1,721,002 research outputs found
The state of diabetes care and obstacles to better care in Aceh, Indonesia: a mixed-methods study
No full textAbstract
Background
Cardio-metabolic diseases are a major cause of death worldwide, including in Indonesia, where diabetes is one of the most critical diseases for the health system to manage.
Methods
We describe the characteristics, levels of control, health behavior, and diabetes-related complications of diabetes patients in Aceh, Indonesia. We use baseline data and blood testing from a randomized-controlled trial. We conducted semi-structured interviews with eight health providers from Posbindu and Prolanis programs that target diabetes and other non-communicable diseases (NCDs). We also conducted three focus group discussions with 24 diabetes patients about their experiences of living with diabetes and the existing support programs.
Results
The blood tests revealed average HbA1c levels indicative of poor glycemic control in 75.8 percent of patients and only 20.3 percent were free from any symptoms. Our qualitative findings suggest that patients are diagnosed after diabetes-related symptoms manifest, and that they find it hard to comply with treatment recommendations and lifestyle advice. The existing programs related to NCDs are not tailored to their needs.
Conclusion
We identify the need to improve diabetes screening to enable earlier treatment and achieve better control of the disease. Among diagnosed patients, there are widespread beliefs about diabetes medication and alternative forms of treatment that need to be addressed in a respectful dialogue between healthcare professionals and patients. Current diabetes screening, treatment and management programs should be revised to meet the needs of the affected population and to better respond to the increasing burden of this disease.Open-Access-Publikationsfonds 202
Real-world smartphone-based point-of-care diagnostics in primary health care to monitor HbA1c levels in people with diabetes
No full textBackgroundThe lack of accurate and affordable monitoring of glycated hemoglobin (HbA1c) is a common issue among patients with diabetes in low- and middle-income countries. We aimed to test a tablet- and smartphone-based point-of-care (TSB POC) device against a local laboratory-based measure of HbA1c for monitoring diabetes under real-world conditions.MethodsFor this cross-sectional clinical method applicability study, capillary and venous blood was collected in duplicate and analyzed at local primary health care centers. For a heterogeneity test, the tests were performed by an expert, and by a team of local nurses. The study was conducted in a multicenter design in rural and urban Aceh, Indonesia in 2019, and included a total of 533 adults. We mainly used Bland-Altman plots to assess the number of readings within the 95%-limits of agreement (LoA) and Deming regressions.ResultsThe results show a mean difference between capillary HbA1c on the test device and the reference method of −0.54 [CI0.95 = −1.6933; 0.6048] with 5.21% of measurements outside the LoA and a Pearson’s r = 0.91 in the Deming Regression. There is no significant difference in test concordance between local nurses and the expert (4.23% versus 5.13% results outside the LoA [CI0.95 = −0.0331; 0.0511]).ConclusionsTSB POC for analysis of HbA1c is an acceptable alternative for accessible monitoring of diabetes patients under these conditions. This method could provide access to high-quality diagnostic decisions through regular and cost-effective HbA1c monitoring directly in healthcare facilities, thus providing better access to essential health services.Plain language summary People with diabetes in low- and middle-income countries often lack access to reliable and affordable tests to monitor their long-term blood sugar levels, known as HbA1c. This study tested a simple tablet- or smartphone-based device to measure HbA1c directly at primary health centers. The study was conducted in urban and rural areas of Indonesia with 533 participants. The results showed that the device’s measurements were almost identical to laboratory tests. There was hardly any difference in the results, regardless of whether the tests were carried out by experienced experts or by nurses in the field. This method could provide a basis for regular and affordable HbA1c testing to improve diabetes care and access to basic health services for patients in these regions.Rhode et al. investigate the applicability of smartphone-based point-of-care diagnostics for monitoring HbA1c levels of diabetes patients under real-world conditions in a lower-middle income setting. They discover that the method offers an acceptable alternative for accessible monitoring under these conditions
Beliefs, Knowledge, and Perception of Indonesian Mental Healthcare Workers Regarding Mental Illness: A Cross-Sectional Study
No full textBackground:
The actions of healthcare workers in treating and caring for people with mental illness are influenced by various factors. Therefore, this study aimed to assess beliefs, knowledge, and perception of Indonesian Mental Healthcare Workers (MHWs) regarding mental illness.
Materials and Methods:
A cross-sectional study was conducted among 173 MHWs in May 2021 using a newly developed questionnaire distributed through convenience sampling methods.
