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The Intersection of Care Seeking and Clinical Capacity for Patients With Highly Pathogenic Avian Influenza A (H5N1) Virus in Indonesia: Knowledge and Treatment Practices of the Public and Physicians

  • Jennifer M. Kreslake (a1), Yunita Wahyuningrum (a1), Angela D. Iuliano (a2), Aaron D. Storms (a2) (a3), Kathryn E. Lafond (a2), Amalya Mangiri (a2), Catharina Y. Praptiningsih (a4), Basil Safi (a1), Timothy M. Uyeki (a2) and J. Douglas Storey (a1)...

Abstract

Background

Indonesia has the highest human mortality from highly pathogenic avian influenza (HPAI) A (H5N1) virus infection in the world.

Methods

A survey of households (N=2520) measured treatment sources and beliefs among symptomatic household members. A survey of physicians (N=554) in various types of health care facilities measured knowledge, assessment and testing behaviors, and perceived clinical capacity.

Results

Households reported confidence in health care system capacity but infrequently sought treatment for potential HPAI H5N1 signs/symptoms. More clinicians were confident in their knowledge of diagnosis and treatment than in the adequacy of related equipment and resources at their facilities. Physicians expressed awareness of the HPAI H5N1 suspect case definition, yet expressed only moderate knowledge in questioning symptomatic patients about exposures. Self-reported likelihood of testing for HPAI H5N1 virus was high after learning of certain exposures. Knowledge of antiviral treatment was moderate, but it was higher among clinicians in puskesmas. Physicians in private outpatient clinics, the most heavily used facilities, reported the lowest confidence in their diagnostic and treatment capabilities.

Conclusions

Educational campaigns can encourage recall of possible poultry exposure when patients are experiencing signs/symptoms and can raise awareness of the effectiveness of antivirals to drive people to seek health care. Clinicians may benefit from training regarding exposure assessment and referral procedures, particularly in private clinics. (Disaster Med Public Health Preparedness. 2016;10:838–847)

Copyright

Corresponding author

Correspondence and reprint requests to Jennifer M. Kreslake, PhD, MPH, Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Hampton House, 2nd Floor, Baltimore, MD 21205 (e-mail: jkreslak@jhsph.edu).

References

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1. World Health Organization. Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO, 2003-2016. 2016. http://www.who.int/influenza/human_animal_interface/EN_GIP_20160404cumulativenumberH5N1cases.pdf?ua=1. Accessed April 4, 2016.
2. Arabi, Y, Gomersall, CD, Ahmed, QA, Boynton, BR, Memish, ZA. The critically ill avian influenza A (H5N1) patient. Crit Care Med. 2007;35(5):1397-1403.
3. Kandun, IN, Tresnaningsih, E, Purba, WH, et al. Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series. Lancet. 2008;372(9640):744-749.
4. Adisasmito, W, Chan, PKS, Lee, N, et al. Effectiveness of antiviral treatment in human influenza A(H5N1) infections: analysis of a Global Patient Registry. J Infect Dis. 2010;202(8):1154-1160.
5. Adisasmito, W, Aisyah, DN, Aditama, TY, et al. Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation. BMC Public Health. 2013;13(1):571.
6. Chan, PK, Lee, N, Zaman, M, et al. Determinants of antiviral effectiveness in influenza virus A subtype HPAI H5N1. J Infect Dis. 2012;206(9):1359-1366.
7. Directorate General of Medical Services, Indonesian Ministry of Health. [Clinical Management Guidelines Avian Flu (H5N1) in the Hospital]. 2010. https://www.k4health.org/sites/default/files/AI Case Management Guideline.pdf. Accessed April 4, 2016.
8. Adisamito, W, Suwandono, A, Aisyah, DN. Measuring Indonesia H1N1 pandemic preparedness through stakeholder analysis. Health Care Curr Rev. 2014;2:119.
9. Schünemann, HJ, Hill, SR, Kakad, M, et al. WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus. Lancet. 2007;7(1):21-31.
10. Strategies Against Flu Emergence (SAFE). Avian & Pandemic Influenza Resources for Indonesia Toolkit. Washington, DC: United States Agency for International Development, 2013. https://www.k4health.org/toolkits/safe-indonesia. Accessed May 3, 2016.
11. Storms, A, Kusriastuti, R, Misriyah, S, et al. The East Jakarta Project: surveillance for highly pathogenic avian influenza A(H5N1) and seasonal influenza viruses in patients seeking care for respiratory disease, Jakarta, Indonesia, October 2011–September 2012. Epidemiol Infect. 2015;2012(165):1-11.
12. Praptiningsih, CY, Lafond, KE, Wahyuningrum, Y, et al. Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey. J Epidemiol Global Health. 2016;6(2):7786.
13. Mangiri, A, Iuliano, A, Wahyuningrum, Y, et al. Physician’s knowledge, attitudes, and practices regarding seasonal influenza, pandemic influenza, and highly pathogenic avian influenza A (H5N1) virus in Indonesia. In: Proceedings from the Options VIII for Control of Influenza; September 8, 2013; Cape Town, South Africa.
14. World Health Organization. WHO guidelines for global surveillance of influenza A/H5. 2004. http://www.who.int/influenza/resources/documents/globalsurveillance.pdf. Accessed on October 20, 2015.
15. Kusriastuti, R. Enhanced influenza surveillance for H5N1 & seasonal influenza in East Jakarta District, Indonesia. 2012. http://www.who.int/influenza_vaccines_plan/resources/Session2_Case_Studies_Indonesia_Rita_Kusriastuti.pdf. Accessed on October 20, 2015.
16. Indonesia strides towards universal health care. Lancet. 2014;383(9911):2.
17. Harimurti, P, Pambudi, E, Pigazzini, A, Tandon, A. The Nuts & Bolts of Jamkesmas: Indonesia’s Government-Financed Health Coverage Program for the Poor and Near-Poor. Universal Health Coverage (UNICO) studIes series no. 8. Washington, DC: The Worldbank; 2013.
18. Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus, Abdel-Ghafar, A, Chotpitayasunondh, T, et al. Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med. 2008;358(3):261-273.
19. World Health Organization. Comparative Analysis of National Pandemic Influenza Preparedness Plans. Geneva, Switzerland; 2011. http://www.who.int/influenza/resources/documents/comparative_analysis_php_2011_en/en/. Accessed October 20, 2015.
20. Uyeki, TM. Human infection with highly pathogenic avian influenza A (H5N1) virus: review of clinical issues. Clin Infect Dis. 2009;49(2):279-290.

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