Protecting those who care: The characteristics of occupational Tuberculosis risk in health care workers

Nosocomial TB infection remains an urgent public health problem that requires relentless efforts to overcome. In general, health care workers (HCWs) have a significantly higher risk of suffering from active and latent TB owing to their daily occupational TB risk exposure. The risk is indeed more severe in high TB burden countries, such as Indonesia. In this research, we aimed to: (1) investigate the underlying factor structure of risk characteristics, specifically the risk of nosocomial TB transmission in health care facilities; (2) estimate the effects of work-related determinants and risk characteristics on risk perception; and (3) compare occupational risk perception of contracting TB with expert risk assessment. A paper-based questionnaire was administered to 179 HCWs working for ten public health centres and two hospitals in Surabaya, Indonesia. An exploratory factor analysis of nine risk characteristics revealed a two-factor solution (knowledge-evoked dread and controllability of damage). Structural equation modelling indicated a piece of suggestive evidence that controllability of damage positively affected risk perception, while knowledge-evoked dread did not. Perceived safety conditions yielded a positive and moderate association to controllability of damage, implying that safety infrastructure could be perceived as ‘a cue’ to the presence of a dangerous hazard. The intensity of exposure to TB patients was negatively correlated with the controllability of damage. This indicates that more experience in handling TB patients could lead to underestimation of risk. Our research showed that HCWs tended to accurately estimate the risk of contracting TB based on their specific profession/duties, yet overestimated the risk of contracting TB when it was aggregated to the health care facility level. Although further research is necessary, to include the prevalence of latent/active TB as a part of risk assessments, our research highlights the importance of addressing risk perception, especially encouraging HCWs to become more active in advocating for the required allocation resources for their workplaces or even aiding in raising communities’ awareness of TB transmission.

Urban and rural disparities in hospital utilization among Indonesian adults

Background:
Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was de-signed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 – 1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.