Alimin Maidin

Childhood Acute Respiratory Infections and Household Environment in an Eastern Indonesian Urban Setting

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children’s respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children’s bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother’s education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children.

Life in a landfill slum, children's health, and the Millennium Development Goals.

People living in slums can be considered left behind with regard to national successes in achieving Millennium Development Goals (MDGs). The objective of this study was to evaluate the living and working conditions of waste pickers and their children in a landfill slum located in the largest city in eastern Indonesia. A total of 113 people from the landfill slum and 1184 people from the general population participated in face-to-face interviews. Municipal solid waste (MSW) was analyzed for metals, metalloids and fecal indicator bacteria. Ambient air quality including particulate matter was measured in the landfill. Households in the landfill slum were 5.73 (p=0.04) times more likely to be below the international poverty line (MDG 1: Poverty) and 15.6 times (p<0.01) more likely to have no one in the household possessing a primary education (MDG 2: Universal Education), and 107 times (p<0.01) more likely not to have improved sanitation facilities (MDG 7: Environmental Sustainability) when compared to the general population. Diarrhea is one of the leading causes of death in children under five in Indonesia. Young children living in the landfill slum were 2.87 times (p=0.02) more likely to develop diarrhea than their general population counterparts. Other survey results and environmental measurements suggest that landfill slum children have additional adverse health effects (e.g. infections and poisoning). Poverty underlies several MDG issues that directly or indirectly affect child health. Therefore, eradicating extreme poverty will continue to be the most critical challenge for the MDGs beyond 2015.

Challenges in evaluating PM concentration levels, commuting exposure, and mask efficacy in reducing PM exposure in growing, urban communities in a developing country.

Particulate matter (PM) contributes to an increased risk of respiratory and cardiovascular illnesses, cancer, and preterm birth complications. This project assessed PM exposure in Eastern Indonesias largest city, where air quality has not been comprehensively monitored. We examined the efficacy of wearing masks as an individual intervention effort to reduce in-transit PM exposures. Handheld particulate counters were used to investigate ambient air quality for spatial analysis, as well as the differences in exposure to PM2.5 and PM10 (μg/m(3)) by different transportation methods [e.g. motorcycle (n=97), pete-pete (n=53), and car (n=55); note: n=1 means 1m(3) of air sample]. Mask efficacy to reduce PM exposure was evaluated [e.g. surgical masks (n=39), bandanas (n=52), and motorcycle masks (n=39)]. A Monte Carlo simulation was used to provide a range of uncertainty in exposure assessment. Overall PM10 levels (91±124 μg/m(3)) were elevated compared to the World Health Organization (WHO)s 24-hour air quality guideline (50 μg/m(3)). While average PM2.5 levels (9±14 μg/m(3)) were below the WHOs guideline (25 μg/m(3)), measurements up to 139 μg/m(3) were observed. Compared to cars, average motorcycle and pete-pete PM exposures were four and three times higher for PM2.5, and 13 and 10 times higher for PM10, respectively. Only surgical masks were consistent in lowering PM2.5 and PM10 (p<0.01). Young children (≤5) were the most vulnerable age group, and could not reach the safe dosage even when wearing surgical masks. Individual interventions can effectively reduce individual PM exposures; however, policy interventions will be needed to improve the overall air quality and create safer transportation.

Understanding modifiable risk factors associated with childhood diarrhea in an eastern Indonesian urban setting

This study evaluated multiple factors that may contribute to an increased risk of childhood diarrhea in eastern Indonesia. Mothers with at least one child under the age of 5 years (n = 303) were interviewed face-to-face in two sub-districts of a large city in eastern Indonesia. Results showed that children were 4.72 times more likely to develop diarrhea if mothers washed their hands without soap after defecation (95% confidence interval (CI) 1.22–18.3; p = 0.03), 3.83 times more likely if households had no access to improved sources of drinking water (95% CI 1.12–13.1; p = 0.03), and 3.21 times more likely if households had income levels below

Quality of Life of Chronic Renal Failure Patients Before and After Hemodialysis Treatment in Hospital Undata and Hospital Anutapura Palu in 2016

152/month (95% CI 1.40–7.35; p < 0.01). Although lower household income did not influence accessibility to improved drinking water sources, lower income households more likely lacked a refrigerator (odds ratio (OR) = 8.96; 95% CI 4.87–16.5; p < 0.01) and were also associated with mothers who had no primary education (OR = 5.44; 95% CI 1.71–17.3; p < 0.01). Mothers without primary education tended to think childhood diarrhea was not life threatening (OR = 10.8; 95% CI 3.45–33.6; p < 0.01), and mothers with such a perception were more likely wash their hands without soap after defecation (OR = 9.31; 95% CI 2.80–31.0; p < 0.01). In order to protect low-income children from diarrhea, it will be necessary to apply multiple health promotion efforts at both individual and community levels. Promoting mothers’ education is a key intervention for improving childhood health.

