Colonization of Anopheles maculatus from Central Java,Indonesia

The routine colonization of Anopheles maculatus, a reputed malaria vector from Central Java, is described. The strain is free mating and long lived in the laboratory. This species will readily bloodfeed on small rodents and artificial membrane systems. Either natural or controlled temperatures, humidity, and lighting provide acceptable conditions for continuous rearing. A simple larval diet incorporating a 10:4 powdered mixture of dried beef and rice hulls proved acceptable. Using a variety of simple tools and procedures, this colony strain appears readily adaptable to rearing under most laboratory conditions. This appears to be the first report of continuous colonization using a free-mating strain of An. maculatus. Using this simple, relatively inexpensive method of mass colonization adds to the short list of acceptable laboratory populations used in the routine production of human-infecting plasmodia.     

Tetanus toxoid immunization of prospective brides in Central Java, Indonesia

A serf-sustaining and highly successful routine programme todeliver tetanus toxoid (TT) immunization to prospective bridesin Central Java, Indonesia, is documented. This initiative involvedintersectoral collaboration between the Ministries of Health,Religious Affairs and Interior, relied on communication by localIslamic leaders, and was supported by a small administrativefee levied on the prospective brides prior to marriage registration.Collaboration with local religious institutions and leadersmay accelerate both immunization and safe motherhood initiatives.This programme could be extended to all areas of Indonesia andprospective brides could be designated a priority group forTT immunization.     

Zika virus,a cause of fever in Central Java,Indonesia

In 1977 and 1978 selected in-patients at the Tegalyoso Hospital, Klaten, Indonesia who had recent onsets of acute fever were serologically studied for evidence of alphavirus and flavivirus infections. A brief clinical history was taken and a check list of signs and symptoms was completed on admission. Acute and convalescent phase sera from 30 patients who showed evidence that a flavivirus had caused their illnesses were tested for neutralizing antibodies to several flaviviruses which occur in South-east Asia. Paired sera from seven patients demonstrated a fourfold rise in antibody titre from acute to convalescent phase. The most common clinical manifestations observed in this series of patients included high fever, malaise, stomach ache, dizziness and anorexia. None of the seven patients had headache or rash despite the fact that headache and rash had been associated with two of the three previously studied. The onsets of illness clustered toward the end of the rainy season when populations of Aedes aegypti, a probable vector in Malaysia, were most abundant.     

Weight-gain patterns from prepregnancy until delivery among women in Central Java,Indonesia

BACKGROUND: Representative data on pregnancy weight-gain patterns from developing countries are scarce. The reasons include difficulties in obtaining population-based samples and in collecting data before and throughout pregnancy. OBJECTIVE: The objective was to measure weight-gain patterns from prepregnancy until after delivery in a population-based sample of rural Indonesian women. DESIGN: Two cross-sectional surveys of nutritional status among nonpregnant women of reproductive age were carried out through a surveillance system in Purworejo District, Central Java, Indonesia, in 1996 and 1997. Between 1996 and 1998, 846 newly pregnant women were enrolled in a cohort study in which weight was monitored monthly throughout pregnancy. Prepregnancy weights and other anthropometric measures were available for 251 of the women who had live births. RESULTS: Before pregnancy, 16.7% of the women had chronic energy deficiency and 10.0% were obese. The mean total pregnancy weight gain for all the women was 8.3 +/- 3.6 kg, and 79% did not meet the international recommendation regarding weight gain for their prepregnant body mass index. The rate of weight gain was highest during the second trimester (0.34 kg/wk). In the first and third trimesters, it was 0.08 and 0.26 kg/wk, respectively. Total weight gain was associated with prepregnant body mass index, education, and socioeconomic status. CONCLUSIONS: Many women in rural Central Java, Indonesia, enter pregnancy with suboptimal nutritional status. For most of these women, total weight gain during pregnancy is insufficient. It is likely that this contributes to adverse health outcomes for both the mothers and their newborns.     

