ORCID Profile
0000-0002-6962-5565
Current Organisations
University of Oxford
,
Eijkman-Oxford Clinical Research Unit (EOCRU)
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Publisher: Public Library of Science (PLoS)
Date: 09-12-2022
DOI: 10.1371/JOURNAL.PGPH.0000893
Abstract: The impact of SARS-CoV-2 infections upon Indonesian health care workers (HCWs) is unknown due to the lack of systematic collection and analysis of mortality data specific to HCWs in this setting. This report details the results of a systematic compilation, abstraction and analysis of HCW fatalities in Indonesia during the first 18 months of COVID-19. HCW who passed away between March 2020 and July 2021 were identified using Pusara Digital , a community-based digital cemetery database dedicated to HCW. We calculated the mortality rates and death risk ratio of HCWs versus the general population. The analysis indicates that at least 1,545 HCWs died during the study period. Death rates among males and females HCWs were nearly equivalent (51% vs. 49%). The majority were physicians and specialists (535, 35%), nurses (428, 28%), and midwives (359, 23%). Most deaths occurred between the ages of 40 to 59 years old, with the median age being 50 years (IQR: 39–59). At least 322 deaths (21%) occurred with pre-existing conditions, including 45 pregnant women. During the first 18 months of COVID-19 in Indonesia, we estimated a minimum HCW mortality rate of 1.707 deaths per 1,000 HCWs. The provincial rates of HCW mortality ranged from 0.136 (West Sulawesi) to 5.32 HCW deaths per 1,000 HCWs (East Java). The HCW mortality rate was significantly higher than that of the general population (RR = 4.92, 95% CI 4.67–5.17). The COVID-19 pandemic in Indonesia resulted in the loss of many hundreds of HCWs, the majority of whom were senior healthcare workers. The HCW mortality rate is five times that of the general population. A national systematic surveillance of occupational mortality is urgently needed in this setting.
Publisher: Cold Spring Harbor Laboratory
Date: 28-04-2022
DOI: 10.1101/2022.04.27.22274334
Abstract: The impact of SARS-CoV-2 infections upon Indonesian health care workers (HCWs) remains unclear, as mortality data specific to HCWs is not systematically collected or analyzed in this setting. This report describes findings from a systematic collation, abstraction and analysis of HCW fatalities during the first 18 months of COVID-19 in Indonesia. HCW who died during the period of March 2020 to July 2021 across Indonesia were identified on Pusara Digital , a community web-based digital cemetery database dedicated to HCW. We calculated mortality rates and death risk ratio among HCWs and the general population. Qualitative methods explored concerns regarding mortality among HCWs. The analysis suggests that at least 1,545 HCWs died during the study period. The death of males and females HCWs were almost equally distributed (51% vs. 49%). Most were medical doctors and specialists (535, 35%), nurses (428, 28%), and midwives (359, 23%). Deaths most frequently occurred in the age group of 40 to 59 years old with the median age of 50 years (IQR: 39-59). At least 322 (21%) deaths occurred with pre-existing conditions, including 45 who were pregnant. We estimated a minimal HCW mortality rate in Indonesia at 1.707 deaths per 1000 HCW during the first 18 months of COVID-19. Provincial HCW mortality rates ranged from 0.136 (West Sulawesi) to 5.32 HCW deaths per 1000 HCWs (East Java). HCW had a significantly higher mortality rate than the general population (RR = 4.92, 95% CI 4.67 – 5.17). The COVID-19 event in Indonesia resulted in the loss of many hundreds of HCWs, most of them being senior physicians, nurses, and midwives. The HCW death rates is 5-times higher than everyone else. The sheer sparseness of the workforce requires more protective steps and a national systematic surveillance of occupational mortality is urgently needed in this setting.
Publisher: Springer Science and Business Media LLC
Date: 30-11-2020
DOI: 10.1186/S12936-020-03511-2
Abstract: Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi —a non-human primate malaria parasite—were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers, including adapting reactive case detection. Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviours, and willingness to participate in malaria surveys at forest work sites and using peer-referral. Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day’s journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviours. Adapting active surveillance to specifically target forest workers through work-site screening and/or peer-referral appears promising for addressing currently undetected infections.
