BackgroundThe UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung.ObjectiveTo explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017.MethodsThis qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation.ResultsFamily members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community.ConclusionConcurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

Background Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. Methods A case-control study was conducted in Bogor Regency from May–June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung . Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012–16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. Results A total of 114 case and 136 control subjects were studied. Patient’s aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52–8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09–6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1–5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43–4.43) were associated with pasung . Patient’s aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. Conclusions Patient’s aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.

Hepatitis A adalah penyakit hati akibat virus hepatitis A yang dapat menyebabkan kesakitan ringan sampai berat. Dampak ekonomi dari wabah tersebut seperti epidemi Shanghai pada tahun 1988 yang menyerang sekitar 300.000 orang. Di negara-negara berkembang dengan kondisi sanitasi yang buruk dan praktek-praktek higienis, kebanyakan anak-anak (90%) telah terinfeksi hepatitis A virus sebelum usia 10 tahun. Di Indonesia Hepatitis A sering muncul dalam Kejadian Luar Biasa (KLB). Tahun 2014 tercatat 3 Provinsi dan 4 Kabupaten terjadi KLB dengan jumlah penderita 282. Penyelidikan epidemiologi ini bertujuan untuk mengetahui gambaran KLB dan mengidentifikasi faktor risiko KLB Hepatitis A di Kabupaten Tangerang tahun 2016. Desain studi yang digunakan dalam penelitian ini adalah desain kasus kontrol. Penyelidikan dilaksanakan pada bulan Maret 2016 di Kabupaten Tengerang. besar sampel yaitu kasus 44 dan control sebanyak 95. Data yang dikumpulkan dalam penyelidikan ini berupa data primer dan sekunder. Data primer meliputi identifikasi responden dan faktor risiko Hepatitis A. Penyelidikan dilakukan dengan metode wawancara menggunakan kuesioner terstruktur serta observasi lingkungan. Data sekunder diambil berdasarkan laporan puskesmas, catatan dinas kesehatan Kabupaten Tangerang dan data demografi. Data dianalisis dengan Stata menggunakan uji bivariate; Chi Square (X2) dan multivariate; regresi logistik. KLB terjadi pada bulan Februari-Maret 2016 dengan kasus sebanyak 44, kasus terbanyak terjadi pada minggu ke-10 pada bulan Maret 2016. KLB hepatitis A berdasarkan kelompok umur 6-10 tahun sebesar 3 orang (6.82%) lebih sedikit dibanding umur 11-16 tahun yaitu 41 orang (93.18%) dengan OR 1.78 (CI95% 0.43-10.48) . KLB hepatitis A berdasarkan jenis kelamin lebih banyak pada perempuan yaitu 24 orang (54.55%) dibanding laki – laki yaitu 20 orang (45.45%) dengan OR 0.71 (CI95% 0.32-1.56). Faktor risiko diantaranya tidak cuci tangan pakai sabun sehabis bab OR 7.90 (CI 95% 3.14 -19.88) dan jenis kantin yang digunakan (Warung 2) OR 2.92 (CI 95% 1.21 - 7.02). KLB hepatitis A terjadi karena berbagai faktor risiko diantaranya tidak cuci tangan pakai sabun sehabis bab dan jenis kantin yang digunakan (Warung 2). Selain itu PHBS penjamah makanan kurang baik dan sanitasi lingkungan juga buruk. Upaya pencegahan bisa dilakukan melalui perbaikan sanitasi sekolah dan penyuluhan tentang PHBS dan imunisasi hepatitis A. Faktor risiko diantaranya tidak cuci tangan pakai sabun sehabis bab OR 7.90 (CI 95% 3.14 -19.88) dan jenis kantin yang digunakan (Warung 2) OR 2.92 (CI 95% 1.21 - 7.02). KLB hepatitis A terjadi karena berbagai faktor risiko diantaranya tidak cuci tangan pakai sabun sehabis bab dan jenis kantin yang digunakan (Warung 2). Selain itu PHBS penjamah makanan kurang baik dan sanitasi lingkungan juga buruk. Upaya pencegahan bisa dilakukan melalui perbaikan sanitasi sekolah dan penyuluhan tentang PHBS dan imunisasi hepatitis A.