Spatial distribution of trace metals in sediments from urban streams of Semarang, Central Java, Indonesia

Elevated environmental concentrations of metals are usually associated with the impact of urbanization. The present study is focused on metal contamination in urban sediments. A field survey was carried out to determine the distribution of four metals, i.e., cadmium (Cd), lead (Pb), copper (Cu), and zinc (Zn), in the coastal urban area of Semarang, Central Java, Indonesia. Sediment samples were collected from 101 grids of 2x2 km. To map the spatial distribution of these metals, concentrations of each metal were plotted against the corresponding grid coordinate. Cd was below the detection limit (<0.03 microg/g) in all samples, whereas concentrations of Pb, Zn, and Cu fell into a wide range. Frequency distributions of Pb, Zn, and Cu concentrations indicated a similar pattern, in which the major proportion of the sites had a low metal concentration. Some sites, however, had extremely high metal concentrations, Zn up to 1257 microg/g, Pb up to 2666 microg/g, and Cu up to 448 microg/g. The data were used to define background concentrations for sediments in coastal zones of Indonesia ("reference values"). The proposed reference values are 25.6 microg/g, 132.2 microg/g, and 40.7 microg/g, respectively, for Pb, Zn, and Cu. The degree of metal contamination of each individual site was classified according to the calculated value of a combined pollution index, W. Four categories of the degree of metal contamination were proposed, i.e., unpolluted, slightly polluted, polluted, and heavily polluted. Based on this classification, from 101 sites investigated in the greater Semarang area, 51 are unpolluted, 36 slightly polluted, 9 polluted, and 5 heavily polluted.     

Rickettsia felis in Xenopsylla cheopis, Java, Indonesia

Rickettsia typhi and R. felis, etiologic agents of murine typhus and fleaborne spotted fever, respectively, were detected in Oriental rat fleas (Xenopsylla cheopis) collected from rodents and shrews in Java, Indonesia. We describe the first evidence of R. felis in Indonesia and naturally occurring R. felis in Oriental rat fleas.     

Village health workers in Java,Indonesia: Coverage and equity

Village health workers are often the main vehicle for promoting the primary health care approach in developing countries. Services provided by these workers are expected to be more appropriate to the health needs of populations than those of clinic-based services, to be less expensive and to foster self-reliance and local participation. Because village workers are more accessible and acceptable to clients in their communities, they are expected to improve the overall coverage of services as well as equity—increased service use by poorer individuals and households.This paper presents research on coverage and equity from village health worker programs in Java, Indonesia. Rural health and nutrition projects in Java using village-level volunteers with limited training have grown since the early 1970s to include large national programs managed by the government's rural health system. Volunteer village workers are now the most extensive link between the rural population and the formal health service structure.Previous research on coverage and equity of these village worker activities is reviewed and results from the author's own study are presented. Services provided by village health workers achieve significantly higher levels of population coverage than similar clinic-based services. In most cases, village workers show no bias towards better-off clients and they may favor poorer beneficiaries.These findings show that village workers are meeting the coverage and equity objectives of the primary health care approach. However, some of the research reviewed raises questions about the ability of village worker activities to maintain these results over a longer period. The rapid expansion of these programs requires continued research, not only on coverage and equity, but also on health outcomes, costs, and participation.     

Tourism Developments Increase Tsunami Disaster Risk in Pangandaran,West Java,Indonesia

On 17 July 2006,the tourist resort of Pangan-daran on Java's south coast was hit by a tsunami,resulting in 413 fatalities and severe damage to buildings.The tsu...     

Malaria control with residual fenitrothion in Central Java, Indonesia: an operational-scale trial using both full and selective coverage treatments

An operational-scale trial, using residual fenitrothion, for control of malaria was carried out in Central Java, Indonesia, from 1980 to 1982. Two areas, each comprising about 70 km² and a population of about 50 000, were treated with fenitrothion (40% water dispersible powder) at a target dosage of 2 g/m² for 3 cycles at 6-monthly intervals. One area was treated with full coverage (i.e., the interiors of houses and cattle shelters were sprayed to a height of 3 m) for 2 cycles, followed by a third cycle with selective coverage (i.e., the interiors of houses were sprayed with one 75 cm horizontal swath between 10 cm and 85 cm from the floor while the cattle shelters were sprayed to a height of 3 m). The other area was treated for 3 cycles with only selective coverage. While both treatment methods reduced malaria rates and vector populations to very low levels, the full coverage treatment was more rapidly effective and also reduced the Plasmodium falciparum index. However, the selective coverage treatment was 68% less expensive than full coverage and greatly reduced the degree of cholinesterase depressions among the spraymen. The trial also showed that a dosage of 1 g/m² with full coverage was nearly as effective as the 2 g/m² dosage.     

Informing rubella vaccination strategies in East Java,Indonesia through transmission modelling

An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000 live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.     

