Melbourne School of Population and Global Health - Research Publications

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    The Republic of Indonesia health system review
    Mahendradhata, Y ; Laksono, T ; Listyadewi, S ; Soewondo, P ; Marthias, T ; Harimurti, P ; Prawira, J ; Hort, K ; Patcharanarumol, W (WHO Regional Office for South-East Asia, 2017)
    Overview: Government investment in health has increased in Indonesia over the past two decades, but it is still inadequate. The insufficient facilities and workforce needed for public services has encouraged the growth of private health facilities. While noncommunicable diseases (NCDs) are emerging as new priorities, problems of maternal and child health, nutrition and communicable diseases continue to persist. The progress on maternal mortality and communicable diseases has been slower, with maternal mortality remaining high (210 deaths per 100 000 live births in 2010), and continuing high incidences of tuberculosis (TB). Risk factors for NCDs, such as high blood pressure, high cholesterol, overweight and smoking are increasing. Indonesia remains the only country in Asia, and one of 10 worldwide, not to have ratified the WHO Framework Convention on Tobacco Control (FCTC). Indonesia also suffers from significant regional disparities in terms of health status and quality, availability, and capacity of health services. Despite this, indicators of overall health status in Indonesia have improved significantly over the last two and half decades, with life expectancy rising from 63 years in 1990 to 71 years in 2012; under-five mortality falling from 52 deaths per 1000 live births in 2000 to 31 deaths in 2012, and infant mortality falling from 41 deaths per 1000 live births in 2000, to 26 deaths in 2012. Indonesia has also experienced an increase in health infrastructure, including primary and referral health facilities, in the last two decades. Inpatient beds in both public and private hospitals as well as primary health centres (puskesmas) have increased. Human resources for health have also grown in the last two decades, with increases in health worker to population ratios. However, the ratios of hospital beds, puskesmas, and physician to population remain below WHO standards and lag behind other Asia-Pacific countries. Indonesia faces the challenge of increasing health expenditures, as nominal health spending has been steadily increasing in the last eight years, by 222% overall. Although there has been a substantial increase in health spending at the national level, health spending as a proportion of gross domestic product (GDP) remains below average among the low-to-middle-income countries (3.1% of GDP in 2012). The Government’s share of total health expenditure also remains low, at only 39%, whereas private, primarily out-of-pocket (OOP) expenditure, is 60%. Commencing in 2014, the government has introduced a national health insurance scheme (JKN: Jaminan Kesehatan Nasional) which progressively aims to expand coverage to cover the whole population by 2019. Moving forward, the challenge for the Government is to manage the expansion of this scheme, while addressing regional disparities in service quality and accessibility, managing resources effectively, containing costs and minimizing fraud, engaging the private sector, and maintaining investment in health promotion and prevention programmes.
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    Bayesian Validation of the Indirect Immunofluorescence Assay and Its Superiority to the Enzyme-Linked Immunosorbent Assay and the Complement Fixation Test for Detecting Antibodies against Coxiella burnetii in Goat Serum
    Muleme, M ; Stenos, J ; Vincent, G ; Campbell, A ; Graves, S ; Warner, S ; Devlin, JM ; Nguyen, C ; Stevenson, MA ; Wilks, CR ; Firestone, SM ; Pasetti, MF (AMER SOC MICROBIOLOGY, 2016-06)
    Although many studies have reported the indirect immunofluorescence assay (IFA) to be more sensitive in detection of antibodies to Coxiella burnetii than the complement fixation test (CFT), the diagnostic sensitivity (DSe) and diagnostic specificity (DSp) of the assay have not been previously established for use in ruminants. This study aimed to validate the IFA by describing the optimization, selection of cutoff titers, repeatability, and reliability as well as the DSe and DSp of the assay. Bayesian latent class analysis was used to estimate diagnostic specifications in comparison with the CFT and the enzyme-linked immunosorbent assay (ELISA). The optimal cutoff dilution for screening for IgG and IgM antibodies in goat serum using the IFA was estimated to be 1:160. The IFA had good repeatability (>96.9% for IgG, >78.0% for IgM), and there was almost perfect agreement (Cohen's kappa > 0.80 for IgG) between the readings reported by two technicians for samples tested for IgG antibodies. The IFA had a higher DSe (94.8%; 95% confidence interval [CI], 80.3, 99.6) for the detection of IgG antibodies against C. burnetii than the ELISA (70.1%; 95% CI, 52.7, 91.0) and the CFT (29.8%; 95% CI, 17.0, 44.8). All three tests were highly specific for goat IgG antibodies. The IFA also had a higher DSe (88.8%; 95% CI, 58.2, 99.5) for detection of IgM antibodies than the ELISA (71.7%; 95% CI, 46.3, 92.8). These results underscore the better suitability of the IFA than of the CFT and ELISA for detection of IgG and IgM antibodies in goat serum and possibly in serum from other ruminants.
