Publications by authors named "Budi Utomo"

33 Publications

Systematic Review and Meta-Analysis of the Efficacy of MLC901 (NeuroAiD II) for Acute Ischemic Brain Injury in Animal Models.

J Evid Based Integr Med 2021 Jan-Dec;26:2515690X211039219

Department of Neurosurgery, 194160Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Introduction: Moleac (MLC) 901 is a traditional Chinese medication approved by the Sino Food and Drug Administration in 2001 for treating stroke. This study aims to analyze the efficacy of MLC901 in animal stroke models after medial cerebral artery occlusion (MCAO).

Methods: Literature selection was performed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) 2015. Inclusion criteria for the experimental studies were the use of animal models, publication in English between 1990 and 2020, information regarding the intervention technique used, and outcomes regarding the efficacy of MLC901 administration.

Results: MLC901 administration resulted in significantly less infarction volume by a mean difference of 17.17 compared to the control group (p < .00001). The MLC901 group resulted in significant improvement in 5-bromo-20-deoxyuridine (BrdU)-positive cells expression by a mean difference of 662.79 (p < .00001) and neurological function, which was indicated by a mean difference in the Bederson Neurological Outcome Score of 1.40 (p < .00001).

Conclusions: MLC901 administration in an animal stroke model resulted in a better reduction in infarction volume and improvement in BrdU expression and neurologic function. These data could help in further determining the efficacy of MLC901 for acute ischemic brain injury in humans.
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http://dx.doi.org/10.1177/2515690X211039219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369951PMC
August 2021

Chronic subdural hematoma-induced parkinsonism: A systematic review.

Clin Neurol Neurosurg 2021 Sep 21;208:106826. Epub 2021 Jul 21.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases, especially in elderly individuals. Secondary parkinsonism due to CSDH is a rare entity. The mechanism of parkinsonism symptoms in chronic subdural hematoma has been suggested to include direct mechanical compression of the basal ganglia due to hematoma or indirectly through brain structure changes due to space lesions and vascular disorders. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms.

Objectives: To systematically review the literature on CSDH-induced parkinsonism.

Search Methods: This is a systematic review on case reports. Literature search was performed using the predefined keywords on PubMed, ProQuest, and Google Scholar. We also provided our own case report and compared it with published studies.

Result: Sixteen cases from 13 case reports/series were identified, predominantly consisting of male patients with the mean age of 66.5 ± 9.73 years. The most common symptoms were rigidity, gait disturbance, and bradykinesia, observed in 12 (75%) cases each. The second and third most common symptoms were tremor (11; 68.75%) and facial masking (8; 50%), respectively. Other reported symptoms were dysphasia (3; 18.75%), dysarthria (3; 18.75%), and urinary incontinence (2; 12. 5%). Time gap between the symptom onset and CSDH diagnosis and unilateral location seemed to influence the outcome.

Conclusion: Only 16 CSDH-induced parkinsonism were identified since the 1960s. This condition is thought to occur due to basal ganglia compression. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Timely CSDH diagnosis might yield better outcome. However, further research on CSDH-induced parkinsonism is needed, especially in the mechanisms and treatment outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2021.106826DOI Listing
September 2021

VIM Line Technique for Determining the Ventral Intermediate Location.

Turk Neurosurg 2021 ;31(4):601-606

Universitas Airlangga, Faculty of Medicine, Post Graduate Doctoral Program, Surabaya, Indonesia.

Aim: To prove that VIM line technique created by using a mathematical model, can be used to identify the location of the ventral intermediate nucleus of the thalamus (VIM) MATERIAL and METHODS: Eleven patients with Parkinson?s disease (PD) were assessed. To determine the VIM location, 3-T magnetic resonance imaging and stereotactic protocol 128-slice computed tomography were used. The VIM line technique was performed by drawing a line from the end-point of the right external globus pallidus to that of the left external globus pallidus in the intercommissural plane. PD severity was measured using the Unified Parkinson?s Disease Rating Scale (UPDRS).

Results: A mathematical model was constructed to describe the VIM line technique for determining the VIM location. UPDRS scores before and after thalamotomy showed a significant decreasing trend (p=0.003).

Conclusion: The VIM line technique using the mathematical model can be considered a referential method to determine the VIM location. Its effectiveness was demonstrated by decreased UPDRS scores in patients after VIM thalamotomy.
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http://dx.doi.org/10.5137/1019-5149.JTN.31961-20.2DOI Listing
July 2021

Contraceptive use and maternal mortality in Indonesia: a community-level ecological analysis.

Reprod Health 2021 Feb 17;18(1):42. Epub 2021 Feb 17.

Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.

Background: Prior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood.

Methods: Data from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions.

Results: Higher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality.

Conclusions: Community contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010-2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal.
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http://dx.doi.org/10.1186/s12978-020-01022-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887778PMC
February 2021

The impact of family planning on maternal mortality in Indonesia: what future contribution can be expected?

Popul Health Metr 2021 01 11;19(1). Epub 2021 Jan 11.

Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.

Background: Although efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal.

Methods: The study takes advantage of data from long series of population censuses and large-scale surveys that are available in few other low- and middle-income countries. We use the decomposition method suggested by (Matern Child Health J, 16:456-463, 2012) and regression-based policy simulations to estimate the number of maternal deaths averted during 1970-2017 due to contraceptive use and project potential future contributions to the year 2030.

