Quality of life, work, and social participation among individuals with spinal cord injury

Spinal cord injury (SCI) refers to damage of the spinal cord due to trauma or disease that can cause paralysis and secondary health problems. The aim of this thesis is to explore how people with SCI perceive their quality of life (QOL), whether they are capable to work and participate in social activities and how long it takes to return to work. A qualitative study performed in Indonesia showed that, for Indonesian people with SCI, QOL is equal to being able to participate, having social support, having relationship with God, being independent and accepting the condition. This study also showed that desired levels of work and social participation were out of reach, because these people encountered significant hurdles such as inaccessible environment and stigma. A survey study performed in the Netherlands showed that five years after hospitalization, almost half of the people with SCI were able to return to work, especially those with higher education and better functional status. However, a longitudinal analysis of work participation during these five years, revealed that only 20% of these people with SCI showed a relatively fast and sustained return to work trajectory. Addressing gaps in participation of people with SCI requires long-term, multifaceted and comprehensive approaches depending on the existing health and social welfare system. As participation in work and community life are almost universally regarded as important for QOL, future research should address intervention strategies on these aspects to improve participation and hence QOL

Trajectory and Determinant of Functional Independence among Patient with Traumatic and Non-Traumatic Spinal Cord Injury

The level of functional independence was directly proportional to life satisfaction and quality of life in patients with spinal cord injury. By knowing the determinants that predict changes in functional independence, medical treatment and rehabilitation can be better planned to improve the patient’s quality of life. We conducted a prospective cohort study on 49 patients with spinal cord injury at Dr. Sardjito general hospital Yogyakarta from April to June 2016. The data were taken before patient underwent surgery, before discharged from the hospital, and 3 months after underwent surgery. We found that most common spinal cord injury was at the level of lumbar vertebra with 28 patients (58%). There was a positive trajectory of the patients with spinal cord injury with ASIA grade B-E classification. However, patients with spinal cord injury with ASIA classification grade A have a neutral trajectory.We conclude there was a positive trajectory between functional independence and traumatic or non-traumatic spinal cord injury except in patients with ASIA grade A classification spinal cord injury. The determinants that affected the trajectory of patients with spinal cord injury were the level of the injured vertebra and severity of the neurological deficit.

Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: A mixed methods study

Introduction: The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia.Methods: Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client requesting it. We used multivariable random effects logistic regression to assess factors associated with the primary outcome and conducted 31 interviews with drug outlet staff to explore these factors in greater depth.Results: Antibiotic dispensing without prescription occurred in 69% of SP visits. Dispensing antibiotics without a prescription was more likely in standalone pharmacies and pharmacies attached to clinics compared with drug stores, with an OR of 5.9 (95% CI 3.2 to 10.8) and OR of 2.2 (95% CI 1.2 to 3.9); and more likely for TB and URTI SP-performed cases compared with child diarrhoea cases, with an OR of 5.7 (95% CI 3.1 to 10.8) and OR of 5.2 (95% CI 2.7 to 9.8). Interviews revealed that inappropriate antibiotic dispensing was driven by strong patient demand for antibiotics, unqualified drug sellers dispensing medicines, competition between different types of drug outlets, drug outlet owners pushing their staff to sell medicines, and weak enforcement of regulations.Conclusion: This study shows that inappropriate dispensing of antibiotics by private drug retail outlets is widespread. Interventions will need to address not only the role of drug sellers, but also the demand for antibiotics among clients and the push from drug outlet owners to compete with other outlets

Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: A qualitative study

Background: Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place.Methods: In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis.Results: A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement.Conclusions: Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study

Meaning and components of Quality of Life among individuals with spinal cord injury in Yogyakarta Province, Indonesia

Purpose: Knowledge on the meaning of quality of life in individuals with spinal cord injury in developing countries is limited. This study aims to explore the meaning and components of quality of life for individuals with spinal cord injury in a rural area in Indonesia. Method: Data were obtained through semi-structured interviews with 12 individuals with paraplegia (8 males, 4 females) aged 24–67 years. Thematic analysis was used to identify themes that constitute meaning and components of quality of life. Results: Quality of life was not an easily understood concept, while “life satisfaction” and “happiness” were. Life satisfaction was associated with a person’s feeling when achieving goals or dreams and related to fulfillment of needs. Thirteen components of life satisfaction were identified and categorized into five domains as follows: (1) participation: earning income and work, being useful to others, community participation, and having skills and knowledge, (2) social support: social support, social relationship, (3) relationship with God: injury is God’s will, praying, (4) independence: being independent, mobility and accessibility, and health, and (5) psychological resources: accepting the condition, maintaining goals and motivation. Conclusions: Social, cultural and religious influences were prominent in the perception of life satisfaction. The measurement of quality of life for individuals with spinal cord injury in Indonesia needs to consider locally perceived meaning and components of quality of life. Implications for Rehabilitation Financial, social and health needs of individuals with spinal cord injury in Indonesia must be immediately addressed. To increase financial independence, rehabilitation professionals should equip individuals with spinal cord injury with adequate self-employment skills. Sociocultural and religious aspects should be considered in the measurement of quality of life

The response to COVID-19 among drug retail outlets in Indonesia: A cross-sectional survey of knowledge, attitudes, and practices.