Results:
Most respondents were female (n = 135, 77.14%) and married (n = 148, 84.57%), with a mean (SD) of age of 37.57 (6.55) years old. Most believed that mental illness was caused by personal weakness (n = 131, 74.86%) and often led to mental retardation (n = 115, 65.71%). Furthermore, approximately half of this population believed mental illness could be cured through marriage (n = 80, 45.71%).
Conclusions:
The evaluated MHWs commonly held misconceptions about the cause and treatments of mental illness. Consequently, relevant training was recommended to be performed for mental health literacy enhancement
Metabolisches Syndrom und Hautkrankheiten bei psychiatrischen stationären Patienten in Aceh - Indonesien
No full textBackground In Indonesia, treatment of people with mental disorders is largely
institutionalised in psychiatric hospitals. During hospitalisation, patients
receive both psycho- and pharmacotherapies. Treatments with antipsychotics
cause numerous adverse effects. Such effects include alterations in weight,
blood pressure, plasma glucose, triglycerides, albumin and LDL and HDL
cholesterol, all of which are components of metabolic syndrome (MetS).
Furthermore, long-term hospitalisation and the use of antipsychotics are also
associated with the development of skin diseases in the patients.
Nevertheless, despite theses major potential side effects, research on rates
of MetS and skin problems among psychiatric inpatients in Indonesia was
lacking. Therefore our studies aim at revealing rates of MetS and skin
diseases among psychiatric inpatients. Methods Cross-sectional studies were
conducted at Aceh psychiatric hospital in Indonesia. The first study aimed to
estimate rates of overweight and obesity among inpatients. The study applied a
random sampling method and included a total of 242 inpatients. The second
study aimed to unveil rates of metabolic syndrome among inpatients with
schizophrenia. In this study also a random sampling was used and a total of 86
inpatients were included. The third study aimed at unveiling rates of skin
disorder among long stay psychiatric patients. This study applied a total
population sampling methods and was conducted at the distance wards of the
hospital. The distance wards, also called “the filial”, are devoted to the
longer stay patients. Metabolic syndrome was assessed based on the
International Diabetes Federation (IDF) criteria for South Asian, while
diagnosis of skin diseases was evaluated according to ICD-10. In each study,
descriptive statistics were performed, reporting frequencies, mean, media or
range when appropriate. Inferential statistics were later performed to test
for significant association between dependent and independent variables. The
independent sample t-test, chi-squared test, Mann-Whitney, Fisher Exact, or
spearman’s rho correlation coefficient tests were used when appropriate
Results The majority of psychiatric inpatients population had a normal body
weight. There were more underweight than overweight or obesity observed among
patients with shorter hospital stay. The rates of obesity were 5%, 2.3% and
8.6% in the first, second and third study, consequently. Approximately 9.3% of
the sample met the IDF criteria for MetS. Women had a higher proportion of
Metabolic Syndrome than men (23.8% vs. 4.6%, p = 0.02). Reduced HDL
cholesterol was the most frequent (81.4%) metabolic abnormality, followed by
central obesity (29.1%), raised triglycerides (23.3%), raised fasting plasma
glucose (12.8%), and raised blood pressure (10.5%). Furthermore, around 73% of
psychiatric inpatients in the long stay wards suffered from a dermatological
disease. Conclusions The findings suggest that rates of overweight, obesity
and rate of metabolic syndrome in this population are relatively lower
compared to developed countries as previously reported. The rate of skin
diseases among psychiatric patients was high, which is in line with previous
reports in other settings. Nevertheless, the high a proportion of patients
with underweight call for further studies in the future. In addition, the role
of socio-economic condition before hospitalization and the methods of caring,
including the adequacy of nutritional intake during hospitalisation, should be