Results: It is estimated that between 523,885 and 663,146 maternal deaths were averted from 1970 to 2017 due to contraceptive use, a 37.5-43.1% reduction. If the contraceptive prevalence rate (CPR) were to rise from 63% in 2017 to 70% in 2030 and unmet need for family planning were to fall to from 10 to 7%, an additional 34,621-37,186 maternal deaths would be averted, an 18.9-20.0% reduction. A 2030 CPR of 75% and unmet need for family planning of 5% would result in 51,971-54,536 maternal deaths being averted, a 28.4-29.4% reduction. However, the CPR growth rate would have to nearly double the 2000-2017 rate to reach 70% CPR by 2030 and more than triple to reach 75%. Achieving the most ambitious target would still leave the maternal mortality ratio at 125 in 2030 without corresponding improvements in maternal health services.

Conclusions: Although substantial reductions in maternal mortality between 1970 and 2017 can be attributed to contraceptive use and further contributions to the year 2030 are probable, smaller contributions are likely due to the already relatively high CPR and the challenges that must be overcome to move the CPR significantly higher. The ability of Indonesia to reach the 2030 SDG maternal mortality target of 70 maternal deaths per 100,000 live births will depend primarily upon health system effectiveness in addressing health risks to women once they are pregnant.
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http://dx.doi.org/10.1186/s12963-020-00245-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802230PMC
January 2021

Vim line technique thalamotomy for Parkinson tremor: Case series.

Int J Surg Case Rep 2020 20;77:573-575. Epub 2020 Nov 20.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Introduction: The ventral intermediate (Vim) nucleus of the thalamus is difficult to identify even with 3 T magnetic resonance imaging. Stereotactic Vim thalamotomy is a usual procedure to control Parkinson tremor. Successful relieving of the tremor depends on the accuracy of defining the Vim location.

Presentation Of Cases: Three patients with Parkinson tremor were subjected to stereotactic thalamotomy using the Vim line technique (VLT) so as to precisely determine the Vim location. All patients showed good results, with improved tremors, as indicated by the UPDRS score, without any complications.

Discussion: The precise targeting of the Vim nucleus is crucial importance for the successful Vim thalamotomy. Various method has been developed to determine Vim location. Atlas based and Guiot's technique routinely used by neurosurgeon. VLT is a new technique that has been developed to determine the Vim location on MRI.

Conclusion: VLT is useful for the determination of the Vim location. However, further research is warranted to prove its effectiveness.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708753PMC
November 2020

Health system capacity for post-abortion care in Java, Indonesia: a signal functions analysis.

Reprod Health 2020 Nov 25;17(1):189. Epub 2020 Nov 25.

Center for Health Research, University of Indonesia Faculty of Public Health, Building G 211, Depok, West Java, 16424, Indonesia.

Background: The quality of obstetric care has been identified as a contributing factor in Indonesia's persistently high level of maternal mortality, and the country's restrictive abortion laws merit special attention to the quality of post-abortion care (PAC). Due to unique health policies and guidelines, in Indonesia, uterine evacuation for PAC is typically administered only by Ob/Gyns practicing in hospitals.

Methods: Using data from a survey of 657 hospitals and emergency obstetric-registered public health centers in Java, Indonesia's most populous island, we applied a signal functions analysis to measure the health system's capacity to offer PAC. We then used this framework to simulate the potential impact of the following hypothetical reforms on PAC capacity: allowing first-trimester uterine evacuation for PAC to take place at the primary care level, and allowing provision by clinicians other than Ob/Gyns. Finally, we calculated the proportion of PAC patients treated using four different uterine evacuation procedures.

Results: Forty-six percent of hospitals in Java have the full set of services needed to provide PAC, and PAC capacity is concentrated at the highest-level referral hospitals: 86% of referral hospitals have the full set of services, staffing, and equipment compared to 53% of maternity hospitals and 34% of local hospitals. No health centers are adequately staffed or authorized to offer basic PAC services under Indonesia's current guidelines. PAC capacity at all levels of the health system increases substantially in hypothetical scenarios under which authorization to perform first-trimester uterine evacuation for PAC is expanded to midwives and general physicians practicing in health centers. In 2018, 88% percent of PAC patients were treated using dilation and curettage (D&C).

Conclusions: Offering first-trimester uterine evacuation for PAC in PONEDs and allowing clinicians other than Ob/Gyns to perform this procedure would greatly improve the capacity of Java's health system to serve PAC patients. Increasing the use of vacuum aspiration and misoprostol for PAC-related uterine evacuation would lower the burden of treatment for patients and facilitate the task-shifting efforts needed to expand access to this life-saving service.
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http://dx.doi.org/10.1186/s12978-020-01033-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687770PMC
November 2020

Estimating the Incidence of Induced Abortion in Java, Indonesia, 2018.

Int Perspect Sex Reprod Health 2020 Oct 1;46:211-222. Epub 2020 Oct 1.

Principal research scientist, Guttmacher Institute, New York.

Context: In Indonesia, maternal mortality is high and abortion is restricted. Reliable information on induced abortion is needed; however, the difficulty of measuring abortion in settings where it is legally restricted and highly stigmatized calls for innovation in approaches to measuring abortion incidence.

