge and attitude scores. Conclusions Although knowledge of pregnancy-related complications of ZIKV infection is relatively high among GPs in Indonesia, more than 75% of them had a poor attitude towards pregnancy-related issues of Zika. Strategies for enhancing the capacity of GPs to develop positive attitudes and respond to ZIKV infection are needed.

Abstract Objective To provide a national incidence rate and case fatality rate of dengue hemorrhagic fever in Indonesia through an analysis of the National Disease Surveillance database from the Directorate General of Disease Prevention and Control of Ministry of Health. Results Available data has indicated an increasing trend of dengue hemorrhagic fever incidence in Indonesia over the past 50 years. Incidence rates appear to be cyclic, peaking approximately every 6–8 years. In contrast, the case fatality rate has decreased approximately by half each decade, since 1980. Java Island contributed the highest average number of dengue hemorrhagic fever cases each year. In recent years, Bali and Borneo (Kalimantan) have had the highest incidence while Papua Island, the easternmost region of the Indonesian archipelago, has had the lowest incidence.

Abstract Background Despite the high number of chikungunya cases in Indonesia in recent years, comprehensive epidemiological data are lacking. The systematic review was undertaken to provide data on incidence, the seroprevalence of anti-Chikungunya virus (CHIKV) IgM and IgG antibodies, mortality, the genotypes of circulating CHIKV and travel-related cases of chikungunya in the country. In addition, a phylogenetic and evolutionary analysis of Indonesian CHIKV was conducted. Methods A systematic review was conducted to identify eligible studies from EMBASE, MEDLINE, PubMed and Web of Science as of October 16th 2017. Studies describing the incidence, seroprevalence of IgM and IgG, mortality, genotypes and travel-associated chikungunya were systematically reviewed. The maximum likelihood phylogenetic and evolutionary rate was estimated using Randomized Axelerated Maximum Likelihood (RAxML), and the Bayesian Markov chain Monte Carlo (MCMC) method identified the Time to Most Recent Common Ancestors (TMRCA) of Indonesian CHIKV. The systematic review was registered in the PROSPERO database (CRD42017078205). Results Chikungunya incidence ranged between 0.16-36.2 cases per 100,000 person-year. Overall, the median seroprevalence of anti-CHIKV IgM antibodies in both outbreak and non-outbreak scenarios was 13.3% (17.7 and 7.3% for outbreak and non-outbreak events, respectively). The median seroprevalence of IgG antibodies in both outbreak and non-outbreak settings was 18.5% (range 0.0–73.1%). There were 130 Indonesian CHIKV sequences available, of which 120 (92.3%) were of the Asian genotype and 10 (7.7%) belonged to the East/Central/South African (ECSA) genotype. The ECSA genotype was first isolated in Indonesia in 2008 and was continually sampled until 2011. All ECSA viruses sampled in Indonesia appear to be closely related to viruses that caused massive outbreaks in Southeast Asia countries during the same period. Massive nationwide chikungunya outbreaks in Indonesia were reported during 2009–2010 with a total of 137,655 cases. Our spatio-temporal, phylogenetic and evolutionary data suggest that these outbreaks were likely associated with the introduction of the ECSA genotype of CHIKV to Indonesia. Conclusions Although no deaths have been recorded, the seroprevalence of anti-CHIKV IgM and IgG in the Indonesian population have been relatively high in recent years following re-emergence in early 2001. There is sufficient evidence to suggest that the introduction of ECSA into Indonesia was likely associated with massive chikungunya outbreaks during 2009–2010.

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched as of April 5, 2020. The quality of the included papers was appraised using the Newcastle-Ottawa scale (NOS). Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

