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