Publisher: Cold Spring Harbor Laboratory
Date: 02-10-2020
DOI: 10.1101/2020.10.02.20198663
Abstract: As in many countries, quantifying COVID-19 spread in Indonesia remains challenging due to testing limitations. In Java, non-pharmaceutical interventions (NPIs) were implemented throughout 2020. However, as a vaccination c aign launches, cases and deaths are rising across the island. We used modelling to explore the extent to which data on burials in Jakarta using strict COVID-19 protocols (C19P) provide additional insight into the transmissibility of the disease, epidemic trajectory, and the impact of NPIs. We assess how implementation of NPIs in early 2021 will shape the epidemic during the period of likely vaccine roll-out. C19P burial data in Jakarta suggest a death toll approximately 3.3 times higher than reported. Transmission estimates using these data suggest earlier, larger, and more sustained impact of NPIs. Measures to reduce sub-national spread, particularly during Ramadan, substantially mitigated spread to more vulnerable rural areas. Given current trajectory, daily cases and deaths are likely to increase in most regions as the vaccine is rolled-out. Transmission may peak in early 2021 in Jakarta if current levels of control are maintained. However, relaxation of control measures is likely to lead to a subsequent resurgence in the absence of an effective vaccination c aign. Syndromic measures of mortality provide a more complete picture of COVID-19 severity upon which to base decision-making. The high potential impact of the vaccine in Java is attributable to reductions in transmission to date and dependent on these being maintained. Increases in control in the relatively short-term will likely yield large, synergistic increases in vaccine impact. In many settings, limited SARS-CoV-2 testing makes it difficult to estimate the true trajectory and associated burden of the virus. Non-pharmaceutical interventions (NPIs) are key tools to mitigate SARS-CoV-2 transmission. Vaccines show promise but effectiveness depends upon prioritization strategies, roll-out and uptake. This study gives evidence of the value of syndrome-based mortality as a metric, which is less dependent upon testing capacity with which to estimate transmission trends and evaluate intervention impact. NPIs implemented in Java earlier in the pandemic have substantially slowed the course of the epidemic with movement restrictions during Ramadan preventing spread to more vulnerable rural populations. Population-level immunity remains below proposed herd-immunity thresholds for the virus, though it is likely substantially higher in Jakarta. Given current levels of control, upwards trends in deaths are likely to continue in many provinces while the vaccine is scheduled to be rolled out. A key exception is Jakarta where population-level immunity may increase to a level where the epidemic begins to decline before the vaccine c aign has reached high coverage. Further relaxation of measures would lead to more rapidly progressing epidemics, depleting the eventual incremental effectiveness of the vaccine. Maintaining adherence to control measures in Jakarta may be particularly challenging if the epidemic enters a decline phase but will remain necessary to prevent a subsequent large wave. Elsewhere, higher levels of control with NPIs are likely to yield high synergistic vaccine impact.
Publisher: Cold Spring Harbor Laboratory
Date: 19-04-2022
DOI: 10.1101/2022.04.18.22273950
Abstract: As control efforts progress towards elimination, malaria is likely to become more spatially concentrated in few local areas. The purpose of this study was to quantify and characterise spatial heterogeneity in malaria transmission-intensity across highly endemic Indonesian Papua. We analysed in idual-level malaria surveillance data for nearly half a million cases (2019–2020) reported in the Papua and West Papua provinces and adapted the Gini index approach to quantify spatial heterogeneity at the district and health-unit levels. We showed malaria incidence trends and the spatial and temporal distribution of sociodemographic characteristics and aetiological parasites among cases. While Papua province accounted for the majority of malaria cases reported in the region and had seen a rise in transmission since 2015, West Papua province had maintained a comparatively low incidence. We observed that Gini index estimates were high, particularly when the lower spatial scale of health units was evaluated. The Gini index appears to be inversely associated to annual parasite-incidence, as well as the proportions of vivax malaria, male sex, and adults. This study suggests that areas with varying levels of transmission-intensities exhibited distinct characteristics. Malaria was distributed in a markedly disproportionate manner throughout the region, emphasising the need for spatially targeted interventions. Periodic quantification and characterisation of risk heterogeneity at various spatial levels using routine malaria surveillance data may aid in tracking progress towards elimination and guiding evidence-informed prioritisation of resource allocation. Strengthening Preparedness in the Asia-Pacific Region through Knowledge (SPARK) project. We searched PubMed up to and including November 19, 2021, for relevant articles on the spatial distribution of malaria in the Papua region of Indonesia, using the terms (“malaria”) AND (“distribution” OR “variation” OR “heterogeneity” OR “cluster” OR “aggregation”) AND (“Papua”) AND (“Indonesia”). Despite the region’s mostly stable transmission areas, there has been considerable variation in transmission intensity across the region. According to community surveys conducted up to 2010, estimates of parasite prevalence of Plasmodium falciparum and Plasmodium vivax were highly variable, ranging from 0% to at least 40% and from 0% to at least 7%, respectively, across the region. Similarly, when the Papuan subset of the 2007 National Basic Health Research data was used, the degree of spatial heterogeneity in malaria risk among Papuan districts remained apparent even after sociodemographic were adjusted. Current evidence that is more representative of the current situation, including an easily interpretable and comparable measure of spatial heterogeneity across space and time, is limited. Our analysis of large-scale and routinely collected malaria surveillance data from January 2019 to December 2020 revealed significant spatial heterogeneity across the Papua region, as measured by the Gini index. Complementing conventional approaches using geospatial maps and risk tables, the Gini index can be used to provide a single, and sensitive numerical indicator summarising the degree of transmission heterogeneity at a specified spatial level of interest. Along with the previously recognised high spatial heterogeneity among districts, this study revealed a greater degree of intra-district heterogeneity at the health-unit level. That is, within the districts, there were also few health centres and hospitals with a disproportionately higher malaria burden. We observed distinct characteristics of in iduals who contracted malaria in districts with varying levels of incidence. The higher transmission magnitude was associated with a lower Gini index, as well as with lower proportions of vivax malaria, male sex, and adults among the cases. This study provides contemporary empirical evidence for the spatial heterogeneity of malaria distribution across the Papua region of Indonesia, particularly at the lower spatial resolution of health units. Evaluating spatial heterogeneity at a lower spatial scale is likely essential to refine and update local malaria control strategic planning. The combination of comprehensive, routine malaria surveillance data and the Gini index may enable policymakers to assess the magnitude and characteristics of spatial heterogeneity with increased frequency, interpretability, and comparability, allowing for the rapid identification of transmission foci and the deployment of public health measures. Effective control of parasite reservoirs associated with intense transmission may further shrink the risk of infection in adjacent areas with a lower degree of malaria exposure.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Lenny Ekawati.