First documented outbreak of hepatitis E virus transmission in Java,Indonesia

A suspected hepatitis outbreak occurred in Bondowoso District, East Java Province, Indonesia, in March-May 1998. An investigation was initiated in April 1998, involving a retrospective review of hospital records, a community-based cross-sectional study, and a health service-based case detection and household follow-up. Sera and epidemiological information were collected from 962 individuals: 235 from 3 outbreak-affected communities along the same rural stretch of river, 101 from community controls living distant from the river, 151 cases detected in health centres, 141 family members of the cases, and 334 subjects from neighbouring families. The prevalence of acute hepatitis E virus (HEV), based on anti-HEV IgM, total antibody (Ig) to HEV and polymerase chain reaction (PCR), was significantly (P < 0.00001) higher (52.4%) among the outbreak communities than among the community controls (3%). The background prevalence of HEV, based on anti-HEV IgG, was also significantly (P < 0.00001) higher (47%) among the outbreak communities than among the community controls (3%). None of the 476 sera screened for anti-HAV (hepatitis A virus) IgM was positive. These results indicate that HEV was the aetiological agent responsible for the outbreak. The overall attack rate (AR) for the 3 outbreak-affected communities surveyed was 19%, with AR determined on the basis of clinically recognized, acute jaundice illness. The usage of river water as primary source for bathing, human-waste disposal, and drinking purposes differed significantly (P < 0.00001) between the communities in outbreak areas and those in non-outbreak areas. There is no significant influence attributed to 'boiling water' on acute HEV. No climatic influences (flooding or drought) predisposed this instance of epidemic HEV transmission. This outbreak represents the first documented evidence of epidemic HEV transmission in Java, Indonesia.     

Metal Concentrations of River Water and Sediments in West Java,Indonesia

To determine the water environment and pollutants in West Java, the contents of metals and general water quality of the Ciliwung River in the Jakarta area were measured. High Escherichia coli number (116–149/mL) was detected downstream in the Ciliwung River. In addition to evaluate mercury pollution caused by gold mining, mercury contents of water and sediment samples from the Cikaniki River, and from paddy samples were determined. The water was not badly polluted. However, toxic metals such as mercury were detected at levels close to the baseline environmental standard of Indonesia (0.83–1.07 μg/g of sediments in the Cikaniki River). From analyses of the paddy samples (0.08 μg/g), it is considered that there is a health risk caused by mercury.     

Scavenging Ducks and Transmission of Highly Pathogenic Avian Influenza, Java, Indonesia

In Java, Indonesia, during March 2007–March 2008, 96 farms with scavenging ducks that were not vaccinated against highly pathogenic avian influenza (HPAI) were monitored bimonthly. Bird-level (prevalence among individual birds) H5 seroprevalence was 2.6% for ducks and 0.5% for chickens in contact with ducks. At least 1 seropositive bird was detected during 19.5% and 2.0% of duck- and chicken-flock visits, respectively. Duck flocks were 12.4× more likely than chicken flocks to have seropositive birds. During 21.4% of farm visits, ≥1 sampled duck was H5 seropositive when all sampled in-contact chickens were seronegative. Subtype H5 virus was detected during 2.5% of duck-flock visits and 1.5% of chicken-flock visits. When deaths from HPAI infection occurred, H5 virus shedding occurred in apparently healthy birds on 68.8% of farms. Of 180 poultry deaths investigated, 43.9% were attributed to H5 virus. These longitudinal study results indicate that ducks are a source of infection for chickens and, potentially, for humans.     

Vitamin A intake is low among pregnant women in central Java,Indonesia

From 1996-1998, a longitudinal study on nutritional status during pregnancy was carried out in Purworejo District, Central Java, Indonesia. Dietary intake was assessed in each trimester using six 24-hour recalls, and analyzed cross-sectionally among 493 women. The proportion of women below the Indonesian RDI for vitamin A (700 RE) ranged from 83% in the first trimester to 76% in the third. Regardless of total vitamin A intake, plant sources contributed 64-79% in all three trimesters. The contribution from animal and fortified sources was generally lower throughout pregnancy for those with low education compared to those with high education. Significant risk factors for having a low vitamin A intake (< FAO/WHO basal RDI, 370 RE) in the second and third trimesters were fewer than six years of education, low socio-economic status, a low energy intake, and a low vitamin A intake in the previous trimester. Home gardening and chicken-raising were not positively associated with vitamin A intakes. Given the large percentage of women with inadequate vitamin A intakes, further strategies are needed to increase the vitamin A intake of all pregnant women in this area.     

Cyclospora cayetanensis among expatriate and indigenous populations of West Java, Indonesia.

From January 1995 through July 1998, we investigated the occurrence of Cyclospora cayetanensis infection associated with gastrointestinal illness or diarrhea in foreign residents and natives of West Java, Indonesia. We found that C. cayetanensis was the main protozoal cause of gastrointestinal illness and diarrhea in adult foreign residents during the wet season. The parasite rarely caused illness in the indigenous population or in children.