Introduction: Several vaccine candidates are being clinically tested in response to the 2019 coronavirus disease (COVID-19) pandemic. This study was conducted to assess the acceptance of a 50 or 95% effective COVID-19 vaccine, when it becomes available in southeast Asia, among the general population in Indonesia.Methods: A cross-sectional online survey was conducted between March 25 and April 6, 2020. Participants were asked if they would accept a free vaccine which was 95 or 50% effective. Using a logistic regression model, we assessed the associations between sociodemographic characteristics, exposure to COVID-19 information, or perceived risk of infection with acceptance of a hypothetical COVID-19 vaccine.Results: Among 1,359 respondents, 93.3% of respondents (1,268/1,359) would like to be vaccinated for a 95% effective vaccine, but this acceptance decreased to 67.0% (911/1,359) for a vaccine with 50% effectiveness. For a 95% effective vaccine, being a healthcare worker and having a higher perceived risk of COVID-19 infection were associated with higher acceptance, adjusted odds ratio (aOR): 2.01; 95%CI: 1.01, 4.00 and aOR: 2.21; 95%CI: 1.07, 4.59, respectively; compared to civil servants, being retired was associated with less acceptance (aOR: 0.15; 95%CI: 0.04, 0.63). For a 50% effective vaccine, being a healthcare worker was also associated with greater acceptance, aOR: 1.57; 95%CI: 1.12, 2.20.Conclusion: Acceptance of a COVID-19 vaccine was highly influenced by the baseline effectiveness of the vaccine. Preparing the general population to accept a vaccine with relatively low effectiveness may be difficult.

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients’ family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Abstract Background Hepatitis B (HepB) is a major public health concern in Malaysia yet little is known about knowledge and awareness of this infection in the country. Such information is essential for designing effective intervention strategies for HepB prevention and control. The aim of this study was to characterize knowledge and awareness regarding HepB in Malaysia and to identify their associated sociodemographic determinants. Methods A community-based cross-sectional survey was conducted between January and May 2016 in Selangor state of Malaysia. A two-stage cluster random sampling design was used and one adult member of selected households was interviewed face-to-face. Logistic regression was used to estimate the differences in knowledge and awareness between groups. Results A total of 764 households completed the interviews and were included in the final analysis. Only 36.9 and 38.8% of the participants had good knowledge and awareness, respectively. The factors associated with good knowledge were being in the 35–44 year age group, Malay ethnicity, high educational attainment and high family income. Being Chinese, being older and having high educational attainment were determinants of having good awareness towards HepB. Participants who had good knowledge were 2.5 times more likely to also have good awareness (OR: 2.41, 95% CI: 1.78–3.26, p

Abstract Background The Indonesian region of Aceh was the area most severely affected by the earthquake and tsunami of 26 December 2004. Department of Health data reveal an upward trend of dengue cases in Aceh since the events of the tsunami. Despite the increasing incidence of dengue in the region, there is limited understanding of dengue among the general population of Aceh. The aim of this study was to assess the knowledge, attitude, and practice (KAP) regarding dengue among the people of Aceh, Indonesia in order to design intervention strategies for an effective dengue prevention program. Methods A community-based cross-sectional study was conducted in Aceh between November 2014 and March 2015 with a total of 609 participants living in seven regencies and two municipalities. Information on the socio-demographic characteristics of participants and their KAP regarding dengue was collected using a pre-tested structured questionnaire. The KAP status (good vs. poor) of participants with different socio-demographic characteristics was compared using Chi Square-test, ANOVA or Fisher’s exact test as appropriate. Logistic regression analysis was used to determine the predictors of each KAP domain. Results We found that 45% of participants had good knowledge regarding dengue and only 32% had good attitudes and good dengue preventive practices. There was a significant positive correlation between knowledge and attitudes, knowledge and practice, and attitudes and practice. In addition, people who had good knowledge were 2.7 times more likely to have good attitudes, and people who had good attitudes were 2.2 times more likely to have good practices regarding dengue. The level of education, occupation, marital status, monthly income, socioeconomic status (SES) and living in the city were associated with the knowledge level. Occupation, SES, and having experienced dengue fever were associated with attitudes. Education, occupation, SES and type of residence were associated with preventive practices. Conclusion Our study suggests that dengue prevention programs are required to increase KAP levels regarding dengue in the communities of Aceh.

