scholarly journals KEY FACTORS FOR SUSTAINABLE RATIONAL USE OF MEDICINE PROGRAM IN GUNUNGKIDUL AND SLEMAN DISTRICTS, INDONESIA

Author(s):  
Sunartono H ◽  
Prabandari Ys ◽  
Kusnanto H ◽  
Suryawati S

 Objective: Many of the rational use of medicines (RUM) interventions have been proven effective in improving medicine use, but the impacts were usually not sustainable for longer period of time. Gunungkidul and Sleman Districts of Indonesia have succeeded in implementing RUM program for more than two decades. This is considered rare, and therefore, it is important to identify factors contributing to the success. Methods: This is a single case study with non-experimental exploratory design. Quantitative and qualitative data were collected integratively to obtain information concerning the indicators and the process of RUM implementation. Quantitative data were collected in reference to the World Health Organization (WHO) 1993 RUM indicators, including average number of medicines per prescription (polypharmacy), percentage of patients receiving antibiotics, and percentage of patients receiving injections. Qualitative data were analyzed descriptively and were arranged chronologically in respective to each district. Results: Implementation of RUM in the two districts has successfully lasted up to 20 years. The annual medicine use indicators from 1994 to 2014 in Gunungkidul District show that polypharmacy decreased from 4.2 to 2.89, percentage patients receiving injections declined from 68.05% to 0%, and percentage of patients receiving antibiotics improved from 52.1% to 24.1%. The same indicators in Sleman District show that, between 1998 and 2014, polypharmacy remained stable at 3, percentage of patients receiving injections declined from 4.9% to 0.18%, and percentage of patients receiving antibiotics improved from 44.31% to 20%. Culturization of RUM program is the main key for sustainable impacts. Another important key is the high commitment of health policymakers to implement the principles of evidence-based treatment. Conclusions: The culturization of RUM program followed by continuous monitoring and evaluation by district health managers were the key factors to maintain the impact of the intervention.

2020 ◽  
Vol 4 (2) ◽  
pp. 72-74
Author(s):  
Atiq ur Rahman ◽  
Muhammad Imran ◽  
Zarmeena Yasmeen ◽  
Muzammil Irshad

Objective: The objective of the study was to assess the effects of COVID-19 and lockdown on OPD services. Materials and Methods: A cross-sectional study was conducted at District Headquarter Hospital (DHQ) and Tehsil Headquarter (THQ) Hospitals of District Layyah. The data was collected from one DHQ hospital and six THQ hospitals. The OPD data of three years (the years 2018 to 2020) was extracted from District Health Information System (DHIS). Trends of outpatients’ flow during months of March and April of three years were taken. The data were analyzed using SPSS version 24. RESULTS: The COVID-19 pandemic was declared by World Health Organization (WHO) on March 11, 2020, and all countries started lockdown nationwide which imposed a major impact on all areas of life. Fear of coronavirus spread and lockdown resulted in significant reduction in number of patients at outdoor services. In our study, we analyzed outdoor services of seven hospitals of district Layyah - one DHQ hospital and six THQ hospitals. Conclusion: Fear of coronavirus spread and lockdown resulted in significant reduction in number of patients at outdoor services.


2019 ◽  
Vol 10 (2) ◽  
pp. 773-782
Author(s):  
Nora Rahmanindar ◽  
Juhrotun Nisa ◽  
Nilatul Izah