Cost Effective Analysis on the Implementation of Clinical Pathway in Anwar Makkatutu Hospital, Bantaeng District, South Sulawesi, Indonesia

The aim of this study to determine influence of life quality, social support, comorbidity and depression toward the chronic renal failure patients before and after hemodialysis treatment at Undata Hospital and Anutapura Palu Hospital in 2016. The study was conducted with quasi experimental design with one group pretest and post test design approach. The samples were all patients with chronic renal failure who performed hemodialysis therapy in Undata Hospital and Anutapura Hospital in 2016. The samples were new cases of chronic renal failure patients of stage V before hemodialysis treatment and after 4 months of hemodialysis treatment with 20 samples. Before hemodialysis treatment, the respondents filled out a questionnaire on their life quality and returned to questionnaires after 4 months of hemodialysis therapy. The data was used Wilcoxon test and paired T test. This study found p<0.05 (p=0.000<0.05) meant life quality had influenced in chronic renal failure patients before and after hemodialysis treatment. The patients life quality was improved after undergone hemodialysis treatment for 4 months at mean of 103.00 with standard deviation, SD=4.437 from low life quality before hemodialysis therapy at the mean of 59.05 and standard deviation, SD=6.863. Besides, the study also showed there was influenced in the patient with social support (p=0.002< 0.005) before and after hemodialysis treatment. There was influenced of hemodialysis therapy toward comorbidity (p=0.006<0.05). The high depression was suffered by chronic renal failure patient before their hemodialysis therapy with mean 200.00 and depression was reduced after patient undergone hemodialysis therapy with mean= 123.40.

Cost Effectiveness Analysis Based Through Nutrition Intake and Nutritional Status in Kidney Failure Patients Who Underwent Hemodialysis and Non Hemodialysis Therapy Productive Age at Makassar City

Cost Effective Analysis on the Implementation of Clinical Pathway in Anwar Makkatutu Hospital, Bantaeng District, South Sulawesi, Indonesia Alimin Maidin, Fridawaty Rivai Faculty Public Health , Hasanuddin University, Makassar, Indonesia Introduction: The National Health Insurance (JKN) has been implemented in Indonesia since 2014 and the dreams for Universal Health Coverage (UHC) by the year 2019. It encourages the need for systems that can reduce losses for patients and hospitals through INA-CBGs. Currently, the participant number and health facilities that cooperate with Social Health Insurance (BPJS) increased significantly, while facts shown the lack of funds for the implementation of JKN during 2014-2015. These situations forced the hospitals to take effective action as quality-cost control by using clinical pathway as a guide of medical treatment for patient. Therefore, this study will analyze comprehensively, about the availability, loyalty, conformity, and cost effectiveness after the implementation of clinical pathway. Method; This study used mix-method approach with sequential explanatory design. Data was collected through observations, in-depth interviews, document reviews, and also Focus Group Discussion (FGD). Respondents were selected purposively, consist of medical and managerial staff, and insured patients. This study was a pilot project which was conducted in Bantaeng district Hospital, one of public hospital in south Sulawesi Results; The early study shown that, Bantaeng District Hospital did not implement the qualitycost control system due to the unavailability of clinical pathway guidance. Therefore, this study encouraged medical and managerial staff to establish clinical pathway guidance and evaluating the implementation (The study is still going on and predicted until July 2017). Conclusions; Quality-cost control system through clinical pathway implementation can reduce the Medical Errors, Length of Stay, Unnecessary Expenditure, also increasing Satisfaction and Quality of service. Therefore, the hospital need to provide clinical guidance through clinical pathway document to ensure patients to get the required services according to their condition and the cost accordance to the treatment received by the patients. Keywords; Cost Effective Analysis, Clinical Pathway, Hospital