Effect of Oral Iron Tablet Administration on Serum Feritin and Hemoglobin Concentration of Pre-pregnant Women with Mild Iron Deficiency Anemia in Bali

Iron deficiency anemia (IDA) is still to be a problem of pregnant women healthrelated to its high prevalence and its negative effects on health. Prevention efforts by ironsuplementation in pregnant woman have not reducing IDA problem in pregnant women yet. This failure is probably due to the assumption that IDA have been seen pre-pregnant. Totest this hypothesis, a quasi experimental study was conducted by randomized pre and posttest control group design. Sample were collected by multistage sampling random technicconsist of 47 women in treated group and 52 in control group. Both group were serumferritin and hemoglobin value test untill 3 time, pre-pregnant, early pregnant and duringpregnant. Iron tablet was administrated to treated group from the beginning of pre-pregnantperiod, continued until the first 3 months of pregnancy, while in control group iron tabletwas only given during the first 3 months of pregnancy. T-group result shown that meanserum ferritin and hemoglobin concentration at pregnant women on treated group(33,45±14,12 ?g/dL dan 12,25±1,20 g/dl) more high than control group (19,65±8,99 ?g/dLdan 10,91±0,67 g/dl), p<0,05. Mean difference serum ferritin and hemoglobinconcentration at pregnant women is 13,8 ?g/dL dan 1,34 g/dl (p<0,05). Benefid analysisresult shown that iron suplementation since pre-pregnant more benefid than ironsuplementation during pregnant (BCR >1). Based on these results, it can be concluded thatiron supplementation to IDA women starting from pre-pregnant period results in a bettereffect compare to oral iron supplementation during pregnancy only

Perbandingan Efek Suplemen Besi Pra-hamil dan Selama Kehamilan dalam Upaya Menurunkan Anemia Defisiensi Besi pada Wanita Hamil dengan Anemia Ringan di Bali

Anemia defisiensi besi (ADB) masih merupakan masalah kesehatan wanita hamilterkait dengan tingginya prevalensi dan efek negatifnya terhadap kesehatan. Upayapencegahan telah dilakukan dengan pemberian tablet besi selama kehamilan. Akan tetapihasilnya belum memuaskan. Kegagalan ini mungkin diakibatkan oleh rendahnya bahkankosongnya cadangan besi tubuh sewaktu pra-hamil, terutama di negara sedangberkembang. Oleh karena itu, suplemen besi yang hanya diberikan waktu kehamilantidak cukup untuk mencegah terjadinya ADB. Oleh karena itu, dilakukan a quasiexperimental study pada 99 pasangan baru yang belum hamil yang terdiri atas 47 groupperlakuan dan 52 sebagai group kontrol. Tablet besi (200 mg ferrous sulfate) diberikansejak periode sebelum hamil pada group perlakuan yang dilanjutkan sampai dengan 3bulan kehamilan. Sementara, pada group kontrol diberikan tablet besi dimulai hanya padakehamilan trimester pertama. ADB didasarkan atas konsentrasi hemoglobin dan serumferitin sesuai dengan criteria WHO dan keuntungan pemberian tablet besi didasarkan atasteknik BCR. Pada penelitian ini didapatkan bahwa pemberian tablet besi pada pra-hamildapat menurunkan prevalensi ADB lebih tinggi dibandingkan dengan pemberian tabletbesi yang dimulai saat kehamilan (0% vs 38.46%, p<0.05). Perbedaan yang signifikanjuga pada rerata serum feritin pada akhir pengamatan yaitu 33.45±14.12 ?g/dL padagroup perlakuan dan 19.65±8.99 ?g/dL pada group kontrol. Sementara itu, kadarhemoglobin adalah 12.25±1.20 g/dL pada group perlakuan dan 10.91±0.67 g/dL padagroup kontrol (p<0.05). Analisis menunjukkan bahwa pemberian tablet besi yang dimulaisaat pra-hamil adalah lebih menguntungkan dibandingkan dengan pemberian tablet besimulai hanya pada kehamilan (BCR >1). Tidak terdapat perbedaan bermakna pada efeksamping dan kepatuhan pada group perlakuan dan kontrol. Berdasarkan hasil-hasil inidapatlah disimpulkan bahwa pemberian tablet besi yang dimulai masa pra-hamil adalahlebih baik dibandingkan dengan pemberian tablet besi yang diberikan hanya pada saatkehamilan. Program ini sangat mungkin diterapkan pada masyarakat karenakepatuhannya adalah baik