Dengue is a mosquito-borne disease of public health concern affecting tropical and subtropical countries, including Indonesia. Although studies on dengue epidemiology have been undertaken in Indonesia, data are lacking in many areas of the country. The aim of this study was to determine dengue virus (DENV) and chikungunya virus (CHIKV) molecular epidemiology in western regions of the Indonesian archipelago. A one-year prospective study was conducted in Aceh and Jambi in 2015 and 2016, respectively, where patients with dengue-like illness were enrolled. Of 205 patients recruited, 29 and 27 were confirmed with dengue in Aceh and Jambi, respectively, and three from Jambi were confirmed with chikungunya. DENV-1 was the predominant serotype identified in Aceh while DENV-2 was predominant in Jambi. All DENV-1 and DENV-2 from both regions were classified as Genotype I and Cosmopolitan genotype, respectively, and all DENV-3 viruses from Jambi were Genotype I. Some viruses, in particular DENV-1, displayed a distinct lineage distribution, where two DENV-1 lineages from Aceh were more closely related to viruses from China instead of Jambi highlighting the role of travel and flight patterns on DENV transmission in the region. DENV-2 from both Aceh and Jambi and DENV-3 from Jambi were all closely related to Indonesian local strains. All three CHIKV belonged to Asian genotype and clustered closely with Indonesian CHIKV strains including those previously circulating in Jambi in 2015, confirming continuous and sustainable transmission of CHIKV in the region. The study results emphasize the importance of continuous epidemiological surveillance of arboviruses in Indonesia and simultaneous testing for CHIKV among dengue-suspected patients.

The transmission of dengue and other medically important mosquito-borne viruses in the westernmost region of Indonesia is not well described. We assessed dengue and Zika virus seroprevalence in Aceh province, the westernmost area of the Indonesian archipelago. Serum samples collected from 199 randomly sampled healthy residents of Aceh Jaya in 2017 were analyzed for neutralizing antibodies by plaque reduction neutralization test (PRNT). Almost all study participants (198/199; 99.5%) presented with multitypic profiles of neutralizing antibodies to two or more DENV serotypes, indicating transmission of multiple DENV in the region prior to 2017. All residents were exposed to one or more DENV serotypes by the age of 30 years. The highest geometric mean titers were measured for DENV-4, followed by DENV-1, DENV-2 and DENV-3. Among a subset of 116 sera, 27 neutralized ZIKV with a high stringency (20 with PRNT90 > 10 and 7 with PRNT90 > 40). This study showed that DENV is hyperendemic in the westernmost region of the Indonesian archipelago and suggested that ZIKV may have circulated prior to 2017.

Penelitian ini bertujuan untuk mengetahui perbedaan hasil belajar siswa menggunakan model pembelajaran kooperatif tipe STAD dan Jigsaw pada materi sistem reproduksi manusia. Metode penelitian adalah metode eksperimen dengan desain kontrol grup tes awal dan tes akhir. Penelitian telah dilaksanakan pada kelas XI IPA 3 menggunakan model kooperatif tipe STAD dan kelas XI IPA 1 menggunakan model kooperatif tipe Jigsaw di MAN I Takengon. Instrumen yang digunakan adalah instrumen tes hasil belajar. Teknik pengumpulan data dengan mengumpulkan data kemampuan awal siswa (pre-test), data kemampuan akhir siswa (post-tes), data peningkatan pemahaman konsep (N-Gain). Analisis data hasil belajar menggunakan uji-t. Hasil penelitian menunjukkan bahwa hasil belajar siswa kelas eksperimen STAD dan Jigsaw diperoleh t hitung 25,20 dan t tabel 1,65. Kesimpulan dari penelitian ini adalah terdapat perbedaan hasil belajar siswa antara kelas eksperimen STAD dan Jigsaw. Kata Kunci: Kooperatif tipe STAD, Jigsaw, Sistem Reproduksi Manusia. This research is aimed to know the difference of study result using cooperative study model for STAD and Jigsaw type in the material of human reproduction system material. The research method is experiment method with one control group design for beginning and ending test. It has been done at XI IPA 3 class using cooperative model of STAD type and XI IPA 1 class using cooperative model of Jigsaw type at MAN 1 Takengon. Instruments used are study result test. Data collecting techniques by collecting data of students beginning capability (pre test), data of students ending capability (post test), data of concept understanding improvement (N-Gain). Data analysis of study result was using t-test. The result showed that students’ study result of STAD and Jigsaw experiment class gives t-counted is 25,20 and t-table is 1,65. The conclusion of this research was, there was a student study result difference between STAD experiment class and Jigsaw. Keyword: CooperativeSTAD, Jigsaw, Reproductive System.