Latar Belakang: Masalah gizi merupakan salah satu masalah kesehtan masyarakat yang belum pernah tuntas di tanggulangi dunia. Organisasi Kesehatan Dunia memperkirakan bahwa sekitar 60 % dari semua kematian, yang terjadi antara anak-anak yang berusia kurang dari lima tahun dinegara berkembang, bisa dihubungkan dengan mal nutrisi. Therapeutic Feeding Center (TFC) atau Pusat Pemulihan Gizi (PPG) adalah pemuliha gizi kurang dengan perawatan serta pemberian makanan secara intensif dan adekuat sesuai usia dan kondisinya dengan melibatkan peran serta orang tua (ibu) agar mandiri ketika sudah kembali ke rumah.Tujuan: Penelitian ini bertujuan untuk menganalisa pelaksanaan program Posyandu TFC di Puskesmas Kabupaten Tegal.Metode: Penelitian ini bersifat kualitatif dengan menggunakan metode deskriptif. Pengumpulan data dilakukan dengan teknik wawancara mendalam sesuai dengan pedoman wawancara. Responden yang diteliti ada 8 orang yaitu 2 petugas sebagai informan kunci yaitu dokter penanggungjawab dan koordinator gizi di Puskesmas Bumijawa, 4 petugas sebagai informan utama yaitu 2 petugas kesehatan bidan dan petugas gizi serta 2 petugas kader posyandu dan 2 ibu yang mempunyai anak gizi kurang sebagai informan Triangulasi.Hasil: Penelitian menunjukan bahwa sumber-sumber program, tenaga, dana dan sarana prasarana sudah memadai, proses pelaksanaan program tersebut pada tahap perencanaan sudah didukung dan di analisa permasalahan serta sudah melibatkan lintas program dan lintas sektoral, tahap pengorganisasian sudah di bentuk, ada standar prosedur yang jelas, pembagian tugas sudah baik, pelaksanaan monitoring dan evaluasi program sudah memadai ada pengawasan dari pihak kepala puskesmas bumijawa dan dari Dinas Kesehatan kabupaten Tegal.Simpulan: Balita yang gizi kurang sudah ada pendataan dan di tangani dengan baik di posyandu TFC baik rawat inap atau rawat jalan, balita tersebut 100 persen mengalami kenaikan BB 0,5 kg per minggu, kecuali balita yang gizi kurang dengan kelainan penyerta seperti jantung, TBC dll perlu penanganan intensif.Sehingga program posyandu TFC sudah berjalan dengan baik sebagai penuntasan dan pemulihan gizi kurang bagi balita di Puskesmas Bumijawa Kabupaten Tegal.Kata Kunci : Implementasi kebijakan, program posyandu TFC Background: The problem of nutrition is one of the people's health problems that has never been solved in the world tackling. The World Health Organization estimates that around 60% of all deaths, which occur among children aged less than five years in developing countries, can be attributed to malnutrition. Therapeutic Feeding Center (TFC) or Nutrition Recovery Center (PPG) is recovery of malnutrition by intensive and adequate care and feeding according to age and condition by involving the participation of parents (mothers) to be independent when they return home.Objective: This study aims to analyze the implementation of the TFC Posyandu program at the Tegal District Health Center.Method: This research is qualitative by using descriptive methods. Data collection was carried out using in-depth interview techniques in accordance with interview guidelines. There were 8 respondents surveyed, namely 2 officers as key informants, namely the physician in charge and nutrition coordinator at Bumijawa Public Health Center, 4 officers as the main informants namely 2 midwife health workers and nutritionists as well as 2 posyandu cadre officers and 2 mothers who have undernourished children as informants Triangulation Results: Research results show that program resources, personnel, funds and infrastructure are adequate, the process of implementing the program at the planning stage has been supported and analyzed for problems and has involved cross-program and cross-sectoral, the organizing stage has been established, there are standard procedures clearly, the division of tasks is good, the implementation of program monitoring and evaluation is adequate, there is supervision from the head of the bumijawa puskesmas and from the Tegal district health office.Conclusion: Toddlers who lack nutrition already have data collection and are handled well in TFC posyandu both inpatient or outpatient, the toddler is 100 percent increasing in weight of 0.5 kg per week, except toddlers who are malnourished with comorbid disorders such as heart disease, tuberculosis etc. need intensive handling. So that the TFC posyandu program has been running well as the completion and recovery of malnutrition for children under five in the Bumijawa Health Center in Tegal Regency.Keywords: Policy implementation, TFC posyandu program


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1059-1059
Author(s):  
Raza Mirza ◽  
Melissa Macri ◽  
Deirdre Kelly-Adams ◽  
Carley Moore ◽  
Andrea Austen ◽  
...  

