Effect of Dapagliflozin on Patients with Rheumatic Heart Disease Mitral Stenosis

(1) Background: Mitral stenosis is the most common rheumatic heart disease (RHD). Inflammation and fibrosis are the primary pathophysiology, resulting in left atrial stress and dysfunction. Dapagliflozin is a new heart failure treatment with anti-inflammation and anti-fibrosis effects from previous studies. However, the specific role of dapagliflozin in RHD mitral stenosis is unknown. This study aims to investigate (i) the effect of dapagliflozin on biomarkers of fibrosis, NT-pro BNP levels and left atrial function; (ii) the relationship between the changes in fibrosis biomarkers with left atrial function and NT-pro BNP levels. (2) Methods: An open-label randomized study was conducted on 33 RHD mitral stenosis patients divided into a dapagliflozin group which received 10 mg dapagliflozin and standard therapy, and a control group which only received standard therapy. All patients were examined for levels of PICP, MMP-1/TIMP-1 ratio, TGF-β1, NT-proBNP, mitral valve mean pressure gradient (MPG), and net atrioventricular compliance (Cn) pre- and post-intervention. (3) Results: This study found a significant increase in PICP and TGF-β1 and a reduction in the MMP-1/TIMP-1 ratio in the dapagliflozin group and the control group (p < 0.05). In the dapagliflozin group, the levels of NT-pro BNP decreased significantly (p = 0.000), with a delta of decreased NT-pro BNP levels also significantly greater in the dapagliflozin group compared to the control (p = 0.034). There was a significant increase in Cn values in the dapagliflozin group (p = 0.017), whereas there was a decrease in the control group (p = 0.379). Delta of changes in Cn values between the dapagliflozin and control groups also showed a significant value (p = 0.049). The decreased MPG values of the mitral valve were found in both the dapagliflozin and control groups, with the decrease in MPG significantly greater in the dapagliflozin group (p = 0.031). There was no significant correlation between changes in the value of fibrosis biomarkers with Cn and NT-pro BNP (p > 0.05). (4) Conclusions: This study implies that the addition of dapagliflozin to standard therapy for RHD mitral stenosis patients provides benefits, as evidenced by an increase in net atrioventricular compliance and decreases in the MPG value of the mitral valve and NT-pro BNP levels (p < 0.05). This improvement was not directly related to changes in fibrosis biomarkers, as these biomarkers showed ongoing fibrosis even with dapagliflozin administration.

The Influence of Health, Social, and Economic Determinants on the Obesity to Teenagers during the COVID-19 Pandemic

Obesity is fat accumulation in the human body that increases or excessive weight. This case may cause diseases appearing in the human body, such as hypertension, cardiovascular, diabetes, and stroke. The number of obesities increased when the Covid-19 virus started to infect Indonesia. This study was conducted in October 2021 to discover the dominant factor of health, social, and economic determinants on the obesity that increased during the pandemic, especially to the first grade in SMKN 7 Malang. This study is used analytical observational with the cross-sectional study approach. This study's population is 465 students; however, the study divides them into the sample using purposive sampling with inclusion and exclusion criteria. Hence, the final samples of the study are 102. There primarily taken from interviews and observations, also secondary data related to the name, age, gender, address of respondents. The data collection will analyze by multivariate analysis. This study found that the father's education level/mother and parents' income do not influence obesity. Then, food management, physical activity, and street food consumption have influenced obesity. In addition, the considered variable can explain the obesity variable on the teenager around 37,2%.

Missed opportunities in hypertension risk factors screening in Indonesia: a mixed-methods evaluation of integrated health post (POSBINDU) implementation

OBJECTIVES

To assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia.

DESIGN

This was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU.

SETTING

The study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100).

PARTICIPANTS

From 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants.

PRIMARY OUTCOMES AND MEASURES

Proportion of POSBINDU visitors getting the hypertension screening and risk factors' assessment, and barriers of POSBINDU implementation.

RESULTS

Out of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia.

CONCLUSIONS

This study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).