Infeksi cacing usus yang ditularkan melalui tanah Soil Transmitted Helminths (STH) masih merupakan masalah penting pada kesehatan masyarakat, khususnya di negara berkembang termasuk Indonesia. Cacing penyebab kecacingan yang ditularkan melalui tanah yang sering dijumpai pada anak usia Sekolah Dasar yaitu Ascaris lumbricoides, Trichuris trichiura dan Hookworm (Ancylostoma duodenale dan Necator americanus). Tujuan penelitian ini untuk mengetahui hubungan pengetahuan, sikap dan tindakan dengan infeksi STH murid kelas 1, 2 dan 3 SDN Pertiwi Lamgarot Kecamatan Ingin Jaya Kabupaten Aceh Besar. Jenis penelitian ini adalah desain cross sectional. Populasi dalam penelitian ini adalah murid kelas 1, 2 dan 3 SDN Pertiwi sebanyak 125 orang, sampel berjumlah 95 orang murid diambil secara proportional sampling. Data diperoleh dengan menggunakan kuesioner mengenai pengetahuan, sikap dan tindakan serta dilakukan juga pemeriksaan tinja responden (murid) dengan menggunakan metode Kato-Kazt. Data diolah menggunakan uji Chi Square untuk melihat hubungan pengetahuan, sikap dan tindakan dengan infeksi STH. Hasil penelitian menunjukkan bahwa 32 responden positif terinfeksi STH dengan tingkat prevalensi 33,68%. Berdasarkan hasil uji Chi Square diperoleh bahwa ada hubungan antara pengetahuan, sikap dan tindakan dengan infeksi STH pada murid kelas 1, 2 dan 3 SDN Pertiwi Lamgarot. Kata Kunci: Pengetahuan, Sikap, Tindakan, dan Soil Transmitted Helminths. Intestinal worm infections that are transmitted through the soil so called Soil Transmitted Helminthes (STH) is still an important public health problem, particularly in developing countries including Indonesia. Worms that caused intestinal infections which are transmitted through soil are often found in in elementary school-age children namely Ascaris lumbricoides, Trichuris trichiura and hookworm (Ancylostoma duodenale and Necator americanus). This study tried to find out the relationship of knowledge, attitudes and actions to STH infection at grade 1, 2 and 3 of SDN Pertiwi Lamgarot Ingin Jaya Aceh Besar district. This is a cross-sectional design research. The population of this study was all students grade 1, 2 and 3 of SDN Pertiwi for about 125 students. There were 95 samples were selected by using proportional sampling. The data were collected by using questionnaires about knowledge, attitudes and actions, and also by examining students’ faeces by using Kato-Kazt. The data were processed by using Chi Square to see the relationship of knowledge, attitudes and actions with STH infection. The results showed that 32 students were positively infected with STH prevalence rate 33.68%. Based on the results of the Chi Square test, it was showed that there were relationships among knowledge, attitudes and actions with STH infection at students grade 1, 2 and 3 of SDN Pertiwi Lamgarot Ingin Jaya Aceh Besar district. Keyword: Problem Based Learning, Critical Thinking, Human System Respiratory

