Sutopo Patria Jati

Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia

BackgroundSputum smear microscopy is the standard diagnostic method for detection of smear positive pulmonary tuberculosis (TB). Insufficient quality of sputum might result in missing cases. In this study we aimed at assessing the quality of sputum in a district in Central Java and determining patient and health worker factors associated with submission of three good quality sputum samples.MethodsIn 16 health centers information was collected on the quality of sputum submitted by TB suspects, i.e. volume, color, and viscosity. TB suspects were interviewed to assess their knowledge of TB, motivation to provide sputum and whether they were informed why and how to produce a sputum sample. Health workers were interviewed to assess what information they provided to TB suspects about the reason for sputum examination, methods to produce sputum and characteristics of a good quality sputum sample. All health worker and patient factors were evaluated for association with sputum quality.ResultsOf 387 TB suspects, 294 (76.0%) could be traced and interviewed, and of 272 (70.3%) information about sputum quality was available. Of those 203 (74.6%) submitted three samples, 90 (33.1%) provided at least one good sample, and 37 (13.6%) provided three good quality sputum samples. Of the 272 TB suspects, 168 (61.8%) mentioned that information on the reason for sputum examination was provided, 66 (24.3%) remembered that they were informed about how to produce sputum and 40 (14.7%) recalled being informed about the characteristics of good quality sputum. Paramedics reported to provide often/always information on the importance of sputum examination, and when to produce sputum. Information on how to produce sputum and characteristics of a good sputum sample was less often provided. None of the studied patient characteristics or health worker factors was associated with providing good quality sputum.ConclusionA considerable number of TB suspects did not provide three sputum samples and a large number of sputum samples were of insufficient quality. Training of health workers in providing health education to the TB suspect about the reason for sputum examination and how to produce a good quality sputum sample should be a priority of the TB program.

Implementation of Water Safety Plans (WSPs): A Case Study in the Coastal Area in Semarang City, Indonesia

An area of 508.28 hectares in North Semarang is flooded by tidal inundation, including Bandarharjo village, which could affect water quality in the area. People in Bandarharjo use safe water from deep groundwater, without disinfection process. More than 90% of water samples in the Bandaharjo village had poor bacteriological quality. The aimed of the research was to describe the implementation of Water Safety Plans (WSPs) program in Bandarharjo village. This was a descriptive study with steps for implementations adopted the guidelines and tools of the World Health Organization. The steps consist of introducing WSPs program, team building, training the team, examination of water safety before risk assessment, risk assessment, minor repair I, examination of water safety risk, minor repair II (after monitoring). Data were analyzed using descriptive methods. WSPs program has been introduced and formed WSPs team, and the training of the team has been conducted. The team was able to conduct risks assessment, planned the activities, examined water quality, conduct minor repair and monitoring at the source, distribution, and households connection. The WSPs program could be implemented in the coastal area in Semarang, however regularly supervision and some adjustment are needed.

Potential impact of climate variability on respiratory diseases in infant and children in Semarang

Temperature, humidity, and rainfall may influence respiratory disease, including acute respiratory infection (ARI) and pneumonia. In Semarang, the temperature and humidity has increased 0.1°C and 1.6% respectively during 2002-2011. ARI and pneumonia in children under 5 years had increased during 2012-2014. This study aimed to analyze the relationship of climate variability and ARI and pneumonia incidence. It was an ecological study. Subject consisted of patients visited primary health care of Bandarharjo from 2011 to 2015. Pneumonia was related to infants (<1-year-old) and children (1-4 years old), while ARI was related to children (≥5 years old). Data of climate was obtained from Agency for Meteorology, Climatology and Geophysics (BMKG) Semarang. Pearson correlation (α=0.05) was used to analyse the correlation of the 60 samples. Mean of temperature was 27.96° C, relative humidity was 74.73%, and rainfall was 179.98 mm/month. The total of ARI was 38523 cases and pneumonia was 1558 cases. Temperature, humidity, and rainfall had no correlation to pneumonia. Humidity had a significant correlation to ARI on female children and total ARI (r=0.3 and r=0.26; p–value=0.02 and 0.04 respectively). Rainfall and temperature had no correlation to total ARI. This study concluded humidity has potential impact to ARI.