A Matched Case-Control: Effect of Early Initiation of Breast Feeding, Exclusive Breastfeeding, and Infectious Diseases on Stunting Incidence during the Covid-19 Pandemic in Balangan Regency

Background: The Covid-19 pandemic is thought to affect a number of causes of stunting, including exclusive breastfeeding, early breastfeeding initiation, and illness exposure. Objectives: This study aims to investigate the effect of early initiation of breastfeeding, exclusive breastfeeding, and infectious diseases on stunting during the Covid-19 pandemic. Methods: The study was conducted in 6 stunting focus location villages in 2 subdistricts in Balangan Regency in June 2022. Children aged 6-23 months, both stunted and normal, served as the case samples in the case-control research design. Utilizing the Lemeshow formula, 66 samples with a 1:2 comparison were selected using a simple random sampling technique. In the case and control groups, the characteristics were equalized based on gender and age. Statistical analysis was conducted using the chi-square test and binary logistic regression. Results: early initiation of breastfeeding (p=0.001, OR=6.806, CI=2.185-21.201), exclusive breastfeeding (p=0.021, OR=4.080, CI=1.363-12.209) and infectious diseases (p=0.000, OR=12.244, CI=3.118-48.086). Infectious diseases had the most influence on the incidence of stunting during the Covid-19 pandemic, proved by the magnitude of the OR value. Conclusions: During the Covid-19 pandemic, the rate of stunting was influenced by early breastfeeding initiation, exclusive breastfeeding, and infectious diseases.

Sociodemographic Differences in Multimorbidity: A Closer Look from Indonesian Family and Life Survey

The prevalence of multimorbidity, the coexistence of two or more chronic diseases, is expected to increase, including in Indonesia. This phenomenon is associated with increased life expectancy and incidence of non-communicable diseases. Therefore, this study assesses the burden of multimorbidity in Indonesia by sociodemographic factors. The researchers analyzed cross-sectional data from the latest wave of IFLS conducted in 2014, the IFLS wave 5. The researchers included individuals aged 15 and above with blood pressure measurements (n= 32.256) from 13,536 households. Meanwhile, the researchers excluded individuals with missing data on BMI (183 individuals) or who had biologically implausible or extreme values (n=6). The analyses were then conducted on 32,067 individuals. The analyses comprised the ten most common self-reported chronic diseases diagnosis in IFLS-5. The findings revealed that the prevalence of self-reported multimorbidity in Indonesia was relatively high, at 9.32% (n= 2.989), with the highest proportion of multimorbidity reported among the elderly. Approximately 2.76% of the respondents (n- 885) reported having three or more chronic diseases. The most common combinations were hypertension and digestive problem (2.15%, n= 689), followed by hypertension and arthritis (1.79%, n= 574), and hypertension and high cholesterol (1.68%, n= 539). When stratified by sociodemographic factors, the researchers found a higher proportion of multimorbidity among females (11.01%, n= 3,530) compared to males (7.41%, n= 2.376), elderly (21.54%, n= 3.530) compared to younger adults, and previous smokers (20.90%, n= 6.072). People who were obese and overweight also reported a higher prevalence of multimorbidity (13.73%, n= 4.403 and 9.3%, n= 2.998, respectively). In addition, those living in urban areas had a higher proportion of multimorbidity (10.33%, n= 3.313) compared to rural areas (7.2%, n= 2.527). In conclusion, this study uncovered a relatively high prevalence of multimorbidity. People living in urban areas were overweight/obese and those who had low SES had a higher proportion of multimorbidity. With the nature of self-reported data and previously reported underdiagnosis of chronic diseases, screening to examine multimorbidity is needed.

Beyond personal factors: Multilevel determinants of childhood stunting in Indonesia

BACKGROUND

Stunting is still a major public health problem in low- and middle-income countries, including Indonesia. Previous studies have reported the complexities associated with understanding the determinants of stunting. This study aimed to examine the household-, subdistrict- and province-level determinants of stunting in Indonesia using a multilevel hierarchical mixed effects model.

METHODS

We analyzed data for 8045 children taken from the 2007 and 2014 waves of the Indonesian Family and Life Surveys (IFLS). We included individual-, family-/household- and community-level variables in the analyses. A multilevel mixed effects model was employed to take into account the hierarchical structure of the data. Moreover, the model captured the effect of unobserved household-, subdistrict- and province-level characteristics on the probability of children being stunted.

RESULTS

Our findings showed that the odds of childhood stunting vary significantly not only by individual child- and household-level characteristics but also by province- and subdistrict-level characteristics. Among the child-level covariates included in our model, dietary habits, neonatal weight, a history of infection, and sex significantly affected the risk of stunting. Household wealth status and parental education are significant household-level covariates associated with a higher risk of stunting. Finally, the risk of stunting is higher for children living in communities without access to water, sanitation and hygiene.