Abstrak. Rendahnya hasil belajar siswa dilihat dari nilai ujian akhir semester, hal ini disebabkan target waktu untuk mencapai isi pembelajaran dan keterbatasan guru dalam mengolah pembelajaran khususnya ketika ada materi yang menyangkut dengan praktikum seperti halnya materi hidrolisis garam. Penelitian ini dilakukan dengan metode quasi eksperimental dengan pretest-posttest group design yang dilaksanakan di SMAN 12 Banda Aceh tahun akademik 2015/2016, yang terdiri masing-masing 25 siswa kelas eksperimen dan kelas kontrol. Pengumpulan data dilakukan dengan 3 (dua) instrumen; 1) Tes untuk melihat peningkatan KPS siswa pada pokok bahasan hidrolisis garam; 2) Angket motivasi untuk melihat peningkatan motivasi belajar siswa; dan 3) Angket respon untuk melihat tanggapan siswa terhadap model pembelajaran berbasis masalah dengan menggunakan metode praktikum. Uji normalitas dilakukan untuk melihat kenormalan data dan menunjukkan bahwa data berdistribusi normal. Hasil penelitian menunjukkan bahwa 1) pembelajaran berbasis masalah menggunakan metode praktikum dapat mempengaruhi keterampilan proses sain siswa dalam belajar kimia. Hal ini dapat dilihat tingginya perolehan skor N-Gain pada kelas eksperimen dibandingkan penerapan pembelajaran konvensional di kelas kontrol; 2) pembelajaran pembelajaran berbasis masalah menggunakan metode praktikum dapat meningkatkan motivasi belajar siswa dalam belajar kimia; 3) Respon siswa terhadap penerapan pembelajaran berbasis masalah menggunakan metode praktikum pada pokok bahasan hidrolisis garam mendapatkan respon positif dari siswa. Kata Kunci: PBM, metode praktikum, KPS, motivasi belajar, hidrolisis garam. Abstract. Low student learning outcomes seen from the final exams, and this is the target date for achieving the learning content and limitations of the teachers in the process of learning, especially when there is material pertaining to the lab as well as the material salt hydrolysis. This research was conducted by quasi experimental method with a pretest-posttest group design conducted at SMAN 12 Banda Aceh academic year 2015/2016, which consists of 25 students in the experimental class and same as the control class. The data collection is done with three instruments; 1) Tests to see an increase in KPS students on the subject of salt hydrolysis; 2) Questionnaire motivation to see an increase in student motivation; and 3) Questionnaire responses to see the students' of the problem based learning using practical methods. Normality test is done to see the normality of data and shows that the normal distribution of data. The results showed that 1) the problem-based learning using practical methods can affect science process skills of students in learning chemistry. This can be seen high score of N-Gain acquisition of the experimental class compared to conventional classroom learning application control; 2) learning problem-based learning using practical methods may increase students' motivation to learn chemistry; 3) The response of students to the application of problem-based learning using practical methods on the topic of salt hydrolysis get a positive response from students. Keywords: PBL, practical methods, SPS, motivation to learn, salt hydrolysis.

The coronavirus disease 2019 (COVID-19) pandemic is a major global threat. With no effective antiviral drugs, the repurposing of many currently available drugs has been considered. One such drug is ivermectin, an FDA-approved antiparasitic agent that has been shown to exhibit antiviral activity against a broad range of viruses. Recent studies have suggested that ivermectin inhibits the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus suggesting its potential for use against COVID-19. This review has summarized the evidence derived from docking and modeling analysis, in vitro and in vivo studies, and results from new investigational drug protocols, as well as clinical trials, if available, which will be effective in supporting the prospective use of ivermectin as an alternative treatment for COVID-19.

The aim of this study was to assess the possible association of El Niño Southern Oscillation (ENSO) and Dipole Mode Index (DMI) on chikungunya incidence overtime, including the significant reduction in cases that was observed in 2017 in Indonesia. Monthly nation-wide chikungunya case reports were obtained from the Indonesian National Disease Surveillance database, and incidence rates (IR) and case fatality rate (CFR) were calculated. Monthly data of Niño3.4 (indicator used to represent the ENSO) and DMI between 2011 and 2017 were also collected. Correlations between monthly IR and CFR and Niño3.4 and DMI were assessed using Spearman’s rank correlation. We found that chikungunya case reports declined from 1972 cases in 2016 to 126 cases in 2017, a 92.6% reduction; the IR reduced from 0.67 to 0.05 cases per 100,000 population. No deaths associated with chikungunya have been recorded since its re-emergence in Indonesia in 2001. There was no significant correlation between monthly Niño3.4 and chikungunya incidence with r = −0.142 (95%CI: −0.320–0.046), p = 0.198. However, there was a significant negative correlation between monthly DMI and chikungunya incidence, r = −0.404 (95%CI: −0.229–−0.554) with p < 0.001. In conclusion, our initial data suggests that the climate variable, DMI but not Niño3.4, is likely associated with changes in chikungunya incidence. Therefore, further analysis with a higher resolution of data, using the cross-wavelet coherence approach, may provide more robust evidence.