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    Developing a Career Access Program (CAP) for people with intellectual disability in the Victorian public sector: The evidence base to inform the development and implementation of CAP
    McVilly, K ; Murfitt, K ; Crosbie, J ; Rouget, D ; Jacobs, P (Department of Health and Human Services and The University of Melbourne, 2019)
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    Three Certificates are not enough: Rover Thomas and Art Centre Archives
    Spunner, S ; Jorgensen, D ; McLean, I (UWA Publishing, 2017-11-01)
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    Health services : knowledge, use and satisfaction of Afghan, Iranian and Iraqi settlers in Australia
    NEALE, A ; ABU-DUHOU, J ; BLACK, J ; BIGGS, B (Radcliffe Publishing, 2007)
    This paper reports the findings of a study examining the knowledge of, use of and satisfaction with local primary healthcare services reported by new arrivals to Australia from Iran, Iraq and Afghanistan. The study sample consisted of a purposive sample of 98 new settlers from the selected countries and used a semi-structured questionnaire and focus groups to attain information. Key findings were that friends and family were the greatest sources of health provider information and there was a lack of both more general health information and understanding of the health system. While study participants were able to access primary healthcare services and were generally satisfied, several major operational deficiencies were reported. General practitioners (GPs) were the major health providers for these groups. Health-seeking behaviours were strongly influenced by the country of birth in comparison with the other examined factors, and experiences of health service encounters also varied greatly between countries of birth. The facility’s proximity to the participant’s home was a strong influence in the selection of health services. The researchers recommend that a network of appropriately supported and staffed community health centres and/ or GP clinics is needed in areas where there are high concentrations of refugees and immigrants.
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    No long-term evidence of hyporesponsiveness after use of pneumococcal conjugate vaccine in children previously immunized with pneumococcal polysaccharide vaccine
    Licciardi, PV ; Toh, ZQ ; Clutterbuck, EA ; Balloch, A ; Marimla, RA ; Tikkanen, L ; Lamb, KE ; Bright, KJ ; Rabuatoka, U ; Tikoduadua, L ; Boelsen, LK ; Dunne, EM ; Satzke, C ; Cheung, YB ; Pollard, AJ ; Russell, FM ; Mulholland, EK (Elsevier, 2016-06)
    Background: A randomized controlled trial in Fiji examined the immunogenicity and effect on nasopharyngeal carriage after 0, 1, 2, or 3 doses of 7-valent pneumococcal conjugate vaccine (PCV7; Prevnar) in infancy followed by 23-valent pneumococcal polysaccharide vaccine (23vPPV; Pneumovax) at 12 months of age. At 18 months of age, children given 23vPPV exhibited immune hyporesponsiveness to a micro-23vPPV (20%) challenge dose in terms of serotype-specific IgG and opsonophagocytosis, while 23vPPV had no effect on vaccine-type carriage. Objective: This follow-up study examined the long-term effect of the 12-month 23vPPV dose by evaluating the immune response to 13-valent pneumococcal conjugate vaccine (PCV13) administration 4 to 5 years later. Methods: Blood samples from 194 children (now 5-7 years old) were taken before and 28 days after PCV13 booster immunization. Nasopharyngeal swabs were taken before PCV13 immunization. We measured levels of serotype-specific IgG to all 13 vaccine serotypes, opsonophagocytosis for 8 vaccine serotypes, and memory B-cell responses for 18 serotypes before and after PCV13 immunization. Results: Paired samples were obtained from 185 children. There were no significant differences in the serotype-specific IgG, opsonophagocytosis, or memory B-cell response at either time point between children who did or did not receive 23vPPV at 12 months of age. Nasopharyngeal carriage of PCV7 and 23vPPV serotypes was similar among the groups. Priming with 1, 2, or 3 PCV7 doses during infancy did not affect serotype-specific immunity or carriage. Conclusion: Immune hyporesponsiveness induced by 23vPPV in toddlers does not appear to be sustained among preschool children in this context and does not affect the pneumococcal carriage rate in this age group.