Methods: The data were from three original surveys conducted in Java among health facilities, knowledgeable informants and women aged 15-49, fielded in April 2018-January 2019. Two methods were used to estimate the one-year induced abortion incidence rate in Java: the standard Abortion Incidence Complications Method (AICM) and a modified AICM. Each method was evaluated on the basis of data quality, and what is known about sexual and reproductive health indicators related to abortion rates, to determine which performed best in measuring abortion incidence in Java.

Results: Estimates of complications resulting from induced abortion from knowledgeable informants and the women differed substantially. The modified AICM produced an estimate of 42.5 abortions per 1,000 women aged 15-49, while the standard AICM estimate was lower (25.8 per 1,000). A comparison of the distribution of abortion methods used revealed that knowledgeable informants believed abortion was less safe than indicated by women's reports of their own experiences. Therefore, the standard AICM likely underestimates abortion.

Conclusions: The modified AICM performed better than the standard AICM and indicates that abortion is common in Java. Increased access to contraceptives and high-quality postabortion care is needed. Future research should investigate the safety of abortion, especially with respect to self-managed abortion.
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http://dx.doi.org/10.1363/46e0220DOI Listing
October 2020

An Application of the Confidante Method to Estimate Induced Abortion Incidence in Java, Indonesia.

Int Perspect Sex Reprod Health 2020 09 29;46:199-210. Epub 2020 Sep 29.

Senior research scientist, Guttmacher Institute, New York.

Context: Induced abortion is legally restricted and highly stigmatized in Indonesia, and is thus extremely difficult to measure. Indirect methods leveraging women's social networks, such as the Confidante Method, have shown promise in estimating hidden behaviors, including abortion, in similar settings.

Methods: A community-based survey was conducted among 8,696 women aged 15-49 in Java, Indonesia, in November 2018-January 2019. Data were collected via in-person interviews with respondents about their own abortions and those of up to three of their closest confidantes. One-year induced abortion incidence rates per 1,000 women were estimated using a direct-report approach and the Confidante Method.

Results: The direct-report abortion rate was 3.4 per 1,000 women in 2018, compared with the Confidante Method rate of 11.3 per 1,000. Among the confidantes of women who reported an abortion in the past five years, the abortion rate was 42.0 per 1,000. Half of the women reported that they had no confidantes with whom they shared private information. Among women reporting an abortion and at least one confidante, 58% had disclosed their abortion to their confidante, indicating that substantial transmission bias was present.

Conclusions: The Confidante Method relies on several assumptions that did not hold in this study. Although the method performed better than the direct-report approach, it underestimated the incidence of abortion in Java. More research is needed to understand how abortion-related information is shared within social networks and to assess the appropriateness of applying the Confidante Method to estimate abortion in a given context.
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http://dx.doi.org/10.1363/46e0120DOI Listing
September 2020

The Association of -ITD Gene Mutation with Bone Marrow Blast Cell Count, CD34, Cyclin D1, Bcl-xL and hENT1 Expression in Acute Myeloid Leukemia Patients.

Iran J Pathol 2020 16;15(4):306-312. Epub 2020 Jul 16.

Department of Biochemistry and Molecular Biology, Faculty of Medicine, Airlangga University, Jawa, Indonesia.

Background & Objective: -ITD has been recently used as a molecular prognostic marker for risk classification in acute myeloid leukemia (AML) therapy. In this study we aimed to investigate the association of -ITD gene mutation with bone marrow blast cell count, CD34 expression as malignant cell burden, cyclin D1 and Bcl-xL expressions as indexes of cell proliferation and anti-apoptosis and human equilibrative nucleoside transporter 1 (hENT1) expression as cytarabine transporter during AML treatment.

Methods: We investigated -ITD mutations, bone marrow blast cell count, CD34, cyclin D1, Bcl-xL and hENT1 expression in bone marrow aspirates from 22 de novo AML patients in a cross sectional study.

Results: -ITD mutations were observed in 5 out of 22 de novo AML patients (22.7%). Patient with -ITD mutations had higher blast cell counts (79.5% vs 56.1%, =0.004). In patients with -ITD mutations, CD34 and cyclin D1 expressions were higher (MFI 328.80 vs 25.78, =0.003 and MFI 74.51 vs 57.15 =0.005) than the patients without mutations. hENT1 expression in AML with -ITD mutation was lower (MFI 29.64 versus 56.32, =0.0000) than in mutation-free AML. There was no significant difference in Bcl-xL expression between patients with and without mutations (=0.61).

Conclusion: A significant association was found between -ITD gene mutations in AML patients with bone marrow blast cell count, CD34, cyclin D1 and hENT1 expressions, however no association was obtained with Bcl-xL expression. These findings support the role of such mutation in pathogenesis of AMLand its contribution in rearrangement of standard therapy with cytarabine in management of AML.
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http://dx.doi.org/10.30699/ijp.2020.122579.2328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477678PMC
July 2020

Profile of follicle-stimulating hormone and polymorphism of follicle-stimulating hormone receptor in Madrasin cattle with ovarian hypofunction.

Vet World 2020 May 11;13(5):879-883. Epub 2020 May 11.

Department of Veterinary Reproduction, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya 60115, Indonesia.

Background And Aim: The follicle-stimulating hormone (FSH) gene is an essential regulator of fertility in livestock. This study aims to provide information on the genetic makeup of Madrasin cattle experiencing hypofunction by the FSH profile and FSH receptors (FSHR) polymorphism.

Materials And Methods: Blood samples were collected from the Bangkalan regency in Indonesia. DNA was isolated and purified following the extraction protocol of polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism.