further investigated.Hintergrund In Indonesien sind Behandlungen von Menschen mit psychischen
Störungen weitgehend in psychiatrischen Kliniken institutionalisiert. Während
des Krankenhausaufenthaltes erhalten die Patienten Psycho- und
Pharmakotherapien. Behandlungen mit antipsychotisch wirkender Medikation (AP)
führen zu zahlreichen unerwünschten Wirkungen, zu denen die Veränderung des
Gewichts, des Blutdrucks, der Plasmaglucose, der Triglyceride, des Albumin und
des LDL- sowie HDL-Cholesterins zählen. Bei allen hier aufgeführten
unerwünschten Wirkungen handelt es sich um Komponenten des Metabolischen
Syndroms. Die Einnahme von antipsychotisch wirkender Medikation (AP) scheint
mit einem langfristigen Krankenhausaufenthalt auch mit der Entwicklung von
Hauterkrankungen bei den Krankenhauspatienten in Verbindung zu stehen. Bei den
vorgelegten Studien handelt es sich um die ersten zum Metabolischen Syndrom
und Hautproblemen bei stationären psychiatrischen Patienten in Indonesien. Sie
wurden durchgeführt, um Daten zum Metabolischen Syndrom und zu
Hauterkrankungen bei stationär behandelten psychiatrischen Patienten in
Indonesien zu erfassen. Methoden Es wurden Querschnittsuntersuchungen in einem
psychiatrischen Krankenhaus in Banda Aceh, Indonesien, durchgeführt. Bei der
ersten Studie wurde ein einfaches Zufallsstichprobenverfahren angewandt, und
insgesamt 242 stationäre Patienten in die Studie eingeschlossen. Ziel dieser
Untersuchung war, den Anteil von Übergewichtigkeit und Adipositas bei
stationären Patienten zu erfassen. Auch bei den Patienten der folgenden zwei
weiteren Studien wurden jeweils Daten zum Gewicht mit erfasst. Auch bei der
zweiten Studie wurde ein einfaches Zufallsstichprobenverfahren eingesetzt, die
insgesamt 86 stationäre Patienten einschloss. Hier ging es um die Erfassung
der Parameter des Metabolischen Syndroms unter stationär psychiatrischen
Patienten mit einer Erkrankung aus dem Schizophrenen Formenkreis. In der
dritten Studie wurde eine Vollerhebung aller stationär behandelten Pateinten
durchgeführt. Hier ging es um die Erfassung von Hauterkrankungen unter den
stationär sich in Langzeitbehandlung befindenden psychiatrischen Patienten in
eigens dafür vorhandenen Dependancen. Die Beurteilung des Metabolischen
Syndroms erfolgte auf der Grundlage der Kriterien der International Diabetes
Federation (IDF) für Süd-Asien, während die Diagnose von Hauterkrankungen nach
ICD-10 - Kriterien für Hauterkrankungen bewertet wurde. Bei der Auswertung
kamen deskriptive und Inferenzstatistiken zur Anwendung. Ergebnisse Die
Mehrzahl der stationär behandelten psychiatrischen Patienten hatte ein
normales Körpergewicht. Bei Patienten mit kürzerer stationärer
Behandlungsdauer konnte häufiger ein Untergewicht als Übergewicht oder
Fettleibigkeit registriert werden. Eine Fettleibigkeit lag mit 5% bei
Pateinten der ersten Studie, 2,3% bei Pateinten der zweiten und mit 8,6% bei
Patienten der letzten Studie vor. Von diesen erfüllten 9,3% die Kriterien
eines Metabolischen Syndroms. Frauen hatten einen höheren Anteil an MetS als
Männer (23,8% vs. 4,6%, p = 0,02). Reduziertes HDL-Cholesterin war die
häufigste (81,4%) Stoffwechselveränderung, gefolgt von zentraler Adipositas
(29,1%), erhöhten Triglyceride (23,3%), erhöhtem Nüchtern-Blutzucker (12,8%)
und Bluthochdruck (10,5%). Darüber hinaus konnte eruiert werden, dass 73% der
psychiatrisch stationär behandelten Langzeitpatienten an einer Hautkrankheit
litt. Schlussfolgerungen Unsere Ergebnisse zeigen auf, dass der Anteil an
Übergewicht, Adipositas und Metabolischem Syndrom in der hier untersuchten
Population an stationär psychiatrisch behandelten Patienten im Gegensatz zum
bislang in der Literatur aus den Entwicklungsländern beschriebenen Anteil
niedriger liegt. Demgegenüber konnten wir die Ergebnisse in Bezug auf
Hauterkrankungen unter stationär psychiatrisch behandelten Langzeitpatienten
mit den Ergebnissen aus der Literatur bestätigen. Künftige Studien könnten z.
B. der Frage nachgehen, warum ein hoher Anteil der stationär behandelten
Patienten untergewichtig ist
Impact of the WHO Safe Childbirth Checklist on safety culture among health workers: A randomized controlled trial in Aceh, Indonesia.