BackgroundIn Malaysia, one million individuals are estimated to be infected with the hepatitis B virus. A vaccine for infants has been compulsory since 1989, whereas those born before 1989 need to spend their own money to be vaccinated in private clinics or hospitals. The aim of this study was to investigate and ascertain the determinants of willingness to pay (WTP) for adult hepatitis B vaccine in Selangor, Malaysia.MethodsIn 2016, 728 households were selected through a stratified, two stage cluster sample and interviewed. Willingness to pay for hepatitis B vaccine was estimated using the Contingent Valuation Method, and factors affecting WTP were modelled with logit regression.ResultsWe found that 273 (37.5%) of the households were willing to pay for hepatitis B vaccination. The mean and median of WTP was estimated at Ringgit Malaysia (RM)303 (approximately US$73) for the three dose series. The estimated WTP was significantly greater in those with higher levels of education, among Malays and Chinese (compared to others, predominantly Indians), and for those with greater perceived susceptibility to hepatitis B virus infection. Other factors-perceived severity, barriers, benefits and cues to action-were not significantly associated with WTP for adult hepatitis B vaccination.ConclusionAdditional resources are needed to cover the households that are not willing to pay for hepatitis B vaccination. More awareness (particularly in regards to hepatitis B virus susceptibility) could change the national perception towards self-paid hepatitis B virus vaccination and increase hepatitis B vaccine coverage.

BackgroundMalaysia has a comprehensive, publicly-funded immunization program for hepatitis B (HepB) among infants, but adults must pay for the vaccine. The number of HepB carriers among adults is expected to increase in the future; therefore, we examined the impact of five constructs (cues to action, perceived barriers, perceived benefit, perceived severity, and perceived susceptibility) on adults' willingness to pay (WTP) for HepB vaccine; secondarily, we examined the association between perceived barriers and perceived benefits.MethodsAdults were selected through a stratified, two-stage cluster community sample in Selangor, Malaysia. The reliability, convergent validity, and discriminant validity of the measurement model were assessed before implementing a partial least squares structural equation model (PLS-SEM) to evaluate the significance of the structural paths.ResultsA total of 728 participants were enrolled. The five constructs all showed adequate internal reliability, convergent validity, and discriminant validity. There was a significant, positive relationship to WTP from constructs (perceived barriers [Path coefficient (β) = 0.082, P = 0.036], perceived susceptibility [β = 0.214, PConclusionsPolicy and programs should be targeted that can modify individuals' thoughts about disease risk, their obstacles in obtaining the preventive action, and their readiness to obtain a vaccine. Such programs include educational materials about disease risk and clinic visits that can pair HepB screening and vaccination.

One of the crucial steps during trials for Zika and other vaccines is to recruit participants and to understand how participants’ attitudes and sociodemographic characteristics affect willingness to participate (WTP). This study was conducted to assess WTP, its explanatory variables, and the impact of financial compensation on WTP in Indonesia. A health facility-based cross-sectional study was conducted in eleven regencies in the Aceh and West Sumatra provinces of Indonesia. Participants were recruited via a convenience sampling method and were interviewed. The associations between explanatory variables and WTP were assessed using a two-step logistic regression analysis. A total of 1,102 parents were approached, and of these 956 (86.8%) completed the interview and were included in analysis. Of those, 144 (15.1%) were willing to participate in a Zika vaccine trial without a financial compensation. In the multivariate analysis, WTP was tied to an age of more than 50 years old, compared to 20⁻29 years (odds ratio (OR): 5.0; 95% confidence interval (CI): 2.37⁻10.53), to being female (OR: 2.20; 95% CI: 1.11⁻4.37), and to having heard about Zika (OR: 2.41; 95% CI: 1.59⁻3.65). Participants’ WTP increased gradually with higher financial compensation. The rate of WTP increased to 62.3% at the highest offer (US$ 350.4), and those who were still unwilling to participate (37.7%) had a poorer attitude towards childhood vaccination. This study highlights that pre-existing knowledge about Zika and attitudes towards childhood vaccination are important in determining community members being willing to participate in a vaccine trial. Financial incentives are still an important factor to enhance participant recruitment during a vaccine trial.

Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients’ family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.