Results: Our results showed that the FSH gene had a band length of 310 bp and produce two alleles (A and B) with restriction enzymes at 250 bp, 230 bp, and 145 bp. Furthermore, the FSHR gene had a band length of 303 bp and produced two homozygous genotypes: GG at bp 239 and CC at bp 188.

Conclusion: Based on these differences, there was no change in allele frequency and genotype between Madura and Madrasin cattle due to crossbreeding with Limousin cattle. Thus, further detailed investigations of Madrasin cattle are required to elucidate the profile of the LH and LHR genes.
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http://dx.doi.org/10.14202/vetworld.2020.879-883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311873PMC
May 2020

Stereotactic aspiration of spontaneous intracerebral hematoma: Case series.

Int J Surg Case Rep 2020 11;72:229-232. Epub 2020 Jun 11.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Indonesia.

Introduction: Minimally invasive techniques such as stereotactic aspiration of spontaneous intracerebral hematoma (SICH) evacuation can minimize brain tissue damage due to surgery. We share our experience of adopting stereotactic aspiration of SICH in our center without compromising safety.

Presentation Of Cases: Three stereotactic aspiration procedures for SICH immediately after 24 h of onset are reported. All cases showed good results. Level of consciousness of all the patient returned to normal. Two patients could carry out routine activities independently. One patient has left hemiparesis.

Discussion: Stereotactic aspiration of SICH has been newly implemented at our center with acceptable results achieved. Patient selection has an important role in determining the choice of technique. The procedures were done without anticoagulant agent. Stereotactic aspiration of SICH is associated with limited brain tissue damage, shorter duration of surgery, reduced length of stay, faster postoperative healing, and better functional improvement.

Conclusion: Stereotactic aspiration of SICH is a minimally invasive defined strategy for hematoma evacuation without compromising safety.
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http://dx.doi.org/10.1016/j.ijscr.2020.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298528PMC
June 2020

Effects of a standardized 40% ellagic acid pomegranate ( L.) extract on seminiferous tubule histopathology, diameter, and epithelium thickness in albino Wistar rats after heat exposure.

Vet World 2019 Aug 17;12(8):1261-1265. Epub 2019 Aug 17.

Department of Veterinary Clinics, Faculty of Veterinary Medicine, Universitas Airlangga. Jl. Mulyorejo, Kampus C Unair, Surabaya 60115, Indonesia.

Background And Aim: It has long been known that the spermatogenic tissue is very sensitive to temperatures higher than its physiologic temperature and causing cessation of activity and resulting in sterility. This study investigated the effect of a standardized 40% ellagic acid extract of pomegranate on the histopathology, diameter, and epithelial thickness of seminiferous tubules in albino rats exposed to heat.

Materials And Methods: Twenty-five male albino Wistar rats were randomized at 7-8 months of age to five treatment groups. Group C was not treated; Group T0 was treated with 0.5% of Na carboxymethyl cellulose (CMC) 2 ml/day and exposed to heat. T1, T2, and T3 were treated with 75, 150, and 300 mg/kg/day of a standardized 40% ellagic acid extract of pomegranate ( L.), respectively. The animals were orally administered Na CMC or pomegranate extract and were exposed to sunlight for 15 min at 40°C-42°C for 14 days. The animals were sacrificed on day 15 and the testes were removed for histological evaluation and measurement of seminiferous tubule diameter and epithelium thickness.

Results: The diameter of seminiferous tubules from rats exposed to heat and treated with 300 mg/kg/day pomegranate extract was larger and the epithelia thicker than those in the other groups (p<0.05). The protective effects of the standardized 40% ellagic acid extract may have been mediated by its antioxidant activity.

Conclusion: Compared with controls, administration of 300 mg/kg/day of a standardized 40% ellagic acid extract of L. for 14 days increased seminiferous tubule diameter and epithelium thickness in albino Wistar rats exposed to heat.
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http://dx.doi.org/10.14202/vetworld.2019.1261-1265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755400PMC
August 2019

Prenatal Secondhand Smoke Exposure: Correlation Between Nicotine in Umbilical Cord Blood and Neonatal Anthropometry.

Osong Public Health Res Perspect 2019 Aug;10(4):234-239

Faculty of Medicine, Universitas Indonesia, Depok, Indonesia.

Objectives: Nicotine narrows uterine blood vessels reducing the flow of oxygen and nutrients to the developing fetus. This study examined the effects of fetal exposure to secondhand smoke on neonatal anthropometry.

Methods: This cross sectional study recruited 128 pregnant women in the third trimester of single pregnancies who had no chronic illness, were not active or ex-smokers, and who were willing to participate in the study. Pregnant women who were exposed to secondhand smoke had umbilical cord blood nicotine concentrations of ≥ 1 ng/mL. Neonatal anthropometry was assessed according to the newborn birth weight and length. The independent t-test was used to determine the neonatal difference in mean birth weight and length between the women who were exposed to secondhand smoke, and those who were not exposed. A multiple linear regression analysis was employed to assess the effect of secondhand smoke exposure on birth weight and birth length, controlling for potential confounding variables (weight gain during pregnancy, body mass index, parity, maternal age, and maternal hemoglobin).

Results: There were 35 women exposed to secondhand smoke (nicotine ≥ 1 ng/mL). Neonate birth weight and birth length were lower among mothers who were exposed to secondhand smoke. However, only neonate birth weight was significantly reduced by exposure to secondhand smoke ( = 0.005). The mean birth weight of these neonates was 2,916.5 g ± 327.3 g which was 205.6 g less than in unexposed fetuses.