CONCLUSIONS

Stunting is associated with not only child-level characteristics but also family- and community-level characteristics. Hence, interventions to reduce stunting should also take into account family and community characteristics to achieve effective outcomes.

Core health-components, contextual factors and program elements of community-based interventions in Southeast Asia - a realist synthesis regarding hypertension and diabetes

Background

In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia.

Methods

A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements.

Results

We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice.

Conclusions

We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11244-3.

Community capacity building for culturally sensitive prevention and control of NCDs

 

In Southeast Asia, it is common practice to have community-based interventions targeting health promotion, prevention and management of diseases. Often interventions developed by WHO or health programmes in the regions are copied. From literature it is known that community-based interventions are more effective when tailored to the local language, including the lingo, and custom traditions and adapted to preferences, needs, values, interests, religion, and other sociocultural specific aspects. Cultural and contextual adaptation of an intervention is difficult and dynamic, and to date there is no practical and scientific base how to do this. In this presentation the developing of contextual and culturally sensitive and responsive capacity building materials for health promotion and screening by community volunteers and community groups will be elaborated by the following topics:

Development of general capacity building methods and curricula, taking into account local training needs of community workers Tools for pre-test post-test of training to assess the level of understanding by participants Tools for measuring contextual and cultural sensitivity of training modules and training activities Tools for adjustment of training and materials to context and culture, building on the findings in the previous tools

 

The presentation will show the application of these tools and the final outcome when applying them in practice.

Improving knowledge, acceptance, and utilization of female condoms among sex workers through a peer education: a mixed methods study in Surakarta Municipality, Central Java Province, Indonesia

Female sex workers (FSW) are high-risk for HIV infection. The authors conducted a quasi-experimental study by providing peer education on 110 FSWs, and routine HIV education on 120 controls, in Surakarta Indonesia. An additional qualitative study was performed to explain the contextual factors contributing to the effectiveness of peer education. The difference in difference approach showed that peer education improved knowledge, acceptance, and utilization of female condom. The improvements were related to the clients' perceptions, access, and available interactive communication with the peer educator. The peer education program should be enhanced to support the prevention of HIV/AIDS.

The patterns of self-reported maternal complications in Indonesia: are there rural-urban differences?

INTRODUCTION

Specific and targeted intervention is needed to reduce the relatively high maternal mortality and morbidity in Indonesia. The apparent rural-urban disparities might require different intervention strategies. Therefore, this study aims to assess patterns and sociodemographic determinants of self-reported maternal morbidity in rural and urban areas.

METHODS

Data from the Indonesian Demographic and Health Survey 2012 were analyzed. In this cross-sectional survey, maternal morbidity status and sociodemographic factors were obtained through questionnaire-based interviews. Women who completed the maternal morbidity questionnaire were included in the analyses (n=12 679). Descriptive statistics were used to assess differences in proportion; mixed-effects regression was used to evaluate the association between sociodemographic factors and maternal morbidity.

RESULTS

Approximately 53.3% of women reported experiencing pregnancy and/or labor complications, with a lower proportion in rural areas (51.3%) than in urban areas (55.1%). The patterns of pregnancy morbidities were similar for rural and urban women. The highest proportion of pregnancy morbidity was classified as 'other', followed by 'bleeding'. There were slight differences in the type of labor morbidities. Compared to urban women, women in rural areas had a higher prevalence of bleeding and infection, but a significantly lower prevalence of pregnancy rupture of membrane. Nulliparity was a dominant factor for self-reported maternal morbidity. Younger urban, but not rural, women represented a higher proportion of maternal morbidity. In urban areas, women with social disadvantage represented a higher proportion of morbidity. However, in rural areas, a higher prevalence of maternal morbidity was seen in women of higher socioeconomic status. These rural-urban disparities might be partially caused by differences in knowledge of maternal morbidities and sociodemographic status between rural and urban women.

CONCLUSIONS

This study found similar patterns of pregnancy morbidity, but slight differences in labor morbidity patterns. Specific interventions for major maternal complications within rural or urban areas are important. There were also differences in the proportion of self-reported maternal complications by sociodemographic factors, which might be caused by differences in reporting. Intervention to improve knowledge and awareness of maternal complication is needed, specifically for socially disadvantaged women and women living in rural areas.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

Background: Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem.

Objective: To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity.

Methods: We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762).

Results: There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia.

Conclusion: The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.