Background: The decrease of immunity acquired from COVID-19 vaccines is a potential cause of breakthrough infection. Understanding the dynamics of immune responses of vaccine-induced antibodies post-vaccination is important. This study aimed to measure the level of anti-SARS-CoV-2 receptor-binding domain (RBD) total antibody in individuals at different time points upon the receipt of the second dose of CoronaVac vaccine, as well as evaluate the plausible associated factors. Methods: A cross-sectional study was conducted among CoronaVac-vaccinated residents in Banda Aceh, Indonesia. The level of anti-SARS-CoV-2 RBD total antibody was measured using Elecsys immunoassay. A set of standardized and validated questionnaires were used to assess the demographics and other associated factors. Results: Our results showed waning anti-SARS-CoV-2 RBD total antibody titres over time post-vaccination. Compared to samples of the first month post-vaccination, the antibody titres were significantly lower than those of five-months (mean 184.6 vs. 101.8 U/mL, p = 0.009) and six-months post-vaccination (mean 184.6 vs. 95.59 U/mL, p = 0.001). This suggests that the length of time post-vaccination was negatively correlated with titre of antibody. A protective level of antibody titres (threshold of 15 U/mL) was observed from all the samples vaccinated within one to three months; however, only 73.7% and 78.9% of the sera from five- and six-months possessed the protective titres, respectively. The titre of antibody was found significantly higher in sera of individuals having a regular healthy meal intake compared to those who did not (mean 136.7 vs. 110.4 U/mL, p = 0.044), including in subgroup analysis that included those five to six months post-vaccination only (mean 79.0 vs. 134.5 U/mL, p = 0.009). Conclusions: This study provides insights on the efficacy of CoronaVac vaccine in protecting individuals against SARS-CoV-2 infection over time, which may contribute to future vaccination policy management to improve and prolong protective strategy.

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic.

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic.

Background: The decrease of immunity acquired from COVID-19 vaccines is a potential cause of breakthrough infection. Understanding the dynamics of immune responses of vaccine-induced antibodies post-vaccination is important. This study aimed to measure the level of neutralizing antibody (NAb) anti-SRBD in individuals at different time points upon the receipt of the second dose of CoronaVac vaccine, as well as evaluate the plausible associated factors. Methods: A cross-sectional study was conducted among CoronaVac-vaccinated residents in Banda Aceh, Indonesia. The level of NAb titre was measured using Elecsys Anti-SARS-CoV-2 S immunoassay. A set of standardized and validated questionnaires were used to assess the demographics and other plausible associated factors. Results: Our results showed waning SARS-Cov-2 NAb titres over time post-vaccination. Compared to samples of the first month post-vaccination, the levels of NAb titres were significantly lower than those of five-months (mean 184.6 vs. 101.8 IU/mL, p = 0.009) and six-months post-vaccination (mean 184.6 vs. 95.59 IU/mL, p = 0.001). This suggests that the length of time post-vaccination was negatively correlated with antibody anti-SRBD titre. A protective level of NAbs titres (threshold of 15 IU/mL) was observed from all the samples vaccinated within one to three months; however, only 73.7% and 78.9% of the sera from five- and six-months possessed the protective titres against SARS-CoV-2, respectively. The titre of NAb anti-SRBD was found significantly higher in sera of individuals having a regular healthy meal intake compared to those who did not (mean 136.7 vs. 110.4 IU/mL, p = 0.044), including in subgroup analysis that included those five to six months post-vaccination only (mean 79.0 vs. 134.5 IU/mL, p = 0.009). Conclusions: This study provides insights on the efficacy of CoronaVac vaccine in protecting individuals against SARS-CoV-2 infection over time, which may contribute to future vaccination policy management to improve and prolong protective strategy.

Introduction: Social distancing and wearing a face mask are highly recommended to mitigate the transmission of coronavirus disease 2019 (COVID-19). However, the success of these strategies relies on individuals’ adherence and public compliance. This study was conducted to assess the level of belief in social distancing and face mask practices in communities in low- and middle-income countries (LMICs) and to identify their possible determinants. Methods: A cross-sectional study was conducted in ten LMICs countries in Asia, Africa, and South America from February to May 2021. A questionnaire was used to assess the belief, practice, and their plausible determinants. Identification of the associated determinants was performed using a logistic regression model. Results: Our data revealed that only 62.6% and 66.9% of the participants had good beliefs in social distancing and good face mask practices, respectively. Residing in the Americas, having a healthcare-related job, knowing people in immediate social environment who are or have been infected and exposure to information of COVID-19 cases on social media or TV were factors significantly associated with good belief in social distancing. Residing country, gender, monthly household income, type of job and exposure to information of COVID-19 cases were significantly associated with face mask wearing practice. Conclusion: The proportion of participants having good beliefs in social distancing and good face mask practices is relatively low (