Conclusion: Exposure of mothers to secondhand smoke during pregnancy reduces fetal development and neonatal weight.
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http://dx.doi.org/10.24171/j.phrp.2019.10.4.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711716PMC
August 2019

Perceptions of Contraception and Patterns of Switching Contraceptive Methods Among Family-planning Acceptors in West Nusa Tenggara, Indonesia.

J Prev Med Public Health 2019 Jul 19;52(4):258-264. Epub 2019 Jul 19.

Department of Health Education and Behavioral Science, Faculty of Public Health, University of Indonesia, Depok, Indonesia.

Objectives: The perceptions of family-planning (FP) acceptors regarding contraception influence the reasons for which they choose to switch their method of contraception. The objective of this study was to analyze the perceptions of contraception and rationales for switching contraceptive methods among female FP acceptors in West Nusa Tenggara, Indonesia.

Methods: This study involved the analysis of secondary data from the Improve Contraceptive Method Mix study, which was conducted in 2013 by the Center for Health Research, University of Indonesia. The design of the study was cross-sectional. We performed 3 stages of sampling using the cluster technique and selected 4819 women who were FP acceptors in West Nusa Tenggara Province, Indonesia as the subjects of this study. The data were analyzed using multiple logistic regression.

Results: The predominant pattern of switching contraceptive methods was switching from one non-long-term method of contraception to another. Only 31.0% of the acceptors reported a rational pattern of switching contraceptive methods given their age, number of children, and FP motivations. Perceptions of the side effects of contraceptive methods, the ease of contraceptive use, and the cost of the contraceptives were significantly associated (at the level of α=0.05) with rational patterns of switching contraceptive methods.

Conclusions: Perceptions among FP-accepting women were found to play an important role in their patterns of switching contraceptive methods. Hence, fostering a better understanding of contraception through high-quality counseling is needed to improve perceptions and thereby to encourage rational, effective, and efficient contraceptive use.
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http://dx.doi.org/10.3961/jpmph.18.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686111PMC
July 2019

Perceptions of Contraception and Patterns of Switching Contraceptive Methods Among Family-planning Acceptors in West Nusa Tenggara, Indonesia.

J Prev Med Public Health 2019 Jul 19;52(4):258-264. Epub 2019 Jul 19.

Department of Health Education and Behavioral Science, Faculty of Public Health, University of Indonesia, Depok, Indonesia.

Objectives: The perceptions of family-planning (FP) acceptors regarding contraception influence the reasons for which they choose to switch their method of contraception. The objective of this study was to analyze the perceptions of contraception and rationales for switching contraceptive methods among female FP acceptors in West Nusa Tenggara, Indonesia.

Methods: This study involved the analysis of secondary data from the Improve Contraceptive Method Mix study, which was conducted in 2013 by the Center for Health Research, University of Indonesia. The design of the study was cross-sectional. We performed 3 stages of sampling using the cluster technique and selected 4819 women who were FP acceptors in West Nusa Tenggara Province, Indonesia as the subjects of this study. The data were analyzed using multiple logistic regression.

Results: The predominant pattern of switching contraceptive methods was switching from one non-long-term method of contraception to another. Only 31.0% of the acceptors reported a rational pattern of switching contraceptive methods given their age, number of children, and FP motivations. Perceptions of the side effects of contraceptive methods, the ease of contraceptive use, and the cost of the contraceptives were significantly associated (at the level of α=0.05) with rational patterns of switching contraceptive methods.

Conclusions: Perceptions among FP-accepting women were found to play an important role in their patterns of switching contraceptive methods. Hence, fostering a better understanding of contraception through high-quality counseling is needed to improve perceptions and thereby to encourage rational, effective, and efficient contraceptive use.
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http://dx.doi.org/10.3961/jpmph.18.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686111PMC
July 2019

Is Iron Supplementation Influenced by Sub-Clinical Inflammation?: A Randomized Controlled Trial Among Adolescent Schoolgirls in Myanmar.

Nutrients 2019 04 24;11(4). Epub 2019 Apr 24.

Northern Ireland Centre for Food and Health, School of Biomedical Science, University of Ulster, Coleraine BT52 1SA, UK.

Iron absorption was impaired in the presence of sub-clinical inflammation (SCI) and might hamper the effect of iron supplementation. The purpose of the study was to identify the influence of SCI on iron supplementation. A randomized, double-blinded, placebo-controlled experimental study was conducted among anaemic adolescent schoolgirls in Ayeyarwady region, Myanmar. A total of 402 schoolgirls were recruited from six schools screened from 1269 girls who were assigned into one of four groups: Folate group (2.5 mg of folate), Vitamin A group (15,000 IU of vitamin), Iron folate group (60 mg elemental iron and folate) and Iron, and vitamin A and folate group. Supplementation was done once a week for 12 weeks. Iron, vitamin A and inflammation were measured at the baseline, middle and endline. Changes in serum ferritin and body iron were significantly higher in the IFA and IFA + vitA among those without SCI. There was interaction between vitamin A and SCI on Hb changes. Analysis of GLM repeated measure showed interactions between treatment and SCI for hemoglobin and serum transferrin receptor. Those treated with vitamin A had better outcomes when there was SCI. Inflammation accompanied a negative effect on iron supplementation and vitamin A improved efficacy of iron supplementation in the presence of SCI.
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http://dx.doi.org/10.3390/nu11040918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520863PMC
April 2019

Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children.

