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Background The COVID-19 pandemic resulted in extreme strain on health systems including the health workforce, essential health services and vaccination coverage. We examined disruptions to immunisation and maternal and child health (MCH) services, concerns of personal well-being and delivery of healthcare during the pandemic as well as factors associated with self-reported trauma or burnout among healthcare providers (HCPs).Methods In March–April 2022, we conducted a cross-sectional survey among HCPs in two provinces of Indonesia. HCPs involved in COVID-19 or routine immunisation and MCH services were randomly selected from district/city health office registration lists. We descriptively analysed service disruptions experienced by HCPs as well as trauma, burnout and concerns of personal well-being and delivery of healthcare during the pandemic. Multivariate logistic regression analyses were undertaken to identify factors associated with trauma or burnout.Results We recruited 604 HCPs. Mobilisation of staff from routine health services to COVID-19 response duties was a key reason for service disruptions (87.9%). Strategies such as community outreach and task shifting were implemented to overcome disruptions. Trauma or burnout during the pandemic was reported by 64.1% HCPs, with 23.5% reporting worse mental or emotional health.Factors associated with trauma or burnout included delivery of COVID-19 immunisation (adjusted OR (aOR) 2.54, 95% CI 1.08 to 5.94); and delivery of both COVID-19 immunisation and routine immunisation compared with no involvement in vaccination programmes (aOR 2.42, 95% CI 1.06 to 5.52); poor treatment in the workplace (aOR 2.26, 95% CI 1.51 to 3.38) and lower confidence to respond to patient queries on COVID-19 immunisation (aOR 1.51, 95% CI 1.03 to 2.22).Conclusion HCPs experienced service disruptions, trauma and burnout and implemented strategies to minimise disruptions to service delivery and improve patient experiences. Our study highlights the need to ensure that workforce resilience and strategies to protect and support HCPs are considered for pandemic planning, preparedness and management.

Abstract Background Indonesia’s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the “Three Delays” model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region. Methods This qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death. Results For maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level. Conclusions For maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite.

Semakin berkembangnya penggunaan biodesel sebagai bahan bakar yang bersifat renewable mendorong bertambahnya jumlah gliserol di pasaran sebagai produk samping reaksi pembuatan biodesel. Upaya peningkatan nilai jual gliserol dilakukan dengan pengolahan gliserol menjadi produk turunannya, salah satunya gliserol karbonat. Gliserol karbonat memiliki fungsi sebagai bahan baku polimer, surfaktan, emulsifier dan sebagainya yang juga bersifat biodegradable. Gliserol karbonat dapat diperoleh melalui reaksi karboksilasi katalitik antara gliserol dengan urea. Reaksi ini dilakukan dalam reactor batch dilengkapi yang dilengkapi dengan pompa. Gliserol, urea dan katalis dimasukkan dalam reaktor, kemudian dipanaskan. Saat suhu operasi tercapai, pompa vakum dinyalakan vakum untuk mengeliminasi gas ammonia yang terbentuk sebagai produk samping. Penelitian ini diawali dengan seleksi 3 jenis katalis yakni Ni powder, Ni yang diambil dari NiCl2.6H2O dan Ni/γAl2O3, jumlah katalis yang digunakan dalam seleksi sebesar 3% dengan suhu proses 150oC selama 4 jam. Hasil yang terbaik adalah katalis Ni/γAl2O3 dengan konversi gliserol 38,88% dan yield gliserol karbonat 23,56%. Kemudian dilakukan uji pengaruh jumlah katalis 1%, 3% & 5% dari berat gliserol dengan menggunakan Ni/γAl2O3. Hasil terbaik pada berat katalis 5% dengan konversi gliserol 43,93% dan yield gliserol karbonat 27,83%. Penelitian dilanjutkan dengan seleksi suhu proses antara 100oC, 125oC, 150oC, 175oC & 200oC. Pada seleksi ini terpilih suhu 150oC yang menghasilkan konversi gliserol 43,93% dan yield gliserol karbonat sebesar 27,83%. Berikutnya adalah mengetahui pengaruh waktu terhadap konversi gliserol dan yield gliserol karbonat dengan variable 0 jam, 1 jam, 2 jam, 3 jam dan 4 jam. Hasil terbaik diperoleh pada 4 jam proses dengan konversi gliserol 43,93% dan yield gliserol karbonat sebesar 27,83%.

Background: The COVID-19 pandemic resulted in extreme strain on health systems including the health workforce, essential health services and vaccination coverage. We examined disruptions to immunisation and maternal and child health (MCH) services, concerns of personal well-being and delivery of healthcare during the pandemic as well as factors associated with self-reported trauma or burnout among healthcare providers (HCPs)., Methods: In March-April 2022, we conducted a cross-sectional survey among HCPs in two provinces of Indonesia. HCPs involved in COVID-19 or routine immunisation and MCH services were randomly selected from district/city health office registration lists. We descriptively analysed service disruptions experienced by HCPs as well as trauma, burnout and concerns of personal well-being and delivery of healthcare during the pandemic. Multivariate logistic regression analyses were undertaken to identify factors associated with trauma or burnout., Results: We recruited 604 HCPs. Mobilisation of staff from routine health services to COVID-19 response duties was a key reason for service disruptions (87.9%). Strategies such as community outreach and task shifting were implemented to overcome disruptions. Trauma or burnout during the pandemic was reported by 64.1% HCPs, with 23.5% reporting worse mental or emotional health.Factors associated with trauma or burnout included delivery of COVID-19 immunisation (adjusted OR (aOR) 2.54, 95% CI 1.08 to 5.94); and delivery of both COVID-19 immunisation and routine immunisation compared with no involvement in vaccination programmes (aOR 2.42, 95% CI 1.06 to 5.52); poor treatment in the workplace (aOR 2.26, 95% CI 1.51 to 3.38) and lower confidence to respond to patient queries on COVID-19 immunisation (aOR 1.51, 95% CI 1.03 to 2.22)., Conclusion: HCPs experienced service disruptions, trauma and burnout and implemented strategies to minimise disruptions to service delivery and improve patient experiences. Our study highlights the need to ensure that workforce resilience and strategies to protect and support HCPs are considered for pandemic planning, preparedness and management., Competing Interests: Competing interests: Julie Leask receives funding from the World Health Organization and has received reimbursement for travel to an overseas meeting from Sanofi., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)