Defisiensi Vitamin A dan Zinc Sebagaifaktor Risiko Terjadinya Stunting pada Balita di Nusa Tenggara Barat

Children of 1 - 5 years old often face nutrition problems such as undernourishment, vitamin A and zinc deficiency, anemia, stunting and low mental development index (MDI). Vitamin A deficiency can cause growth disorder and declining zinc transport and mobilization in the heart meanwhile zinc is needed in retinol binding protein synthesis. If the deficiency lasts for long it can cause growth disorder as manifested in stunting incidence. To study vitamin A and zinc deficiency as risk factors for the incidence of stunting among underfives at Nusa Tenggara Barat. The study was analytic observational with cross sectional design. Subject of the study were 327 underfives of 6 - 59 months at the Province of Nusa Tenggara Barat. Nutrition status was assessed through measurement of anthopometry, retinol serum level using HPLC, zinc serum level using AAS and hemoglobin using hemoCue. Data of individual characteristics and rearing pattern were obtained through interview and nutrient intake were measured using recall 2 x 24 hours. Data analysis used bivariate technique for variable related to stunting, chi square test for category data, independent t-test for ratio and logistic regression test to measure risk of some variables simultaneously related to incidence of stunting. The result of bivariate analysis showed that was difference in age between stunted and normal underfives (p<0.05) . In the group of underfives that were no longer breastfed there was difference in intake of zinc between stunted and normal underfives (p<0.05). The result of multivariate analysis showed that underfives that were no longer breastfed had risk 2 times greater for being stunted after the control of age, status of vitamin A and zinc. The effect is modified by age and breast-feeding. There was no evidence that showed that vitamin A and zinc deficiency among underfives were risk factors for the incidence of stunting. Variable that was individually as well as simultaneously significant for the incidence of stunting was breastfeeding status. Underfives that were not breastfed had risk 2 times greater for being stunted than those that were breastfed, and the effect is modified by age and breast-feeding

Perubahan Pengetahuan dan Sikap Ibu dan Pendukungnya yang TerpaparProgram Promosi Menyusui Eksklusif

Tujuan penelitian ini adalah untuk menilai kegiatan promosi ASI eksklusif dalam meningkatkanpengetahuan dan sikap target audiens pada tingkat ibu dan pendukungnya di lingkungan keluarga,masyarakat. dan organisasi. Desain penelitian adalah quasi experiment with repeated measure pretestposttest control 9roup design. Hasil da ri promosi ASI eksklus if yang dilakukan di dua pusat kesehatanmasyarakat (Puskesmas) di Kabupaten Demak Provinsi Jawa Tengah Indonesia. Subjek penelitian sebanyak655 partisipan, terdirl dari 163 ibu ham ii. 163 ayah, 163 nenek. 28 kader. 27 kyai, 2 7 kepala desa, 28 bidandesa, dan 56 staf Puskesmas. Pengetahuan dan sikap, sebelum dan sesudah intervensi pada 8, 16, dan 24minggu. Analysis of covariance repeated measure dengan kovariat kondisi demografi dan kondisi pretest.Dilakukan juga analisis item pengetahuan dan sikap. Hampir semua pengetahuan partisipan pada levelindividu, keluarga, desa, dan kecamatan setelah menerima pelatihan dan promosi meningkat secar.1s ignifikan (p0.05). Demikian pula. sikappartisipan di kelompok intervensi pada level individu, keluarga, dan masyarakat sebagian besar meningkatsecara signifikan setelah menerima pelatihan (p0.05). Promosi menyusuieksklusif dapat meningkatkan hampir semua pengetahuan dan sikap peserta, kecuali pengetahuan bidandesa dan staf non klinis Puskesmas, serta sikap bidan desa da n tim gizi

Does exclusive breastfeeding relate to the longer duration of breastfeeding? A prospective cohort study

© 2018 Elsevier Ltd Objectives: Suboptimal breastfeeding contributes to morbidity and mortality in children. Studies in high-income countries (HICs) show that exclusive-breastfeeding (EBF) is associated with longer breastfeeding duration. The aim of this study was to determine whether maternal reports of EBF at six months are associated with longer duration of breastfeeding during the first two years of life in a low and middle-income country (LMIC) setting, and to identify determinants of breastfeeding duration. Methods: This prospective cohort includes data from an EBF promotion program in Demak District, Central Java Province, Indonesia, with a non-randomized pretest-posttest control group. Mothers and infants were followed through 26 months postnatal age. Data were analyzed using Cox proportional hazard regression with time to cessation of EBF as the outcome. Results: A total of 147 families were included in the study. Longer EBF duration was not associated with prolonged duration of breastfeeding. Longer breastfeeding duration was associated with mothers who disagreed with a statement of being ashamed to breastfeed (HR 0.035, 95%CI 0.003,0.44). Risk factors for shorter breastfeeding duration included mothers’ plan to breastfeed for less than 24 months (HR 4.28 95%CI 1.91,9.60), mothers’ belief that breastfeeding less than 24 months was the norm (HR 2.98 95%CI 1.31,6.77) and exposure to EBF promotion (HR:4.09 95%CI 2.14,7.82). Conclusions: In a LMIC community where long breastfeeding duration is common, EBF is not associated with breastfeeding duration. However, modifiable behavioral factors were significant predictors of breastfeeding duration. We therefore recommend that prolonged breastfeeding duration can be achieved through programs that improve breastfeeding behavior

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research