Br J Nutr 2016 07 23;116 Suppl 1:S16-26. Epub 2015 Dec 23.

6London School of Hygiene and Tropical Medicine, The Faculty of Epidemiology and Population Health,London WC1E 7HT,UK.

Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.
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http://dx.doi.org/10.1017/S000711451500481XDOI Listing
July 2016

Folate and vitamin B12 status and dietary intake of anaemic adolescent schoolgirls in the delta region of Myanmar.

Br J Nutr 2016 07 20;116 Suppl 1:S36-41. Epub 2015 Oct 20.

7Department of Human Nutrition,University of Otago,Dunedin 9054,New Zealand.

The aim of the present study was to assess the prevalence of deficiency of folate and vitamin B12 and, simultaneously, the nutrient intake adequacy of folate, vitamin B12, iron, vitamin A, vitamin C, vitamin B6 and calcium in 391 adolescent anaemic (Hb<120 g/l) schoolgirls living in the delta region of Myanmar (Burma). Dietary intakes were assessed using a 3 d estimated food record. The distribution of observed intakes calculated from the food records were adjusted for usual intakes, and the prevalence of inadequacy was estimated using the estimated average requirement cut-point method. Median (first, third quartile) serum folate and vitamin B12 concentrations were 6·5 (4·6, 8·5) nmol/l and 612·8 (443·2, 795·2) pmol/l, respectively. The prevalence of folate deficiency defined as <6·8 nmol/l was 54 %; however, vitamin B12 deficiency defined as <148 pmol/l was negligible (<1 %). The prevalence of inadequate intake of folate was high (100 %) as was the prevalence of inadequate intakes of vitamin A, vitamin C, vitamin B6 and calcium, ranging from 60 to 100 %. Red meat or poultry was rarely consumed, but fish was consumed on a daily basis. Green leafy vegetables were also consumed frequently but consumption of dairy products was uncommon. Folate deficiency was high, and the prevalence of inadequate intake of folate among other key micronutrients was relatively common in this sample of anaemic adolescent schoolgirls. Appropriate strategies such as food fortification and dietary diversification are needed to improve the micronutrient status of these young women to ensure optimal health and future reproductive success.
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http://dx.doi.org/10.1017/S0007114515001609DOI Listing
July 2016

The effect of rational emotive behavior therapy (REBT) on antiretroviral therapeutic adherence and mental health in women infected with HIV/AIDS.

Acta Med Indones 2014 Oct;46(4):283-91

Department of Psychiatry, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.

Aim: To identify the effectiveness of rational-emotive-behavior-based therapy (REBT-based therapy) on improved mental health and antiretroviral (ART) therapeutic adherence in women infected with HIV/AIDS (female subjects with HIV/AIDS).

Methods: A randomized and single-blinded clinical trial in women infected with HIV/AIDS who had their treatment at the outpatient clinic of Pokdiksus AIDS RSCM and at the AIDS Comprehensive Diagnostic Unit of Dharmais Hospital was conducted between October 2011 and March 2012. A block randomization of 160 female subjects with AIDS was performed that resulted in a REBT-based treatment group (n=80) and a control group (n=80). The treatment group received REBT-based intervention of 8 sessions weekly including 6 individual-therapeutic sessions/week and 2 group-therapeutic sessions/week. Instruments used in the study were questionnaires on demography, ART adherence (measured by self report and pill count), and mental health (SRQ-20). Data were analyzed using Chi-Square test, Generalized Linear Model, and Generalized Estimating Equations.

Results: There were 148 respondents analyzed including in the REBT-based group (n=72) and in the control group (n=76) with mean age of 33-34 years. After 8 weeks of REBT-based intervention, there was improved (increased) mean value of the self-reported adherence score (self-report) compared to control group (100%; CI 95%,83.3-96.7 vs. 84%; CI 95%,77.5-87.8) and improved (decreased) SRQ-20 mean score in REBT-based treatment group compared to control group (2.9; CI 95%, 2.7-13.0 vs. 5.4; CI 95%: 5.0-13.6). ART adherence based on viral load titer was not analyzed in both group since most of VL titer were undetected (<400 copies/mL). GLM analysis showed decreased SRQ-20 mean score and increased mean value of self-reported ART adherence (self-report) in the REBT-based treatment group, which were more significant (p<0.000) than control group on the 8th week. GEE analysis showed that 1 point decrement of SRQ-20 would increase self-reported ART adherence as much as 0.722 point and the correlation was statistically significant (p<0.00).

Conclusion: After 8 weeks of REBT-based intervention to female subjects with HIV/AIDS, there is a decrease of SRQ-20 mean score which may result in increased ART adherence mean score in the treatment group compared to the control.
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October 2014

Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia.

Public Health Nutr 2015 Oct 16;18(14):2511-22. Epub 2015 Jan 16.

9Global Alliance for Improved Nutrition,PO Box 55,1211 Geneva 20,Switzerland.

Objective: To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.

Design: Pre-post evaluation between two surveys.

Setting: Twenty-four villages in West Java.

Subjects: Poor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6-11 months (n 318/n 335) and children aged 12-59 months (n 469/477), and cohorts of children aged 5-9 years (n 186) and women aged 15-29 years (n 171), alongside food and oil consumption from dietary recall.

