Impact of the anti-hypertensive diets virtual education towards knowledge, attitude, practice, and reduction of blood pressure during covid-19 pandemic

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Universitas Airlangga Project Grants for Community Empowerment

OnBehalf

Universitas Airlangga

Background. One of the efforts to reduce hypertension rates in the community is through dietary changes that refer to the Dietary Approach to Stop Hypertension guidelines or abbreviated as DASH. However, in the COVID-19 pandemic, there is a significant obstacle regarding the most effective way to transfer knowledge, skill, and attitude towards society. 

Aims. Department of Cardiology and Vascular Medicine created a virtual education series about dietary guideline that refers to DASH by adapting the local wisdom of the Surabaya community. We aimed to evaluate the impact of Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series towards knowledge, attitude, practice, and reduction of blood pressure in the primary care setting during COVID-19 pandemic. 

Methods. This type of online action research is quantitative with a quasi-experimental design that designs using one group pretest-posttest, when this study was conducted in October-December 2020. The population in this study were all patients with hypertension who were treated in Mojo primary health care setting. A purposive sampling technique were done to receive 110 participants using online questionnaire.

Results. A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation, the only parameter that showed significant improvement were knowledge and attitude (p < 0 .001). There is no significant change in the skill parameters (p = 0.131) and blood pressure parameters (p = 0.433) .

Conclusion. Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation in our study population seems to be effective to improve knowledge and attitude of participants, however, this program seems to be ineffective to improve skill and blood pressure reduction in participants. Future study with longer durations and more comprehensive programme needs to be done to scrutinize the clinical impact of this program nationwide.

Using syndromic measures of mortality to capture the dynamics of COVID-19 in Java, Indonesia, in the context of vaccination rollout

BACKGROUND

As in many countries, quantifying COVID-19 spread in Indonesia remains challenging due to testing limitations. In Java, non-pharmaceutical interventions (NPIs) were implemented throughout 2020. However, as a vaccination campaign launches, cases and deaths are rising across the island.

METHODS

We used modelling to explore the extent to which data on burials in Jakarta using strict COVID-19 protocols (C19P) provide additional insight into the transmissibility of the disease, epidemic trajectory, and the impact of NPIs. We assess how implementation of NPIs in early 2021 will shape the epidemic during the period of likely vaccine rollout.

RESULTS

C19P burial data in Jakarta suggest a death toll approximately 3.3 times higher than reported. Transmission estimates using these data suggest earlier, larger, and more sustained impact of NPIs. Measures to reduce sub-national spread, particularly during Ramadan, substantially mitigated spread to more vulnerable rural areas. Given current trajectory, daily cases and deaths are likely to increase in most regions as the vaccine is rolled out. Transmission may peak in early 2021 in Jakarta if current levels of control are maintained. However, relaxation of control measures is likely to lead to a subsequent resurgence in the absence of an effective vaccination campaign.

CONCLUSIONS

Syndromic measures of mortality provide a more complete picture of COVID-19 severity upon which to base decision-making. The high potential impact of the vaccine in Java is attributable to reductions in transmission to date and dependent on these being maintained. Increases in control in the relatively short-term will likely yield large, synergistic increases in vaccine impact.

Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: A hospital-based retrospective cohort study

Background

Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.

Methods

This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used logistic regression to examine factors associated with mortality.

Findings

Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32-57), 5% were children, and 31% had >1 comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age, male sex; pre-existing hypertension, diabetes, or chronic kidney disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; immediate ICU admission, or intubation. Across all ages, risk of death was higher for patients with >1 comorbidity compared to those without; notably the risk was six-fold increased among patients <50 years (adjusted odds ratio 5.87, 95%CI 3.28-10.52; 27% vs 3% mortality).

Interpretation

Overall in-hospital mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. Deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.