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    Immunogenicity of a locally produced hepatitis B vaccine with the birth dose stored outside the cold chain in rural Vietnam
    Hipgrave, DB ; Tran, TN ; Huong, VM ; Dat, DT ; Nga, NT ; Long, HT ; Van, NT ; Maynard, JE ; Biggs, BA (AMER SOC TROP MED & HYGIENE, 2006-02)
    The heat stability of hepatitis B vaccine (HepB vaccine) should enable its storage outside the cold chain (OCC), increasing access to the birth dose in areas lacking refrigeration. We compared the immunogenicity of a locally produced vaccine among infants who received three doses stored within the cold chain (n = 358) or for whom the first dose was stored OCC for up to one month (n = 748). Serum was collected from these infants at age 9-18 months. The vaccine was protective in 80.3% of all infants. There were no differences in the prevalence of a protective level of antibody or antibody titer among groups of infants according to storage strategy. Differences in antibody titer between certain groups of infants could be explained by different vaccination schedules. Where birth dose coverage will be improved, HepB vaccine can be taken OCC for up to one month without affecting its immunogenicity.
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    The carbon footprint of treating patients with septic shock in the intensive care unit
    McGain, F ; Burnham, J ; LAU, R ; Aye, L ; Kollef, MH ; McAlister, S (College of Intensive Care Medicine of Australia and New Zealand, 2018-12-01)
    OBJECTIVE: To use life cycle assessment to determine the environmental footprint of the care of patients with septic shock in the intensive care unit (ICU). DESIGN, SETTING AND PARTICIPANTS: Prospective, observational life cycle assessment examining the use of energy for heating, ventilation and air conditioning; lighting; machines; and all consumables and waste associated with treating ten patients with septic shock in the ICU at BarnesJewish Hospital, St. Louis, MO, United States (US-ICU) and ten patients at Footscray Hospital, Melbourne, Vic, Australia (Aus-ICU). MAIN OUTCOME MEASURES: Environmental footprint, particularly greenhouse gas emissions. RESULTS: Energy use per patient averaged 272 kWh/day for the US-ICU and 143 kWh/day for the Aus-ICU. The average daily amount of single-use materials per patient was 3.4 kg (range, 1.0-6.3 kg) for the US-ICU and 3.4 kg (range, 1.2-8.7 kg) for the Aus-ICU. The average daily particularly greenhouse gas emissions arising from treating patients in the US-ICU was 178 kg carbon dioxide equivalent (CO2-e) emissions (range, 165-228 kg CO2-e), while for the Aus-ICU the carbon footprint was 88 kg CO2-e (range, 77-107 kg CO2-e). Energy accounted for 155 kg CO2-e in the US-ICU (87%) and 67 kg CO2-e in the Aus-ICU (76%). The daily treatment of one patient with septic shock in the US-ICU was equivalent to the total daily carbon footprint of 3.5 Americans' CO2-e emissions, and for the Aus-ICU, it was equivalent to the emissions of 1.5 Australians. CONCLUSION: The carbon footprints of the ICUs were dominated by the energy use for heating, ventilation and air conditioning; consumables were relatively less important, with limited effect of intensity of patient care. There is large opportunity for reducing the ICUs' carbon footprint by improving the energy efficiency of buildings and increasing the use of renewable energy sources.
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    Survivor-led ethics in multi-agency work
    Davis, E (DVRCV Advocate, 2015)
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    The Importance of Regional Integration and Coordination in Practice within the National Plan to Reduce Violence Against Women and their Children
    Davis, E ; Trainor, R ; Faulkner, J (Parity, 2011)
    The National Plan to Reduce Violence Against Women and their Children (the National Plan) presents an opportunity for state and territory governments to work collaboratively to address and reduce the incidence of women and children experiencing physical violence and sexual violence in Australia.