Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation

BMC Public Health

Richard Coker⁵  Nancy A Dreyer⁶  Anna Swenson⁶  MJN Mamahit⁴  Nurshanty A Sapada⁷  Prasenohadi⁸  Ondri Dwi Sampurno²  Agus Suwandono²  Trihono²  Rita Kusriastuti³  Tjandra Yoga Aditama³  Dewi Nur Aisyah¹  Wiku Adisasmito¹ 

[1]Universitas Indonesia, Depok, Indonesia

[2]NIHRD MoH, Jakarta 10560, Indonesia

[3]CDC-EH MoH, Jakarta, Indonesia

[4]Tangerang Hospital, Tangerang, Indonesia

[5]CDPRG, London School of Hygiene and Tropical Medicine, Bangkok, ThailandCDPRG, London School of Hygiene and Tropical Medicine, Bangkok, Thailand

[6]Outcome Quintiles, Cambridge, MA, USA

[7]Sulianti Saroso Hospital, North Jakarta, Sunter, Indonesia

[8]Persahabatan Hospital, Persahabatan Raya St. No. 1, East Jakarta, Pisangan Timur, Pulo Gadung 13230, Indonesia

关键词: Indonesia;    Virulence;    Delivery of health care;    Influenza A virus H5N1;   

Others  :  1162111
DOI  :  10.1186/1471-2458-13-571

 received in 2012-07-20, accepted in 2013-04-04,  发布年份 2013

【 摘 要 】

Background

Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world’s highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes.

Methods

Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival.

Results

Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days).

Conclusions

Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

【 授权许可】

   
2013 Adisasmito et al.; licensee BioMed Central Ltd.

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