Analisis Penyusunan Draf Panduan Praktik Klinis Pelayanan Radiologi di RRSUD Ajibarang Kabupaten Banyumas

Panduan Praktik Klinis adalah prosedur yang dilaksanakan oleh sekelompok profesi yang mengacu pada Pedoman Nasional Pelayanan Kedokteran yang dibuat oleh organisasi profesi dan disyahkan oleh Pimpinan Rumah Sakit.Dalam memberikan pelayanan kesehatan kepada pasien maka pelayanan radiologi harus berdasarkan pada Panduan Praktik Klinis yang ada pada pelayanan tersebut. Tujuan dari penelitian ini yaitu menjelaskan proses penyusunan draf Panduan Praktik Klinis Pelayanan Radiologi di RSUD Ajibarang Kabupaten Banyumas. Metode penelitian yang digunakan adalah penelitian kualitatif dengan tujuan ingin menggali lebih dalam dari berbagai sumber dan informan mengenai proses penyusunan panduan praktik klinik pelayanan radiologi di RSUD Ajibarang Kabupaten Banyumas. Pengumpulan data dengan menggunakan metode wawancara mendalam, observasi dan telaah dokumen. Metode pengolahan data dengan contens analisys (analisis isi ) . Data dalam penelitian ini disajikan dalam bentuk narasi dan dilengkapi dengan matriks hasil wawancara.Penyajian data didukung dengan hasil observasi lapangan dan telaah dokumen. Hasil penelitian menunjukan bahwa dari aspek sumber daya terdapat hambatan, yaitu dokter spesialis radiologi belum berperan dalam proses penyusunan,dan kurang terjalinnya komunikasi antara pelaksana radiologii dengan tim penyusun panduan praktik klinis rumah sakit. Aspek pola tarif tidak terdapat hambatan, tarif INA-CBGs sudah digunakan pada program Jaminan Kesehatan Nasional (JKN) dan diberlakukan per 1 Januari 2014. Pada aspek ketersediaan bukti, panduan praktik klinis yang tersusun sudah berdasarkan literature dan textbook. Format draf panduan praktik klinis yang tersusun meliputi, judul prosedur tindakan, pengertian, indikasi, kontra indikasi, persiapan, prosedur tindakan , pasca prosedur tindakan, tingkat evidens, tingkat rekomendasi, penelaah kritis, indikator prosedur tidakan penata radiologi, kepustakaan Kesimpulan bahwa proses penyusunan panduan praktik klinis sudah berjalan dengan baik, tetapi dokter spesialis radiologi belum berperan. Direkomendasikan agar surat keputusan direktur tentang Tim Penyusun Panduan Praktik Klinis RSUD Ajibarang direvisi. Pelayanan radiologi untuk menyelesaikan dan menetapkan draf panduan praktik Panduan Praktik Klinis yang sudah final. A clinical practice guideline is a procedure implemented by group of a profession referred to National Guideline of Medical Service made by organisation of profession and approved by Director of a hospital. In providing health services to patients, radiology service must refer to the clinical practice guideline that is available in its service. The aim of this study was to explain the process of draft arrangement of the clinical practice guideline of radiology service at Ajibarang Public Hospital in Banyumas District. This was qualitative research aimed at investigating the arrangement process of the clinical practice guideline of radiology service collected from various sources and informants at Ajibarang Public Hospital in Banyumas District. Data were collected using methods of indepth interview, observation, and literature review, analysed using content analysis, and presented descriptively combined with matrix of interview results. In addition, data presentation was supported by results of field observation and literature review. The results of this research showed that viewed from aspects of resources, there were any barriers as follows: radiologist did not involve in the arrangement process and there was lack of communication between radiographer and an arrangement team of the clinical practice guideline of hospital. On the other hand, there was no barrier in the aspect of tariff pattern. Tariff of INA- CBGs have been used in a program of National Health Insurance and implemented since 1 January 2014. In the aspect of evidence availability, arranged clinical practice guideline was based on literature and textbook. A format of arranged clinical practice guideline draft consisted of title of action procedure, definition, indication, contra-indication, preparation, action procedure, post action procedure, levels of evidence, levels of recommendation, reviewers, indicators of action procedure of radiographer, and references. In conclusion, the arrangement process of the clinical practice guideline had been well implemented. However, radiologist had not involved. Director’s decree about arrangement team of the clinical practice guideline at Ajibarang Public Hospital needs to be revised. Radiology service needs to accomplish and determine final draft of the clinical practice guideline.