When complexity matters: a step-by-step guide to incorporating a complexity perspective in guideline development for public health and health system interventions

Background Guidelines on public health and health system interventions often involve considerations beyond effectiveness and safety to account for the impact that these interventions have on the wider systems in which they are implemented. This paper describes how a complexity perspective may be adopted in guideline development to facilitate a more nuanced consideration of a range of factors pertinent to decisions regarding public health and health system interventions. These factors include acceptability and feasibility, and societal, economic, and equity and equality implications of interventions. Main message A 5-step process describes how to incorporate a complexity perspective in guideline development with examples to illustrate each step. The steps include: (i) guideline scoping, (ii) formulating questions, (iii) retrieving and synthesising evidence, (iv) assessing the evidence, and (v) developing recommendations. Guideline scoping using stakeholder consultations, complexity features, evidence mapping, logic modelling, and explicit decision criteria is emphasised as a key step that informs all subsequent steps. Conclusions Through explicit consideration of a range of factors and enhanced understanding of the specific circumstances in which interventions work, a complexity perspective can yield guidelines with better informed recommendations and facilitate local adaptation and implementation. Further work will need to look into the methods of collecting and assessing different types of evidence beyond effectiveness and develop procedural guidance for prioritising across a range of decision criteria

Evaluation of Work Performance Two Types of Community TB Workers in Gianyar Regency

Background and purpose: One of the strategies adopted to improve coverage of TB patients (BTA+) in GianyarRegency is to involve the pakraman (desa adat) TB cadres and the regular (PPTI) TB cadres with four tasks in order tohelp health care workers to trace and find tuberculosis suspect patients. The purpose of this study was to evaluatework performance between two types of community TB cadres in Gianyar Regency.Methods: This study was an observational research using secondary data of cadres work reports and interview tostudy participants to understand cadres characteristics and health workers supervision. Numbers of participants wereall village TB cadres namely 29 pakraman and 88 regular TB cadres located in Gianyar Regency. Data collection wascarried out using questionnaires and observation sheets. Univariate, bivariate and multivariate analysis was conducted.Results: The result shown that work performance of pakraman TB cadres was statistically better than regular TBcadres (adjusted RP=6.1; 95%CI: 3.3-11.2). Better work performance of pakraman TB cadres was found in all four tasksof cadres namely helping education (adjusted RP=7.8; 95%CI: 4.2-14.2), finding tuberculosis suspects (adjusted RP=7.4;95%CI: 1.7-33.1), tracing of defaulters TB suspects (adjusted RP=17.1; 95%CI: 1.8-166.4) and tracing loss of follow up TBpatients (adjusted RP=3.8 x 108 (95%CI: 1.6-8.9 x 108).Conclusion: Work performance of pakraman TB cadres was better than regular TB cadres in all four tasks. &nbsp

The Association Between Social Functions and Quality of Life Among Elderly in Denpasar

Background and purpose: Good quality of life among elderly will reduce social and economic burden among the productive age people. This study aims to determine association between social function and quality of life among elderly in Denpasar.Methods: A cross-sectional survey was conducted among 144 elderly in Denpasar who were selected by cluster sampling and data were collected by a structured interview. Data were analyzed using logistic regression to determine the relationship between quality of life of the elderly with social activities, social interactions and family functions.Results: The study showed that the proportion of lower quality of life of the elderly in Denpasar was 64.58%. Proportion of elderly with lower quality of life was found among elderly of older age, female, low education, not working, low-income and widow/widower. Multivariate analysed showed that there was an association between quality of life of elderly with gender (AOR=6.42; 95%CI: 1.79-23.0), employment (AOR=9.81; 95%CI: 2.45-39.1), health status (AOR=8.65; 95%CI: 2.57-29.02), social activities (AOR=3.85; 95%CI: 1.22-12.1), social interactions (AOR=5.59; 95%CI: 2.01-15.5) and family functions (AOR=21.7; 95%CI: 6.09-77.7)Conclusion: Good quality of life of elderly was found associated with gender, employment, health status, social activities, social interactions and family functions