Results: Fortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol was 2-19 % higher at endline than baseline (P<0·001 in infants aged 6-11 months, children aged 5-9 years, lactating and non-lactating women; non-significant in children aged 12-23 months; P=0·057 in children aged 24-59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5-18 % across groups at baseline, and 0·6-6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6-59 months (P=0·003) and 5-9 years (P=0·03).

Conclusions: Although this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.
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http://dx.doi.org/10.1017/S136898001400322XDOI Listing
October 2015

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar.

Public Health Nutr 2014 Oct 16;17(10):2325-32. Epub 2013 Oct 16.

5Northern Ireland Centre for Food and Health,School of Biomedical Science,University of Ulster,Coleraine,UK.

Objective: The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA).

Design: Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA.

Setting: Myanmar.

Subjects: Adolescent schoolgirls (n 391).

Results: One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 μmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 μmol/l) and low (≤1·056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA.

Conclusions: Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.
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http://dx.doi.org/10.1017/S1368980013002723DOI Listing
October 2014

Microcytic anaemia predominates in adolescent school girls in the delta region of Myanmar.

Asia Pac J Clin Nutr 2012 ;21(3):411-5

South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, University of Indonesia, Salemba Raya 6, Jakarta, Indonesia.

Objective: Anaemia is one of major nutritional problems in Myanmar affecting all age groups. However, there is lack of recent information and a study was conducted to acquire information on the current status of anaemia among adolescent schoolgirls in Nyaung Done township, Ayeyarwady division where an intervention study was planned.

Subjects And Methods: A cross-sectional survey was conducted on 1269 subjects to obtain complete blood count, anthropometry and socioeconomic characteristics were obtained by questionnaire. Using red cell indices, we applied Bessman's, and Green and King's index classification to differentiate the types of anaemia. Electrophoresis was also done on a subsample (n=228).

Results: Stunting was 21.2% and wasting was 10.7% respectively. Prevalence of anaemia was 59.1% and was mainly microcytic. Green and King's index showed 35.8% were iron deficient. Electrophoresis revealed 36 cases of Hb E haemoglobinopathy in the subsample.

Conclusion: Anaemia is still a major nutrition problem in Myanmar. The reasons for this high prevalence should be explored and properly addressed. The study highlights the need for a comprehensive and large scale survey for the anaemia control programme in Myanmar.
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August 2012

Population burden of betel quid abuse and its relation to oral premalignant disorders in South, Southeast, and East Asia: an Asian Betel-quid Consortium Study.

Am J Public Health 2012 Mar 19;102(3):e17-24. Epub 2012 Jan 19.

Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.

Objectives: We investigated the population burden of betel quid abuse and its related impact on oral premalignant disorders (OPDs) in South, Southeast, and East Asia.

Methods: The Asian Betel-Quid Consortium conducted a multistage sampling of 8922 representative participants from Taiwan, Mainland China, Malaysia, Indonesia, Nepal, and Sri Lanka. Participants received an interviewer-administered survey and were examined for oral mucosal disorders.

Results: The prevalence of betel quid abuse was 0.8% to 46.3% across 6 Asian populations. The abuse frequency was over 40.5% for current chewers, with the highest proportion in Nepalese and Southeast Asian chewers (76.9%-99.6%). Tobacco-added betel quid conferred higher abuse rates (74.4%-99.6%) among Malaysian, Indonesian, and Sri Lankan men than did tobacco-free betel quid (21.8%-89.1%). Gender, lower education level, younger age at chewing initiation, and clustering of familial betel quid use significantly contributed to higher abuse rates. Indonesian betel quid abusers showed the highest prevalence of OPDs and had a greater risk of OPDs than did nonabusers.

Conclusions: Betel quid abuse is high in regions of Asia where it is customarily practiced, and such abuse correlates highly with OPDs. By recognizing abuse-associated factors, health policies and preventive frameworks can be effectively constructed to combat these oral preneoplasms.
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http://dx.doi.org/10.2105/AJPH.2011.300521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487678PMC
March 2012

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia.

Int J Equity Health 2011 Nov 9;10:47. Epub 2011 Nov 9.

Department of Biostatistics and Population, Faculty of Public Health University of Indonesia, Depok, Indonesia.

Introduction: Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998.

Methods: This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders.

Results: The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor.

Conclusions: Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.
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http://dx.doi.org/10.1186/1475-9276-10-47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258219PMC
November 2011

Predictive factors for treatment retention in methadone programs in Indonesia.

J Subst Abuse Treat 2012 Apr 22;42(3):239-46. Epub 2011 Sep 22.

Directorate of Mental Health, Ministry of Health, Republic of Indonesia.

This article presents the results of a 6-month prospective cohort study of methadone maintenance treatment (MMT) in Indonesia. The study aimed to investigate the predictor variables of retention in MMT in Indonesia. The duration of treatment (in days) was the main outcome of the study. For the study, program, client, social network, and accessibility factors were investigated as potential predictors of retention. The study analyzed the relative weight of each factor in predicting treatment retention. The sample consisted of 178 clients drawn from three participating clinics: Rumah Sakit Ketergantungan Obat and Tanjung Priok in Jakarta and Sanglah in Bali. The 3- and 6-month retention rates were 74.2% and 61.3%, respectively. These rates are comparable with previous studies conducted in developed countries. A survival analysis using a robust estimation for the Cox PH regression found that the strongest predictors of retention were methadone dose followed by an interaction between take-home dose and the experience of the clinic providing this treatment. Other significant predictor variables included age, perceived clinic accessibility, and client's belief in the program. The study concludes that MMT cannot solely rely on the pharmacology for retention but should also promote informed access to take-home doses.
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http://dx.doi.org/10.1016/j.jsat.2011.07.009DOI Listing
April 2012

Intercountry prevalences and practices of betel-quid use in south, southeast and eastern Asia regions and associated oral preneoplastic disorders: an international collaborative study by Asian betel-quid consortium of south and east Asia.