Abstract Most global cities, like Toronto, have rapidly aging populations who want to remain in homes and communities of their choice. Concurrently, seniors face vulnerabilities associated with low income, ageism, social isolation and loneliness. These vulnerabilities inhibit many seniors’ desires to age-in-place. The Toronto HomeShare Program, an intergenerational homesharing program facilitates aging-in-place by matching seniors with post-secondary students. The program, with an implementation focus and a research study, was developed to address and understand the needs of seniors seeking assistance, light supports and companionship at home, in exchange for reduced-rent housing for students. A mixed methods research design was employed. Seniors and students (n=22) completed a 167 question survey (n=22) and in-depth interviews (n=18). Quantitative data yielded descriptive statistics and qualitative data was subject to thematic content analysis. Participants agreed that homesharing programs could address risk for social isolation (95%), the need to move from their community (96%), and reduce risks of economic and social exclusion for young and old (97%). From the qualitative data, six benefits were apparent for all participants: (1) reduced social isolation and loneliness, (2) increased intergenerational exchange, (3) increase financial security, (4) household assistance, (5) increased general wellbeing; (6) enhanced companionship/safety. In 2020, Toronto HomeShare (now Canada HomeShare) was recognized by the World Health Organization as an age-friendly best practice, and has been scaled nationally in 16 cities. Intergenerational homesharing programs could be a catalyst for policy and cultural reform and to support older adults to not only remain in their communities, but to thrive-in-place.


2020 ◽  
Vol 17 (12) ◽  
pp. 1458-1464
Author(s):  
Sweta Kamboj ◽  
Rohit Kamboj ◽  
Shikha Kamboj ◽  
Kumar Guarve ◽  
Rohit Dutt

Background: In the 1960s, the human coronavirus was designated, which is responsible for the upper respiratory tract disease in children. Back in 2003, mainly 5 new coronaviruses were recognized. This study directly pursues to govern knowledge, attitude and practice of viral and droplet infection isolation safeguard among the researchers during the outbreak of the COVID-19. Introduction: Coronavirus is a proteinaceous and infectious pathogen. It is an etiological agent of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Coronavirus, appeared in China from the seafood and poultry market last year, which has spread in various countries, and has caused several deaths. Methods: The literature data has been taken from different search platforms like PubMed, Science Direct, Embase, Web of Science, who.int portal and complied. Results: Corona virology study will be more advanced and outstanding in recent years. COVID-19 epidemic is a threatening reminder not solely for one country but all over the universe. Conclusion: In this review article, we encapsulated the pathogenesis, geographical spread of coronavirus worldwide, also discussed the perspective of diagnosis, effective treatment, and primary recommendations by the World Health Organization, and guidelines of the government to slow down the impact of the virus are also optimistic, efficacious and obliging for the public health. However, it will take a prolonged time in the future to overcome this epidemic.


2020 ◽  
Author(s):  
Lukman Olagoke ◽  
Ahmet E. Topcu

BACKGROUND COVID-19 represents a serious threat to both national health and economic systems. To curb this pandemic, the World Health Organization (WHO) issued a series of COVID-19 public safety guidelines. Different countries around the world initiated different measures in line with the WHO guidelines to mitigate and investigate the spread of COVID-19 in their territories. OBJECTIVE The aim of this paper is to quantitatively evaluate the effectiveness of these control measures using a data-centric approach. METHODS We begin with a simple text analysis of coronavirus-related articles and show that reports on similar outbreaks in the past strongly proposed similar control measures. This reaffirms the fact that these control measures are in order. Subsequently, we propose a simple performance statistic that quantifies general performance and performance under the different measures that were initiated. A density based clustering of based on performance statistic was carried out to group countries based on performance. RESULTS The performance statistic helps evaluate quantitatively the impact of COVID-19 control measures. Countries tend show variability in performance under different control measures. The performance statistic has negative correlation with cases of death which is a useful characteristics for COVID-19 control measure performance analysis. A web-based time-line visualization that enables comparison of performances and cases across continents and subregions is presented. CONCLUSIONS The performance metric is relevant for the analysis of the impact of COVID-19 control measures. This can help caregivers and policymakers identify effective control measures and reduce cases of death due to COVID-19. The interactive web visualizer provides easily digested and quick feedback to augment decision-making processes in the COVID-19 response measures evaluation. CLINICALTRIAL Not Applicable


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Walusa Assad Gonçalves-Ferri ◽  
◽  
Fábia Martins Pereira-Cellini ◽  
Kelly Coca ◽  
Davi Casale Aragon ◽  
...  