BACKGROUND: Pharmacists have been at the frontline of the COVID-19 response in Indonesia, providing medicines, advice, and referral services often in areas with limited healthcare access. This study aimed to explore their knowledge, attitudes, and practices during the pandemic, so that we can be better prepared for future emergencies. METHODS: A cross-sectional online survey of community pharmacists and pharmacy technicians in Indonesia was conducted between July and August 2020. The dataset was analysed descriptively, and logistic regression was used to explore willingness to participate in COVID-19 interventions. FINDINGS: 4716 respondents participated in the survey. Two-thirds (66·7%) reported knowing only "a little" about COVID-19 and around a quarter (26·6%) said they had not received any COVID-19 guidelines. Almost all were concerned about being infected (97·2%) and regularly took steps to protect themselves and their clients (87·2%). Stock-outs of Personal Protective Equipment (PPE) and other products (32·3%) was the main reason for not taking any precautions. Around a third (37·7%) mentioned having dispensed antibiotics to clients suspected of having COVID-19. To support COVID-19 response efforts, most respondents were willing to provide verbal advice to clients (97·8%), distribute leaflets to clients (97·7%), and participate in surveillance activities (88·8%). Older respondents, those identifying as male, and those working in smaller outlets were more willing to provide information leaflets. Those working in smaller outlets were also more willing to engage in outbreak surveillance. INTERPRETATION: Drug retail outlets continue to operate at the frontline of disease outbreaks and pandemics around the world. These providers have an important role to play by helping to reduce the burden on facilities and providing advice and treatment. To fulfil this role, drug retail outlets require regular access to accurate guidelines and steady supplies of PPE. Calls for drug retail outlet staff to plat in response efforts including the provision of information to clients and surveillance could ease escalating pressures on the health system during future outbreaks. FUNDING: This study was funded by a grant from the Department of Foreign Affairs and Trade, Australia, under the Stronger Health Systems for Health Security Scheme

Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study.

INTRODUCTION: The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia. METHODS: Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client requesting it. We used multivariable random effects logistic regression to assess factors associated with the primary outcome and conducted 31 interviews with drug outlet staff to explore these factors in greater depth. RESULTS: Antibiotic dispensing without prescription occurred in 69% of SP visits. Dispensing antibiotics without a prescription was more likely in standalone pharmacies and pharmacies attached to clinics compared with drug stores, with an OR of 5.9 (95% CI 3.2 to 10.8) and OR of 2.2 (95% CI 1.2 to 3.9); and more likely for TB and URTI SP-performed cases compared with child diarrhoea cases, with an OR of 5.7 (95% CI 3.1 to 10.8) and OR of 5.2 (95% CI 2.7 to 9.8). Interviews revealed that inappropriate antibiotic dispensing was driven by strong patient demand for antibiotics, unqualified drug sellers dispensing medicines, competition between different types of drug outlets, drug outlet owners pushing their staff to sell medicines, and weak enforcement of regulations. CONCLUSION: This study shows that inappropriate dispensing of antibiotics by private drug retail outlets is widespread. Interventions will need to address not only the role of drug sellers, but also the demand for antibiotics among clients and the push from drug outlet owners to compete with other outlets

The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation.

INTRODUCTION: Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia. METHODS: A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ2 tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics. FINDINGS: Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9% (76.3%-55.4%) compared with 2.3% (84.6%-82.3%) in the non-participating group (p value <0.001).Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95% CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95% CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present. INTERPRETATION: Multifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed

Barriers and facilitators for work and social participation among individuals with spinal cord injury in Indonesia

Study design Qualitative study using in-depth interviews. Objectives To describe experienced barriers and facilitators for work and social participation among individuals with spinal cord injury (SCI). Setting Vocational rehabilitation (VR) center in Yogyakarta Province, Indonesia. Methods Semi-structured interviews were conducted with 12 participants (8 males, 4 females) aged 24–67 years. Five participants still underwent vocational rehabilitation, while seven participants lived in the community. Thematic analysis was used. Results None of the participants who worked before the injury returned to her/his previous occupation, most participants became self-employed. The frequency of participation in social activities decreased substantially. Barriers for work and social participation included health conditions and environmental barriers, including inaccessibility, stigma and discrimination and limited institutional support and services. Identified facilitators for work and social participation were perceived importance of work and social participation, adaptations to disability condition, and social support. Conclusion Barriers to engage in work and social activities for individuals with SCI in Indonesia are combination of physical limitations, lack of accessibility, stigma, and institutional barriers. The capacity of social networks such as family in facilitating participation should be strengthened during the VR processes. VR should provide marketing skills and link self-employed clients with the market, in collaboration with the private sector and industries. Immediate policy and programmatic action is needed to enable these individuals to enhance sustainable work and social participation