Int J Cancer 2011 Oct 8;129(7):1741-51. Epub 2011 Mar 8.

Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Health risks stemming from betel-quid (BQ) chewing are frequently overlooked by people. Updated epidemiological data on the increased BQ use among Asian populations using comparable data collection methods have not been widely available. To investigate the prevalence, patterns of practice and associated types of oral preneoplastic disorders, an intercountry Asian Betel-quid Consortium study (the ABC study) was conducted for Taiwan, Mainland China, Malaysia, Indonesia, Nepal and Sri Lanka. A random sample of 8,922 subjects was recruited, and the data were analyzed using survey-data modules adjusted for the complex survey design. Chewing rates among men (10.7-43.6%) were significantly higher than women (1.8-34.9%) in Taiwan, Mainland China, Nepal and Sri Lanka, while women's rates (29.5-46.8%) were higher than that for men (9.8-12.0%) in Malaysia and Indonesia. An emerging, higher proportion of new-users were identified for Hunan in Mainland China (11.1-24.7%), where Hunan chewers have the unique practice of using the dried husk of areca fruit rather than the solid nut universally used by others. Men in the Eastern and South Asian study communities were deemed likely to combine chewing with smoking and drinking (5.6-13.6%). Indonesian women who chewed BQ exhibited the highest prevalence of oral lichen planus, oral submucous fibrosis and oral leukoplakia (9.1-17.3%). Lower schooling, alcohol drinking and tobacco smoking were identified as being associated with BQ chewing. In conclusion, the ABC study reveals the significant cultural and demographic differences contributing to practice patterns of BQ usage and the great health risks that such practices pose in the Asian region.
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http://dx.doi.org/10.1002/ijc.25809DOI Listing
October 2011

Preventing low birthweight through maternal multiple micronutrient supplementation: a cluster-randomized, controlled trial in Indramayu, West Java.

Food Nutr Bull 2009 Dec;30(4 Suppl):S488-95

Center for Health Research, School of Public Health, University of Indonesia, Depok, Indonesia.

Background: Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact.

Objective: To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron-folic acid supplementation.

Methods: We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron-folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality.

Results: The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron-folic acid group). The women consumed the supplements on average 5 days per week. Although there were no significant differences between the groups in the percentage of infants with LBW there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients (6.3% vs. 7.3%), and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron-folic acid group, although the difference was not significant. Among those who consumed 90 or more supplements during pregnancy, women taking multiple micronutrients had a 3.3% combined rate of miscarriage, stillbirth, or neonatal death, as compared with 6.9% for those taking iron-folic acid only (p < .049). The anemia rates in the two groups were similar after supplementation, even though the amount of iron in the multiple micronutrient supplement was half that in the iron-folic acid supplement. Serum retinol was higher in the group receiving multiple micronutrients.

Conclusions: Multivitamin supplementation use among pregnant women is as effective as iron-folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status.
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http://dx.doi.org/10.1177/15648265090304S403DOI Listing
December 2009

Zinc supplementation improved length growth only in anemic infants in a multi-country trial of iron and zinc supplementation in South-East Asia.

J Nutr 2008 Oct;138(10):1969-75

Department Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.

Data from 4 randomized, placebo-controlled, double-blind trials in Indonesia, Thailand, and Vietnam, the South-East Asian Multicountry Trial on Iron and Zinc supplementation in Infants (SEAMTIZI), were pooled to investigate the effects of iron and zinc supplementation infant growth. Infants (n = 2451) aged 4-6 mo old were supplemented with iron (10 mg/d) and/or zinc (10 mg/d) for 6 mo. Overall, neither iron nor zinc supplementation prevented the progressive growth faltering during infancy, which is common in many developing countries. However, infants who received zinc were less likely to be stunted at the end of the supplementation period (odds ratio 0.80; 95% CI 0.64-1.0). Boys had a 30% higher risk of being stunted at the end of the study than girls (P < 0.01). Baseline factors modified the effect of supplementation, with infants anemic at baseline (hemoglobin < 105 g/L) benefiting from zinc supplementation, with an estimated increase in height-for-age Z-score (HAZ) score of 0.17 (P < 0.01), but with no effect of zinc supplementation on growth in infants not anemic at baseline. Iron supplementation negatively affected linear growth in infants with a birth weight of >3500 g (estimated effect size, -0. 14 HAZ score; P < 0.01), but with no significant effect in infants with a lower birth weight. This study shows that blanket supplementation of infants with iron or zinc will not be beneficial to all recipients and may have adverse effects in some. Hence, interventions such as iron and zinc supplementation for infants should be restricted to subgroups in which there is a clear benefit and baseline factors should be considered and characterized before implementing new policies.
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http://dx.doi.org/10.1093/jn/138.10.1969DOI Listing
October 2008
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