Abstract Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.


2021 ◽  
pp. 101053952110260
Author(s):  
Mairead Connolly ◽  
Laura Phung ◽  
Elise Farrington ◽  
Michelle J. L. Scoullar ◽  
Alyce N. Wilson ◽  
...  

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.


Author(s):  
Kirti Sundar Sahu ◽  
Arlene Oetomo ◽  
Niloofar Jalali ◽  
Plinio P. Morita

The World Health Organization declared the coronavirus outbreak as a pandemic on March 11, 2020. To inhibit the spread of COVID-19, governments around the globe, including Canada, have implemented physical distancing and lockdown measures, including a work-from-home policy. Canada in 2020 has developed a 24-Hour Movement Guideline for all ages laying guidance on the ideal amount of physical activity, sedentary behaviour, and sleep (PASS) for an individual in a day. The purpose of this study was to investigate changes on the household and population-level in lifestyle behaviours (PASS) and time spent indoors at the household level, following the implementation of physical distancing protocols and stay-at-home guidelines. For this study, we used 2019 and 2020 data from ecobee, a Canadian smart Wi-Fi thermostat company, through the Donate Your Data (DYD) program. Using motion sensors data, we quantified the amount of sleep by using the absence of movement, and similarly, increased sensor activation to show a longer duration of household occupancy. The key findings of this study were; during the COVID-19 pandemic, overall household-level activity increased significantly compared to pre-pandemic times, there was no significant difference between household-level behaviours between weekdays and weekends during the pandemic, average sleep duration has not changed, but the pattern of sleep behaviour significantly changed, specifically, bedtime and wake up time delayed, indoor time spent has been increased and outdoor time significantly reduced. Our data analysis shows the feasibility of using big data to monitor the impact of the COVID-19 pandemic on the household and population-level behaviours and patterns of change.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maria Clara Saad Menezes ◽  
Alicia Dudy Müller Veiga ◽  
Thais Martins de Lima ◽  
Suely Kunimi Kubo Ariga ◽  
Hermes Vieira Barbeiro ◽  
...  

AbstractThe role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5–9 days, and between 10–15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.


Toxins ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 451
Author(s):  
José María Gutiérrez ◽  
Laura-Oana Albulescu ◽  
Rachel H. Clare ◽  
Nicholas R. Casewell ◽  
Tarek Mohamed Abd Abd El-Aziz ◽  
...  

A global strategy, under the coordination of the World Health Organization, is being unfolded to reduce the impact of snakebite envenoming. One of the pillars of this strategy is to ensure safe and effective treatments. The mainstay in the therapy of snakebite envenoming is the administration of animal-derived antivenoms. In addition, new therapeutic options are being explored, including recombinant antibodies and natural and synthetic toxin inhibitors. In this review, snake venom toxins are classified in terms of their abundance and toxicity, and priority actions are being proposed in the search for snake venom metalloproteinase (SVMP), phospholipase A2 (PLA2), three-finger toxin (3FTx), and serine proteinase (SVSP) inhibitors. Natural inhibitors include compounds isolated from plants, animal sera, and mast cells, whereas synthetic inhibitors comprise a wide range of molecules of a variable chemical nature. Some of the most promising inhibitors, especially SVMP and PLA2 inhibitors, have been developed for other diseases and are being repurposed for snakebite envenoming. In addition, the search for drugs aimed at controlling endogenous processes generated in the course of envenoming is being pursued. The present review summarizes some of the most promising developments in this field and discusses issues that need to be considered for the effective translation of this knowledge to improve therapies for tackling snakebite envenoming.


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