No full textThe World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control facilities). We introduced the SCC in combination with a medium intensity coaching in health facilities which already offered at minimum basic emergency obstetric and newborn care (BEMonC). We assess the effects of using the SCC on 14 outcome variables measuring self-perceived information access, information transmission, frequency of errors, workload and access to resources at the facility level. We apply Ordinary Least Square regressions to identify an Intention to Treat Effect (ITT) and Instrumental Variable regressions to determine a Complier Average Causal Effect (CACE). The results suggest that the treatment significantly improved self-assessed attitudes regarding the probability of calling attention to problems with patient care (ITT 0.6945 standard deviations) and the frequency of errors in times of excessive workload (ITT -0.6318 standard deviations). Moreover, self-assessed resource access increased (ITT 0.6150 standard deviations). The other eleven outcomes were unaffected. The findings suggest that checklists can contribute to an improvement in some dimensions of safety culture among health workers. However, the complier analysis also highlights that achieving adherence remains a key challenge to make checklists effective
Healthcare providers' perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study
No full textOur study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia
Difference of Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, and Platelet-to-Lymphocyte Ratio in Patients with Non-Hodgkin and Hodgkin Lymphoma
Full text linkBackground: Malignancy and inflammation are strongly connected. The inflammatory processes play a significant part in the development of lymphoma. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) can be used as potential biomarkers of inflammation in lymphoma. This study aimed to discover the differences between NLR, MLR, and PLR in patients diagnosed with non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL). Methods: This study employed a retrospective design using data from the lymphoma registry at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from 2020 to 2023. Sampling was carried out consecutively. Hematological data of patients with NHL and HL before chemotherapy were collected. The variance between the two groups was examined utilizing the Mann-Whitney U test.Results: In total, 122 data of patients were included, consisting of 75% NHL patients and 25% HL patients with a median age of 54 years (IQR 43–62). The overall NLR, MLR, and PLR tended to be lower in nHL than in HL patients although the differences were not statistically significant; with NLR 2.7 (0.7 – 12.2) vs. 3.2 (1.1 – 10.8) p=0.287, MLR 0.36 (0.04 – 1.86) vs. 0.46 (0.09 – 1.78) p=0.150, and PLR was 160.6 (20.2 – 1533.3) vs. 211.2 (50.6–1156.3) p=0.189, for NHL and HL, respectively.Conclusion: The lower values of NLR, MLR, and PLR in NHL indicate lower systemic inflammatory status in NHL than HL patients. Further studies are needed to evaluate dynamic changes of these biomarkers during treatment
Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission
Full text linkBackground: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.Methods: A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p <0.001]. Covid-19 patients who died had a higher NLR than those who survived [10.88 (4.17–47.50, IQR 7.00–15.17) vs 6.15 (2.80–97.00, IQR 4.63–8.50), p 0.02]. Patients with moderate-severe symptoms had an initial NLR of 4.63–8.50 and decreased to 2.75–5.43 at the end of the treatment had a greater chance of survival. There was an increased probability of death in patients with moderate-severe symptoms whose initial NLR was 7.00–15.17, which was then elevated to 14.33–23.25.Conclusion: Different NLR at admission is seen among Covid-19 patients with mild and moderate-severe symptoms, leading to significantly different outcomes. The NLR can be used as a simple parameter to determine the severity of the disease and predict the outcome of Covid-19 patients
Investigating the midwives’ knowledge on infant and young child feeding during the COVID-19 pandemic
No full textImplementing the WHO gold standards for Infant & Young Child Feeding (IYCF) may help in preventing stunting, which may worsen during Covid-19 Pandemic. Midwives can help educating the mother in proper child feeding. This research aimed to assess the knowledge of midwives working in the community on IYCF during Covid-19. A total of 88 midwives working in various healthcare facilities participated in this study. Using online survey methods, they were invited to answers questions that measure their knowledge on basic practices of IYCF, Covid-19 transmission risk in breastfeeding dyads, breastfeeding practices, and complementary feeding during the pandemic. It was found that the rate of good, moderate and poor knowledge on IYCF during Covid-19 Pandemic were 23%, 67% and 19%, respectively. In conclusion, less than one third of the respondents showed good knowledge – something requiring investigation on the strategies to build stronger capacity of midwives in terms of IYCF during Covid-19 Pandemic
- …
