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(Sardjito Hospital & Depok I Health Center). DENGUE VALIDATION STUDY Country site :INDONESIA. Banguntapan. BANTUL. Kasihan. BANTUL. BANTUL. (Sewon HC). Sewon. BANTUL. Population and Dengue Incidence by Proposed Study Location. ACTIVITY. Participant s. Study elements. - PowerPoint PPT Presentation
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DENGUE VALIDATION STUDYCountry site :INDONESIA
(Sardjito Hospital & Depok I Health Center)
(Sewon HC)
BANTUL
Sewon
BANTULBanguntapan
BANTUL
Kasihan
BANTUL
Population and Dengue Incidence by Proposed Study Location
Province Hospital/Health Center District Population
PopulationDensity/km2 2006 Incidence* 2007 Incidence*
Jogjakarta province Sardjito Hospital 3.388.733 787.2 6.62 7.44
Jogjakarta municipality Wirosaban hospital 443,118 13,606.4 16.9 14.5
Pantirapih hospital
Wirobrajan health center
Sleman district Depok health center 1,008,295 1,754.1 6.92 8.30
Bantul district Sewon health Center 879,825 1,625.2 5.66 6.67
ACTIVITYACTIVITY DATE Place
General Dissemination Feb 14 th2009 Yogyakarta Province Health Office
Dissemination to each study unit (Public Health Center/ PHC and hospital)
March 03 th 2009 until March 17 th 2009
Depok I PHC, Sewon I PHC, Wirobrajan PHCPanti Rapih Hospital, Sardjito Hospital,Wirosaban Hospital
Training for Health Center Staff April 02 th 2009 Until April 8 th 2009
Panti Rapih Hospital, Sardjito Hospital,Wirosaban Hospital & Yogyakarta Province Health Office
Preliminary Feedback May 28 th 2009 Sardjito Hospital
Focus Group Discussion June 16 th 2009 Until June 23 th 2009
Depok I PHC, Sewon I PHC, Wirobrajan PHCPanti Rapih Hospital, Sardjito Hospital,Wirosaban Hospital
In-depth Interview Activity June 25 th 2009 and July 03 th 2009
Yogyakarta Municipal Health Office, Sleman & Bantul District Health Office
Final Dissemination July 10 th 2009 Yogyakarta Province Health Office
ParticipantsNO ACTIVITY PARTICIPANTS
1. General Dissemination Head of Surveillance Sub-division (MoH)Head of Arbovirus Sub-division (MoH), Head of PHO and DHO, Pediatrician, Internist,Medical Record Unit, General Physician,Nurse
2. Dissemination to each study unit Head of PHCs, Hospital Directors, General Physician, Nurse, Medical Record staff
3. Training for Health Center General Physician,ER Physician,InternistPediatrician,Medical Record staff
4. Preliminary Feedback General Physician,ER Physician,InternistPediatrician,Medical Record staff,Head of HC,Medical record Staf
5. Focus Group Discussion General Physician,ER Physician,InternistPediatrician,Medical Record staff
6. Final Dissemination Head of Surveillance Sub-divisionHead of Arbovirus Sub-divisio, PediatricianInternist,Medical Record Unit, General Physician,Nurse
Study elements
• Retrospective chart review• Questionnaires• Focus Group Discussions
Materials used
POSTER ALGORITHM CLINICAL GUIDE
ResultsACTIVITY Sardjito Wirosaban Panti Rapih Depok I Sewon I Wirobrajan
CHART REVIEWS 80 80 160 20 26 11
QUESTIONNAIRES 42 16 27 9 9 7
FGD 1 1 1 1 1 1
Chart Review: former classification vs revised classification
FGD (1) Strengths of revised classification
Simple and easy to use Safer for patients Useful for triage of patients Promotes early diagnosis and management
Weaknesses of revised classification Too qualitative → no quantitative thresholds Can lead to overdiagnosis → excess hospital admission Not yet in line with existing systems (e.g. ICD, clinical
audit, payment schemes)
FGD (2)
Strengths of revised algorithm More aggressive in management of dengue with
warning signs → shorter hospital stay Patient education messages very useful
Weaknesses of revised algorithm Too conservative for shock management Too risky for patient outcome Too risky for hospital in legal aspect
General recommendations Reconsider adoption of quantitative parameters Reconsider guidance for shock management Facilitate implementation
Stronger involvement of professional associations Strengthened training design (e.g. interactive CD-ROM) Synchronization with ICD, billing system and clinical audits